10. Labour & Post partum

Question 1

when is parturition considered labour? what’s it called before this?

Answer 1

after 24 weeks gestation
spontaneous abortion (miscarriage)

Question 2

define premature

Answer 2

labour before 37 weeks gestation

Question 3

what must the cervix and vagina do in the first stage of labour?

Answer 3

enlarge and realign

Question 4

‘lie’ of fetus

Answer 4

relationship of long axis of fetus to long axis of uterus

Question 5

‘presentation’ of fetus

Answer 5

part of fetus adjacent to pelvic inlet

Question 6

3 things that happen to create the birth canal

Answer 6

1. soften pelvic ligaments
2. increase myometrial activity
3. cervical dilatation by ripening, and effacement by uterine smooth muscle contractions thinking cervix, then dilate it

Question 7

why does myometrium thicken during pregnancy ?

Answer 7

increased cell size and glycogen deposition

Question 8

Braxton hicks contractions

Answer 8

increased aptitude but decreased frequency as pregnancy continues, no effect on fetus

Question 9

action of prostaglandins

Answer 9

increase calcium realise from intracellular stores

Question 10

action of oxytocin

Answer 10

lowers threshold for action potentials

Question 11

brachystasis

Answer 11

uterine smooth muscle contractions shorten muscle fibres but don’t relax fully, uterus shortens

Question 12

Ferguson reflex

Answer 12

oxytocin stimulates uterine contractions, these stimulate oxytocin release from posterior pituitary to have more contractions in uterus

Question 13

when does the first stage of labour end

Answer 13

cervix dilated 19cm

Question 14

what helps prevent bleeding after giving birth?

Answer 14

uterus contracts so compresses blood vessels and reduces bleeding
can be helped by oxytocic drug

Question 15

complications of shoulder dystocia

Answer 15

-erbs palsy
-PPH
-tears
-neurological dysfunction

Question 16

what would be worrying on a CTG?

Answer 16

lack of HR accelrations
decelerations

Question 17

indications for assisted delivery

Answer 17

-failure to progress
-maternal exhaustion
-fetal compromise

Question 18

indications for c section

Answer 18

-macrosomia
-faiure to progress
-previous c section
-malpresentation

Question 19

physiological changes to anatomy post-partum

Answer 19

-reduction in size of vulva, vagina, cervix
-poor lubrication of vagina
-tranformation zone of cervix withdraws into endocervix

Question 20

lochia rubra

Answer 20

initial heavy flow, dark red

Question 21

lochia alba

Answer 21

after 10-14 days, whitish

Question 22

are clots normal postpartum?

Answer 22

no except for one on day 3-4

Question 23

initial ‘breast milk’

Answer 23

colostrum- high fat and immunoglobulins (IgA)

Question 24

volume of milk per day when fully established

Answer 24

800ml

Question 25

important components of breast milk

Answer 25

-lactoferrin: binds iron to prevent e coli -lymphocytes, plasma cells: cell mediated immunity -immunoglobulins

Question 26

primary PPH

Answer 26

> 500 ml blood loss in less than 24 hours

Question 27

secondary PPH

Answer 27

>500 ml blood loss 24 hours-3 weeks

Question 28

psychological conditons post-partum

Answer 28

-post natal blues: day 4-5 peak, reassure -post partum depression: within 4 weeks of delivery -puerperal psychosis: 30% of women with pre existing mental illness -PTSD

Question 29

link contraception to childbirth/post partum

Answer 29

ideal opportunity to discuss range of methods, can save mother and baby's lives if born more than 2 years apart