Normal labour and its management Flashcards

1
Q

What is the common cause of death in childbirth?

A

Severe bleeding
Infection
Pre-eclampsia

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2
Q

What is an intrapartum stillbirth?

A

Foetal death after onset of labour due to inadequate foetal heart rate monitoring measured on a partogram.

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3
Q

How does onset of labour occur?

A

Forces of release overcome forces of retention

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4
Q

What promotes retention of baby in labour?

A

Progesterone inhibits uterine contractions

Adrenaline causes sympathetic activation due to fear or pain slows labour and inhibits oxytocin.

Relaxin causes relaxation of the pelvic ligaments.

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5
Q

What promotes release in labour?

A

Prostaglandins

Oxytocin and vasopressin stimulates uterine contractions.

Uterine distention to swells to prepare for head

Corticotropin releasing hormone and corticol.

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6
Q

What is the role of prostaglandin in labour?

A

Induces labour by causing softening and stretching of the cervix.

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7
Q

What is the role of cortisol in labour?

A

Responsible for maturation of foetal organs before labour and timing of birth

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8
Q

What is the role of oxytocin in labour?

A

Oxytocin is triggered to be released due to stretching of the cervix by the foetal head. It causes uterine contractions, softening and dilation of the cervix and positive feedback for release of prostaglandins.

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9
Q

What are the mechanisms of labour?

A

Passage
Power
Passenger

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10
Q

What is passage in labour?

A

Movement of foetus through pelvis, spine and soft tissues of uterus, cervix, bladder and vagina.
There are 4 pelvic shapes: gynaecoid, android, anthropoid and platypelloid.

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11
Q

What is the most common pelvic type?

A

Gynaecoid which has a wide open shape most ideal for delivery.

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12
Q

How does the foetus interact with the pelvis during labour?

A

Engages with the pelvic inlet in a transverse position and rotates into a anterior-posterior position.

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13
Q

What is the smallest part of the foetal skull?

A

Suboccipital bregmatic, which occurs when the foetal head is in a flexed position.

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14
Q

What is power in labour?

A

Generated by contraction of the uterus myometrium via action of oxytocin and vasopressin hormones.

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15
Q

Where do contractions begin in the uterus?

A

Fundal dominance where contractions begin and are strongest at the fundus. There should be a regular pattern to contractions unless labour has slowed down or baby is in awkward position.

They continue post-birth to return uterus to normal size.

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16
Q

What is tone in labour?

A

Partial contraction of muscle to return it to resting state and help downward movement of foetus. This begins at 35 weeks and is the cause of Braxton Hicks

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17
Q

What is normal rhythmicity in labour?

A

Rate of 4-10 per minute

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18
Q

What is the passenger in labour?

A

Portion of the skull at the opening of the pelvis is the proportion that will descend

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19
Q

What is the role of the skull fontanelles?

A

Allows for growth of the brain and skull during foetal development

20
Q

What is the size of the pelvic outlet?

A

11cm

21
Q

What is the average size of a foetal head?

A

9.5cm

22
Q

What can cause failure of labour in the passenger stage?

A

Cephalopelvic disproportion: mismatch between foetal head and pelvic size that causes the bones of the skull to compress and overlap

23
Q

What are the stages of labour?

A

Latent phase
1st stage
2nd stage
3rd stage

24
Q

What is the latent phase of labour?

A

Onset of contractions which become regular
3-4cm dilated cervix
Cervix effaced: softening, thinning and shortening of cervix to allow unobstructed passage of the head due to action of prostaglandins when the head presses on the cervix.

25
Q

What is cervical dilation?

A

Increase in diameter of the cervix opening. Requires effacement (softening) for dilation to occur via the action of oestrogen and progesterone.

26
Q

What is the first stage of labour?

A

Regular contractions, and fully dilated at 10cm. It is the longest stage of labour

27
Q

What is the second stage of labour?

A

Passive contractions of foetus into pelvis
Active pushing

28
Q

What are the cardinal movements?

A

Occur in the 2nd stage of labour with the movement of the foetus through the pelvis

1)Engagement in transverse position
2)Descent
3)Flexion of foetal head to create more space
4)Internal rotation of baby which pelvic floor muscles allow
5)Extension of head beneath the suprapubic arch via abdominal pressure. This causes stretching of the perineum.
6)External rotation of the head and the shoulders to an anterior-posterior position
7)Expulsion

29
Q

What is restitution?

A

Realignment of the shoulders of the foetus with the head to an anterior-posterior position.

30
Q
A
31
Q

What is the third stage of labour?

A

Post birth with delivery of baby, placenta and membranes. At the interface between placenta and endometrium, large vascular connections for transfer of nutrients.

32
Q

What happens once the placenta is delivered?

A

Open vascular beds which can bleed torrentially.

33
Q

What affects labour time?

A

Primiparous: first birth which is shorter at all stages of labour
Multiparous: previous history of birth where labour is longer.

34
Q

What is a treatment for delayed labour?

A

Oxytocin and controlled cord contraction to apply pressure to uterus to promote uterine contraction and speed up third stage uterus.

35
Q

What causes post-partum haemorrhage?

A

Inability of the uterus muscles to contract around the blood vessels to prevent haemastasis. This can be prevented by controlled cord contractions and synthetic oxytocin to promote uterine contractions around the blood vessels for hameastasis.

36
Q

How is normal labour regulated?

A

Regulate bladder emptying, evaluation of maternal and foetal condition and evaluation of birth plan. Provide episiotomy and controlled head delivery.

37
Q

What is partogram?

A

Used to document the progress of labour via cervical dilation

38
Q

What are the analgesics of the labour?

A

Transcutaneous nerve stimulation
Opiates
Epidural
Oral analgesics

39
Q

What causes hypoxia in the foetus?

A

Overactivity of the uterine muscle activity or not enough muscle tone

40
Q

How is foetal wellbeing assessed?

A

Craniotopography to assess foetal heart rate and uterine muscle activity.

41
Q

What is normal resting newborn heart rate?

A

Considered tacychardic at above 160bpm. Variation is normal due to immature nervous sytem.

42
Q

What is the most common cause of direct maternal death?

A

Thromboembolism.

43
Q

What is the leading cause of maternal mortality?

A

Suicide
Post-partum haemorrhage

44
Q

What is the most common cause of indirect maternal death?

A

Cardiac disease

45
Q

What is the role of oestrogen in labour?

A

Levels decline gradually in the 2nd and 3rd trimester but it promotes the release of prostaglandins and expression of oxytocin receptors. There is a significant decrease after placenta delivery along with progesterone.

46
Q

What is a non-hormonal method to induce labour?

A

Using a cooked ballon which causes dilation of the cervix by creating a balloon of air near the baby’s head and at the cervix opening.