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Module 203 Reproduction & endocrinology > T2 L22 Pregnancy and birth > Flashcards

T2 L22 Pregnancy and birth Flashcards

1
Q

How is labour initiated?

A

Remains uncertain

Multifactorial in origin - hormonal and mechanical

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2
Q

Describe how labour initiation is mechanical?

A

Stimulation of uterus and cervix caused by overstitching and pressure

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3
Q

What happens during the initiation of labour?

A 
Foetal hypothalamus is triggered
Maternal posterior pituitary releases oxytocin
Decidua releases prostaglandins
Increase in oestrogen
Decrease in progesterone
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4
Q

What are the stages of labour?

A

Latent phase
1st stage
2nd stage
3rd stage

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5
Q

What happens in the latent phase of labour?

A

Effacement of cervix
Contractions
Intensity varies

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6
Q

What is effacement?

A

Cervix softens, shortens and thins

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7
Q

Describe the stages of effacement of the cervix during labour

A

Before labour - 0% effacement
Early effacement - 30%
Complete effacement -100%
Complete dilatation

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8
Q

What happens during the first stage of labour?

A

Duration from established labour to full cervical dilation
Vaginal examinations carried out every 4 hours
Descent of foetal head in relation to ischial spine

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9
Q

What is the rate of cervical dilation if this is their first baby?

A

0.5 cm per hour

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10
Q

How is labour diagnosed?

A

Painful, regular contractions
Cervical effacement
Dilation of cervix of 4cms or more

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11
Q

What is the second stage of labour?

A

Duration from full dilation to delivery of the baby

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12
Q

Describe the mechanism of birth

A

1) Head at pelvic brim in OT position
2) Flexion of neck
3) Head descends and engages
4) Head reaches pelvic floor and rotates to OA position
5) Head delivers by extension
6) Head restitutes
7) Shoulders rotate into anterior / posterior diameter of pelvis
8) Anterior shoulder delivered by lateral flexion from downward pressure on baby’s head
9) Posterior shoulder delivered by upward lateral flexion

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13
Q

What happens in the 3rd stage of labour?

A

Delivery of the placenta

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14
Q

What are the 2 methods of delivering the placenta?

A

Active management

Physiological

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15
Q

How is the placenta delivered by active management?

A

Oxytocin given I.M. into maternal thigh
Causes sustained uterine contraction
Aids delivery of the placenta and contraction of the placental bed
Decreases risk of postpartum haemorrhage

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16
Q

How is the placenta delivered physiologically?

A

Mother naturally expels placenta and membranes with contractions
Usually occurs within 1 hour
Encourage mother to breastfeed as this releases oxytocin which aids contractions

17
Q

What is the estimated blood loss?

A

300-500mls

18
Q

What is the anteroposterior diameter of the pelvis?

A

12cm

19
Q

What are the 3 diabetes of the pelvic outlet?

A

Anteroposterior - coccyx is deflected backwards to provide space for birth
Oblique
Transverse

20
Q

Describe the anterior fontanelle

A

Bregma
Diamond-shaped intersection of 4 sutures
2 x 3cms
Closes at 18 months

21
Q

Describe the posterior fontanelle

A

Y-shaped intersection of 3 sutures

Closes at 6-8 weeks

22
Q

What is the diameter and delivery position of the suboccipitobregmatic?

A

9.5cms

OA position

23
Q

What is the diameter and delivery position of the occipitofrontal?

A

11cms

OP position

24
Q

What is the diameter and delivery position of the supraoccipitomental?

A

13.5cms

Brow position

25
Q

What is the diameter and delivery position of the submentalbregmatic?

A

9.5cms

Face position

26
Q

Why is foetal monitoring in labour important?

A

To detect foetal hypoxia and deliver baby if needed

27
Q

How can we screen foetal heart rate?

A

Intermittent auscultation by pinard or sonicaid
CTG
FBS

28
Q

How often is intermittent auscultation carried out?

A

Every 15 minutes after a contraction during 1st stage of labour
Every 5 minutes in the second stage

29
Q

What happens if an abnormality is heard on intermittent auscultation?

A

CTG is used

30
Q

What is a CTG?

A

Cardiotocograph
Continuous print out of foetal heart rate and contractions
Abdominal ultrasound
FSE

31
Q

What is FSE?

A

Clip applied to foetal scalp

Detects R-R wave of foetal ECG

32
Q

What is FBS?

A

Foetal blood sampling
Stab on foetal scalp, collect blood in glass pipette
pH and base excess result

33
Q

When is FBS contraindicated?

A

Infections e.g. HIV or hep B
Foetal bleeding disorder
Prematurity below 32 weeks

34
Q

When should FBS used instead of CTG?

A

CTG is highly sensitive but poorly specific

Using CTG leads to 4 fold increase in C-sections for foetal distress so need to check CTG findings with FBS

Module 203 Reproduction & endocrinology (52 decks)

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