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Urogenital System > 9. Principles of Labour And Delivery > Flashcards

9. Principles of Labour And Delivery Flashcards

1
Q

What is the first phase of labour

A

Contractions: Regular Uterine activity

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2
Q

What is the Second Phase of Labour?

A

Progressive effacement (shortening) and dilation (opening) of the cervix

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3
Q

What is the last stage of labour

A

Expulsion of the products of conception POC

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4
Q

What is the embryonic origin of the uterus

A

Paramesonephric ducts

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5
Q

What is the weight of the uterus in the nulliparous woman

A

60-80g

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6
Q

What are the four parts of the uterus

A

Fundus, body, isthmus and cervix

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7
Q

What are the three payers of the uterus

A

Endometrium
Myometrium
Peritoneum

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8
Q

Describe the layers of the muscle fibres of the myometrium of the uterus

A

Deep- circular layer
Superficial- Longitudinal layer

( majority of the fibres run obliquely, in an interlacing fashion)

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9
Q

Define Immune Tolerance

A

It is the process by which both cell mediated and, to a lesser extent, humoral immunity are reduced

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10
Q

What is the result of failure of Immune Tolerance

A

Pregnancy loss

Pre eclampsia

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11
Q

What causes Anatomical Tolerance in Pregnancy

A

Progesterone produced by the placenta, causes relaxation of the uterine muscle

NB// a hollow viscera which becomes occluded and distended tends to automatically contract in an effort to clear the obstruction….the progesterone secretion prevents this from happening in pregnancy until full term

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12
Q

The Gravid Uterus increases in length from 7-8cm to ______

A

36-40cm

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13
Q

The Gravid Uterus increases in weight from 60g-80g to _______

A

850-950g

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14
Q

List six main changes in the gravid uterus

A 
Increases in length
Increases in weight
General thickening of the ligaments supporting the uterus
Blood vessels enlarged 
Gap junctions develop
Hyperplasia and hypertrophy
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15
Q

What is the significance of the development of gap junction in the Gravid Uterus

A

They allow changes in membrane potential to spread rapidly from one cell to another facilitating depolarization and synchronous contractions

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16
Q

What is the function of the functional linkage of the myometrial cells during labour

A

Allows the pacemaker activity of the uterine fundus to promote the co ordinated, fundal dominant contractions necessary for labour

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17
Q

Which hormones are thought to be the triggering event in initiating labour

A

Corticotrophin releasing hormone CRH

Cortisol

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18
Q

Which structures produce CRH and Cortisol to initiate labour

A

The fetus and the placenta

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19
Q

Which hormones are termed the placental clock

A

CRH (corticotrophin Releasing Hormone)

Cortisol

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20
Q

How does CRH and Cortisol release from fetus and placenta affect estrogen release from the placenta

A

Increases production of estrogen

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21
Q

What is the effect of estrogen on the uterine muscle during labour

A

Reduces the inhibition of the uterine muscle by progesterone

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22
Q

List five effects of Estrogen on uterus in preparation for labour

A

Reduces the inhibition of uterine muscle by progesterone
Upregulates oxytocin receptors
Increases the number of gap junctions between smooth muscle cell
Increases actin and myosin which are the proteins needed for contraction
It also increases the production of prostaglandins

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23
Q

What is the effect of estrogen on actin and myosin in uterus in prep for labour

A

Increases them

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24
Q

What is the effect of estrogen on oxytocin receptors in the uterus in prep for labour

A

Upregulation

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25
Q

Which hormone is responsible for “ripening” of the cervix (softening and shortening )

A

Prostaglandins

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26
Q

Prostaglandins causes an increase in production and activity of which enzymes

A 
Collagenase
Elastase
Hyaluronidase
Matrix
Metalloproyeinases
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27
Q

What is the effect of increases in Collagenase, Elastase, Hyaluronidase, Matrix, Metalloproyeinases on the uterus

A

Ripens the cervix

Softening and shortening of the cervix

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28
Q

Which hormone is mainly responsible for uterine contractions

A

Oxytocin

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29
Q

How do we know that oxytocin is responsible for uterine contractions

A

An increase in the number of oxytocin receptors in the uterine muscle
Increased secretion by the posterior Pituitary
Positive feedback to posterior pituitary via stretching of cervix

30
Q

True or False

Sensitivity to Oxytocin increases with gravidity

A

True

Because the number of oxytocin receptors never go back to normal after pregnancy

31
Q

Define Labour

A

Regular uterine activity (contractions), leading to progressive effacement and dilation of the cervix, and culminating in the expulsion of the products of conception

32
Q

Where do uterine contractions start

A

At a pacemaker located at the junction between the fallopian tubes and uterus

33
Q

Describe the path contractile waves in the uterus

A

Inwards and downwards to involve the entire uterus

34
Q

In a normal labour where is the intensity of the contraction greatest

A

In the upper uterine segment as the muscle is thicker

35
Q

Why is the intensity of the contraction greatest in the upper uterine segment

A

The muscle is thicker and there is greater amount of actinomyosin to contract

36
Q

What is the formula for measuring uterine activity

A

The intensity of the contraction x the frequency of the contraction (per ten minutes)

37
Q

Measure of uterine activity is expressed in which inits

A

Montevideo units

38
Q

True or False

In a normal labour the intensity and frequency of the contractions increase but there is no increase in resting tone

A

True

39
Q

In late labour, what value does the intensity increase to

A

60mmHg

40
Q

In late labour what is the frequency of contractions

A

3-5 contractions every 10minutes

41
Q

What is the measurement of uterine activity in Montevideo units

A

150-200 Montevideo units

42
Q

What is the average duration of contractions in early labour

A

20secs

43
Q

What is the average contraction duration in late labour

A

40-60secs

44
Q

Which events lead to the descent of the fetus through the birth canal

A

The progressive shortening of the uterine muscle coupled with the progressive dilatation of the cervix

45
Q

When does descent / engagement occur in primigravidas

A

36-37 weeks

46
Q

When does descent / engagement occur in multigravidas

A

After onset of labour

47
Q

What is meant by the term engagement

A

Widest part of the fetal head has entered the pelvis

48
Q

What is the flexion position of the head of the fetus

A

Fetal head flexes to the chin to chest position

49
Q

What aspects of the uterus lead to internal rotation of the fetal head

A

Funnel shaped pelvic floor

Uterine contractions result in a torsional force in the head causing it to rotate

50
Q

What are the six mechanics of labour

A 
Descent
Flexion
Internal Rotation 
Extension 
External Rotation 
Delivery
51
Q

Explain the Extension Mechanics of Labour

A

After the head crowns, delivery is accompanied by extension of the neck

52
Q

Describe external rotation in mechanics of labour

A

The fetal shoulders have reached the pelvic floor

Torsional forces again turn the infant, to allow the anterior shoulder to pass below the pubic symphysis

53
Q

How many stages of labour are there

A

Three

Stage I
Stage II
Stage III

54
Q

Define stage I labour

A

Beginning of labour to full dilatation

55
Q

Which stage of labour is described as

the Beginning of labour to full dilatation

A

Stage I

56
Q

What are the two phases of labour

A

Latent phase

Active Phase

57
Q

What is the dilation measurement in the latent phase of stage I labour

A

3-4cm dilated

58
Q

What is the dilation measurement in the active phase of stage I labour

A

4cm to fully (10cm) dilated

59
Q

Describe Stage II labour

A

Full dilation to delivery of the infant

60
Q

Describe Stage III labour

A

Delivery of the infant to delivery of the placenta

61
Q

What are the three factors that affect the time spent in each stage of labour

A

Parity
Size of mother / fetus
Presentation / position of fetus

62
Q

What is the time spent in Stage I latent phase

A

Variable

63
Q

What is the time spent in Stage I active phase in primigravidas

A

6-12 hrs

64
Q

What is the time spent in the active phase of Stage 1 in multigravidas

A

6-8hrs

65
Q

Define precipitate labour

A

When a labour is very quick and short, and the baby is born less than 3hrs after the start of contractions

66
Q

What is the average time spent at Stage II labour in Primigravidas

A

2hrs

+1hr if epidural given

67
Q

What is the average time spent at Stage II labour in Multigravidas

A

1hr

+1hr is epidural given

68
Q

What is the average time spent at Stage III labour

A

30minutes

69
Q

Patients are advised seek medical care when which two events occur when close to end term pregnancy

A

Sudden rupture of Membrane SROM

Contracting 2 per ten minutes

70
Q

List five steps of postnatal care

A

Check for or repair Lacerations
Express uterus
Put infant on breast as soon as possible
Monitor maternal vitals and vaginal blood loss
Mild analgesics for after pains

Urogenital System (17 decks)

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