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Flashcards in Labour Deck (32)
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1

What are the roles of the different hormones involved in the initiation of labour?

Progesterone inhibits contractions
Oestrogen stimulates contractions
(more oestrogen : progesterone for labour)

Oxytocin initiates and sustains contractions and acts on decidual tissues to promote prostaglandin release

2

What are the fetal contributions to the initiation of labour?

Fetal pulmonary surfactant - secreted into the amniotic fluid - stimulates prostaglandin synthesis

Fetal cortisol stimulates an increase in maternal oestrogen

Fetus causes stretch of the cervix (fergusons reflex)

3

Describe the cervical changes which occur in normal labour?

Cervical softening and ripening

4

What is Bishops score for?

To determine whether it is safe to induce labour

Score <5 = induction will be necessary, score >9= labour will likely occur spontaneously

5

What are the 5 things involved in Bishops score?

Position

Consistency

Effacement

Dilatation

Station in the pelvis

6

What happens in the first stage of labour?

Involves a latent and an active stage

latent stage: up to 4cm dilatation with mild irregular contractions

active stage: 4-10cm dilatation with slow descent of the presenting part, contractions are strong and rhythmic

7

What happens in the second stage of labour?

From 10cm dilated to expulsion of the baby

8

What happens in the third stage of labour?

Expulsion of the placenta and fatal membranes

9

What analgesia options are available for labour?

Entonox

Paracetamol/ co-codamol

Diamorphine

Epidural

Remifentanyl

TENS machine

10

What are the 7 cardinal movements in labour?

Engagement
Descent
Flexion
Internal rotation
Crowning and extension
Restitution and external rotation
Expulsion

11

When is the fetus considered to be 'engaged' in labour?

When the widest brim of the fetal head has entered the brim of the pelvis

3/5ths = engaged (2/5ths can be palpated abdominally)

12

What is crowning?

Appearance of the fatal head at the introitus

13

Why is delayed cord clamping important?

Involves good blood flow to vital organs following delivery

14

What volume is considered normal blood loss in labour?

<500mls

15

What is the puerperium?

The period of 6 weeks after birth when there is repair and recovery of tissues and return to a non-pregnant state

16

How long does blood stained discharge last following birth?

10-14 days

17

When should labour be induced after rupture of the membranes?

Labour should usually be induced within 48 hours due to the risk of infections

18

What is the normal frequency and duration of contractions in labour?

3-4 contractions in 10 minutes

Initially last 10 seconds and then increase up to about 45 seconds

19

How is cord prolapse managed?

Urgent C-section

20

What are some of the possible complications of using epidural anaesthesia for labour?

Hypotension

Dural puncture headache

21

What are some of the possible signs of obstruction in labour?

Moulding

Caput

Anuria/ haematuria

Vulval oedema

22

"DR BRAVADO" is a mnemonic used to help remember what to look for on a CTG. What does it stand for?

Dr = determine risk
BRA = baseline heart rate
V = variability
A = accelerations
D = decelerations
O = overall

23

What is the normal baseline heart rate of a fetus?

110-150bpm

24

Fatal blood sampling can be done during labour to determine hypoxia. What is the normal pH value?

Scalp pH >7.25 is normal

<7.2 requires immediate delivery

25

What are the signs of placental separation?

Uterus contracts, hardens and rises

Increasing length of the umbilical cord is visible at the introitus

Gush of blood

Mother has a feeling of fullness

26

What manoeuvre should be done if the babies shoulder gets stuck during delivery?

McRobert's manoeuvre

27

What are some of the causes of post partum haemorrhage?

Uterine atony (most common)

Retained products

Clotting factor deficiency

Perineal trauma

28

What are some of the causes of antepartum haemorrhage?

Uterine rupture

Vasa praevia

Placental abruption

Placental accreata

Vasa praevia

29

Which is the preferred drug for active managed of the 3rd stage of labour; syntometrine or syntocinon?

Syntometrine is preferred because it causes a sustained tonic contraction and reduces the risk of PPH

30

Which cause of APH requires a laparotomy to remove the baby?

Uterine rupture