Labour Flashcards
What foetal hormones are released at parturition?
Prostaglandins, oxytocin and adrenal hormones (all control the timings of labour)
Prostaglandins will stimulate more vigorous muscle contractions
What mechanical changes help to bring about labour?
Increased muscle stretch will increase muscle contractility
Dilation of the cervix will also stimulate muscle contractions
What are the stages of labour?
1 - cervical dilation (8-24 hrs)
2 - passage of foetus through the birth canal (mins to 120mins)
3 - expulsion of placenta
Do eostrogen and prgesterone increase milk production?
No - they actually inhibit milk production
There will be a sudden decrease in E and P after birth.
What is the ‘milk let down reflex’?
also called the suckling stimulus - will promote the release of oxytocin from the post. pituitary gland to cause smooth muscle contraction within the breast and ejection of milk.
What are Braxton-Hicks contractions?
These are ‘practice contractions’ caused by the contraction of the uterine muscles. These differ from labour contractions as they are shorter, less painful and can be relived by changing activity level, position or taking sips of water.
What is Bishop’s score?
Score of the cervical readiness for labour and the foetal station: Dilation Effacement Consistency Position Foetal station
What is meant by ‘foetal station’?
The distance the foetal head is from the ischial spines:
- 3 cm is above the ischial spines
0 cm is at the ischial spines
+2cm is past the ischial spines
What is meant by cervical effacement?
How thin the cervix is - by 2nd stage of labour the cervix should be >80% effaced
What is meant by the cervical position?
How the cervix is orientated - in the first stage of labour it will move from the posterior to the anterior position
What occurs in the 1st stage of labour?
This is the movement of the foetus to the level of the ischial spines associated with cervical dilation/effacement/other changes.
What is the latent stage of stage 1 labour?
This is characterised by 3-4cm dilation and irregular contractions
Can last for a few days
What is the active stage of stage 1 labour?
Characterised by >4cm dilation and regular contractions (should be monitored every 30mins)
How much should the cervix dilate during active stage of stage 1 labour last in a nulliparous and multiparous woman?
N = 1cm/hr MP = 2cm/hr
What is stage 2 labour?
the progression from complete dilation to birth
How long should stage 2 labour take in nulliparous and multiparous women?
NP = 2 hrs (3 hrs with analgesia) MP = 1 hr (2 hrs with analgesia)
What is stage 3 labour?
The expulsion of the placental products - should take 5-10 mins if actively managed.
How is stage 3 labour managed actively?
With syntometrine infusion (oxytocin) - this will decrease blood loss after delivery
if >60 mins then indication to operate.
What is the pueperium?
This is the period of time after delivery where the tissues become normal again (usually about 6 weeks)
What is lochia?
This is vaginal discharge that is present after birth what contains blood, mucous and uterine tissue - it may be present for 2 weeks
What happens to CV system in the pueperium?
Returns to normal within 2 weeks
How fast will the vagina return to normal?
Will usually return to normal tone very quickly (within a week) but may be fragile for 1-2 weeks post-partum
How will the uterus be after birth?
It will be the size of a 20 week gestation baby but will decrease in 1 finger breath per day - day 12 should be non-palpable
What are some contraindications to induction of labour?
Malpresentation foetal distress vasa praevia placenta praevia tumour
