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1. Reproduction > Labour > Flashcards

Labour Flashcards

(56 cards)

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1
Q

What initiates labour?

A

increased oestrogen
decreased progesterone
myometrial stretch increases excitibility of myometrial fibres
mechanical stretch of cervix and stripping of foetal membranes helps
Fergusons reflex

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2
Q

What is Fergusons reflex?

A

fetal distention of the cervix or vaginal walls stimulates a neuroendocrine response that leads to oxytocin production which leads to contraction of the uterus

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3
Q

How does progesterone act in labour?

A

keeps the uterus settled
prevents the formation of gap junctions
hinders the contractibility of myocytes

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4
Q

How does oestrogen act in labour?

A

makes the uterus contract

promotes prostaglandin production

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5
Q

How does oxytocin act in labour?

A

initiates and sustains uterine contractions
acts on decidual cells to promote prostaglandin release
increase of receptors in myometrial and decidual tissue towards the end of pregnancy causes increased phospholipase C activity which increases Ca and contractibility

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6
Q

Where is oxytocin synthesised?

A

in decidual and extraembryonic fetal tissues and in the placenta

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7
Q

How does pulmonary surfactant help in labour?

A

stimulates prostaglandin synthesis

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8
Q

What does fetal cortisol do to the mother?

A

increases oestrogen

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9
Q

What cervical changes happen during labour?

A

increase in hyaluronic acid gives increase in molecules among collagen fibres
decrease in bridging among collagen fibres gives decrease in firmness of cervix

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10
Q

How does cervical ripening happen?

A

decrease in collagen fibre alignment and strength
decrease in tensile strength of cervical matrix
increase in cervical decorin

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11
Q

What type of collagen makes up the cervix?

A

type 1,2,3,4

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12
Q

What does a high Bishops score indicate?

A

more likely to go into labour

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13
Q

What 5 elements make up the Bishops score?

A 
position
effacement
dilation
station in pelvis 
consistency
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14
Q

What makes up the first stage of labour?

A

latent and active phases

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15
Q

Describe the latent phase?

A

mild irregular uterine contractions
cervix shortens and softens
may last a few days

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16
Q

Describe the active phase?

A

4cm -> full dilation
contractions become more rhythmic and stronger
slow descent of the presenting part

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17
Q

What is normal progress during the active phase?

A

1-2cm per hour

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18
Q

What makes up the second stage of labour?

A

full dilation (10cm) -> delivery of the baby

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19
Q

In nulliparous (first time) pregnancy when is 2nd stage of labour considered prolonged?

A

if exceeds 3 hours with analgesia

2 hours if no analgesia

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20
Q

In multiparous (previous) pregnancy when is 2nd stage of labour considered prolonged?

A

> 2 hours with analgesia

>1 hour without

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21
Q

When should the membranes rupture?

A

just before labour

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22
Q

What comprises the third stage of labour?

A

delivery of the baby to expulsion of the foetal membranes and placenta

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23
Q

What is the average duration of the third stage of labour?

Study These Flashcards
A

10 mins

can be anywhere between 3 mins -> longer

24
Q

What happens if the third stage is still going on after 1 hour?

Study These Flashcards
A

removal under general anaesthetic

25
What is the expectant management of the third stage?
spontaneous delivery of the placenta
26
What is the active management of the third stage?
use of oxytocic drugs and controlled cord traction = lowers the risk of PPH
27
What are Braxton Hicks contractions?
false contractions - tightening of the uterine muscles to prepare the body for birth - they are irregular more likely in those that have had children before
28
How do you stop Braxton Hicks contractions?
with ambulation or change in activity
29
What causes true labour contractions?
release of oxytocin
30
What are true labour contractions?
Regular, evenly spaced - time gets shorter between them | length of time of contraction also increases and pain increases too
31
What is the pathway of true labour contractions?
starts in the fundus then spreads down each side symmetrically - pushing the baby towards the birth canal
32
What can be given for pain relief for true labour contractions?
paracetamol -> cocodamol -> diamorphine etonox (gas and air) can also give a spinal/epidural
33
What are the 3 key parts to labour?
Power Passage Passenger
34
What determines the power of labour?
uterine contractions - uterine muscle = smooth muscle, highest density at the fundus - pacemaker = region of tubual atresia, synchronised waves from both astia - polarity = upper segmant contracts + retracts and lower cervix stretches, dilates and relaxes - frequency = normal = 3-4 in 10mins, 10-15 secs are start (max = 45secs)
35
What determines the passage of labour?
maternal pelvis - gynaecoid pelvis = most suitable - arthropoid = oval shape - android = triangular/heart shaped - African/carribean women
36
What determines the passenger for labour?
fetal position normal = longitudinal lie, cephalic presentation, occipital-anterior, head engages occipito-transverse, flexed head abnormal = breech presentation, transverse lie, oblique position - occipito anterior
37
Describe engagement - the 1st cardinal movement of labour?
fetal head engaged when the widest diameter of the head has entered the brim of the pelvis - 3/5ths entered, 2/5ths still felt abdominally
38
Describe descent - the 2nd cardinal movement of labour?
dowards passage of the presenting part through the pelvis
39
Describe flexion - the 3rd cardinal movement of labour?
flexion of the foetal head occurs passively as the head descends due to the shape of the bony pelvis and resistance offered by soft tissues
40
Describe internal rotation - the 4th cardinal movement of labour?
rotation of the presenting part to the anterior position as it passes through the pelvis
41
What happens if the head does not internally rotate?
need to do a mediolateral episiotomy
42
Describe extension - the 5th cardinal movement of labour?
occurs once the foetus has reached the level of the opening of the vagina it brings the base of the occiput in contact to the inferior margin at the symphysis pubis
43
Describe external rotation - the 6th cardinal movement of labour?
return of the foetal head to the correct anatomical position
44
Describe expulsion - the 7th cardinal movement of labour?
delivery of the baby
45
What is crowning?
appearance of a large section of the foetal head at the introitus (vaginal opening) labia are stretched to full capacity burning and stinging feeling for the mother
46
How long should cord clamping be delayed by? Why?
3 minutes | to increase the red blood cells that the baby recieves by 50%
47
How long should skin to skin be done after birth?
1 hour
48
What are the signs of the 3rd stage of labour?
5-10 mins after delivery uterus contracts, hardens and rises umbilical cord lengthens permanently frequently gush blood immediately before
49
What is the active management of the 3rd stage of labour?
prophylactic administration of Syntrometerine or Oxytocin 10 units also do cord clamping and controlled cord traction and bladder emptying
50
What are two methods of placental separation?
Matthew Duncan | Schultz
51
What is normal blood loss in labour?
<500mls
52
What blood loss contitutes giving medication?
>800mls
53
What is the puerperium?
6 week period of recovery and return of tissues to non pregnant state
54
What is lochia?
vaginal discharge containing blood, mucus + endometrial castings
55
What are the different types of lochia?
rubra - fresh red - 3-4 days serosa - brownish red - 4-14 days alba - yellow - 10-20 days
56
How does the uterus change in the puerperium?
weight reduces from 1000gms -> 50-100 gas endometrium regenerates in a week vagina, cervix and perineum regress but not to the same as the pre pregnancy state fundal height goes back to the pelvis within 2 weeks physiological diuresis - 2-3 days post natally

1. Reproduction (50 decks)

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