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Labour Flashcards

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1
Q

Define ‘Childbirth’.

A

Childbirth is the act/process of bringing forth a child from the Uterus/Womb.

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2
Q

Define ‘Labour’.

A

Labour is defined as a pregnant woman with the onset of regular contractions (2 contractions in 10 minutes, lasting for 20 seconds each) with effacement, show and dilatation of Internal OS.

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3
Q

What are the 5 essential factors that affect the process of labour and delivery?

A
  1. Passenger
  2. Passage
  3. Power
  4. Placenta
  5. Patient
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4
Q

What are the characteristics of a normal labour?

A

NORMAL LABOUR CHARACTERISTICS

  • Single, Live foetus
  • Delivered at term (37 weeks)
  • Presentation : Vertex
  • Vaginal delivery
  • Without undue prolongation
  • No morbidity/mortality
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5
Q

What are the 4 phases of Parturition (Labour)?

A

Phases of Parturition :

  • PHASE 1 (Quiescence)
  • PHASE 2 (Activation)
  • PHASE 3 (Stimulation)
  • PHASE 4 (Involution)
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6
Q

Explain Phase 1 of Parturition.

A

Phase 1 is the phase between conception to initiation of parturition. It is a state of uterine quiescence, contractile unresponsiveness and cervical softening occurs.

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7
Q

Explain Phase 2 of Parturition.

A

Phase 2 is the phase between initiation of parturition and onset of labour. It is a state in which uterus is preparing for labour and cervical ripening occurs

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8
Q

Explain Phase 3 of Parturition.

A

Phase 3 is the phase between onset of labour and delivery of conceptus. It is a state in which uterine contraction, cervical dilatation and the 3 stages of labour involving foetal and placental expulsion occurs

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9
Q

Explain Phase 4 of Parturition.

A

Phase 4 is the phase between delivery of conceptus and restored fertility. It is a state in which uterine involution, cervical repairs and breast feeding occurs

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10
Q

How is parturition regulated?

A

Parturition is regulated with the loss of Pregnancy Maintaining Factors and synthesis of Parturition Inducing Factors.

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11
Q

What are the regulating factors of Phase 1 of Parturition?

A

REGULATING FACTORS OF P1

Endocrine : Oestrogen, Progesterone, CRH, hCG, Relaxin

Paracrine : CRH, Relaxin, PGDH

Autocrine : PGI2, PGE2

Other : Nitric Oxide

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12
Q

What are the regulating factors of Phase 2 of Parturition?

A

REGULATING FACTORS OF P2

  • Estrogen (increase)
  • Progesterone (decrease)
  • Uterine stretch
  • Gap junction receptors
  • Relaxin
  • Hyaluron
  • Fetal Signal (SPA, CRH)
  • Prostaglandin
  • Cortisol
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13
Q

What are the regulating factors of Phase 3 of Parturition?

A

REGULATING FACTORS OF P3

  • Prostaglandin (increase)
  • Oxytocin (increase)
  • Relaxin
  • CRH
  • Inflammatory Cell activation
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14
Q

What are the regulating factors of Phase 4 of Parturition?

A

REGULATING FACTORS OF P4

  • Oxytocin (increase)
  • Inflammatory Cell activation
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15
Q

Define ‘Cervical Softening’.

A

Cervical Softening is cervical tissue remodelling leading to cervical compliance through structural changes in the extracellular matrix and change in collagen processing.

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16
Q

What is occuring in Phase 2 of Parturition?

A

The Myometrium contractions increase gradually due to increase in oxytocin, prostaglandins, their receptors, gap junctions in the myometrium and Connexin 43, which in turn, increase the uterine irritability and responsiveness in preparation for labour. Cervical Ripening is also seen.

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17
Q

What is the unique characteristic seen with contraction of the Myometrium?

A

Retraction (Normal muscles usually relaxes after contracting, however in the Myometrium, after contraction, the muscle fibers don not relax and retain their form)

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18
Q

Why is retraction of the Myometrium essential during labour?

A

The plexiform arrangement of the middle muscular layer of the Myometrium retracts to ensure a greater force can be generated and exerted in multiple directions.

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19
Q

What are the stimulating factors that cause uterine myocyte contractions?

A

UTERINE MYOCYTE CONTRACTIONS STIMULATING FACTORS :

  • Actin-myosin filament interactions
  • Increased myometrial gap junctions
  • Increased intracellular CA2+
  • Increased cell surface receptors
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20
Q

Define ‘Cervical Ripening’.

A

Cervical Ripening is when the length of the cervix is shortens, in order to merge with the lower segment of the uterus and the texture of the cervix is becoming more softer.

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21
Q

What is Lightening?

A

Lightening is the sensation of relief felt by the pregnant woman when the foetal head descends into the pelvic inlet (Lower Segment)

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22
Q

When does Lightening usually occur?

A

At 36-37 weeks of pregnancy

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23
Q

What occurs in Phase 3 of Parturition?

A

The clinical stages of labour occurs in Phase 3 of Parturition.

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24
Q

Define the ‘1st Stage of Labour’.

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A

The 1st Stage of Labour is further divided into 2 phases, Early Labour and Active Labour.

Early Labour is the period from the onset of contractions up till dilatation of the Internal OS up to 3 cm.

Active Labour is the period from the dilatation of the Internal OS from 3 cm till full dilatation at 10 cm.

25
What is the normal duration of the Active Stage of 1st Stage of Labour?
6 hours. It takes 1 hour for the Internal OS to dilate 1 cm.
26
Define the '2nd Stage of Labour'.
The 2nd Stage of Dilatation is the period from full cervical dilatation till the delivery of the baby.
27
What is the normal duration of the 2nd Stage of Labour?
1 hour
28
Define the '3rd Stage of Labour'.
The 3rd Stage of Delivery is the period from delivery of the baby till the delivery of the Placenta and Membranes.
29
Define the '4th Stage of Labour'.
The 4th Stage of Labour is the period in which the mother of a low risk pregnancy, after delivery is observed for any post-natal complications
30
What is the normal duration of the 4th Stage of Labour?
1 hour
31
Why is the 10 cm dilatation of the Internal OS considered as it's maximum dilatation?
Because both the Biparietal Diameter (BPD) and the Engaging Anteroposterior Diameter (Sub-occipital Bregmatic) of a foetal head measures at 9.5 cm.
32
What the features that are usually seen in a pregnant woman who is in the 1st Stage of Labour?
FEATURES OF 1ST STAGE OF LABOUR (Causes of pain) - Regular true labour pains (contractions) which are increasing in frequency, intensity and duration, leading to hypoxia of the Myometrium. - Increased intra-amniotic pressure (20-60 mmHg) - Dilatation of Cervix, heralded by a 'Bloody Show' (A plug of cervical mucous mixed with blood). - Effacement of the Cervix, beginning with the Internal OS, followed by the cervical canal and finally, the External OS. - Compression of the nerve ganglia in the Cervix and Lower Uterus. - Stretching of the peritoneum over the Fundus
33
Why does uterine contractions occur in intervals and doesn't occur continously?
Uterine contractions take place in intervals (2 in 10 mins) to ensure that the foetus receives blood in between the contractions and doesn't come out asphyxiated.
34
Define 'Effacement'.
Effacement is a process in which the muscular fibers of the Cervix are pulled upwards and merges with the fibers of the Lower Uterine Segment.
35
How is effacement of the Cervix measured?
Effacement is measured in percentage (0%-100%). 3 cm : Not effaced 2. 5 cm : 25% effaced 2. 0 cm : 50% effaced 1. 5 cm : 75% effaced 1. 0 cm : 100% effaced
36
In a primigravida, does effacement or dilatation of the Cervix occur first?
In a primigravida, effacements precedes dilatation of the Cervix.
37
In a multigravida, does effacement or dilatation of the Cervix occur first?
In a multigravida, both effacement and dilatation of the Cervix occurs simultaneously.
38
What are the causes of dilatation of the Cervix?
CAUSES OF DILATATION OF THE CERVIX : - Uterine contraction and retraction - Hydrostatic action of amniotic membrane - Ball-valve like action of a flexed head - Mechanical stretching by foetal axis
39
During the 1st Stage of Labour, what are the characteristics of the Upper and Lower Uterine Segment?
- Upper Segment (Active) : Firm, contracts, retracts and expels - Lower Segment (Passive) : Soft, distends and dilates
40
What does the presence of Bandl's Ring indicate?
Presence of Bandl's Ring is a sign of obstructed labour.
41
State the different Lies of the Foetus
- Longitudinal Lie | - Transverse Lie
42
State the different Presentations of the Foetus
- Vertex presentation - Breech presentation - Shoulder presentation
43
State the different Positions of the Foetus
- Right Occipito-anterior - Left Occipito-anterior - Right Occipito-posterior - Left Occipito-anterior
44
How is the 2nd Stage of Labour assessed?
The 2nd Stage of Labour is assessed using the Fifth's Palpable Method (Station)
45
How many phases are there in the 2nd Stage of Labour?
2 stages. The pelvic and perineal phase
46
What occurs in the pregnant mother when the baby reaches the pelvic floor (Pelvic Phase)?
- Stretching of Levator Ani - Thinning of Central Perineum - Anus becomes dilated when the Perineum is distended maximally
47
State some ancillary forces in labour
- Maternal intra-abdominal pressure | - Contraction of abdominal muscles simultaneously with forced expiratory efforts and the glottis closed
48
What occurs in the 3rd Stage of Labour?
- Separation of placenta | - Extrusion of placenta
49
How does the separation of placenta occurs?
Due to contraction and retraction of the uterus, there is reduction in the area of the uterus. The placenta buckles due to limited elasticity at it's weakest layer (Decidua Spongiosa). The membranes are peeled off by traction of the separated placenta.
50
What are the mechanisms of separation of the Placenta?
There are 2 mechanisms depending on where the placenta is attached : - Central Separation (Schultze's Method) - Marginal Separation (Mathew Duncan's Method)
51
How does Central Separation occur?
The placenta is dragged and descends due to a hematoma in the central part of the Uterus.
52
How does Marginal Separation occur?
The placenta is peeled off either side of the Uterine wall.
53
What are the signs of placental separation?
- Fresh pains asso. with Uterine contractions - Fresh vaginal bleeding - Extra-vulval lengthening of the Umbilical Cord - Raising of the Fundus of the Uterus above the Umbilicus - Presence of Suprapubic Bulge - After delivery, when the fundus of the Uterus is gently pushed back, the Umbilical Cord doesn't move back along with the Uterus.
54
What is the normal amount of blood seen after delivery?
< 500 ml
55
How is the bleeding after delivery controlled, physiologically?
Bleeding after delivery is controlled by retraction of the interlacing muscle fibers around the Uterine vessels. This is also known as 'Living Ligatures'.
56
What is the condition called if the bleeding after delivery is not controlled?
Atonic Post-partum Haemorrhage
57
What is looked for and examined in the 4th Stage of Labour?
- General Examination : B.P., P.R. - Has the uterus contracted? - Is there excessive bleeding per vagina?
58
What advice would you give a stable mother in the 4th Stage of Labour?
- Encourage the mother to empty her bladder - Start breast-feeding her child - Encourage her to eat and drink properly

OBGYN (3 decks)

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