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Labour Flashcards

1
Q

Define labour

A

Physiological process during which the foetus membranes, umbilical cord and placenta are expelled from the uterus

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2
Q

What is a sign pregnancy is about to begin?

A

‘Show’ - clear mucus like discharge

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3
Q

What helps to maintain the mucus plug during pregnancy?

A

Progesterone

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4
Q

Name four substances involved in imitation of labour

A
  • progesterone
  • oestrogen
  • oxytocin
  • prostaglandins
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5
Q

What is the function of progesterone in pregnancy?

A

Keeps the uterus settled and prevents gap junctions forming

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6
Q

What is the function of oestrogen in pregnancy?

A

Makes the uterus contract and promotes prostaglandin production

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7
Q

Describe the effect of oestrogen on oxytocin

A

Under the influence of oestrogen number of receptors increases causing the uterus to respond to the pulsatile release from the pituitary

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8
Q

What is the Ferguson Reflex?

A

Increase in oxytocin due to afferent impulses from the vagina/cervix stretch from the baby’s head causes a positive feedback loop

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9
Q

Describe cervical ripening

A

Softening of the cervix before labour to help dilate

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10
Q

What substances break down cervical connective tissue?

A

Oestrogen, relaxin and prostaglandins

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11
Q

What changes happen in cervical ripening?

A
  • reduced collagen
  • increased glycosaminoglycans
  • increased hyaluronic acid
  • reduced aggregation of collagen fibres
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12
Q

What is Bishops score used for?

A

Predicts how likely a patient is to respond to initiation of labour

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13
Q

Describe bishops score

A

Dilatation 0,1-2,3-4,5+
Effacement 0-30%, 40-50%, 60-70%, 80-100%
Station -3,-2,-1 or +1/+2
Cervical consistency - firm, med or soft
Cervix position - posterior, mid or anterior

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14
Q

Name the two parts of stage 1

A

Latent Phase

Active Phase

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15
Q

Describe the stage 1 latent phase

A

Slow cervical dilatation over several hours which lasts until 4cm dilated.

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16
Q

How does the amniotic sac rupture?

A

Due to regular painful contractions increasing the pressure

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17
Q

Describe stage 1 active phase

A

4cm - full dilatation, typically 1cm/hour nulliparous and 2cm/hour multiparous
Contractions become more rhythmic and stronger

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18
Q

Name the two parts of stage 2

A

Passive - no urge to push

Active - head reaches pelvic floor and involuntary desire to push

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19
Q

What happens in stage 2?

A

Uterine contractions become expulsive and foetus is pushed through the birth canal

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20
Q

How long should stage 2 take?

A

Nulliparous - <3 hours

Multiparous - <2 hours

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21
Q

What three factors are considered during labour?

A

Power
Passage
Passenger

22
Q

Name two types of contractions

A

Braxton Hicks Contractions

True contractions

23
Q

What are Braxton Hicks Contractions?

A

Tightening of uterine muscles, irregular, mild contractions resolve with change in activity, relatively painless

24
Q

Describe true contractions

A

Under the influence of oxytocin contractions are evenly spaced with less and less time between them and get more intense over time

25
How does pressure in the uterus increase with contractions?
The myometrial fibres do not relax fully following each contraction
26
How do prostaglandins and oxytocin alter contractions?
Prostaglandins - more calcium is released for AP increasing force Oxytocin - lowers threshold for AP, increasing frequency
27
Where is the density of muscle highest in the uterus?
Fundus
28
Where is the pacemaker in the uterus?
Tubal ostia
29
How often do contractions occur?
3-4 in 10 minutes range from 10-45 seconds
30
Name three types of pelvis
Gynaecoid - most suitable Anthropoid - oval inlet and anteroposterior diameter largest Android - triangle/heart shaped (afro-caribbean)
31
Where in the inlet/outlet is the widest diameter?
Inlet - widest transverse | Outlet - widest antero-posteriorly
32
What analgesia can be given during labour?
``` Paracetamol TENS Entonox IM opiates e.g. Diamorphine Epidural IV patient controlled Remifentanyl Spinal anaesthesia ```
33
What are the cardinal movements?
Changes in position of baby's head in the pelvis
34
Name the seven cardinal movements
1. Engagement 2. Descent 3. Flexion 4. Internal rotation 5. Extension 6. External rotation 7. Expulsion
35
At what level does extension occur?
Interoitus - brings the base of the occiput in contact with the symphysis pubis due to force from the uterus and pelvic floor
36
What is crowning?
Appearance of foetal head at introitus, labia is stretched to full capacity and the largest diameter encircled by the vulval ring causing burning/stinging
37
Why should cord clamping be delayed?
To allow higher infant haematocrit, Hb, blood volume and BP leading to overall better outcomes
38
What is stage 3 of labour?
Expulsion of placenta and membranes takes around 10 minutes on average
39
How long should you wait in stage 3 until surgical management?
1 hour
40
What are the signs stage 3 is occurring?
- uterus contracts/hardens and rises - umbilical cord lengthens permanently - frequently a gush of blood - placenta and membranes appear at introitus
41
What is involved in active stage 3?
Syntometrine Cord clamping Bladder emptying Cord Traction
42
Why is active stage 3 offered to all women?
50% lower risk of post partum haemorrhage
43
What is syntometrine?
Combination of ergometrine and oxytocin
44
How is the placenta separated?
Shearing force on the spongy layer of decide basalis. The inelastic placenta reduces SA on placental bed due to sustained contractions
45
Name two technniques of placenta separation
- Matthew Duncan | - Schultz
46
What volume of blood loss is normal in pregnancy?
<500ml
47
How is haemostasis maintained in labour?
- tonic contraction (muscle strangulates vessels) - thrombosis of torn vessel ends (hypercoaguable state) - myo-tamponade opposition
48
What is the puerperium?
Period of recovery and repair - return of tissues to non-pregnant state. Around 6 weeks
49
Name the discharge that can be experienced in the puerperium
Lochia - blood, mucus and endometrial castings Rubra - fresh red for 3-4 days Serosa - brown watery 4-14 days Alba - yellow 10-20 days
50
What uterine changes occur in puerperium?
Involution, reduction in weight and height, endometrium regenerates by the end of a week
51
How long does physiological diuresis last?
2-3 days

Reproduction & Sexual Health (36 decks)

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