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Repro > Labour and birth > Flashcards

Labour and birth Flashcards

1
Q

Define labour

A

Process by which the fetus and it’s supporting placenta and membranes pass from the uterus to the outside world

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2
Q

How does labour occur?

A

Regular uterine contractions resulting in thinning and dilation of the cervix

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3
Q

3 key processes of labour

A

Regular high intensity of contractions
Softening and dilation of cervix
Rupture of foetal membranes

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4
Q

What triggers labour? Broad

A

Mechanical
Hormonal - drop in progesterone
Prostaglandins
Neurological

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5
Q

When is labour called labour?

A

If it occurs after 24 weeks gestation

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6
Q

What is spontaneous abortion or miscarriage?

A

If labour occurs before 24 weeks gestation

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7
Q

What is the biological term for labour?

A

Parturition

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8
Q

What is labour called if it occurs before 37th week gestation?

A

Premature or Pre-term labour

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9
Q

How many stages of labour?

A

Three - first, second and third stage

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10
Q

What happens in first stage labour?

A

Onset of established labour (regular uterine contractions) until the cervix is fully dilated
Creation of birth canal
Cervix and vagina realigned
Structures which retain foetus in utero are released

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11
Q

Which stage is longest of labour?

A

First stage - 12-18 hrs

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12
Q

What is the second stage of labout?

A

From full dilatation until fetus is born
Expulsion of foetus

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13
Q

Third stage of labour - what happens?

A

from the birth of fetus until delivery of placenta and membranes
Expulsion of placenta and changes to minimise blood loss

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14
Q

2 parts of the first stage of labout

A

Latent phase and active phase
Latent - 8 hrs long
Active - 6 hrs long, where cervix dilates most and contractions happen

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15
Q

What does clinical management of labour depend on?

A

Lie and presentation of foetus

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16
Q

What is the ‘lie’?

A

Relationship of long axis of the foetus to the long axis of the uterus
Commonest is longitudinal with head/buttocks posterior

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17
Q

What is the ‘presentation’ of the foetus?

A

Which part of the foetus is adjacent to the pelvic inlet (birth canal) - which part facing pelvis to go through it
If baby is longitudinal it may be cephalic - head first or breech - feet first

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18
Q

Two types of foetus lie

A

Longitudinal lie - 99%
Transverse lie - less than 1%

Oblique lie - but unstable and during labour adopts one of the above

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19
Q

Problem with transverse lie

A

Cannot have vaginal delivery - too wide diameter

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20
Q

3 types of breech

A

Complete - babys bum is going through inle, crossed legs and curled up

Frank - babys bum is through inlet with legs up by head

Footling - one foot is through birth canal

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21
Q

Problem with footling breech?

A

Foot can be birthed before dilated cervix
Umbilical prolapse can occur and come out with foot
Can become compressed and cause fetal distress

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22
Q

How is foetal position determined?

A

Obstetric abdominal examination
Vaginal examination - palpate fontanelles, feel for ischial spines of mother and see if head is before or after these to give bishops score

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23
Q

What creates the limits of the birth canal?

A

Sacral promontory
Iliopectineal line
Pubic symphysis

Cannot extend past these limits created by pelvis

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24
Q

Dimeter of birth canal?

A

11cm

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25
Q

How is the birth canal created to be as large as it can be? (3)

A

Softening of pelvic ligaments allow some expansion - progesterone
Increased myometrial activity - contractions
This causes cervical dilation and effacement

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26
Q

What happens to cervix to create birth canal?

A

Cervical ripening -softening
Strong contractions of myometrium smooth muscle causes thinning of cervix - effacement and then dilation of it

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27
Q

When does cervical ripening occur?

A

Weeks before delivery - get Braxton Hicks contractions to practice for birth and ripen cervix (soften it, they do not have any effect in dilation though)

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28
Q

What happens at a cellular level during cervical ripening?

A

Connective tissue of cervix has reduction in collagen and an increase in glycosaminoglycans which decreases the aggregation of collagen fibres

Collagen bundles ‘loosen’

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29
Q

What is the normal cervix cellular structure?

A

High connective tissue content made up of collagen fibres embedded in proteoglycan matrix

30
Q

What increases during cervical ripening?

A

Influx of inflammatory cells and increase nitric oxide output

31
Q

What triggers cervical ripening?

A

Prostaglandins E2 and F2alpha

32
Q

What happens to the myometrium during pregnancy?

A

Gets much thicker due to increased cell size and glycogen deposition

33
Q

How does myometrium contract?

A

A rise in intracellular calcium triggers a intracellular apparatus containing actin and myosin to generate force
Rise in calcium is produced by action potentials

34
Q

Myometrium contractions - when do you get them

A

Early pregnancy - every 30 mins or so but low amplitude
As continues, frequency falls with some amplitude increase producing noticeable Braxton Hicks contractions
But none powerful enough to effect cervix

35
Q

What do prostaglandins do to myometrium?

A

Enhance the release of calcium from intracellular stores

36
Q

What does oxytocin do to myometrium?

A

Lowers threshold for triggering action potentials

37
Q

Where does oxytocin come from?

A

Posterior pituitary gland - hypothalamus synthesises it and controls release

38
Q

What is the ‘ferguson reflex’?

A

Positive feedback loop to increase release of oxytocin

Babys head pushes on cervix = stretch
Nerve impulses from cervix to brain
Brain stimulates Pos pituitary to release oxytocin
Uterine contractions increased by increased oxytocin
Pushes babys head harder against cervix creating another cycle

39
Q

What is brachystasis?

A

With each contraction muscle fibres shorten but do not fully relax.
Uterine smooth muscle does this creating a shorter and shorter uterus pushing the presenting part of baby into birth canal

40
Q

What is effacement vs dilatation?

A

Effacement - thinning cervix
Dilation = opening cervix

41
Q

What is cervix maximum dilation?

A

10cm - enough for 9.5cm baby head to emerge

42
Q

When does first stage of labour end?

A

When cervix fully dilated - 10cm

43
Q

Length of second stage of labour

A

1 hour in multiparous women
2 hrs in primigravida

44
Q

What is it called if second stage of labout is prolonged?

A

Failure to progress - could be due to position, size of foetus or reduced contractions

45
Q

What are the 5 steps of the second stage of labour?

A

The descended head FLEXES as it meets pelvic floor reducing diameter
INTERNAL ROTATION
FLEXED HEAD DESCENDS to vulva, stretching vagina and perineum
HEAD IS DELIVERED - CROWNING
EXTERNAL ROTATION AND EXTENSION OF HEAD
Shoulders rotate - anterior shoulder delivery and then posterior delivery

46
Q

Two types of third stage labour

A

Physiological - wait for umbilical cord to stop pulsating before it’s cut and delver placenta passively (10 mins)

Active - given oxytocic drugs to keep uterus contracting to deliver placenta, given usually and esp in increased risk of PPH

47
Q

Why do uterus contractions help stop PPH?

A

Compresses blood vessels that were feeding placenta so reduces bleeding
Increase in clotting factors in pregnancy also helps this

48
Q

What is an APGAR score?

A

Score given to baby at birth out of 10 (10 good) can score 2, 1 or 0

Appearance - pink, blue extremeties or blue
Pulse - should be more than 100
Grimace - crying?
Activity - movement
Respiration - strong cry slow mover or no breathing

49
Q

3 Ps affecting labour

A

Passage - birth canal
Passenger - foetus
Powers - uterine contractions

50
Q

Passage explained

A

Can have different shapes of pelvis and cephalopelvic dysproportion

51
Q

What happens to the foestuses head during birth

A

Moulding - foetus head shape changes from external compressive forces and reduces in diameter
Bones not fully fused so can mould

52
Q

What is shoulder dystocia?

A

Vaginal cephalic delivery that requires additional obstetric manouveres to deliver foetus after head has been delivered and gentle traction has failed

53
Q

When does shoulder dystocia occur?

A

Either anterior or less commonly posterior shoulder impacts on maternal pubic symphysis or sacral promontory.

54
Q

Complications of shoulder dystocia

A

Brachial plexus injury - Erbs palsy (waiters tip)
Neurological dysfunction/disability
Neonatal mortality
PPH - trauma to uterus, not likely to keep contracting following birth
Tears

55
Q

Risk factors shoulder dystocia prelabour

A

Previous SD
Macrosomia >4.5kg
Diabetes mellitus
Maternal body mass index >30kg/m2
Induction of labour

56
Q

Risk factors for SD during labout

A

Prolonged first stage
Secondary arrest
Prolonged second stage
Oxytocin augmentation
Assisted vaginal delivery - forceps

57
Q

Position of arm in erbs palsy

A

Adducted
Extended
Internally rotated
Flexed wrist
Pronated hand

58
Q

Which nerve is injured in Erbs palsy?

A

Upper brachial plexus injury - C5 and C6

59
Q

What happens to contractions during active labour?

A

Stronger and maternal pushing effort increases amount

60
Q

Methods of intrapartum monitoring: intermittent

A

Used in uncomplicated pregnancies
Doppler/pinard stethoscope
Every 15 mins in 1st stage and every 5 mins in second stage

61
Q

Methods of intrapartum monitoring: continuous electronic fetal monitoring

A

CTG - cardiotocography
Fetal scalp electrode

62
Q

Another method of intrapartum monitoring

A

Fetal blood sample to check pH, if acidotic suggests distress

63
Q

Why is fetal scalp electrode better than CTG?

A

Not affected by babys movements

64
Q

4 methods of inducing labour

A

Membrane sweep - 39+ weeks
Prostaglandins vaginally - cervical ripening
IV Oxytocin
Artificial rupture of membranes with amniohook

65
Q

Why induce labour?

A

Risk of intrauterine death if in uterus longer than normal

66
Q

What is Bishops score?

A

Before you induce someone you see how favourable the cervix is to see if induction is likely to be successful

Measure cervix position, consistency, effacement, dilation and baby station

67
Q

What is baby station?

A

Measuring ischial spines of mum and seeing if babys head is there, before or after them
+ve score if further forward

68
Q

When does assisted delivery occur?

A

Failure to progress
Maternal exhaustion
Maternal conditions
Fetal compromise in 2nd stage

69
Q

2 methods of assisted delivery

A

Forceps - on either side of babys head
Suction cup/Ventouse

70
Q

When are Caesarean sections indicated?

A

Malpresentation/lie - breech or transverse
Macrosomia
Failure to progress
Fetal compromise
Fetal malformations
Previous caesarean

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