Labour and delivery

Question 1

what is the definition of labour

Answer 1

Presence of regular painful uterine contractions becoming progressively stronger and more frequent, accompanied by effacement and progressive dilatation of the cervix and descent of the head through the cervix into the vagina and out

Question 2

what does effacement mean

Answer 2

cervix undergoes changes – thins and has contact with the head of the baby, at 8 months it will turn round so its head is on top of the cervix

Question 3

what does labour begin and end with

Answer 3

Usually begins with bloody mucoid “show”

Ends with expulsion of baby and other products of conception

Question 4

what does the mucus plug do

Answer 4

acts as a stopper prevents things getting in that would harm the baby and prevent the baby from leaving

Question 5

what is another word for labour

Answer 5

parturition

Question 6

when do contractions start

Answer 6

from the 6th week of pregnancy contractions take but they are not noticed until 3rd trimester

Question 7

when do Braxton hicks contractions take place

Answer 7

6-4 weeks before end of gestation uterus has uncoordinated contractions

Question 8

what is a Braxton hick contraction

Answer 8

• these are contractions that happen before 6-4 weeks before end of gestation uterus has uncoordinated contractions, they may or may not be aware of these contractions

Question 9

what are the cause of increased labour contractions

Answer 9

Progressive hormonal changes

Progressive mechanical changes

Question 10

what are the mechanical phases that take place that increase contraction

Answer 10

• baby moves the head to be at the top of the cervix

Question 11

what are the hormonal changes that take place that lead to increased labour contractions

Answer 11

• foetal itself is producing some of hormones such as oxytocin, this feds back to the myometrium to increase oxytocin receptor which increases contraction, mothers oxytocin does the same thing

Oestrogen – pro smooth muscle contraction, increase in the amount of oestrogen and the amount of progesterone decreases

Relaxin is also produced by the placenta, it relaxes the ripening of the cervix and the softening of the cervix, also causes softening of the pubic symphysis to allow the joint to move further apart

Also local prostaglandin production – this causes relaxation and causes the contraction of the uterus

Question 12

what does progesterone do

Answer 12

• it inhibits uterine contractility during pregnancy this prevents expulsion of the foetus

Question 13

what does oestrogen do

Answer 13

• Oestrogens increase the degree of uterine contractililty

- Oestrogens increase number of gap junctions between adjacent smooth muscle

Question 14

what happens in the 7th month of pregnancy

Answer 14

• Both oestrogen and progesterone are secreted in progressively greater quantities throughout pregnancy
• But from 7th month oestrogen continues to increase while progesterone stays the same or declines

Question 15

describe what happens in the Ferguson reflex

Answer 15

Babies head stretches cervix and feedbacks on pituitary

Pituitary secretes oxytocin into blood and travels to uterine muscle

Oxytocin stimulates uterine contraction and pushes baby down, stretching the cervix further which feedbacks to the pituitary releasing more oxytocin

Cycle repeats until baby is
born

Abdominal muscles are activated by neurogenic reflexes to contract and their contraction aids the expulsion of the baby

Question 16

what are the stages of labour

Answer 16

Latent
baby expulsion
placental expulsion

Question 17

what happens in the latent phase (first stage of the first stage of labour)

Answer 17

• 0-4 cm cervix dilation
• Duration not easily determined nothing to show other than cramps and possible backache,
• Often long, especially in women having their first baby
• Contractions last 30-60 second and are 5-20 mins apart
• average duration is 12 hours

Question 18

how long do the contractions last in the latent phase

Answer 18

Contractions last 30-60 second and are 5-20 mins apart

Question 19

what happens in the active phase of labour ( second stage of the first stage of labour)

Answer 19

• 4-10cm dilatation
• Established labour
• Cervix dilates at the rate of about 0.5 – 1 cm/hour
• May be faster in multiparous women or slower in first
• Average duration – 12 hrs
• Contractions last 45-60 seconds and are 2-5 mins apart
• Transistion contractions last 60-90 seconds and are 2-3 mins apart

Question 20

when do the 2nd stage of labour starts

Answer 20

Starts at full dilatation of the cervix to delivery of the baby

Question 21

describe the 2nd stage of labour

Answer 21

• Within 3 hrs for first
• Within 2 hrs for multiparous and often much quicker
• Contractions last 45-90 secs and 3-5 mins apart

Question 22

describe the third stage of labour

Answer 22

• After the delivery of the baby to the delivery of the placenta and amniotic membranes
• Usually within 30 mins

Question 23

what is the most common fatal head position in delivery

Answer 23

• • left occiput anterior is most common

- Babies head is slightly off centre in the pelvis with back of the head toward the mothers thigh

Question 24

what does the left occiput anterior mean in regards to head position

Answer 24

Babies head is slightly off centre in the pelvis with back of the head toward the mothers thigh
- this is the better position

Question 25

what does left occiput transverse mean

Answer 25

- When back of baby’s head points directly at the mothers thigh the baby is left occiput transverse - May lead to more pain and slower progression

Question 26

describe what is special about the fatal head

Answer 26

Bones of the fetal skull are not firmly united which allow moulding - Bones overlap makes it easier to get out of the pelvic bone - Head can rotate, flex and extend

Question 27

describe how the pelvis changes during pregnancy

Answer 27

Widest diameter of pelvic canal changes from transverse diameter at pelvic inlet to AP diameter at pelvic outlet

Question 28

why must the head rotate during pregnancy

Answer 28

To obtain best fit of fetal head, the longest diameter of the fetal head passes through the widest diameter of the pelvis Therefore head must rotate during labour

Question 29

how do you measure the fatal descent

Answer 29

- Measured in negative and positive numbers - Ischial spine is in 0 station - If the presenting part is higher than the ischial spine the station has a negative number - Positive means that the presenting part has passed the ischial spine

Question 30

where is the pelvic outlet

Answer 30

+4cm

Question 31

how is the process of cervical ripening compared to an inflammatory reaction

Answer 31

``` Prostaglandins Oestrogens Progesterone and antiprogesterones Relaxin Inflammatory mediators Nitric oxide Apoptosis ```

Question 32

what is cervical ripening

Answer 32

Increased softening, distensibility, (effacement and dilatation of the cervix)

Question 33

how do the biochemical changes to the cervix happen in cerivcal ripening

Answer 33

Rearrangement and realignment of collagen and an increase in the ground substance when compared early pregnant cervix

Question 34

what is the bishops score

Answer 34

Assess whether labour and pregnancy is progressing at a normal rate or whether we need to induce with for example oxytocin to induce

Question 35

what does a bishop score o... - 5 suggest - 9 suggest - 5-9 - 6 or less

Answer 35

A score of 5 or less suggests labour is unlikely to start without induction A score of 9 or more indicates that labour will most likely commence spontaneously Scores between 5 – 9 require additional consideration A score of 6 or less indicates that induction with PGE2 is unlikely to be successful

Question 36

what does the bishops score do

Answer 36

- how much the cervix has dilated - where the head is in the cervix - how soft the cervix is

Question 37

describe individuals parts of labour

Answer 37

First stage - Engage - flex and descent second stage - full dilation - internal rotation and then extension - external rotation - expulsion 3rd stage - placental devilry

Question 38

describe the first stage of labour

Answer 38

Head is pushing onto the cervix softening it Uterus is starting to contract and push the head down giving us the positive feedback The mucus plug separates Head moulds and changes shape

Question 39

describe the full dilation stage

Answer 39

- the mucus plug is gone - The head is through the cervix - The cervix is fully dilated at up to 10cm - Can see aead of feuts at the top of the cervix

Question 40

describe internal rotation and extension

Answer 40

As it comes out it is coming out face down | Rotate the head internally so you can assist in getting the head out

Question 41

describe external rotation

Answer 41

External rotation and delivery of anterior shoulder When the head is out Rotate it so that the shoulders can come out

Question 42

describe expusion

Answer 42

- two shoulders are out | - then the whole body comes out

Question 43

describe placenta expulsion

Answer 43

Uterus is still contracting | The placenta comes out and the rest of the umbolical cord that is attached to it

Question 44

what does oxytocinin do

Answer 44

helps you bond with the baby as soon as it is born It also reduces sesntivity to pain and awareness to pain

Question 45

what is the last stage of labour

Answer 45

- Last from delivery of placenta until postpartum condition of woman stabilises - 1-2 hours after delivery - Uterus will continue to contract which help the uterus to return back to normal size - Not usually painful - Descends 1 cm each day for about 10 days