Normal Labour

Question 1

what are the 3 key factors during labour

Answer 1

POWER: uterine contaction
PASSAGE: maternal pelvis
PASSENGER: fetus

Question 2

What hormone initiates + sustains contractions

Answer 2

oxytocin

Question 3

what other roles does oxytocin have

Answer 3

acts on decidual tissue to promote prostaglandin release

Question 4

what hormone makes the uterus contract

Answer 4

oestrogen

Question 5

name the other function of oestrogen in labour

Answer 5

promotes prostaglandin production

Question 6

what is the role of progesterone

Answer 6

Keeps the uterus settled
Prevents formation of gap junctions
Hinders contractibility of myocytes

Question 7

What hormone changes cause the initiation of labour

Answer 7

progesterone withdrawal

Increase in oestrogen + prostaglandin action

Question 8

what hormone from the placenta is likely involved in starting the changes leading to labour

Answer 8

CRH

Corticotrophin-releasing hormone

Question 9

What is the Ferguson reflex

Answer 9

name given to neuroendocrine reflex that self-sustains the cycle of uterine contractions initiated by the pressure at the cervix/vaginal walls

Question 10

what is the bishop score

Answer 10

method used to assess if it is safe to induce labour

Question 11

Name the 5 components of the bishop score

Answer 11

position 
consistency 
effacement
dilatations
station in pelvis

Question 12

Describe stage 1 of labour

Answer 12

Commences with onset of regular painful contractions
Latent phase - up to 3-4cms dilatation
Active phase - 4-10cms dilatation

Question 13

Describe stage 2 of labour

Answer 13

Full dilatation achieved
Delivery of baby
Divided into pelvic/passive phase (head descends down pelvis)
Active phase (when the mother pushes)

Question 14

describe stage 3 of labour

Answer 14

Expulsion of placenta and membranes after birth of baby

Question 15

After what time is the decision made to remove the placenta under GA if it has not been delivered naturally

Answer 15

1 hour

Question 16

What can be given to help the mother deliver the placenta

Answer 16

Oxytocic drugs- oxytocin 10 units OR syntometerine 1ml

Controlled cord traction, cord clamping + cutting, bladder emptying

Question 17

what causes the cervix to soften in preparation for labour

Answer 17

increased hyaluronic acid

decreases bridging among collagen fibres - decreased firmness

Question 18

what causes the cervix to ripen in preparation for labour

Answer 18

decrease in collagen fibre alignment/stretch/tensile strength
Increase in cervical decorin

Question 19

What are Braxton hicks contractions

Answer 19

Tightening of the uterine muscles, thought to aid the body prepare for birth
Not usually felt until 2nd/3rd trimester

Question 20

what are true labour contractions

Answer 20

pain described as a wave- starts low, rises until it peaks, and finally ebbs away

Question 21

what will the mothers abdomen feel like during contraction

Answer 21

hard

Question 22

where in the uterus do contractions start

Answer 22

fundus

Question 23

what are Braxton Hicks contractions also called

Answer 23

false labour

Question 24

features that differentiate Braxton hicks contractions from true contractions

Answer 24

irregular
do not increase in frequency or intensity
resolve eventually
relatively painless

Question 25

features of true labour contractions

Answer 25

``` evenly spaced (e.g. 5 mins apart) Time between them gets shorter and shorter get more intense and painful promote thinning of the cervix don't resolve ```

Question 26

what is the Ostia

Answer 26

distal tube opening of the infundibulum of uterine tube into abdominal cavity

Question 27

where do contractions synchronise from

Answer 27

both Ostia

Question 28

what shaped pelvis is most suitable for labour

Answer 28

gynaecoid pelvis

Question 29

what are the other shapes of pelvis

Answer 29

anthropoid - oval shaped inlet Android- triangle inlet (afro-carribean women) Platypelloid

Question 30

What is the function of amniotic fluid (liquor)

Answer 30

nurtures and protects the foetus | facilitates movement

Question 31

what colour should liquor be

Answer 31

clear | Red/pink suggests bleeding

Question 32

what is the normal fetal position

Answer 32

longitudinal lie cephalic presentation presenting part = vertex

Question 33

Normal fetal position in labour

Answer 33

Occipitoanterior with head engaging occiptial-transverse

Question 34

what are the major fontanelles in the fetal skull

Answer 34

``` anterior fontanelle (diamond shaped) posterior fontanelle ```

Question 35

how do 95% of fetal heads appear in vertex presentation

Answer 35

flexed

Question 36

What position does a flexed vertex baby go into

Answer 36

NORMAL | e.g. occipitoanterior

Question 37

What position does an extended or deflexed vertex baby go into

Answer 37

ABNORMAL | e.g. occipitoposterior or transverse

Question 38

how is the descent of the head referenced

Answer 38

abdominal 5ths

Question 39

what is crowning

Answer 39

appearance of a large segment of head at the Introitus | Labia are stretched to full capacity

Question 40

what may be required to prevent trauma to the anal sphincters during crowning

Answer 40

episiotomy

Question 41

what are the analgesic options for Labour

Answer 41

``` Paracetemol /co-codamol TENS (electrical pulses) Entonox (inhalation agents) Diamorphine Epidural IV Remifentanyl Combines spinal/epidural ```

Question 42

what is the risk with epidural

Answer 42

respiratory depression

Question 43

what is a normal blood loss in labour

Answer 43

<500mls

Question 44

what is an abnormal blood loss in labour

Answer 44

>500mls

Question 45

what is a significant blood loss in labour

Answer 45

>1500mls

Question 46

what are the signs that the placenta has separated

Answer 46

uterus contracts, hardens and rises Umbilical cord lengthens permanently gush of blood

Question 47

How is haemostasis achieved after delivery

Answer 47

Tonic contaction of uterine muscle strangulates blood vessels Thrombosis of the torn vessel ends- pregnancy is a hyper-coagulable state

Question 48

What is puerperium

Answer 48

period of repair and recovery | Return of tissues to non-pregnant state in 6 weeks

Question 49

What is lochia

Answer 49

vaginal discharge following delivery containing blood, mucus and endometrial castings

Question 50

different types of lochia

Answer 50

rubra (fresh red) Serosa (brownish-red, watery) Alba (yellow)

Question 51

what initiates lactation

Answer 51

placental expulsion

Question 52

what is colostrum

Answer 52

name given to milk produced by mothers

Question 53

what is colostrum rich in

Answer 53

immunoglobulins