Normal Labour and Peurperium

Question 1

What is the second stage of labour

Answer 1

From full dilatation to delivery of baby

Question 2

What is the third stage

Answer 2

Delivery of baby to expulsion of placenta

Question 3

Name the factors that contribute to the initiation of labour

Answer 3

Change in oestrogen/progesterone ratio
Fetal adrenals and pituitary hormones
Stretch fibres in myometrium and cervix
Fergusons reflex

Question 4

What is Fergusons reflex

Answer 4

Pressure on the cervix results in a release of oxytocin which increases contractility. The increases contractions acts as positive feedback on the pituitary resulting in more oxytocin release.

Question 5

Role of progesterone in labour

Answer 5

Inhibits formation of gap junctions and therefore reduces contractility of the uterus

Question 6

Role of oestrogen in labour

Answer 6

Makes uterus contract and promotes prostaglandin production

Question 7

Describe the role of oxytocin in labour

Answer 7

Initiates and sustains contractions

Promotes prostaglandin production

Question 8

What defines the start of labour

Answer 8

Regular contractions which increase in strength and frequency and bring about cervical change.
The show and rupture of membranes does not define the start of labour

Question 9

What is effacement

Answer 9

Process by which the cervix shortens in length as it be c ones included into the lower segment of the uterus

Question 10

When is the second stage of labour considered prolonged in a nulliparous woman

Answer 10

If more than 3hrs with regional anaesthesia

If more than 2hrs without

Question 11

When is the second stage of labour considered prolonged ina multiparous woman

Answer 11

If more than 2hrs with RA

If more than 1hr without RA

Question 12

What is the average duration of the third stage of labour

Answer 12

About the minutes but can be up to thirty minutes

After one hour the placenta needs to be removed under GA

Question 13

Why would active management of the third stage be preferable to expectant

Answer 13

Decrease risk of PPH because oxytocin is injected into cord and ergometrine administered

Question 14

What is the most suitable type of pelvis for labour

Answer 14

Gnaecoid

Question 15

Which pelvis shape is heart shaped and common in tall or Afro Caribbean women

Answer 15

Android

Question 16

What type of pelvis is wider in the AP direction

Answer 16

Anthropoid

Question 17

What is the normal feral position

Answer 17

Cephalic lying longitudinally. Vertex is occipital anterior.

Question 18

Where does placental separation occur

Answer 18

The deciduous basal is at the spongy layer

Question 19

What are the three classic signs of the third stage of labour

Answer 19

Uterus hardens and contracts and rises
Umbilical cord lengthens
Gush of blood

Question 20

How long does it take for. Tissues to return to normal after puerperium

Answer 20

About 6 weeks

Question 21

What is the first stage of labour

Answer 21

Latent + active phase
Up to 3-4cm dilation = latent
4-10cm = active

Question 22

What is lochia

Answer 22

Vaginal discharge after birth - may contain blood mucus and endometrium

Question 23

What are the various colours of lochia

Answer 23

Rubra (red)
Serosa (brown)
Alba (yellow)

Question 24

How long does it take for the endometrium to regenerate after birth

Answer 24

About 1 week

Question 25

How long does it take for the fundal height to reduce and the umbilicas to be in the pelvis

Answer 25

Within 2 weeks

Question 26

What initiates lactation

Answer 26

Placental expulsion Decrease in progesterone and oestrogen Prolactin maintained

Question 27

What is the definition of engagement

Answer 27

When the widest part of the presenting part has passed through the pelvic inlet and is less than 2/5 palpable in the abdomen

Question 28

Which Fontannelle is larger

Answer 28

Anterior

Question 29

Where is oxytocin synthesised

Answer 29

Directly in the decidual and extraembryonic fetal tissue and in the placenta

Question 30

What happens to the number of oxytocin receptors in the myometrial and decidual tissues near the end of pregnancy

Answer 30

Increase

Question 31

What other factors may contribute to the initiation of labour

Answer 31

Pulmonary surfactant secreted into amniotic fluid stimulates prostaglandin release Fetal cortisol rises stimulating maternal estriol Increase in myometrial oxytocin receptors results in increase in calcium and uterine contractility

Question 32

How long may the latent phase of labour last

Answer 32

Can last days

Question 33

What causes cervical softening

Answer 33

Increase in hyaluronic acid results in increased molecules among collagen fibres decreasing the bridging of these fibres and softening the cervix

Question 34

What causes cervical ripening

Answer 34

Decrease in collagen fibre alignment, strength Increase in cervical decorin Decreases in strength of cervical matrix

Question 35

What is the pacemaker for contractions

Answer 35

Tubal ostia

Question 36

How often in the cervix assessed in normal labour

Answer 36

Approx four hourly

Question 37

What is bishops score used for

Answer 37

To asses whether induction of labour is required

Question 38

At why bishops score is it likely that labour will not start without induction

Answer 38

Five or less

Question 39

At what bishops score is it unlikely that induction will be very successful

Answer 39

Less than 8

Question 40

What are the five aspects of the bishops score

Answer 40

``` Position Consistency Effacement Dilatation Station in pelvis ```

Question 41

Dilatation

Answer 41

0cm = 0 1-2cm = 1 3-4cm = 2 5 or more = 3

Question 42

Effacement

Answer 42

0-30%= 0 40-50%= 1 60-70%= 2 80-100%=3

Question 43

Station

Answer 43

-3=0 -2=1 -1=2 +1 or +2=3

Question 44

Consistency

Answer 44

``` Firm = 0 Med = 1 Soft= 2 ```

Question 45

Position

Answer 45

Posterior 0 Mid 1 Anterior 2

Question 46

What are the analgesic options in pregnancy

Answer 46

``` Paracetamol TENS Entonox Diamond phone Epidural Remfentanyl Spinal or epidural ```

Question 47

What blood loss in labour would be abnormal

Answer 47

Any volume greater than 500ml | Any blood loss prior to delivery apart fro the show