Normal Labour and Peurperium Flashcards Preview

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Flashcards in Normal Labour and Peurperium Deck (47)
1

What is the second stage of labour

From full dilatation to delivery of baby

2

What is the third stage

Delivery of baby to expulsion of placenta

3

Name the factors that contribute to the initiation of labour

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

4

What is Fergusons reflex

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.

5

Role of progesterone in labour

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

6

Role of oestrogen in labour

Makes uterus contract and promotes prostaglandin production

7

Describe the role of oxytocin in labour

Initiates and sustains contractions
Promotes prostaglandin production

8

What defines the start of labour

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

9

What is effacement

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

10

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

If more than 3hrs with regional anaesthesia
If more than 2hrs without

11

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

If more than 2hrs with RA
If more than 1hr without RA

12

What is the average duration of the third stage of labour

About the minutes but can be up to thirty minutes
After one hour the placenta needs to be removed under GA

13

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

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

14

What is the most suitable type of pelvis for labour

Gnaecoid

15

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

Android

16

What type of pelvis is wider in the AP direction

Anthropoid

17

What is the normal feral position

Cephalic lying longitudinally. Vertex is occipital anterior.

18

Where does placental separation occur

The deciduous basal is at the spongy layer

19

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

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

20

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

About 6 weeks

21

What is the first stage of labour

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

22

What is lochia

Vaginal discharge after birth - may contain blood mucus and endometrium

23

What are the various colours of lochia

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

24

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

About 1 week

25

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

Within 2 weeks

26

What initiates lactation

Placental expulsion
Decrease in progesterone and oestrogen
Prolactin maintained

27

What is the definition of engagement

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

28

Which Fontannelle is larger

Anterior

29

Where is oxytocin synthesised

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

30

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

Increase

31

What other factors may contribute to the initiation of labour

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

32

How long may the latent phase of labour last

Can last days

33

What causes cervical softening

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

34

What causes cervical ripening

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

35

What is the pacemaker for contractions

Tubal ostia

36

How often in the cervix assessed in normal labour

Approx four hourly

37

What is bishops score used for

To asses whether induction of labour is required

38

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

Five or less

39

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

Less than 8

40

What are the five aspects of the bishops score

Position
Consistency
Effacement
Dilatation
Station in pelvis

41

Dilatation

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

42

Effacement

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

43

Station

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

44

Consistency

Firm = 0
Med = 1
Soft= 2

45

Position

Posterior 0
Mid 1
Anterior 2

46

What are the analgesic options in pregnancy

Paracetamol
TENS
Entonox
Diamond phone
Epidural
Remfentanyl
Spinal or epidural

47

What blood loss in labour would be abnormal

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