Normal labour and puerperium Flashcards

1
Q

Three key factors in labour

A

Powers (contraction)
Passage (pelvis)
Passenger (foetus)

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2
Q

What physiological factors influence the onset of labour?

A

Rising placental oestrogen production
Rising oxytocin levels
Release of prostaglandins
+ve feedback stretch reflexes of cervix and myometrium

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3
Q

First stage of labour

A

From the onset of powerful contractions to full dilatation. latent phase-up to 4cm. Active phase- 4cm onwards

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4
Q

Second stage of labour

A

complete dilatation to delivery of foetus

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5
Q

when is the second stage stage considered prolonged in a) nulliparous b) multiparous women, +/- analgesia?

A

a) more than 2 hours
b) more than 1 hour
c) + 1 hr for epidural analgesia

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6
Q

Third stage of labour

A

Delivery of the foetus to expulsion of the placenta and membranes

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7
Q

How and why is the third stage actively managed?

A

Oxytocin, ergometrine and controlled traction

Reduces primary PPH

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8
Q

Describe the changes that take place in the cervix as part of labour

A

Dilatation
Shortening
Softening- increased hyaluronic acid, decreased collagen

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9
Q

contractions which start as early as 6 weeks but not usually felt until 2nd/3rd trimester

A

Braxton Hicks contractions

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10
Q

When is rupture of membranes deemed premature?

A

if it happens prior to the first stage of labour

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11
Q

when/why is a cervical sweep offered?

A

To induce labour; if overdue, if PROM, if long-term condition such as diabetes

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12
Q

Describe the normal “lie”. What position does the head engage the pelvis?

A

Longitudinal cephalic presentation. Transverse, flexed head

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13
Q

When is the presenting part described as being engaged?

A

When less than 50% of the head is palpable in the abdomen

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14
Q

What are the foetal stations described in relation to?

A

The ischial spines (0 is the level of ischial spines)

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15
Q

Name the cardinal movements

A
Engagement
Descent of presenting part
Head flexion
Internal rotation (so that occiput faces pubis)
Head extension and crowning
External rotation
Delivery of anterior shoulder
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16
Q

What is Bishops score?

A

assess whether it is safe to induce labour (whether the cervix is ready). If Bishops score is greater than 8 the likelihood of success of induction is the same as if labour commenced spontaneously

17
Q

How often should vaginal examination be carried out?

A

Every 4 hours

18
Q

What are the classical signs of placental separation?

A

Cord lengthening
Blood trickle
Uterus hardens and rises

19
Q

How long is it considered normal for placental separation to take?

A

up to 30 mins