Normal Labour and Puerperium

Question 1

describe the levels of oestrogen and progesterone in labour

Answer 1

progesterone goes down

oestrogen goes up (to contract uterus)

Question 2

how is labour induced?

Answer 2

myometrial stretch causes pituitary to release oxytocin which contracts uterus and pushes foetal head down more

Question 3

how does progesterone keep the uterus settled?

Answer 3

prevents formation of gap junctions to hinder the contractability of myocytes

Question 4

where is oxytocin synthesised?

Answer 4

decidual and extraembryonic fetal tissues and in placenta

Question 5

what effect does oxytocin have on decidual tissue?

Answer 5

promotes prostaglandin release from it

Question 6

there is a surge in oestrogen during labour T or F

Answer 6

F, remains higher but constant

Question 7

what substance from the baby in the amniotic fluid can initiate labour? why?

Answer 7

pulmonary surfactant

stimulates prostaglandin synthesis

Question 8

what is liquor?

Answer 8

nurtures and protects fetus and facilitates movement

Question 9

what causes the cervix to lose its firmness in labour?

Answer 9

increase in hyaluronic acid decreases bridging of collagen fibres in the cervix (less strength, alignment)

Question 10

what does the bishop score determine?

Answer 10

if its safe to induce labour

Question 11

name the 5 elements of the bishop score of the cervix?

Answer 11

position
consistency
effacement
dilatation
station in pelvis

Question 12

dilatation is __cm in the latent phase

Answer 12

3-4cm

Question 13

the active stage of labour has a dilation of….

Answer 13

4-10cm

Question 14

describe the uterine contractions in the latent phase of labour

Answer 14

mild irregular

Question 15

describe uterine contractions in active labour

Answer 15

rhythmic

strong

Question 16

normal progress in active labour is about _cm per hr

Answer 16

1-2

Question 17

what factors decrease labour duration

Answer 17

mobility
no analgesia
parity

Question 18

how often are vaginal examinations done in labour?

Answer 18

every 4hrs

Question 19

2nd stage of labour is considered prolonged if it exceeds _ hours in nulliparous women

Answer 19

3 if regional anaesthesia

2 without

Question 20

2nd stage of labour is considered prolonged if it exceeds _ hours in multiparous women

Answer 20

2 with regional anaesthesia

1 without

Question 21

average duration of 3rd stage of labour?

Answer 21

10 mins

Question 22

what marks the start and end of stage 2?

Answer 22

when 10cm dilatation occurs to delivery of the baby

Question 23

what happens if stage 3 lasts over an hr

Answer 23

prep will be made for removal under anaesthetic

Question 24

how is risk of PPH lowered in stage 3

Answer 24

use oxytocic drugs

control cord traction

Question 25

what are braxton hicks contractions?

Answer 25

false sensation of contractions caused by tightening of the uterine muscles "false labour"

Question 26

when are braxton hicks contractions felt?

Answer 26

3rd trimester but can start 6 weeks in to pregnancy

Question 27

describe braxton hicks contractions

Answer 27

irregular with no correlation of frequency or intensity, painless, resolve with change in activity eg lying down

Question 28

describe true labour contractions

Answer 28

timing of contractions become evenly spaced and get shorter eg 2 min in between then 1, can last 10-45 secs, get more intense and painful over time

Question 29

how long do true labour contractions last

Answer 29

10-45 secs

Question 30

name the 3 key factors that affect labour

Answer 30

power eg uterine contractions passage eg mums pelvis passenger eg fetus

Question 31

where is uterine muscle density highest?

Answer 31

at the fundus (top)

Question 32

where is the pacemaker of the uterus located?

Answer 32

tubal ostia

Question 33

how many contractions are expected in 10 mins?

Answer 33

3-4

Question 34

what kind of pelvis is ideal for birth?

Answer 34

gynaecoid

Question 35

what kind of patients are at risk of an android shaped pelvis?

Answer 35

african-caribbean women

Question 36

antero-posterior diameter is larger in a gynaecoid/android pelvis

Answer 36

gynaecoid

Question 37

how can you tell the position of the baby from a vaginal exam?

Answer 37

feel for sutures and fontanelles on baby's skull

Question 38

best analgesic for labour?

Answer 38

entonox

Question 39

what does a partogram measure?

Answer 39

cervical dilatation | fetal heart rate

Question 40

what analgesic is good as a stronger analgesic for 1st stage of labour

Answer 40

diamorphine

Question 41

induced labour tends to be more painful T or F

Answer 41

T

Question 42

name the 7 cardinal movements of the baby in labour

Answer 42

``` engagement descent flexion internal rotation crowning and extension resitution and external rotation expulsion ```

Question 43

what is expelled first in birth

Answer 43

anterior shoulder

Question 44

what are cardinal movements in labour?

Answer 44

changes in position of babys head in the pelvis in relation to vertex presentation

Question 45

what happens in engagement and descend

Answer 45

passage of the head to a level below the pelvic inlet | baby passes downwards

Question 46

where is the sagittal suture located in engagement?

Answer 46

tends to be deflected posteriorly

Question 47

when is a baby said to be engaged?

Answer 47

3/5 of the head is in the pelvis

Question 48

internal rotation involves the baby moving its head from what position to what?

Answer 48

from transverse position to anterior

Question 49

extension occurs once the fetus has reached the level of the ___

Answer 49

interoitus

Question 50

what is restitution?

Answer 50

baby externally rotates its head back to its anatomic position

Question 51

what is crowning?

Answer 51

largest diameter of the fetal head is encircled by the vulval ring

Question 52

what does crowning feel like?

Answer 52

burning and stinging

Question 53

when should you clamp the cord?

Answer 53

leave it for a while to ensure blood supply unless immediate resus is needed

Question 54

what is skin to skin?

Answer 54

placing of naked baby on mothers chest, allows transition to life outside of womb

Question 55

how long after delivery is placenta delivered?

Answer 55

5-10 mins aftery

Question 56

name the 3 classic signs of placental separation

Answer 56

uterus conrtracts, hardens, rises umbilical cord lengthens gush of blood

Question 57

a blood loss of under __ml is normal

Answer 57

500

Question 58

pregnancy is a hypo/hypercoaguable state

Answer 58

hyper

Question 59

what is puerperium?

Answer 59

period of repair and recovery of tissues to a non-pregnant state

Question 60

how long does puerperium last?

Answer 60

6 weeks

Question 61

describe discharge in puerperium?

Answer 61

bloody (up to 2 weeks after) to brown to yellow

Question 62

how long after pregnancy does the endometrium regenerate?

Answer 62

1 week

Question 63

lactation is initiated by...

Answer 63

placental explulsion

Question 64

what is effacement?

Answer 64

thinning of the cervix for birth

Question 65

why does labour take longer with an epidural

Answer 65

anesthesia to S2-S4 will stop supplying the pelvic floor so they cant work as effectively

Question 66

what happens to the bladder with an epidural?

Answer 66

urinary retention

Question 67

what is moulding?

Answer 67

folding over of the baby's skull

Question 68

how do you measure foetal HR in labour in low risk women?

Answer 68

intermittent auscultation

Question 69

how do you measure fetal HR in high risk women?

Answer 69

constantly with a CTG