Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Reproduction > Normal Labour and Puerperium > Flashcards

Normal Labour and Puerperium Flashcards

(81 cards)

Start Studying
1
Q

what is puerperium

A

6 weeks after childbirth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is expelled from the uterus in labour

A

fetus, membranes, umbilical cord and placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is cervical effacement

A

thinning of the cervix during labour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what happens to contractions as labour progresses

A

become more frequent, intense and last longer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what causes the initiation of labour

A

unknown:
change in oestrogen/ progesterone ratio (oestrogen increases)
fetal adrenal and pituitary hormones may have an impact
myometrium stretch increases excitability of myometrial fibres
mechanical stretch of cervix
stripping of fetal membranes - baby pushes more on cervix
fergusons reflex- positive feedback system, pushing down on cervix causes more contractions and dilatation
pulmonary surfactant when secreted into amniotic fluid stimulates prostaglandin synthesis
increase in fetal cortisol -> increases maternal estriol
increases in myometrial oxytocin receptors + their activation = phospholipase C activity = increased cytosolitic calcium and uterine contractility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the role of progesterone in labour

A

(prevents it)
keep uterus settled
prevents the formation of gap junctions
hinders the contractibility of gap junctions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is the role of oestrogen in labour

A

makes the uterus contract

promotes prostaglandin production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the role of oxytocin in labour

A

initiates and sustains contractions

acts on decidual (endometrial) tissue to promote prostaglandin release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

where is oxytocin produced

A

decidual tissue
extraembryonic fetal tissues
placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what happens to oxytocin receptors in the myometrium and decidual tissues in pregnancy

A

numbers increase towards the end of pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the role or liquor

A

nutures and protects the fetus and facilitates movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what doe it mean to be born in a caul

A

when membranes dont rupture and babies born inside them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what makes up cervical tissue

A

collagen tissue mainly (types 1-4), smooth muscle, elastin

held together by connective tissue ground substance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what causes cervical softening

A

increase in hyaluronic acid decreases bridging among the collagen fibres= decrease in the firmness of the cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what causes cervical ripening

A

decrease in collagen fibre strength and alignment
decrease in tensile strength of the cervical matrix
increase in cervical decorin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what does the bishops score determine

A

whether it is safe to initiate labour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what does the bishops score quantify

A 
dilatation 
effacement 
station 
cervical consistency (firm, med, soft) 
cervix position (post, mid, anterior)

higher the score more likely/ safer to go into labour
lower score need cervical priming and induction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are the stages of labour

A

1st stage:

  • latent (0-3cm)
  • active (4cm-7cm)
  • transition (8-10cm)

2nd- from complete dilation and effacement to delivery
of baby

3rd- from delivery of baby to delivery of placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what happens in the latent phase of labour

A

mild irregular contractions
cervix shortens and softens
duration is variable- can last several days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what happens during the active first phase of labour

A

from 4cm to full dilatation
slow descent of the presenting part
contracting become more rhythmic and stronger
normal progress= 1-2cm dilation per hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

when is the 2nd stage of labour considered prolonged

A

nulliparous- when exceed 2 hours or 3 hours if regional anaesthesia
multiparous- if exceeds 1 hour or 2 hours with regional anaesthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

are vaginal exams always done in the 2nd stage of labour

A

not if fully dilated in low risk pregnancies as associated with infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what happens in the third stage of labour

A

delivery of baby

expulsion of placenta and fetal membranes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

how long does the 3rd stage of labour usually last

A

average 10 mins

if longer than an hour emergency CS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what are the different managements for the delivery of the 3rd stage of labour
``` spontaneous delivery active management- oxytocic drugs: prophylactic administration of Syntometerine (1ml ampoule containing 500 micrograms ergometrine maleate and 5IU oxytocin) OR Oxytocin 10 units Cord clamping and cutting, Controlled cord traction Bladder emptying ```
26
what do oxytocic drugs and controlled cord traction lower the risk of
post partum haemorrhage
27
what are braxton hicks contractions
aka false labour tightening of uterine muscles (aids body for birth) can start 6 weeks into pregnancy, usually happen in 3rd trim irregular, do not increase in frequency or intensity resolve with movement/ change in activity relatively painless
28
what hormone causes true labour contractions
oxytocin- stimulates the uterus to contract
29
what are true labour contractions like
timing = evenly spaces, time between gets shorter length of contraction increases usually from 10 -> 45 seconds get more painful starts in fundus and spreads downwards
30
what is the role of contractions
tightens to top part of uterus pushing baby downward into canal to prepare for delivery promotes the thinning of the cervix
31
where is the uterus highest in density of smooth muscle
at the fundus
32
what is the pacemaker of the uterus
region of the tubal ostia wave of contraction spreads downwards from here synchronisation of contraction waves from both ostia
33
what happens to either end of the uterus during contractions
``` upper segment contracts and retracts lower segment (and uterus) stretch, dilate and relax ```
34
how many contractions is it normal to have in 10 mins
3-4
35
is resting tone between contraction important
yes
36
when are contractions at their maximum
in 2nd stage of labour
37
what are the types of female pelvis
anthropoid- oval shaped, large AP diameter, smaller transverse diameter android- triangular/ heart shaped inlet, narrower at the front, more common in african caribbean women gynaecoid pelvis- most suitable for child birth
38
what is the cervix assessed for in labour
``` effacement dilatation firmness position level of presenting part/ station ```
39
what is the normal fetal position in labour
``` longitudinal lie cephalic presentation (vertex is presenting part) occipito-anterior, flexed ```
40
what is an abnormal fetal presentation
breech, oblique or transverse lie | occipito- posterior
41
what are the fetal positions within the pelvis (cephalic presentation)
right and left occipito posterior | right and left occipito anterior
42
what can be felt on vaginal exam to determine the position of the fetus in pelvis
fontanelles
43
what are the analgesic options of birth
paracetamol/ co-codamol (taken in initial stages) TENS entonox diamorphine (1st line for when too sore for paracetamol) epidural remifentanyl combined spinal/ epidural
44
what is recorded in a partogram
- fetal HR and how it is monitored (continuous electronic, intermittent, fetal scalp electrode, handheld doppler, pinard stethescope) - fetal pH - liquor - caput/ moulding - position - cervical dilatation - descent of presenting part - contractions per 10 mins - duration of contractions - time - syntocinon given? - epidural given? - medications given - maternal BP - maternal pulse - maternal urinalysis
45
what are the cardinal movements of the babies head in the fetus
engagement (passage of widest part into plevic inlet, 3/5ths of head in pelvis, 2/5ths abdominal) decent (through pelvis, in occipito transverse position) flexion (passive movement) internal rotation (of presenting part from -usually- transverse to anterior position) crowning and extension (occiput in contact with inferior margin of symphysis pubis) restitution (aka external rotation) (optimal position for shoulder) expulsion (anterior shoulder first)
46
how often should vaginal exams be done in normal labour
every 4 hours
47
what happens at crowning
Appearance of a large segment of fetal head at the introitus Labia are stretched to full capacity Largest diameter of fetal head is encircled by the vulval ring Burning and stinging feeling for the mother
48
when should the umbilical cord be clamped
should be delayed- after pulsations have stops/ 3 mins after birth unless immediate resuscitation is necessary
49
how long skin to skin time after birth
1 hour uniterrupted following birth
50
when is the placenta usually delivered
5-10 mins after birth | considered normal after 30 mins
51
what are the signs that indicate a separation of the uterus
Uterus contracts, hardens and rises Umbilical cord lengthens permanently Frequently a gush of blood variable in amount Placenta and membranes appear at introitus
52
what layer is separated when the placenta is delivered
the spongy layer of decidua basalis
53
what is the mechanism of placental separation
Shearing force | Inelastic placenta reduces surface area on the placental bed due to the sustained contraction of the uterus
54
what is a normal amount of blood loss in childbirth
less than 500ml
55
when is blood loss in childbirth significant
when >1000ml
56
how is haemostasis achieved in labour (to prevent blood loss)
Tonic contraction: Lattice pattern of uterine muscle strangulates the blood vessels Thrombosis of the torn vessel ends: pregnancy is a hyper-coaguable state Myo-tamponade-opposition of the anterior/posterior walls.
57
how long till tissues return to non pregnant state
6 weeks
58
what is lochia and what are the different forms
Vaginal discharge containing blood, mucus and endometrial castings Rubra (fresh red) 3-4 days after birth Serosa (brownish-red, watery) 4-14 days Alba (yellow) 10-20 days Bloodstained discharge lasts for about 10-14 days following birth
59
what uterine changes occur in the puerperuim
involution Weight -1000gms reduces to–50-100gms Fundal height –umbilicus to within pelvis in 2 weeks Endometrium regenerates by end of a week (except the placental site) Regression but never back to pre-pregnancy state; cervix, vagina and perineum Physiological diuresis commences 2-3 days postnatally
60
what initiates lactation
placental expulsion and a decrease in oestrogen and progesterone increase in prolactin
61
what is colostrum rich in
immunoglobulins
62
what are the indications for induction of labour
maternal: - pre eclampsia - poor obstetric Hx - medical disorders fetal: - susoected IUGR - rhesus isoummunisation - antepartum haemorrhage - PROM post dates pregnancy diabetes mellitus obstetric cholestasis
63
what are the mechanisms of induction of labour
Prostaglandins - PGE2 Dinoprostone (Prostin gel / Propess pessary) Mechanical: Membrane sweep, Foley Balloon Catheter Amniotomy IVI Syntocinon
64
what is the action of diamorphine
opiate mu receptor agonists in peri aqueduct grey matter, blocks pain signals
65
what are common SEs of diamorphine
``` arrhythmias confusion constipation dizziness drowsiness dry mouth euphoric mood flushing hallucinations HA hypotension miosis nausea and vomiting (more common in first dose) resp depression pruritis urinary retention bradycardia ```
66
how can a fetus be affected by diamorphine
resp depression withdrawal symptoms gastric stasis inhalation pneumonia
67
what is an epidural
bupivacaine and fentanyl into epidural space, regional anaesthetic
68
what nerves does an epidural block
from T10-12 downwards (uterus supplied by t10-12, vagina S2,3,4)
69
what special precautions should be taken with epidural anaesthesia
before doing it get IV access for fluids- hypotension a SE, risk of fetal distress loose bladder control- catheterise loss of power in legs (when light can move but loose proprioception, when heavy cant move legs (forceps delivery)) measure BP every 5 minutes for 15 minutes if still not pain free 30 mins after administration then get anaesthetist unless the woman has an urge to push or the baby's head is visible, pushing should be delayed for at least 1 hour and longer if the woman wishes, after which actively encourage her to push during contractions. Do not routinely use oxytocin in the second stage of labour for women with regional analgesia.
70
how is an epidural topped up
patient controlled- patient presses button every time they feel pain
71
which has more SEs diamorphine or an epidural
epidural
72
what are the SEs of an epidural
``` arrhythmias dizziness hypertension hypotension nausea paraesthesia urinary retention vomiting longer labour infection from insertion site (abscesses) haematoma dural headache nerve damage increases risk of instrumental delivery ```
73
what are the risk to the fetus from an epidural
neonatal resp depression hypotonia bradycardia hypotension in mother can cause bradycardia
74
What observations/assessments are made to assess the progress in labour?
``` partogram cardiotocography station vaginal exams abdominal palpation (shows descent of head) ```
75
what is meconium
early faeces of infant can be passed due to previous stress of the baby puts baby at risk of aspiration
76
what are the different appearances of liquor
clear meconium stained blood stained absent liquor
77
what is caput
oedema under scalp, more significant in longer labours
78
when do you worry about moulding
when bones overlapping each other and fixed there- worry about whether head will fit through pelvis
79
what can be given to increase the strength of contractions
syntocinon (synthetic oxytocin)
80
what should you do if 2nd stage of labour prolonged
Start on IV oxytocin then reassess in 4 hours Give epidural When dilated 10cm and have epidural already then wait an hour to progress naturally (without epidural then will feel urge to push so cant usually wait an hour) If still failing to progress -> emergency CS
81
what stage of labour is the baby born
2nd

Reproduction (51 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions