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Semester 4 - Reproductive System > Session 10 - Parturition > Flashcards

Session 10 - Parturition Flashcards

1
Q

What is Labour? (Aside from being the most awesomest political party ever!)

A

Expulsion of products of conception after 24 weeks.

So yeh. Actually sounds a bit more like UKIP.

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2
Q

What is a birth <24 weeks called?

A

Spontaneous aboriton

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3
Q

What is a birth <37 weeks called?

A

Pre-term

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4
Q

What is a birth between 37-42 weeks called?

A

Term

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5
Q

Give three different things you should assess about a babies position before labour

A

Lie
Presentation
Position

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6
Q

What is a babies lie?

A
  • Relationship to long axis of uterus
  • Normally longitudinal
  • Fetus normally flexed
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7
Q

What is a babies presentation?

A
  • Which part is adjacent to pelvic inlet
  • Normally head (cephalic)
  • Sometimes buttocks (podalic)
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8
Q

What is a babies position?

A

• Orientation of presenting part

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9
Q

What occurs in the first stage of labour? (2)

A

Creation of birth canal

Onset of labour -> Full cervical dilation

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10
Q

What are two main phases of the onset of labour?

A

Latent phase

Active phase

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11
Q

What occurs in the latent phase of the onset of labour?

A

Onset -> 4cm dilation

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12
Q

What occurs in the active phase of labour?

A

Faster rate of cervical change, 1-1.2 cm/hour

Regular uterine contractions

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13
Q

What is the main event of the second stage of labour?

A

Expulsion of foetus

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14
Q

What is the normal range of time for the second stage of labour?

A

Up to 1 hour

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15
Q

Outline what happens to the baby in the second stage of labour

A
  • Head flexes as it reaches pelvic floor (reduces presentation diameter)
  • Head rotates
  • Head sretches vagina and perineum
  • Head delivered
  • Shoulders rotate and deliver
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16
Q

What occurs in the third stage of delivery?`

A

Expulsion of placenta

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17
Q

How does the body facilitate the expulsion of the placenta?

A

Sheared off by strong contractionas of the uterues
Compresses blod vessels to reduce haemorrhgage
Lasts between five and fifteen minutes

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18
Q

What processes are necessary to create a birth canal?

A

Expansion of soft tissues

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19
Q

Give three tissues which are expanded in creation of a birth canal

A

Cervix
Vagina
Perineum

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20
Q

What does expansion of the cervix cause

A

Foetal membranes to rupture, releasing amniotic fluid

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21
Q

How big is the expansion of the cervix, and what facilitates it?

A

10 cm

Structural changes and a lot of force

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22
Q

What is the normal diameter of a baby’s head?

A

9.5cm

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23
Q

What is maximum size of birth canal?

A

Pelvic inlet typically 11cm

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24
Q

What is the structure and funciton of cervix during pregnancy?

A

Tough, thick collagen which is coiled to give it strength in order to retain the foetus

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25
What is the process of cervical softening called?
Cervical ripening
26
What three things does cervical ripening involve?
 Reduction in collagen production (Turnover altered)  Increase in glycosaminoglycans (Disrupts the matrix)  Reduces aggregation of collagen fibres (Uncoils)
27
What is cervical ripening triggered by?
Prostaglandins  PG E2 and F2x  Locally diffused from the uterus  Once released the cervix is ready to be stretched
28
What happens to myometrium during pregnancy?
Smooth muscles greatly increased in pregnancy
29
How is force generated by myometrium?
By rises in intracellular Ca2+, which increases due to action potentials. Triggered by spontaneous signals from pacemakers
30
What supresses uterine contractions during pregancy?
Progesterone
31
What maintains corpus luteum in pregancny?
HCG
32
Describe early uterine contractions
Low amplitude every 30 minutes, mother usually not aware
33
Describe late uterine contractions
Higher amplitude, less frequent | Braxton-Hicks contractions
34
What are the contractions of the uteryus made more forceful and frequent by? 2
Prostaglandins (as well as ripening the cervix). Causes increased Ca2+ per action potentional. Oxytocin More actionpotentials, threshold lowered
35
What are prostaglandins?
o Biologically active lipids o Local hormones o Produced mainly in the endometrium
36
What is production of prostaglandins controlled by?
Oestrogen: Progesterone ratio
37
What happens to prostglandin production when oestrogen > progesterone?
Increased prostaglandins
38
What happens to prostaglandins when oestrogen < progesterone
Low prostaglandins, feature throughout pregnancy
39
Where is oxytocin secreted?
Posterior pituitary
40
Outline the ferguson reflex
 Mechanical stimulation of the cervix due to prostaglandin contractions increases oxytocin secretions, strengthening contractions, stimulating the cervix more, releasing more oxytocin
41
When is oxytocin more effective?
Oestrogen > Progesterone | More smooth muscle receptors
42
What is brachstasis?
Uterine smooth muscle relaxes less than it contracts. o Unique feature of uterine smooth muscle o Fibres shorten in the body of the uterus o Drives the presenting part of the fetus to the cervix
43
Give the normal physiological processes which initiate labour? (8)
o ↑ Fetal Cortisol (?) o Oestrogen > Progesterone o ↑↑↑ Prostaglandins from Endometrium of Uterus o Increased force of uterine contractions o Cervix Stretched o Oxytocin released from Posterior Pituitary under the Control of Hypothalamus  Ferguson Reflex o Increased frequency of uterine contraction o Cervix stretched more
44
What causes neonate to take first breath?
Multiple stimuli, such a trauma from the birth and cold cause the neonate to take its first breath
45
What are the two main change causing features of first breath
Reduction in pulmonary vascular resistance | Increased arterial pO2
46
What are the three features of a reduction in pulmonary vascular resistance?
 Blood fills lungs, increased return to LA  Pressure in LA > RA  Foramen ovale closes
47
What does increased arterial pO2 cause?
 Ductus Arteriosus contracts
48
How is condition of a neonate scored?
Apgar score
49
What limits maternal blood loss after birth?
Contraction of the unterus, which shears off and expels the placenta (normally after 10 minutes)
50
Why can bleeding after birth be severe?
Blood flow through placenta is normally 500-800ml/minute (10-15% cardiac output).
51
How can post-partum bleeding be treated?
Oxytocic drug
52
What is the most common presenation of a baby?
Most commonly the baby lies longitudinally, in a cephalic presentation, well flexed so that the vertex presents to the pelvic inlet`
53
What are the three P's of labour, problems with which can cause a difficult birth?
Powers Passage Passenger
54
What are the powers of labour?
Delivery dependent on myometrium | Contraction and retraction of multidirectional smooth muscle fibres casues progressive shortening
55
In what three ways can uterine contractons be assesed?
Frequency, amplitude and duration
56
What is the passage made up of?
Pelvic inlet Pelvic cavity Pelvic outlet
57
What are the measurements of pelvic inlet?
 Shorter in the anterior-posterior plane |  10.5cm diameter
58
What are the measurements of pelvic cavity?
 Circular |  12cm diameter
59
What are the measurements of the plevic outlet?
o Pelvic Outlet  Shorter in the medio-lateral plane  11cm diameter
60
What is the passenger?
The size and presentation of the foetus
61
What are the main tree reasons labour is unable to progress?
``` o Inadequate Power  Insufficient uterine contraction o Inadequate Passage  Abnormal bony pelvis  Rigid perineum o Abnormalities of the Passenger  Fetus too big ```
62
How can labour be induced?
Labour can be induced by giving the mother Prostaglandins and Oxytocic drugs. These drugs will cause the cervix to begin to ripen and the uterus to begin its contractions.
63
How can the physiological state of the foetus be monitored?
During labour fetal heart rate can be assessed using a Fetal Scalp Electrode.
64
Describe a C-section
Subrapubic Incision o Linea alba and anterior layers of the rectus sheaths are transected and resected superiorly, o Rectus muscles are retracted laterall or divided through their tendinous parts allowing reattachment without muscle fibre injury
65
Give two methods of operative delivery?
Forceps | Vacuum extraction

Semester 4 - Reproductive System (30 decks)

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