3 - normal labour

Question 1

what is ferguson’s reflux?

Answer 1

when fetal pressure causes stretch which sends reflux to brain that releases oxytocin causing contractions

Question 2

where is pulmonary surfactant released & how can check levels?

Answer 2

• pulmonary surfactant released by type 2 alveoli cells
• can measure levels to check fetal lung maturity in amniotic fluid in labour (since some leaks into amniotic fluid)

Question 3

how does rupture of membranes cause labour?

Answer 3

once ruptured membranes - babies head goes down (since heavy & not being floated up by liquid)

Question 4

what is bishops score? what are the 5 parts?

Answer 4

0-13 scoring system made from vaginal examination to assess cervical readiness for labour

• position of cervix (want it to be anterior)
• consistency of cervix (soft)
• effacement (thinning & shortening of cervix)
• dilation (how wide cervix is)
• station in pelvis (how far up baby is)

Question 5

what is the 1st stage of labour?

Answer 5

it’s split into:

1. latent phase = mild irregular contractions, from 0 - 3/4 cm dilated
2. active phase = more regular contractions that get shorter, every 10/15 mins then every 5 mins etgc

*this stage can last 8-10hrs or more

Question 6

why does standing up & walking about help in labour?

Answer 6

does help to stand up & walk about - any activity helps oxytocin release - also think pressure of baby releases more oxytocin

Question 7

why is stress bad for labour?

Answer 7

stress can react against oxytocin so slows/reduces contractions

Question 8

what are braxton hicks contractions?

Answer 8

practice contractions/false labour

• can get from 4/5 months, usually resolved by sitting down & rest (often triggered by activity)

Question 9

where do true contractions start?

Answer 9

start in fundus (top of uterus) and stretch down both sides, lasting from 10-45 seconds (when closer to delivery)

Question 10

what is 2nd stage of labour?

Answer 10

from complete dilation (10cm) to delivery of baby

• usually about 2 hrs ish

Question 11

what is 3rd stage of labour?

Answer 11

after delivery of baby to expulsion of placenta & membranes

*usually about 10 mins can be 3-30 mins

*give oxytocin jag if >1hr after delivery of baby

Question 12

what are some signs in 3rd stage that placenta about to be released?

Answer 12

• uterus contracts, hardens & rises
• umbilical cord lengthens permanently
• frequently a gush of blood just before placenta
• placenta & membranes appear at introitus

Question 13

what are the 3 types of pelvis? one most common for caucasian, one for asia & one for african-carribean?

Answer 13

• most caucasian women have gynaecoid pelvis (round/wide structure)
• asian women have anthropoid pelvis
• african-caribbean women & tall women = android pelvis

Question 14

what are the 2 abnormal baby positions becoming more common?

Answer 14

ROP & LOP

Question 15

what are analgesia options for labour? (loads, just get sense of different options available)

Answer 15

• paracetamol/co-codamol
• TENS machine (device where put pads on back making tingling sensation boosting endorphins)
• entonox = self administered inhaled analgesia
• diamorphine = slows labour so not give too soon
• epidural = very common now, very effective & useful, more likely to have longer labout
• remifentanyl = IV epidural, not used now really
• spinal = used for operations

Question 16

what are the 7 cardinal movements/mechanisms of labour?

Answer 16

1. engagement = widest part of babies head moves for widest part of pelvis
2. descent of head = assumes occipito-transverse position
3. flexion = baby tucks chin towards chest
4. internal rotation = baby’s head rotates (usually from sideways to face mums back)
5. extension (crowning) = when see head appear at vulva & head extends back
6. external rotation (restitution) = rotates to realign shoulders
7. expulsion (anterior shoulder first)

*Every Darn Fool In Egypt eats Raw Eggs

Question 17

what is normal blood loss in labour?

Answer 17

500 mls normal, significant if up to1000mls and if >1000ml then tranexamic acid

Question 18

what is puerperium?

Answer 18

the 6wks after birth

• usually get bleeding & discharge for 2 weeks
• by 6wks everything should be back to normal size, uterus back to 50g (breastfeeding helps these processes)
• also normal to get physiological diuresis for 2-3 days post natally