Labor and Hormonal Changes Quiz

Labour Process

• Labour is the process where the fetus, placenta, and membranes are expelled through the birth canal after 24 weeks of pregnancy, facilitated by regular uterine contractions.
• This process leads to progressive effacement and dilation of the cervix.

Cervical Dilation

• Cervical dilation is the widening and stretching of the cervix beyond its normal dimensions.
• Measured in centimeters (0-10cm).

Cervical Effacement

• Cervical effacement involves softening, thinning, and shortening of the cervix.
• Expressed as a percentage (0-100%).

Stages of Labour

• There are four stages of labor.

First Stage

• Begins with the onset of true labor and continues until complete cervical dilation (from 0cm to 10cm).
• Latent Phase: Dilation from 0-3 cm. Mild, regular contractions.
• Active Phase: Dilation from 4-7 cm. 5-8 minutes apart, Moderate-Strong contractions lasting 45-60 seconds.
• Transitional Phase: Dilation from 8-10 cm. Strong contractions, 1-2 minutes apart, lasting 60-90 seconds.

Second Stage

• Begins when the cervix is fully dilated and ends with the birth of the baby.
• Signs include an urge to push, bulging of the perineum, possibly expulsion of stool, and an open vaginal introitus.
• Crowning occurs when the infant's head is visible at the vaginal opening.
• Duration varies, potentially 1-3 hours.

Third Stage

• Begins after the birth of the baby and ends with the delivery of the placenta and membranes.
• Usually takes 5-30 minutes.
• Signs of placental separation include lengthening of the umbilical cord, a sudden gush of blood, and a change in the uterus shape to a hard, globular form at the umbilicus.

Fourth Stage

• Post-delivery, lasts approximately 1 hour, focusing on monitoring the mother and baby for any complications. The mother is moved to the post-partum unit.

Factors Affecting Labor Length

• Parity (number of previous pregnancies)
• Birth interval (time between births)
• Psychological status
• Maternal pelvic shape
• Presentation (position of the fetus)
• Contractions
• Fetus position

The Passenger

• Fetus, umbilical cord, and the placenta.
• The fetal head is the widest diameter and crucial for delivery.
• The fetal skull is comprised of 8 bones connected by suture lines allowing for molding during birth.
• Fontanels, soft spots on the skull, help determine the position of the fetus during labor.

The Power

• The power refers to the strength and effectiveness of uterine contractions.
• Contractions must be adequate to initiate and continue labor

The Passage

• The female pelvis.
• Adequate size and shape of the pelvis are essential.
• Shape varies (e.g., gynecoid, android, anthropoid).
• Specific diameters (e.g., antero-posterior, transverse) are important in the birthing process.

Measurement of Labour

• Cervical dilation: measured in centimeters.
• Cervical effacement: measured as a percentage.
• Duration of labour stages: varies based on parity (first-time pregnancy or subsequent)

Signs of True Labor

• Regular, painful uterine contractions
• Show (blood-stained mucus discharge)
• Rupture of membranes (water breaking)

Signs of False Labor

• Irregular uterine contractions
• No cervical change (dilation or effacement)
• No rupture of membranes

Monitoring for Fetal Well-being

• Fetal heart rate (FHR) monitoring is essential.
• Apgar scores are evaluated to assess fetal health at one and five minutes after birth.
• Interventions, such as blood sampling, may be necessary if fetal distress is suspected.

Care in stages of labour

• Emotional support provided to help mother through various stages of labour
• Details of maternal history and appropriate birth plan should be collected.
• Complete physical examination
• Routine observations such as blood pressure, pulse, temperature, and fetal heart rate monitoring are performed.
• Attention to hydration, diet, comfort measures

Leopold's Maneuvers

• Used to determine fetal position and location within the maternal pelvis.

Partograph

• Tool to monitor maternal and fetal wellbeing during the active phase of labor.
• Helps in decision-making if complications arise.

Contractions

• The frequency, duration and strength of uterine contractions.

CTG trace

• A graph showing patterns of FHR and uterine contractions for evaluation.

Interpretation of CTG

• Analyzing FHR patterns (early, late, variable decelerations, accelerations, baseline rate)
• Detects and diagnoses fetal distress
• Determines needed interventions

Care during the Third and Fourth Stages

• Active management of the third stage of labour.
• Delivery of the placenta using controlled techniques (e.g., oxytocin).
• Care of the mother (e.g., uterine massage), monitoring of bleeding
• Postpartum care: monitoring for complications, interventions, and discharge protocol

Care of the newborn

• Clearance of mouth and nose.
• Apgar scoring at 1 and 5 minutes.
• Assessment of heart rate, respiratory rate, muscle tone, color, and reflex irritability.
• Umbilical cord care.
• Assessment of any congenital anomalies, including weight and gestational age determination.

Test your knowledge on the hormonal changes and physiological processes that lead to labor. This quiz covers key hormones like oxytocin and progesterone, their roles, and factors affecting the labor stages. Challenge yourself with questions about the mechanisms and duration of labor.