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Labour

Labour. Vivian Phan. 3 stages of labour. 1. Creation of birth canal Start: sudden increase in frequency & force of contractions (hormones?) Finish: cervix is 10cm dilated 2. Delivery of fetus Finish: baby’s out! 3. Delivery of placenta & management of blood loss. Hormones.

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Labour

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  1. Labour Vivian Phan

  2. 3 stages of labour 1. Creation of birth canal • Start: sudden increase in frequency & force of contractions (hormones?) • Finish: cervix is 10cm dilated 2. Delivery of fetus • Finish: baby’s out! 3. Delivery of placenta & management of blood loss

  3. Hormones PROSTAGLANDINS (E2, F2x) • Induce labour • Increase release of intracellular Ca -> contractions • Lipids, produced mostly by endometrium • Triggered by Progesterone: Oestrogen OXYTOCIN • Produced in posterior pituitary gland (HPO axis) • Receptors on uterine smooth muscle cells • Progesterone: Oestrogen increase receptor numbers -> more sensitive to Oxytocin • Lower threshold for action potentials -> contractions

  4. 1st Stage • Cervical ripening/ softening: triggered by PGD • collagen; GAGs -> “loosen” collagen bundles • Inflammatory cells -> Nitric oxide • Ferguson reflex: +ve feedback loop Contractions -> sensory receptors in cervix & vagina -> hypothalamus -> Oxytocin release ->  force & freq of contractions • Brachystasis Uterine smooth muscle fibres shorten with each contraction -> uterus progressively shortens -> push presenting part of fetus out & dilate cervix over it

  5. 2nd Stage • 10cm dilation -> delivered fetus • Episiotomy 3rd Stage • Powerful contractions -> shearing of placenta, compress blood vessels, reduce bleeding • 10-20mins after baby’s out • Oxytocin drug

  6. Problems • POWERS: uterine contractions • PASSAGE: bony pelvis + soft tissue • PASSENGER: size + presentation of fetus

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