1F - Vaginal Delivery Flashcards
What is early active phase of cervical dilatation?
4-5 cm
This division of labor covers the deceleration phase up to the second stage of labor
Pelvic Division
Covers the cardinal movements of labor.
What dilatation is the phase of maximum slope?
6 - 8 cm
Friedmans’s curve shows what shape?
Sigmoid - this is used
Zhang - exponential staircase
WHO - diagonal straight
According to friedman, after reaching 4 cm, the acceleration of dilatation is at a rate of?
1.2 cm/hr for nullipara and 1.5cm/hr for multipara
What is the purpose of Zhang and Friedmans curve?
Friedman - to define normal progress
Zhang - to prevent CS
Women are in prolonged active phase of labor when they exceed how many hours?
12 hours for nullipara and 10 hours for multipara
Labour guide vs WHO modified partograph active phase?
Labour guide - 5-10 cm
WHO - 4-10
What facilitates the implementation of the WHO intrapartum care recommnedation and model of care?
WHO labor guide
When are fetal heart tone best heard?
After contractions or 1-2 mins before peak of contractions
Frequency of monitoring for low risk patients?
Every 30 for first stage of labor and every 15 for 2nd stage of labor
Frequency of monitoring for high risk patients?
Every 15 for 1st stage of labor and every 5 mins for 2nd stage of labor
What happens in lithotomy position anatomically?
Gliding of sacroililac joints causing widening of pelvic outlet
*Gaskin Maneuver - Racing position while lying down
How much of an increase does lithotomy position have?
1.5 - 2cm
What is the hyperflexion of the thigh to widen functional capacity of the pelvis?
McRoberts Maneuver
What is the shortest diameter of the fetal head?
Subocciitobregmatic - 9.5cm
From within outward what are the tissues of the pelvic floor?
peritoneum - subperiotneal connective tissue - internal pelvic fascia - levator ani and coccygeus muscles - external pelvic fascia - superficial muscles and fascia - subcutaneous tissue - skin
PSILESSS
When do we do episiotomy?
After seeing internal rotation - crowning
This is a surgical incision on the mother’s perineum performed as the baby’s head emerges from the vaginal canal during birth intended to prevent perineal tears of the perineal muscles.
Episiotomy
What is the most important maneuver done during crowning which requires putting pressure at the perineum and supporting the fetal head?
Ritgen’s Maneuver
What is the indicated episiotomy for short prerineum?
Mediolateral episiotomy
What are the disadvantages of median episiotomy?
Prone to 3rd and 4th degree lacerations and higher rates of anal sphincter and rectal injury
Which heals better, is easier to repair and has les blood loss? Medial or mediolateral episiotomy?
Medial episiotomy
Medial episiotomy is good for patients with wide peritoneum but is bad for what condition of the baby?
Macrosomia or large sized baby
What traction is applied on the delivery of the shoulders?
Downward upward traction
Down for anterior shoulder
Up for posterior shoulder
Timing of cord clamping and reason?
Delayed for 3 minutes; for transfer of blood (30cc) and iron (50mg)
How many cm from the baby’s abdomen will the clamp be placed?
1st clamp - 2 cm
2nd clamp - 3 cm from first clamp
What it the third stage of labor?
From the delivery of the fetus to the delivery of the placenta
This is the first sign of placental separation?
change from discoid to globular shaped uterus
What type of placental separation is dirty and bloody separation?
Duncan
If placental separation is at the periphery, what type of separation is this?
Duncan
If the separation is clean and shiny without a sudden gush of blood?
Schultze
If the placental separation is central, what is the type?
Schultze
If there is no contraction after delivery of the fetus, what non pharmacological management can be safely done first?
Fundal massage
What is the most important part of the active management of third stage of labor?
Uterotonics (Oxytocin)
What management in the 3rd stage of labor prevents uterine inversion?
Controlled cord traction
What is the synthetic long acting oxytocin like drug?
Carbetocin
What is the synthetic PGE1 analog?
Misoprostol
Inhibits gastric acid and pepsin secretion and enhances mucosal resistance to injury
What is the available synthetic PGF2 alpha agonist?
Carboprost
What is the ergot alkaloid that increases uterine muscle tone by causing sustained uterine contractions
Ergometrine
What is the most crucial time in the 4th stage of labor?
1-4 hours post placental delivery
At the 4th stage of labor, vital signs are checked every?
15 mins for 1 hours
The shiny side of the placenta is the maternal or fetal side?
Fetal
What are always checked upon delivery of the placenta?
Cotyledons, vein and arteries and
