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OBSTETRICS > 1M - Normal Labor and Delivery > Flashcards

1M - Normal Labor and Delivery Flashcards

1
Q

What is the greatest impediment when on understanding labor?

A

recognizing when labor starts

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2
Q

This is defined as the presence of regular contractions accompanied by progressive changes in in cervical dilatation and effacement?

A

Labor

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3
Q

On PE, what findings are positively associated with labor?

A

Effacement of >50% and cervical dilatation of >2cm

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4
Q

According to William’s, what is the duration of contractions during the active phase of labor?

A

duration of 30 to 90 seconds

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5
Q

According to the CPG, what is the duration and interval of contractions in labor?

A

at least 1 in every 10 minutes or 4 in 20 minutes, either by manual exam of CTG

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6
Q

What is the relationship of the fetus long axis in relation to the mother?

A

Fetal Lie

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7
Q

A singleton in transverse lie will always be delivered how?

A

CS

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8
Q

This refers to the part of the fetus closest to the exit?

A

Fetal presentation

cephalic or breech

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9
Q

This refers to the habitus of the fetus? Either flexed or extended

A

Fetal attitude

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10
Q

What is the fetal attitude when the occipital fontanel is the presenting part?

A

Vertex

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11
Q

When the neck is only partly flexed, what is anterior fontanel is the presenting part, what is the fetal attitude?

A

Sinciput

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12
Q

When the fetal neck is partially extended, what is the fetal attitude?

A

Brow presentation

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13
Q

What is the fetal attitude, if the neck is full extended?

A

Face presentation

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14
Q

This refers to the occiput of the fetal head to the maternal side either the symphysis pubis if anterior or posterior if it is facing scaral?

A

Fetal Position

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15
Q

What position of the occiput can make delivery difficult?

A

Occiput posterior

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16
Q

What is the CS incision made for those presenting in dorsoanterior and dorsoinferior position?

A

Classical CS

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17
Q

What is the grip used in Leopold’s Maneuver 1?

A

Fundal Grip

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18
Q

What grip is used in Leopold Maneuver 2

A

Umbilical Grip

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19
Q

Where is the fetal heart tone best heard?

A

Fetal back

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20
Q

What is the feeling of the fetal back?

A

Hard, resistant or convex structure

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21
Q

What leopold maneuver confirms the fetal presentation and whether the fetus is engaged or not

A

Leopold 3

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22
Q

What is the only leopold maneuver that requires the physician to face the patient’s feet?

A

Leopold 3

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23
Q

What suture can guide you in determining in locating the fontanel?

A

Sagittal suture

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24
Q

Where is the sagittal suture located?

A

Between the 2 parietal bones

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25
Q

What is the shape of the anterior fonatanel?

A

Diamond

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26
Q

What is the shape of the posterior fontanel?

A

triangular

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27
Q

If the fetus has a well flexed head, what is probably the fetal position?

A

Occiput anterior

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28
Q

What is the biggest diameter of the fetal head?

A

Biparietal diameter

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29
Q

What is the most common position for the fetal head when entering the pelvis?

A

Transverse position (left occiput transverse - 40%)

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30
Q

What station will it be if the biparietal diameter has entered and passed through the pelvic inlet?

A

Station 0 (at the level of the ischial spine)

31
Q

What factors affect descent?

A

Uterine contractions, abdominal pressure, bearing down of the mother and amniotic fluid

32
Q

What change in fetal presentation happens during flexion?

A

Change from occipitoanterior to suboccipitobregmatic

33
Q

What change in position happens during internal rotation?

A

occipito transverse to occipitoanterior

34
Q

This is said to occur when the widest diameter of the fetal head successfully negotiates with the narrowest part of the maternal bony plevis?

A

Crowning

35
Q

This cardinal movement causes stretching of the perineum?

A

Extension

36
Q

What change in shoulder position happens during external rotation?

A

transverse position to and anterior posterior position of the shoulder

37
Q

How is the traction applied during delivery of the baby?

A

Downward upward traction

38
Q

A shallow sacral promontory is a sign of?

A

contracted pelvic diameter

39
Q

What is the shape formed if the cervical dilatation is plotted?

A

Sigmoid curve

40
Q

What is the shape formed if the descent of fetal head is plotted?

A

hyperbolic curve

41
Q

When does the latent phase of cervical dilatation end?

A

Nulliparous women - 3-4cm

Multiparous women - 4-5 cm

42
Q

How long does the latent phase of labor last?

A

Nulliparous women - averages 8 1/2 hrs; to 20 hrs

Multiparous women - averages 5 hours; to 14 hrs

43
Q

What is prolonged latent phase?

A

Nulliparous women - >20 hrs

Multiparous women - >14 hrs

44
Q

This phase of labor is marked by increased rapidity of cervical dilatation to 10 cm?

A

Active phase

also the period where the presenting part descends well into the pelvis

45
Q

How long does the active phase last?

A

Nulliparous - 5-7 hrs with dilatation at 1.2 cm/hr

Multiparous - 2-4 hrs with dilatation at 1.5 cm/hr

46
Q

What phase from the active phase is can predict the timing of delivery of a particular labor?

A

Acceleration phase

47
Q

The phase of maximum slope usually happens at what measurement of cervical dialtation?

A

6-8cm

48
Q

What measurement of cervical dilatation does the deceleration phase start?

A

9 cm

49
Q

What phase of active phase of labor can failure of descent happen?

A

deceleration phase

50
Q

This phase of the active phase is more reflective of the fetopelvic relationship?

A

deceleration phase

51
Q

What measurement of cervical dilatation is now heralded as the start of active labor according to Zhang et al?

A

6 cm

52
Q

According to Zhang, how long does the second stage of labor last with and without an epidural for nulliparas?

A

With epidural - 3.6 hrs

Without epidural - 2.8 hours

53
Q

In general, how long does the second stage of labor last for both nullipara and multipara?

A

Nullipara - 2 hours; 3 hours with epidural

Multiparas - 1 hour; 2 hours with epidural

54
Q

What exam is used to check for rupture of membranes?

A

Speculum examination

55
Q

If there is already rupture of membranes, what will be the color of the lithmus paper?

A

Blue because amniotic fluid is alkalotic

56
Q

What shape will you see under the microscope upon viewing the vaginal discharge if amniotic fluid is present?

A

Ferning pattern

57
Q

Palpation of the ischial spine or prominence suggests what condition?

A

Contracted mid plane

58
Q

What findings suggests mid pelvic contraction?

A

Prominence of the ischial spine, pelvic sidewall are convergent, concavity of the sacrum is shallow, bi-ischial diameter is less than 8cm

59
Q

Adequacy of the pelvis is done to multigravid? T or F?

A

False

If there is prolonged labor in multigravid, assess the passenger (fetus)

60
Q

What position may increase progression and comfort during labor?>

A

Upright position

61
Q

What Bishop Score suggests unfavorable cervix?

A

< 4

62
Q

Food can be given during labor? T or F?

A

False

Food is withheld during labor and only clear fluids are given

63
Q

This is the aspiration of stomach contents into the lungs during obstetric anesthesia secondary to delayed gastric emptying time in labor?

A

Mendelson’s Syndrome

64
Q

When there is lag in cervical dilatation, what active managements can be given?

A

amniotomy and oxytocin

65
Q

Oxytocin comes from what part of the hypothalamus? Anterior or Posterior?

A

Posterior

66
Q

What is the half life of oxytocin?

A

5-12 minutes

67
Q

What is the physiologic dose of oxytocin to produce uterine contractions?

A

8-12 mU/min

68
Q

How is low dose oxytocin given?

A

1-2 Mu/min increased incrementally at 30 minute intervals

69
Q

How is high dose oxytocin given?

A

4-6 mU/min every 15-30 minutes

70
Q

How is 1 mU achieved in oxytocin preparation of 10 U per 500 mL?

A

1 mU = 1 drop/min

71
Q

How is 1 mU achieved in oxytocin preparation of 10 U per 1L?

A

1 mU = 2 drops/min

72
Q

How is 1 mU achieved in oxytocin preparation of 5 U per 1L?

A

1 mU = 4 drops/min

73
Q

What should have been done to women at 6cm cervical dilatation with ruptured membranes with 4 hours of adequate contractions before going into cesarean delivery?

A

at least 6 hours of oxytocin with no cervical change and inadequate contractions

OBSTETRICS (36 decks)

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