2.5A Conduct of Labor and Delivery Flashcards
lecturer: Dr. Alicia Bautista
what is the most common EDC?
38-42 WEEKS
What is the intervals of a true labor
5-10 mins in durations
does interval shorten or lengthen in true labor?
shorten
where is the location of the discomfort during true labor
back and hypogastric area in abdomen, some may have no discomfort
what is the most important determinant of true labor
cervical dilation
how do you describe uterine contractions? (3)
frequency, duration, intensity
when should the FHR be taken?
end of contractions
can you hear the FHR during contractions
no
what is the normal FHR?
110-160
What are the things you check during vaginal exam? (ACPSP)
- Amniotic fluid
- cervix status
- presenting part
- station
- pelvic architecture
what is assessed during the speculum exam?
amniotic fluid
if the presenting part is not fixed in the pelvis, there is great possibility of _______ leading to fetal distress and death
umbilical cord prolapse and compression
what is the pH of amniotic fluid
7-7.5 (alkaline), check this if you are not sure if there is ruptured membrane
what is the color and purpose of nitrazine test
used to check pH to determine if its amniotic fluid or vaginal pH (amniotic fluid is 7, vaginal pH is acidic).
a positive nitrazine test is blue, or positive
what is the pattern of the amniotic fluid called
fern like pattern or arborization
what are 4 parameters assessed during cervical exam? (sdcc)
softness, degree of effacement, cervical dilation, cervical position
what are the 3 ways to describe softness of the cervix?
soft, firm, intermediate
this refers to the obliteration or the thinness of the cervix
degree of effacement
when the cervix is paper thin, it is said to be ___ effaced
100%
what is the normal length of the cervical canal?
2 cm
when the cervix is 25% effaced, you can insert _ fingers
2
effacement: 2 fingers is equal to 3.5 cm or __ effaced
50%
estimates the ave. diameter of the original opening
cervical dilation
dilation occurs simultaneously with
effacement
what is the diameter of a fully dilated cervical opening
10cm
used to predict labor induction outcome
bishop’s score
the duration of the labor is ___ correlated to the bishops score
inverse
a Bishop score of 8 is
likely to achieve a successful vaginal birth
a Bishop score of _ requires cervical ripening
6
what are the 5 components of the bishop score
dilation, effacement, consistency, position, fetal station
this is an imp. indicator of the 1st stage of labor progression
cervical dilation
the cervical position becomes ________ (closer to vagina) as labor comes close
more anterior
describes the fetal head in relation to the ischial spines
fetal station
if the fetal station is negative , the head is
further inside than the ischial spines
presenting part may be described as either (2)
breech or cephalic
lowermost portion of the presenting part AT THE LEVEL of the ischial spines is said to be at
station 0
what is the goal of the EINC protocol by 2015?
decrease maternal mortality
the first stage of labor is from ____ to ____
regular uterine contractions to full cervical dilation (10cm)
nulliparous mothers often take ___ hrs during the 1st stage of labor
7 hours
3 signals of the first stage of labor
water breaking, bloody show, contraction
check the fht every _ mins if no prob during the first stage
30
check the fht every _ mins if no prob during the 2nd stage
15
process to minimize fecal contamination
enema
is enema and perineal shaving indicated
no
do you encourage the parturient to move if she has no complications
yes, let her be comfy
vaccine given within 24 hours
Hepa B
Used to augment labor when there is immediate access to caesarian section
Oxytocin
when should u give IM Oxytocin
after birth, to stop bleeding, titrated
said to shorten 2nd labor stage in primis
amniotomy (open the bag)
maternal vitals should be checked every
4 hours, if normal
if membrane is ruptured early, check the temp,
every hour.
periodic vaginal exam should be
2-3 hours
should food be withheld
yes, to prevent aspiration, exception is ice chips.
period of 2nd stage is from ____ to ____
full dilation to delivery
duration of 2nd stage is ___ for nullipara
50 mins
duration of 2nd stage is ___ for multipara
20 mins
delivery: patient is in ___ Position
lithotomy
do not spread legs to wide to avoid
4th degree episiotomy
encirclement of the largest head diameter by the vulvar ring
crowning
when is episiotomy performed
head circumference is visible during a contraction with a diameter of 3 to 4cm
disadv. of a mediolateral episiotomy
rectal orifice can be cut
only advantage of a mediolateral episiotomy
extension thru the anal sphincter and rectum
allows controlled delivery of the head when vaginal introitus is less than 5 cm
ritgens maneuver
anterior shoulder should be pushed ____, then the posterior shoulder pushed ____
pushed down, pushed up
non separation of mom and baby should be strictly
90 mins
3 steps of EINC
Thorough and immediate drying, early ssc, mom and baby rooming in
immediate and thorough drying is time bound by
30 seconds
early ssc should be done
after 30 seconds
properly timed cord clamping time bound
1-3 minutes
position of clamps
2 cm, 5 cm, cut in between
when do you cut the cord
when the pulsations stop/1-2 minutes
what do u add to the umbilical stump
nothing
duration of the 3rd stage of labor
delivery of baby to the delivery of the placenta
2 types of management for the 3rd stage of labor
expectant physiological management, active management
pulling on the placenta can cause
placental inversion
signs of placental separation
gushing of blood, globular and firmer fundus (calkins sign), umbilical cord lengthening
what is the calkin’s sign
globular and firmer fundus
during AMTSL, how much oxytocin is givem
10 mg IM
2 mechanisms of placental separation
duncan’s and schultze
maternal side and cotyledons appear first in this mechanism of placental separation
duncan (dugo, dirty)
fetal side is first delivered during placental separation, termed as
Schultze (shiny)
AMTSL is time bound by _
90 minutes
manuever for placental delivery by applying pressure to the suprapubic area
Brandt Andrews
4th stage of labor is
an hour after placental delivery
during the 4th stage of labor: check for
uterine atony, lacerations, abnormal bleeding
maternal heart rate is highest during
postpartum (walang pupuntahan yung blood)
fourchette - vaginal mucosa is lacerated, but not including the fascia and the muscle. including the periurethral area
1st degree
2nd degree of laceration includes
up to the fascia and muscle of the perineal body
3rd degree of laceration …
up to the anal sphincter
risk of 3rd degree of laceration
fecal incontinence
4th degree
up to rectal MUCOSA
Risk of 4th degree
fistula
episiorrhapy: suture ___ above the laceration point`
1cm
in 4th degree: suture should
go through the rectum
