30 - 27 yo F labor and delivery Flashcards
active labor is associated with strong regular contractions every ____ minutes and a cervical dilation more than ____ cm in the setting of contractions
- 3-5 minutes
- 6 cm
does fetal heart tracing impact the diagnosis of active labor?
no
what are the two absolute contraindications to digital cervical exam?
- vaginal bleeding with an undocumented placental location (or known previa)
- leaking fluid with prematurity
what are the stages of labor?
- first stage:
latent - regular contractions, cervix under 6cm
active - begins when 6cm dilated - second stage: begins at full dilation, ends with delivery
- third stage: begins with birth of baby, ends with delivery of placenta
what are the criteria for preeclampsia with SEVERE features?
requires any one of:
- severe HTN of at least 160 systolic or 110 diastolic
- RUQ pain or doubling of transaminases
- platelet count under 100
- pulmonary edema
what are the criteria for REGULAR preeclampsia?
- BP over 140 systolic or 90 diastolic on at least two readings greater than 6 hrs apart OVER 20 WEEKS GESTATION
AND
- proteinuria: at least 300 mg on a 24 hr urine collection or at least 1+ or 30 mg/dL on dipstick
what are late decelerations? what do they indicate?
- decelerations in fetal heart rate that begin after a contraction begins, with nadir after peak of contraction
- indicate utero-placental insufficiency (baby may not be getting enough oxygen - hypoxemia)
what is the average speed of dilation for multiparous women? nulliparous women? how does that relate to labor duration?
- 2 cm/hr (2.4 hr labor)
- 1 cm/hr (4.6 hr labor)
when does failure to progress get diagnosed?
if there is no cervical dilation for 2 hours in the active phase
what is a Friedman curve used for?
plot labor progression in terms of cervical dilation, effacement, and fetal descent in order to help diagnose labor dystocia
what two methods can be used to augment labor in the event of active phase arrest?
- IV oxytocin
- artificial ROM
what are the cardinal movements of labor?
- engagement: presenting part has entered pelvic inlet
- descent: fetus at 0 station when widest part of presenting part is between ischial spines
- flexion
- internal rotation
- extension
- external rotation
- expulsion
in nulliparous women what is the order of effacement vs dilation? multiparous women?
- nulliparous: efface then dilate
- multiparous: dilate and then efface
a normal fetal HR has a baseline between ____ and ____ beats per minute
110 and 160
what is a ‘reactive’ fetal HR strip?
two HR accelerations of at least 15 bpm over at least 15 seconds in a 20 minute period
