Blue Prints 4: Normal Labor And Delivery Flashcards
In what percentage of pregnancies, do the membranes rupture prior to labor? What do we call this?
When PROM occurs more than 18 hours before labor, what do we call it?
How do we define PPROM?
10%, premature rupture of membranes
Prolonged premature rupture of membranes
Preterm premature rupture of membranes, meaning the rupture is happening prior to 37 weeks
How can we confirm diagnosis of ROM?
Pool, nitrazine and fern tests.
Pool of fluid, nitrazine turns blue because of the alkaline amniotic fluid, and the estrogens in the fluid crystallize like a fern blade
What will US show for ROM?
Oligohydramnios
What are the 5 components of the cervical exam that make up the bishops score?
Dilation, effacement, fetal station, cervical position, and cervical consistency
What is a score that is indicative of a cervix favorable of labor?
Greater than 8
What is cervical dilation for a score of 0,1,2,3? What is effacement for score of 0,1,2,3? 0,1,2,3 score for station? 0,1,2 score for consistency? 0,1,2 score for position?
Closed, 1-2, 3-4, greater than 5 0-30, 40-50, 60-70, greater than 80 -3, -2, -1,0, 1 Firm, medium, soft Posterior, mid, and anterior
When you check the cervix, what level are you at?
The typical cervix is how long?
Internal os
3-5 cm
Describe the anterior fontanelle?
Describe the posterior fontanelle?
Between 2 frontal bones and 2 parietal bones, diamond shaped and larger, closes 1-2 years
Between 2 parietal Bones and occipital bone, triangle shaped and smaller, closes in a couple months
Normal position and presentation for baby before delivery?
Right or left occiput anterior
Baby head down, looking at moms back, neck flexed
4 ways we can induce labor?
Prostaglandins, oxytocin, mechanical dilators, and rupture membranes
5 common dictations for induction of labor?
Postterm baby, diabetes, preeclampsia, non reassuring fetal testing, IGR
What are 2 maternal contraindications to prostaglandins?
What are 2 obstetric reasons?
Asthma and glaucoma
Prior c section and non reassuring fetal test
What bishop score leads to half failure rate with induction?
Less than 5
Besides oxytocin, what is another way to induce labor?
Amniotomy
2 ways we sort of measure strength of contractions?
Cervical change and intrauterine pressure catheter
Normal baby HR?
High HR we are thinking 3 things?
What is a low HR we are worried about?
110-160
Infection, hypoxia or anemia
Less than 90 for over 2 minutes
What is considered absent, minimum, moderate, and marked fetal heart variability?
Less than 3 beats per minute of variation
3-5
5-25
More than 25
A tracing can be identified as reactive if what criteria has been met?
2 acceleration of at least 15 BPM over baseline for at least 15 seconds per 20 minutes
Explain when and why each happens for each fetal deceleration?
Early, variable and late.
Early: increased vagal tone because of compression of baby head. Begin and end with contraction
Variable: anytime, umbilical cord compression. Drop steeper.
Late: uteroplacental insufficiency, start at peak of contraction and slowly return to baseline after contraction.
What can we do to monitor better if there are several decelerations?
Fetal scalp electrode
What is normal intrauterine pressure? During early labor and later labor?
What is the Montevideo unit?
10-15
20-30
40-60
Average variation of pressure from baseline times number of contractions in ten minutes
What fetal scalp pH is good?
Over 7.25
What are the 6 cardinal movements of labor?
What does correct IR do?
What does extend lead to?
What does ER do?
Engages, descends, flexes, IR, extend, and ER.
Allows baby to go OA
Head delivers
Shoulders deliver
What is the normal dilation change in nulli and multi?
1cm and 1.2cm
What Montevideo unit is sufficient contraction strength?
Over 200
What is considered active phase arrest?
No change in cervical dilation or station or 2 hours (some wait 4) and this is a common indication for c section
How much longer is stage 2 of labor if mom has epidural?
1 hour
What can we do with mom if we are seeing lots of late decelerations?
Give her o2, turn her on left side to decreased IVS compression and increase intrauterine perfusion. Stop oxytocin
What can we give to relax the uterus?
Terbutaline
What do we do when the head is delivered?
What are the two options if a nuchal cord exists and is too tight to get off?
Bulb suction airway/mouth
If you know it will be a short delivery, then clamp and cut it right there. If you don’t know that, like shoulder dystocia, then deliver and cut it after.
Explain how to deliver the rest of the baby once head and neck are out?
Deliver anterior shoulder by pushing down on head and then once you can see the anterior shoulder, pull up to get posterior shoulder out. Then just continue gentle traction for the rest.
What are two indications for episiotomy?
Bad deal with these?
Need to quicken delivery or shoulder dystocia
3rd or 4th degree tears
What is required to use forceps? 6 things?
Full cervical dilation, ruptured membranes, +2 station, knowledge of fetal position, empty bladder, experienced operator
What are two common complications of vacuum and 1 rare but emergency?
Laceration and cephalohematoma
Subgaleal hemorrhage
Vacuum has higher rates of what two things?
Forceps has higher rates of what 2 things?
Cephalohematoma and shoulder dystocia
3rd and 4th degree tears and facial nerve palsies
What are the three signs of placental separation?
Cord lengthening, gush of blood, uterine fundal rebound
What is placenta accreta?
Placenta has grown deep into the uterine wall, beyond stroma
What is torn in 1,2,3,4 degree perineal lacerations?
Skin or mucosa
Perineal body
Anal sphincter
Anal mucosa, rectum
What is the most common indication for primary c section?
What is the most common cause for c section overall?
Failure to progress in labor
Previous c section
Requirements if you want to do vaginal delivery after c section?
Low scar and team ready for c section
What is the relationship of the pudendal nerve we need to know for the purposes of pudendal block?
Behind ischial spine and sacrospinous ligament
What anesthesia is commonly used for C sections?
What is a common complication for both spinals and epidurals?
Spinal
Mom hypotension secondary to decreased SVR which lowers uterine perfusion and baby’s HR.
