BP Chapter 4

Question 1

What is the Bishop Score?

Answer 1

cervical readiness - 8 points

cervical effacement, consistency, dilation, position, and fetal station

Question 2

How can you determine if PROM has occurred?

Answer 2

Speculum exam, nitrazine (amniotic fluid is alkaline, turns paper blue), and fern (estrogen causes crystallization)

amniocentesis to inject dye and look for leakage

Amnisure looks for placental alpha micro globulin 1 via immunoassay

Question 3

100% effacement means

Answer 3

cervix is as thing as adjoining uterus

Question 4

When should cephalic be used to describe presentation?

Answer 4

head first

vertex when head is flexed

Question 5

Induction vs augmentation of labor

Answer 5

I - attempt to begin labor in a non laboring patient; prostaglandins, oxytocin agents, mechanical dilation of the cervix, artificial ROM
A - intervening to increase the already present contractions; same indications as I, but also inadequate contractions or a prolonged phase of labor

Question 6

CIs to prostaglandin use

Answer 6

asthma, glaucoma; prior c/s, nonreassuring fetal testing

Question 7

Cause of early, late, and variable decels:

Answer 7

early - head compression
late - utter-placental insufficiency
variable - umbilical cord compression

Question 8

What are the CIs to fetal scalp electrode?

Answer 8

hx of maternal hepatitis or HIV or fetal thrombocytopenia

Question 9

sinusoidal fetal heart tracing

Answer 9

anemia

Question 10

how much intrauterine pressure is normal? with contractions?

Answer 10

10-15mmHg

contractions increase this by 20-30mmHg in early labor and 40-60 as labor progresses

Question 11

What is a Montevideo unit?

Answer 11

average of intrauterine pressures x number of contractions within 10 minutes

Question 12

What fetal blood pH is reassuring?

Answer 12

greater than 7.25
indeterminate when between 7.2 and 7.25
non reassuring when less than 7.20

Question 13

What are the cardinal movements of labor?

Answer 13

engagement, descent, flexion, internal rotation, extension, external rotation

Question 14

During the active phase of stage 1, what dilation is normal?

Answer 14

at least 1cm/hr in nulliparous and 1.2 in multi q

Question 15

How long should stage 2 of labor last?

Answer 15

considered prolonged is greater than 2hrs in null (3 if epi) ; 1hrs in multi (2 if epi)

Question 16

In order to use forceps and vacuums, what must be true?

Answer 16

full dilation, ruptured membranes, engaged head and at least +2 station, absolute knowledge of fetal position, no evidence of CPD, adequate anesthesia, empty bladder, experienced operator

Question 17

What is a rare complication from vacuum use?

Answer 17

subgaleal hemorrhage

more commonly: scalp laceration, cephalohematoma

Question 18

What device more commonly causes cepahlohematomas? and shoulder dystocia? facial nerve palsy?

Answer 18

a. vacuum

b. forces (also higher rates of 3-4th degree tears)

Question 19

What are the three signs of placental separation?

Answer 19

cord lengthening, a gush of blood, and uterine fundal rebound

Question 20

retained placenta is common in

Answer 20

preterm (often previable) devilries

Question 21

What is injured in the 4 degree tears?

Answer 21

1. mucosa or skin
2. extend into the perineal body but do not involve the anal sphincter
3. extend into or completely through the anal sphincter
4. anal mucosa itself is entered

Question 22

Most common indication for c/s is

Answer 22

failure to progress in labor

Question 23

to try VBAC, what c/s scar must be present?

Answer 23

Kerr (low transverse incision) or Kronig (low vertical incision)

Question 24

When is an epidural Cath usually placed?

Answer 24

b/t L3-L4 usually not until also is deemed to be in the active phase

Question 25

Spinal anesthesia provides anesthesia over a region similar to that of an epidural, but differs in that it

Answer 25

is given in a one-time dose directly into the spinal canal leading to more rapid onset of anesthesia.