Case Files Flashcards
What is considered a term pregnancy?
weeks 37-42
What is the active phase of labor? What is labor?
when the cervix dilates > 4cm rapidly
Labor is 2 things: cervical change plus uterine contractions
What is the latent phase?
first part of labor where the cervix effaces (thins) before it dilates to 4 cm
What is protraction of the active phase?
when cervical dilation is less than >1.2 cm/h (nulliparous) and >1.5 cm/h (for a woman who’s had at least 1 vag delivery)
what is arrest of the active phase?
no progress in the active phase for >2h
what are the 3 stages of labor?
First stage: onset of labor to complete dilatation of cervix.
Second stage: complete cervical dilation to delivery of infant
Third stage: delivery of placenta
What are the three types of decelerations?
Early - mirror the contraction
Variable-abrupt dips below the baseline
Late- dips after uterine contractions
What is an acceleration?
increase in fetal heart rate above the baseline for at least 15bpm for at least 15 sec
What do you give when the Power/strength of the contraction is inadequate?
Oxytocin
-what is the range of good contractions? q2-3 mins lasting for about 50 sec
Fetal tachycardia: >160 bpm is due to maternal fever
Fetal bradycardia
Is Category 1 Fetal heart rate pattern reassuring?
yes - normal baseline and variability (no lates or variables)
What is Category II FHR?
deserves monitoring - concerning but not ominous; like fetal tachycardia –> worried that it can become category III
What is Category III FHR?
ominous and likely sever fetal hypoxia or acidosis
Eg: NO baseline variability with recurrent late or variable decels or bradycardia OR sinusoidal heart rate pattern
–> prompt delivery required because it threatens mom’s life
Uterine Inversion can lead to
Post Partum hemorrhage–>start 2 IV lines
it is when the placenta attaches to the uterine fundus so that when doc tries to pull it out, it comes out with a red, shaggy mass attached that is the endometrial surface. The fundus of the uterus comes thru the cervix
Four signs of placenta ready to be delivered?
- gush of blood
- lengthening of cord
- globular and firm uterus
- uterus rises up to the anterior abdominal wall
What is placenta accreta?
an abnormally adherent placenta
What is the treatment of uterine inversion?
- anesthestic Halothane to relax the uterus
- OR u can manually return the uterus if the placenta has already separated
- Terbutalline or Magnesium sulfate to relax the uterus prior to replacement
- Uterotonic agents such as Oxytocin given afterwards to prevent reinversion
What do you do if the placent doesn’t deliver in 30 mins?
attempt manual extraction of placenta
Shoulder Dystocia - when the anterior shoulder is inhibited behind the maternal symphysis pubis
- --What is the maneuver? - --Turtle sign
McRoberts Maneuver (hyperflexion of the maternal hips unto the maternal abdomen and/or suprapubic pressure)
When you artificially rupture the membrane you note fetal bradycardia lasting about 3 mins. What is going on here?
CORD PROLAPSE -
where the umbilical cord protrudes through the cervical os. Normally if the membranes are ruptured the fetal head fills the cervical os–it is engaged. if you rupture and the head is not engaged, then you have cord prolapse.
—
Fetal decels w. use of Misoprostol (used for cervical ripening) is due to?
uterine hyperstimulation (>5 contractions in a ten-minute window). Happens a lot with use of Misoprostol (but it;s cheqp)
SROM, good baseline, normal variability, accels but lots of decels.
How do you improve oxygenation?
STOP the oxytocin (which reduces oxygen delivery to the placental bed; it may also hyperstimulate the uterus
Epidural will lower mom’s BP, which may lead to fetal bradycardia bc it is reducing the amt of blood feeding fetus.
reverse epidural w. sympathetics (Ephedrine)
Woman in active labor has ten minute episode of bradycardia with closed cervix. What to do now?
Assess maternal pulse - distinguish between maternal pulse and FHR
- can be done via U/S
- maternal oxygenation (place mom on side, IVF, O2 face mask, and stopping Oxytocin, IV Terbutalline
Postpartum Hemorrhage (PPH)
blood loss of 500mL after vaginal delivery or > 1000cc after C-section
- boggy uterus
- usually due to uterine atony: myometrium have not contracted to cut off the spiral arteries supplying the placental bed.
- –can give IV dilute Oxytocin first
1) What is the first line treatment of PPH?
2) if bleeding continues, what are the second line treatment?
1) uterine massage (bimanual exam) concurrently w. IV dilute oxytocin
2) Methergine, Prostaglandin F2, rectal Misoprostol - they all increase mymetrial contractility
