Case Files Flashcards
Labor latent phase
the initial part of labor where the cervix mainly effaces rather than dilates (usually cervical dilation <6cm)
Labor active phase
The portion of labor where dilation occurs more rapidly, usually when the cervix is > 6 cm dilation.
arrest of active phase
No progress in the active phase of labor (≥ 6cm) with ruptured membranes for 4 hours with adequate contractions, or 6 hours of inadequate contractions.
stages of labor
First stage: onset of labor to complete dilation of cervix. Second stage: complete cervical dilation to delivery of infant. Third stage: delivery of infant to delivery of placenta.
fetal HR baseline
Normally between 110 and 160 bpm. Fetal bradycardia is a baseline < 110 bpm, and fetal tachycardia is exceeding 160 bpm.
Decelerations
Fetal heart rate episodic changes below the baseline. There are three types of decelerations: early (mirror image of uterine contractions), vari- able (abrupt jagged dips below the baseline), and late, which are offset following the uterine contraction.
accelerations
Episodes of the fetal heart rate that increase above the base- line for at least 15 bpm and last for at least 15 seconds.
latent phase limits
nullipara: ≤18-20 h
multipara: ≤14 h
second stage of labor limits
Nullipara:
≤3 h
≤4 h if epidural
Multipara:
≤2 h
≤3 h if epidural
adequate uterine contractions
defined as contractions every 2 to 3 minutes, firm on palpation, and lasting for at least 40 to 60 seconds
What do late decelerations suggest?
fetal hypoxia
When late decelerations occur together with decreased variability, then _____ is strongly suspected
acidosis
FHR Category I
is reassuring—normal baseline and variability, no late or variable decelerations.
FHR Category II
bears watching—may have some aspect that is concerning but not ominous (eg, fetal tachycardia without decelerations).
FHR Category III
is ominous and indicates a high likelihood of severe fetal hypoxia or acidosis—examples include absent baseline variability with recurrent late or variable decelerations or bradycardia, or sinusoidal heart rate pattern (this requires prompt delivery if no improvement).
Scalp stimulation induc- ing an acceleration highly correlates to…
a normal umbilical cord pH (≥7.20)
McRoberts Maneuver
The maternal thighs are sharply flexed against the maternal abdomen to straighten the sacrum relative to the lumbar spine and rotate the symphysis pubis anteriorly toward the maternal head (for shoulder dystocia)
Suprapubic pressure
The operator’s hand is used to push on the suprapu- bic region in a downward or lateral direction in an effort to push the fetal shoulder into an oblique plane and from behind the symphysis pubis.
When should shoulder dystocia be expected?
prior history of shoulder dystocia, fetal macrosomia, gestational diabetes, excessive weight gain (>35 lbs) in pregnancy, maternal obesity, and prolonged second stage of labor
Wood’s corkscrew
progressively rotating the posterior shoulder in 180° in a corkscrew fashion (for shoulder dystocia)
Zavanelli maneuver
cephalic replacement with immediate cesar- ean section
Key labs for pre-eclampsia
CBC with platelet count
LFTs
Serum creatinine
Preeclampsia
Hypertension (140 systolic or 90 diastolic) measured twice 6 hours apart with the new onset of proteinuria (> 300 mg over 24 hours, or a urine protein to creatinine ratio > 0.3) usually at a gestational age greater than 20 weeks. In the absence of proteinuria, hypertension and one of the following findings may suffice: thrombocytopenia, impaired liver function tests, renal insufficiency, pulmo- nary edema, cerebral disturbances, or visual impairment.
Eclampsia
Seizure disorder associated with preeclampsia.