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CCP 342 Perinatal Anatomy and Physiology 🤰 Flashcards

1
Q

Describe the difference between false and true labor

A

False labour (Braxton Hicks contractions)

  1. Small, uncoordinated uterine contractions
  2. No escalation of frequency or duration
  3. No cervical dilation or effacement
  4. Intact membranes
  5. Relieved with analgesia, ambulation and change in activity

True labour

  1. Cyclic coordinated contractions
  2. Escalation of frequency, duration and severity
  3. Ruptured membranes
  4. Progression
  5. Bloody show / mucus
  6. Plug expelled
  7. Cervical dilation and/or effacement (first stage of labour)
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2
Q

Phase 1 of labour

A
  1. The first stage of labor begins when labor starts and ends with full cervical dilation to 10 centimeters
  2. Multiparas, or women with a history of prior vaginal delivery, tend to demonstrate more rapid cervical dilation
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3
Q

Phase 2 of labour

A
  1. The second stage of labor commences with complete cervical dilation to 10 centimeters and ends with the delivery of the neonate
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4
Q

Phase 3 of labour

A
  1. commences when the fetus is delivered and ends w/ delivery of the placenta
  2. typically takes 5 to 30 minutes
  3. watch for: gush of blood at the vagina, lengthening of the umbilical cord, and a globular shaped uterine fundus on palpation.
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5
Q

Phase 4 of labour

A
  1. 1-2hr post delivery when tone of the uterus is reestablished, with uterus expelling any remaining contents.
  2. These phase is hastened by breastfeeding, which stimulates production of oxytocin
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6
Q

Clinical signs and symptoms that suggest IMMINENT delivery

A
  1. the fetus visibly emerging (crowning)
  2. contractions occurring less than 2 min apart
  3. maternal urge to push
  4. perineal distention or labial separation with contractions
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7
Q

describe External electronic fetal monitoring

A
  1. trans-abdominal pressure transducer creates tracings of fetal HR + uterine activity.
  2. helps confirm true labor + diagnose fetal distress.
  3. Fetal HR tracings have several components that can be assessed—baseline HR, variability, accelerations, decelerations
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8
Q

what information can be gained from antenatal Ultrasonography

A
  1. the gestational age
  2. biophysical profile
  3. amniotic fluid index
  4. a survey of fetal and placental anatomy
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9
Q

what is meant by “baseline fetal heart rate”

A
  1. This is the average fetal heart rate during a 10-minute period (in the absence of a uterine contraction) and is the most important aspect of fetal heart rate monitoring.
  2. Fetal bradycardia is defined as a baseline rate of less than 110 beats/min
  3. fetal tachycardia is defined as a baseline rate of more than 160 beats/min
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10
Q

define fetal bradycardia

A

Fetal bradycardia is defined as a baseline rate of less than 110 beats/min

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11
Q

define fetal tachycardia

A

fetal tachycardia is defined as a baseline rate of more than 160 beats/min

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12
Q

describe and discuss Variability in fetal heart rate

A
  1. variability can be instantaneous (beat to beat) or long term (intervals ≥ 1 minute)
  2. Both types of variability are indicators of fetal well-being.
  3. Accelerations occur during fetal movement and reflect an alert mobile fetus.
  4. ↓ variability may indicate fetal acidemia and hypoxemia or may be a side effect of a wide array of drugs, including analgesics, sedative-hypnotics, phenothiazines, and alcohol.
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13
Q

what are the 7 cardinal movements of childbirth

A

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

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14
Q

Describe the steps in a “normal” delivery. What is your plan/role/approach as a CCP

A
  1. Call for help
  2. Prepare your supplies
  3. radiant warmer (or warm blankets/ready heat) available + heated.
  4. NRP adjuncts ready: towel roll, scissors, umbilical clamps, suction, airway gear, vascular access gear
  5. Don PPE: gloves, gown, face shield
  6. Monitor, oxygen, vitals, IV for mom
  7. Position mom: dorsal lithotomy (“frog leg position”)
  8. Clean: The perineum and drape with sterile towels
  9. Coach mom, time her contractions and breathing (consider entonox)
  10. Support perineum As crowning becomes noticeable!
  11. Cradle head (feel for cord!) Sweep your fingers around the neck!
  12. Deliver shoulders: Gentle downward traction on the head to help deliver the anterior shoulder
  13. Gentle upward traction to deliver the posterior shoulder
  14. Catch baby
  15. Clamp and cut cord
  16. Resuscitate neonate
  17. Prepare for placental delivery
  18. Start oxytocin: Add 20 units of oxytocin to 1 L NS and administer the solution at a rate of 10 mL/min for several minutes until the uterus remains firmly contracted and bleeding is controlled. At this point, ↓ the infusion rate to 1 to 2 mL/min.
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15
Q

discuss Signs of hypovolemia and shock in pregnancy

A

tachycardia and hypotension may be late findings in pregnancy due to the ↑ in maternal blood volume

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16
Q

discuss changes to respiratory dynamics in pregnancy

A
  1. The minute ventilation ↑ in pregnancy, while the total lung capacity, expiratory reserve volume, and FRC ↓.
  2. Clinically, this change can manifest as dyspnea, and pregnant patients are more prone to desaturation.
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17
Q

discuss changes to CXR that occur in pregnancy

A
  1. The gravid uterus should be shielded when performing imaging studies that use ionizing radiation
  2. The enlarged uterus in the 3rd trimester may prevent full inspiration when obtaining a chest X-ray
  3. Uterine distention during pregnancy results in an elevation of the diaphragm that can be seen on chest X-ay.
  4. A broadened cardiac silhouette and prominence of the pulmonary vasculature are also expected due to an increased blood volume and cardiac output.
  5. Pulmonary edema and cephalization are abnormal findings in pregnancy.
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18
Q

discuss changes to ECG that occur in pregnancy

A
  1. ECG changes expected in pregnancy may include left axis deviation, prominent Q waves in II, III, and avF, and flattened or inverted T waves in leads III and V1-V3.
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19
Q

discuss Cardiovascular changes that occur during pregnancy

💵💵💵MONEY SLIDE💵💵💵

A
  1. ~5wks after conception, the maternal CVS begins adapting to provide ↑ blood flow to the fetus.
  2. Initially, SVR begins to ↓ d/t ↑ levels of estrogen, progesterone, and prostaglandins; this vasodilation → lower systemic BP
  3. SVR continues to ↓ until the middle of the 2nd trimester, while the HR steadily ↑ throughout gestation until term.
  4. The SVR ↓ by approximately 35-40% while the heart rate ↑ by approximately 24% throughout pregnancy, leading to an average ↑ of 1.5 L/min of CO
  5. The stroke volume also ↑ throughout pregnancy d/t vasodilation-mediated ↑ in RAAS activation, causing an ↑ in CO and plasma volume
  6. As the uterus grows and IAP ↑, IVC/aorta compression can lead to a ↓ venous return → relative hypotension, especially when supine
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20
Q

discuss respiratory changes that occur during pregnancy

A
  1. Throughout pregnancy, progesterone ↑ the sensitivity of the respiratory center to CO2, therefore increasing the tidal volume and, to a lesser degree, the RR.
  2. This change leads to an ↑ in minute ventilation but can also lead to the development of dyspnea, which can be progressive throughout pregnancy
  3. Maternal hyperventilation → respiratory alkalosis, facilitating the transmission of fetal CO2 to the maternal circulation.
  4. Respiratory alkalosis → increased renal excretion of bicarbonate, shifting the oxygen dissociation curve leftward and facilitating maternal-to-fetal oxygen transmission.
  5. As the gravid uterus grows, intra-abdominal pressure displaces the diaphragm upwards, decreasing the TLC.
  6. Outward flaring of the ribs and decreased chest wall compliance also contributes to the ↓ in TLC and FRC
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21
Q

discuss hematologic changes that occur during pregnancy

A
  1. Erythropoietin levels ↑ in pregnancy, stimulating RBC production (This change is contingent on adequate maternal stores of iron, folic acid, and vitamin B12)
  2. A proportional ↑ in plasma volume (1-1.5 L on average) mediated by renin:angiotensin → a dilutional anemia of approximately 10-20 g/L.
  3. Platelet production increases during pregnancy, but the dilutional effects of ↑ plasma volume and ↑ platelet consumption → a relative thrombocytopenia in pregnancy
  4. Estrogen stimulates the production of neutrophils and results in an ↑ WBC count.
  5. Increased estrogen levels promote protein synthesis, thereby increasing the production of factors VII, VIII, IX, and XII, fibrinogen, and von Willebrand factor by 20-200% in pregnancy
  6. This hypercoagulable state of pregnancy increases the overall risk of thromboembolism but is thought to mitigate the risk of hemorrhage during delivery
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22
Q

discuss renal changes that occur during pregnancy

💵💵💵MONEY SLIDE💵💵💵

A
  1. The renal flow and GFR ↑ in pregnancy throughout the 1st trimester, largely d/t an ↑ CO and systemic vasodilation.
  2. Activation of the RAAS d/t a ↓ in SVR → volume expansion via ↑ water and Na+ reabsorption
  3. Disproportionate reabsorption of water over sodium → a decreased plasma osmolality and mild asymptomatic hyponatremia (Na+ levels still above 130)
  4. Creatinine levels ↓, while urinary protein, albumin, and glucose excretion increase.
  5. Proteinuria ↑ 50-100% by the 2nd trimester, but should not exceed ≥0.3 g protein in a 24-hour urine specimen (Proteinuria ≥0.3 g is concerning for pre-eclampsia)
  6. The ↑ in GFR throughout pregnancy may affect the renal clearance of some medications.
  7. Progesterone → dilation of the renal calyces, pelvis, and ureters. This dilation combined with ureteral compression by an enlarged uterus results in hydronephrosis.
  8. ↑ urinary stasis from relaxation of the ureteric smooth muscle ↑ the risk of UTIs, pyelonephritis, and kidney stones in pregnancy.
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23
Q

discuss GI changes that occur during pregnancy

A
  1. As pregnancy progresses, the enlarging uterus and stretching of the peritoneum can displace anatomic structures and the location of typical landmarks, which can alter the abdominal exam.
  2. Increased gastrin production and a ↓ in the lower esophageal sphincter tone 2nd to progesterone predispose pregnant patients to GERD, esophagitis, and aspiration
  3. Progesterone-mediated increases in gastric emptying times and ↑ gastric transit times may → nausea, vomiting, bloating, and constipation
  4. Smooth muscle relaxation decreases gallbladder contractility, which can → increased gallstone formation, biliary colic, and cholecystitis.
  5. Cholecystitis is the second most common non-OB surgical emergency during pregnancy, after appendicitis
  6. Liver enzyme (AST/ALT) levels are generally unaltered or ↓ during pregnancy, while alkaline phosphatase levels are ↑
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24
Q

discuss endocrine changes that occur during pregnancy

💵💵💵MONEY SLIDE💵💵💵

A
  1. In pregnancy, the levels of multiple hormones, including estrogen and progesterone, increase.
  2. The placenta secretes relaxin, hPL, and human chorionic gonadotropin
  3. Increased insulin production from β-islet cell hyperplasia and insulin resistance from HPL can manifest as gestational diabetes.
  4. The thyroid gland ↑ in size due to hyperplasia, and hCG can stimulate thyroid-stimulating hormone, → transient hyperthyroidism.
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25
Q

discuss dermatologic changes that occur during pregnancy

A
  1. Hyperpigmentation is the most common skin change noted in pregnancy. Estrogen and progesterone can cause melanocyte proliferation/hyperstimulation, primarily in previously hyperpigmented areas such as the areola, axilla, genitals, and inner thighs
  2. Melasma occurs in up to 75% of pregnant women, usually in a malar/mandibular region.
  3. Estrogen levels can → vascular proliferation and dilation in the form of spider angiomas, telectangasias, and pyogenic granulomas in pregnancy.
  4. Vascular compression by the gravid uterus can compress the pelvic and femoral vasculature, contributing to varicose veins.
  5. There are multiple dermatoses of pregnancy involving pruritus (pruritic urticarial papules/plaques in pregnancy, pruritic folliculitis in pregnancy, pemphigoid gestationis).
  6. This condition typically targets the scalp, anus vulva, and abdominal skin
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26
Q

considerations for ETI in the pregnant patient

A
  1. All pregnant patients requiring intubation should be approached as having a potentially difficult airway.
  2. Upper airway changes in pregnancy, including hyperemia, edema, and increased secretions, challenge airway management.
  3. Additionally, pregnant patients are at higher risk for desaturation.
  4. A smaller endotracheal tube (6.5-7.5 mm in diameter) is recommended for intubation
  5. the first attempt should be made by the most experienced provider.
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27
Q

describe the steps in a normal vaginal delivery

A
  1. Place mom in lithotomy position
  2. Control delivery of the baby’s head.
  3. Once head is delivered, check for nuchal cord. If loose, attempt reduction by slipping it over baby’s head.
  4. Place hands on either side of the baby’s face, pinkies to the perineum.
  5. Apply downward and outward traction to deliver anterior shoulder, then upward and outward traction to deliver the posterior shoulder.
  6. Support the delivery of rest of baby’s body.
  7. If infant is vigorous, keep the infant at the level of the perineum for 30-60 s after delivery. clamp + cut the umbilical cord
  8. Place the baby on the mother’s chest, skin-to-skin.
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28
Q

define Precipitous delivery

A
  1. labor that lasts no more than 3 h from the onset of regular contractions to birth
  2. The incidence of reported precipitous deliveries is 3-14%
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29
Q

Explain the process of conception

A

😏😏😏 ayyy

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30
Q

time from the onset of regular contractions to complete cervical effacement and dilation

A

~8hr in nulliparas

~5hr in multiparas

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31
Q

APGAR mnemonic

A 
Appearance (skin colour)
Pulse (heart rate)
Grimace (reflex)
Activity (muscle tone)
Respiration
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32
Q

Active labour definition

A

period after the latent (early) stage of labour when a woman is experiences strong, regular contractions → cervical dilation from 4cms until fully dilated (10cms)

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33
Q

APGAR score definiton

A
  1. quick test performed at 1 minute and 5 minutes after birth.
  2. The 1 minute score determines how well the baby tolerated the birthing process, The 5-minute score assesses how well the newborn is adapting to their new environment.
  3. The rating is based on a total score of 1 to 10, with 10 suggesting the healthiest infant
Appearance (skin colour)
Pulse (heart rate)
Grimace (reflex)
Activity (muscle tone)
Respiration
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34
Q

Primigravida definition

A

A woman pregnant for the first time

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35
Q

Primipara definition

A

Sometimes called the prim or primip – a woman giving birth for the first time

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36
Q

Nullipara definition

A

A woman who has not given birth to a viable child

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37
Q

Multipara definition

A

A woman who has had two or more pregnancies resulting in potentially viable offspring (>20 wks)

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38
Q

Gravidity definition

A

the number of times a woman has been pregnant. Another term used to describe gravidity is gravida

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39
Q

Parity definition

A
  1. the number of times a woman has birthed or completed a pregnancy (meaning the baby is no longer inside mom’s body) at 20 weeks gestation or greater
  2. The count includes babies born alive or stillborn at 20 weeks gestation or greater.
  3. Multiple babies? Just like with gravidity, we’re not counting the number of babies born/birthed. Therefore, if a mom completes a pregnancy at 20 weeks gestation or greater with twins, triplets, quadruplets etc., the parity is just ONE
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40
Q

Multigravida definition

A

a woman has been pregnant two or more times

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41
Q

Multipara definition

A

a woman has completed two or more pregnancies at 20 weeks gestation or greater

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42
Q

Primigravida definition

A

a woman has been pregnant once or is currently pregnant for the first time

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43
Q

Nulligravida definition

A

a woman has never been pregnant

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44
Q

Nullipara definition

A

a woman has never completed a pregnancy at 20 weeks gestation or greater

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45
Q

Stage 1 labour (cervical stage)

A

Starts w/ onset of regular contractions, ends w/ complete cervical effacement + dilatation.

8hr in nulliparas, 5hr in multipara’s

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46
Q

Stage 2 labour (expulsion stage)

A
  1. Begins once the cervix is completely effaced and dilated and continues until delivery of the fetus.
  2. This stage has a wide range of mean durations and is influenced by parity.
  3. The mean range is 36-57 min for nulliparous women and 17-19 min for multiparous women
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47
Q

Stage 3 labour (placental stage)

A

Begins after delivery of the fetus and ends with separation and delivery of the placenta.

48
Q

define and describe nuchal cord

A

umbilical cord wrapped around the baby’s neck 360°

49
Q

The median time to delivery of the placenta

A

5-7 min after delivery of the infant; approximately 75% of placentas are delivered within 6 min

50
Q

describe Active management of the third stage of labor

A
  1. controlled cord traction for placenta
  2. prophylactic administration of a uterotonic agent (oxytocin)

this can significantly decrease the risk of postpartum hemorrhage

51
Q

Discuss the partogram and its use in perinatal care

A
  1. A partogram or partograph is a composite graphical record of key data during labour entered against time on a single sheet of paper.
  2. Relevant measurements might include statistics such as cervical dilation, fetal heart rate, duration of labour and vital signs
52
Q

gestational age classification of prematurity

A
  1. Late preterm birth – GA between 34 and less than 37 weeks
  2. Moderate preterm birth – GA between 32 and <34 weeks
  3. Very preterm (VPT) birth – GA between 28 and 31 6/7 weeks
  4. Extremely preterm (EPT) birth – GA less than 28 weeks
53
Q

classification of low birthweight baby by weight

A
  1. Low birth weight (LBW) – BW less than 2500 g
  2. Very low birth weight (VLBW) – BW less than 1500 g
  3. Extremely low birth weight (ELBW) – BW less than 1000 g
54
Q

5 P’s of labour

A
  1. Passage (maternal bony pelvis and tissues)
  2. Passenger (the fetus)
  3. Power (contractions and maternal effort)
  4. Position (maternal position in labour)
  5. Psyche / Partners (psychological aspect of labour)
55
Q

Key components of “passage” through maternal bony pelvis and tissues - these are the key findings being looked for on pelvic exam in pregnancy

1st P of labour

A
  1. Dilation (How “open” is the cervix)
  2. Effacement (How “thin” is the cervix)
  3. Position [Where is the cervix in the vagina (posterior, mid, anterior)]
  4. Consistency [Firm (chin), medium (cheek), soft (earlobe)]
  5. Station [How low is the fetal head in relation to the bony pelvis (ischial spines)]
56
Q

Key components of “passenger” through maternal bony pelvis and tissues

this is what docs look for when assessing the orientation of the baby prior to it being delivered

2nd P of labour

A
  1. Lie (description of the long axis of the fetus relative to the long axis of the mother). longitudinal, oblique or transverse
  2. Presentation (cephalic, breech , compound)
  3. Presenting part (part closest to cervix. occiput, face, brow, sacrum or lower limbs)
  4. Position (fetal occiput orientation to maternal pelvis. Ex: left occiput anterior)
57
Q

Definition of active labour

A

progressive cervical dilation, effacement, or both, resulting from regular uterine contractions (2 or more in 10 minutes lasting 30-60sec)

“contractions 2 in 10”

58
Q

First Stage of labour

A

Onset of involuntary painful regular contractions to full dilation

59
Q

Second Stage of labour

A

Full dilation to delivery of fetus

60
Q

third Stage of labour

A

Delivery of fetus to delivery of placenta

61
Q

fourth Stage of labour

A

Delivery of placenta to stabilization of maternal condition

62
Q

“Latent” First Stage of labour

A

Onset of contractions
Cervix <3cm dilated
Extremely variable duration

63
Q

“Active” First Stage of labour

A
  1. Regular painful contractions every 2-3 minutes lasting 30-60 sec
  2. Cervix 3-4cm to fully dilated (10cm)
  3. Nulliparas : 1cm/hr
  4. Multiparas: 1.2cm/hr
64
Q

define and describe components of the second stage of labour

A
  1. Full cervical dilation to delivery of fetus
  2. Maternal pushing increases forces directing fetus downwards and outwards
  3. mom pushes against a closed glottis → increase intra abdominal pressure → descent of fetus into pelvis
  4. Majority of the pushing effort is actually from the uterine contractions, this is then assisted by maternal pushing efforts
  5. Nulliparas: average 50 minutes-3hrs
  6. Multiparas: average 20 minutes
65
Q

7 fetal cardinal movements

A

baby does this to navigate the pelvis/birth canal

1) Engagement
2) Descent
3) Flexion
4) Internal rotation
5) Extension
6) External rotation/restitution
7) Expulsion

66
Q

Classic signs of placental separation

A
  1. Gush of blood
  2. Lengthening of cord
  3. Fundus rises up
  4. Uterus becomes firm and globular
67
Q

timeframe for delivery of placenta

A

0-30 minutes (>90% deliver by 15 minutes)

68
Q

complications that account for most maternal transfers

A
  1. Preterm labour
  2. Preterm premature rupture of membranes (PPROM)
  3. Ante partum hemorrhage: previa , abruption
  4. Different forms of hypertension
  5. Twins , triplets and beyond
69
Q

preterm delivery definition

💵💵💵MONEY SLIDE💵💵💵

A

Delivery between 20 weeks GA and 36 weeks 6 days GA

70
Q

these Four predisposing conditions account for 80% of pre-term delivery cases

A
  1. Cervical shortening
  2. Incompetent cervix (IC)
  3. Preterm premature rupture of the membranes PPROM)
  4. Preterm labour (PTL)
71
Q

cerivcal incompetence/insufficiency definition

A

The inability of the uterine cervix to retain a pregnancy in the absence of the signs and symptoms of clinical contractions, or labour, or both in the second trimester.

72
Q

initial treatment/stabilization package for preterm labour (3 items)

A
  1. tocolytics
  2. corticosteroids
  3. ABX
73
Q

tocolytic therapy goals

A

Delay delivery 24-48 hours if GA <34 weeks

74
Q

Antibiotic therapy goals for preterm labour

why give ABX in PTL?

A

prevention of neonatal group B strep/sepsis

75
Q

Steroid therapy goals for preterm labour

A

prevention of neonatal RDS

76
Q

threshold of preterm viability?

what’s the earliest the fetus can come out and possibly make it

A

22 to 25 weeks

77
Q

PROM/PPROM definitions

A
  1. PROM = Rupture of the membranes prior to onset of labour
  2. Term PROM = ≥37 weeks GA
  3. Preterm PROM (PPROM)* = < 37 weeks
78
Q

what’s the number #1 threat with PPROM

A

Ascending infection → Maternal sepsis/Neonatal sepsis is a common consequence and often the limiting factor with respect to continuing pregnancy

79
Q

frank breech

A

Both hips flexed

Knees extended

80
Q

complete breech

A

Hips flexed knees flexed

81
Q

incomplete breech

A

one of baby’s knees is bent and its foot + butt are closest to the birth canal → Risk for cord prolapse + Entrapped head

82
Q

shoulder dystocia definition

A

After the delivery of the head, gentle traction does not result in delivery of the shoulders

83
Q

ALARM acronym for shoulder dystocia

A 
Ask for help
Legs back
Anterior shoulder
Rotate
Manual removal of posterior arm
84
Q

C-section indications

A
  1. Multifetal pregnancy ≥3 fetuses
  2. Twin A non vertex
  3. Abnormal fetal status
  4. Failure to progress in labour
  5. Contraindication to vaginal birth
  6. Unusual complications/circumstances
  7. Conjoined twins
  8. MCMA
85
Q

maternal risk factors of abnormal labour

A
  1. Older maternal age
  2. Epidural anesthesia
  3. Pelvic contraction
  4. Short stature (< 150 cm)
  5. Chorioamnionitis
  6. Post term pregnancy
  7. Obesity
86
Q

risk factors for neonatal infection

A
  1. < 37 weeks
  2. > 18 hours PROM
  3. Intra amniotic infection
  4. Previous affected neonate
87
Q

which women get antenatal corticosteroids

A
  1. At risk of preterm birth. Recommended 23 to 34+6 weeks. Before 23 weeks: no data. After 34 weeks: complications probably outweigh benefit
  2. Betamethasone 12mg IM, q24h x2 OR Dexamethasone 6mg IM q12h x4
  3. No repeat administration
88
Q

What is the most effective way to determine GA?

A

Ultrasound. Accuracy worsens as the fetus develops.

89
Q

What are the two scores used in the assessment of newborns?

A

APGAR

Ballard score

90
Q

What is lanugo?

A

Newborn body hair. More prominent in early pregnancy.

91
Q

What GA is considered term?

A

> 37 weeks

92
Q

What GA is considered preterm?

💵💵💵MONEY SLIDE💵💵💵

A

23 to 36+6 weeks

93
Q

What is considered post term?

A

> 42 weeks

94
Q

What is considered low birth weight?

A

< 2500g

95
Q

What growth percentile is considered AGA?

A

10 to 90%

96
Q

Define asymmetric IUGR

A
  1. Hypotrophic growth restriction that is head sparing. The undernourished fetus directs energy to maintain vital organs (brain/heart).
  2. Related to maternal issues. The baby usually catches up in growth
97
Q

Define symmetric IUGR

A
  1. Entire growth is restricted, considered SGA with a head that is appropriate for the body size.
  2. Related to maternal issues. The baby doesn’t usually catch up with growth
98
Q

What is colostrum?

A

The first breast milk produced by the mammary glands that are rich with immunological factors.

99
Q

What is the Fenton chart?

A

It is the chart used by BCCH to track and assess a newborns growth

100
Q

Define parturition

A

The act of giving birth to the young

101
Q

Define braxton hicks contractions

A

Unorganized contraction of the uterus

“false” contractions

102
Q

List the 4 factors that promote labour

A
  1. Fetus
  2. Myometrial activation
  3. Hormones
  4. Membrane rupture
103
Q

How does membrane rupture induce labour?

A

ROM produces an inflammatory cascade mediated by arachidonic acid → thinning and dilation of the cervix

104
Q

What is a tocolytic

A

A medication used to suppress premature labour

105
Q

Name the commonly used tocolytics

A
  1. Nifedipine (Adalat): Blocks calcium influx to uterus → inhibition of labour contractions
  2. Indomethacin: An NSAID and tocolytic that inhibits prostaglandin synthetase
106
Q

Why is nifedipine usually the first tocolytic agent used at BCCH?

A

It has less adverse effect on the ductus arteriosus and less of risk of causing NEC (compared to Indomethacin)

107
Q

Explain the mechanism of action of oxytocin

A
  1. Oxytocin is classified as a uterotonic.
  2. Oxytocin stimulates uterine contraction by ↑ intracellular calcium
  3. Oxytocin is released from the posterior pituitary during active labour. It is useless when the cervix is fully constricted (as it essentially produces uterine contraction against a closed door).
108
Q

What is the role of tocolytics in preterm labour?

A
  1. Tocolytics delay labour to allow for prelabour growth.
  2. Tocolytics also allow for administration of corticosteroid to allow fetal production of surfactant and to buy time for transport to a specialty centre
109
Q

Explain the mechanism of membrane sweeping in the induction of labour

A
  1. Membrane sweeping breaks the barrier of the cervix, which begins the cascade of inflammation and uterine preparation for birthing
  2. Prostaglandin “tampons” are also used to apply prostaglandin for the induction of labour
110
Q

What are the five P’s of labour?

A
  1. Passage
  2. Passenger
  3. Power
  4. Position
  5. Psyche/Partners
111
Q

At what width of cervical dilation is transport generally not recommended?

A

> 4cm

112
Q

What are the Leopold Maneuvers?

A

Maneuvers used to determine the long axis of the fetus relative to the mother

113
Q

What are the four stages of labour?

💵💵💵MONEY SLIDE💵💵💵

A
  1. Stage 1 → Onset of regular contractions to full dilation.
  2. Stage 2 → Full cervical dilation to delivery of the fetus.
  3. Stage 3 → Delivery of the placenta
  4. Stage 4 → Post-birth care/recovery
114
Q

When delivering the placenta, what are some important considerations?

A
  1. Delivery occurs with maternal effort and gentle cord traction
  2. Place a hand at the symphysis pubis to prevent uterine inversion.
  3. A placenta will normally deliver with a gush of blood, with cord lengthening from the uterus contracting downwards.
  4. Uterus contraction clamps the closure of the ruptured blood vessels form the uterus
115
Q

What is the importance of immediate breast feeding after birth?

A
  1. Oxytocin release, stimulating uterine contraction and reducing hemorrhage
  2. Colostrum feeding for the infant (rich in nutrients and probiotics)
  3. Conduction of heat from mother to infant
116
Q

What is the mechanism of action of ultraviolet light in babies with hyperbilirubinemia?

A

Ultraviolet light acts as a catalyst for the binding of bilirubin to albumin, promoting elimination

117
Q

Determine gestational age based on fundal height

A

Above pubis symphysis: ≈13 wk
At the umbilicus: ≈20 wk
Costal margin: >34-36 wk

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