CF: 1-5 Flashcards
1: Done 2: 3: 4: 5:
26 yo G1P0 woman at term with an adequate pelvis on clinical pelvimetry, nonimmune rubella status, is in labor. Her cervix has changed from 4 to 7 cm dilation over 2 hr w/ uterine contractions noted every 7-10 min.
Next step in management?
Continue to observe labor
Define latent phase of labor. Usually how many cm?
Initial part where cervix mainly effaces (thins) rather than dilates. Typically <4 cm dilation
Define active phase of labor. Usually how many cm?
Part of labor where dilation happens more rapidly. Cervix typically >4 cm (but not 10)
Define protraction of the active phase
Cervical dilation in the active phase that’s less than expected. Normals:
- > /= 1.2 cm/hr in nulliparous
- > /= 1.5 cm/hr in woman w/ at least 1 vag delivery
Define arrest of active phase
No progress in active phase of labor for 2 hr
Normal FHR?
110-160 bpm w/ accel and variability
Define FHR acceleration
Episodes of FHR that increase above the baseline of at least 15 bpm and for at least 15 sec
Normal duration of latent phase for nullipara vs multipara?
NP: </= 14 hr
Normal duration of second stage for nullipara vs multipara?
NP: </= 1 hr (2 w/ epidural)
Normal duration of third stage for nullipara vs multipara?
</=30 min for both
What are the 3 P’s?
Powers
Passenger
Pelvis
What is prolonged latent phase?
Latent phase >ULN
2 definitions of adequate uterine contractions?
- At least 200 MVU in a 10 min window
2. Contractions every 2-3 min, firm on palpation, lasting for at least 40-60 seconds
If powers are thought to be inadequate, what drug can you start?
Oxytocin
What are the MC type of decel and what causes them?
Variable
Cord compression
How do you handle intermittent variable decel w/ abrupt return to baseline?
Obs
What causes early decelerations? Are they benign or scary?
Fetal head compression
Benign
Which type of decel is “offset” from the uterine contraction w/ their onset after the onset of the contraction?
Late decel
What do late decels represent? What about if they’re recurrent (>50% of contractions)?
Uteroplacental insufficiency–> Fetal hypoxia
If recurrent, concern for fetal acidemia
In arrest or protraction of active phase, what’s the major indication for C/S?
Cephalopelvic disproportion
Define the 3 categories of FHR patterns
Category 1: reassuring: normal baseline and variability, no late or variable decels
Category 2: may have some aspect that’s concerning but not ominous
Category 3: ominous, indicates a high likelihood of severe fetal hypoxia
What type of pelvis is defined as a pelvis w/ AP diameter > transverse diameter w/ prominant ischial spines and a narrow anterior segment?
Anthropod pelvis
Define 0 station
When presenting part is right at the plane of the ischial spines
How do you distinguish btwn bloody show and antepartum bleeding?
Bloody show will have sticky mucus admixed with blood, while antepartum bleeding won’t
Which type of decels are mirror images of uterine contractions?
Early decels
Which type of decels are abrupt in decline and abrupt in resolution?
Variable decels
29 yo G2P1 woman at 20 wk gestation comes for routine prenatal care. On exam, BP is 100/60, HR 80 bpm, temp normal. Hb is 9.5 w/ elevated HbA2.
Most likely Dx?
Underlying mechanism?
Anemia 2/2 beta thal minor
Decreased beta globin chain production
31 yo G4P3 woman has normal SVD of baby and after slight lengthening of the cord, a reddish shaggy mass is noted bulging in the introitus.
Most likely Dx?
Most likely Cpx?
Uterine inversion
Postpartum hemorrhage
25 yo obese G2P1 woman is delivering at 42 wk gestation. The fetus appears clinically to be 3700 g (average weight). After a 4 hr 1st stage of labor and a 2 hr second stage of labor, the head delivers, but the shoulders don’t easily deliver.
Next step in management?
Likely complication (1 maternal and 1 neonatal)?
Predisposing maternal condition?
- McRoberts maneuver: hyperflexion of the maternal hips onto the maternal abdomen +/- subrapubic pressure
- Postpartum hemorrhage
- Brachial plexus injury
- GDM
22 yo G3P2 woman at term is in labor w/ a cervical dilation of 5 cm. Vertex is at -3 station. Upon AROM, persistent fetal bradycardia to 70-80 bpm range is noted for 3 min.
Next step?
Vaginal exam to assess for umbilical cord prolapse
Treatment of mild microcytic anemia in pregnant woman w/o RF for thalassemia?
Trial of iron + recheck h/h in 3 wk
Next step for mild microcytic anemia in pregnant woman who didn’t respond to iron trial?
Iron studies + HFE
Hb less than ____ qualifies as anemia in pregnancy?
-Define mild vs severe
<7
Why can babies with beta thal appear healthy at birth?
HbF is present
Pregnant women with sickle cell disease will have worsening and/or incr freq of what 4 complications?
- Anemia
- Pain crisis
- Infections
- Pulm Cpx
Name two fetal complications with incr risk in pregnant women with sickle cell disease. How do you monitor for these?
- IUGR
- Perinatal mortality
Serial US
Major cause of megaloblastic anemia in pregnancy?
Folate deficiency
Which two meds commonly used for UTIs in pregnancy could cause hemolysis in G6PD deficient women?
- Nitrofurantoin
2. TMP-SMX
Anemia w/ elevated A2 suggests?
beta thal
Anemia w/ elevated HbF suggests?
alpha thal
4 signs of placental separation?
- Gush of blood
- Lengthening of the cord
- Firm, globular uterus
- Uterus rises up to anterior abdominal wall
In uterine inversion, what’s the reddish bulging shaggy mass seen adjacent to the placenta?
Endometrial surface (shaggy= big clue)
MCC of uterine inversion?
Undue traction on the cord before complete placental separation
What defines an abnormally retained placenta?
3rd stage of labor >30 min
Name 4 RFs for uterine inverion
- Undue traction on the cord before complete placental separation
- Grand multiparosity
- Placenta accreta
- Placenta implantation in uterine fundus
1st step in treating uterine inversion?
Secure 2 large bore IV lines! Remember that even with proper tx, profuse hemorrhage is almost certain.
After securing your IVs, name the 3 major steps in treating uterine inversion
- Uterine relaxants
- Replace uterus (with hand)
- Stop relaxants and start uterotonics
Name 3 major uterine relaxants used in uterine inversion
Halothane
MgSO4
Terbutaline
How do you treat an abnormally retained placenta?
Attempt manual extraction
Mechanism of hemorrhage in uterine inversion?
Inverted uterus–> uterus can’t establish normal tone and contract–> myometrial fibers can’t exert tourniquet effect on spiral arteries–> placental bed pours out blood
