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EndoRepro 2 Exam 1 > Clin: Normal Labor and Delivery - Moulton > Flashcards

Clin: Normal Labor and Delivery - Moulton Flashcards

1
Q

what shape is the anterior fontanelle?

A

diamond shaped, 2x3 cm

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2
Q

what shape is posterior fontanelle?

A

Y or triangular shape

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3
Q

suboccipitobregmatic

A

head well flexed

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4
Q

occipitofrontal

A

head deflexed

- occiput posterior position

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5
Q

supraoccipitomental

A

brow presentation

- is the longest anterior-posterior diameter of the head

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6
Q

submentobregmatic

A

face presentation

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7
Q

what is the average circumference of a term fetal head measured in the occipitofrontal plane?

A

34.5cm

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8
Q

classic female type of pelvis (50% of females)

  • round at the inlet
  • wide transverse diameter only slightly greater than AP diameter
  • wide suprapubic arch
  • head generally rotates into occiput anterior position = good prognosis for delivery
A

gynecoid

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9
Q

classic male type of pelvis (30% of females)

  • widest transverse diameter closer to sacrum
  • prominent ischial spines
  • narrow pubic arch
  • fetal head is forced to be in occiput posterior position
  • amount of space is restricted and arrest of descent of common = poor prognosis for delivery
A

android

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10
Q

resembles an ape pelvis (20% of females)

  • much larger anteroposterior then transverse diameter
  • creates a long narrow oval shape
  • narrow pubic arch
  • fetal head engages only in AP diameter
  • usually OP position = good prognosis for delivery
A

anthropoid

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11
Q

reference is maternal spine to fetus spine

- determines if infant is longitudinal, transverse, or oblique

A

fetal lie

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12
Q

presenting part to the pelvis

- vertex, breech, transverse, or compound (vertex with hand)

A

fetal presentation

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13
Q
  1. palpate the fundus
  2. palpate for sping and fetal small parts
  3. palpate what is presenting in the pelvis with suprapubic palpation
    4 palpate for cephalic prominence (can feel chin or occipital protuberance if head is not deep in pelvis)
A

leopold maneuvers

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14
Q

thinning of the cervix occurs and is reported as % change in length

  • normal length is 3-5 cm
  • range is thick - 100%
A

effacement

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15
Q

degree of descent of the presenting part of the fetus

  • measured in cm from presenting part to ischial spines
  • when the bony portion of the head reaches the level of the ischial spines = 0
  • range -5 to +5
A

station

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16
Q

onset of true labor to complete cervical dilation

- latent and active phases

A

FIRST stage

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17
Q

complete cervical dilation to delivery of infant

A

SECOND stage

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18
Q

delivery of infant to delivery of placenta

A

THIRD stage

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19
Q

delivery of placenta to stabilization of patient

A

FOURTH

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20
Q

period between onset of labor and is characterized by slow cervical dilation

A

latent (early) labor

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21
Q

faster rate of dilation and usually begins when cervix is dilated to 6cm
- admit for labor at this stage

A

active labor

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22
Q

what is the duration of first stage for primips?

A

6-18 hours

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23
Q

what is the duration of first stage for multips?

A

2-10 hours

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24
Q

what is the bare minimum rate of cervical dilation for primips?

A

1.2 cm per hour

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25
Q

what is the bar minimum rate of cervical dilation for multips?

A

1.5 cm per hour

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26
Q

what med is used AUGMENT labor?

A

oxytocin

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27
Q

what labs should be drawn during the first stage of labor?

A

CBC and T&S (type and screen)

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28
Q

how often should you be monitoring if uncomplicated pregnancy?

A
  • q 30 minutes in active phase of first stage of labor

- q 15 minutes in second stage of labor

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29
Q

how often should you be monitoring if complicated pregnancy?

A
  • q 15 minutes in active phase (following a contraction)

- q 5 minutes during second stage

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30
Q

what allows you to assess the strength of the contractions and is helpful with oxytocin (Pitocin) augmentation?

A

internal pressure catheter (IUPC)

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31
Q

how often should a vaginal exam be done during active phase of labor?

A

cervical check q 2 hrs

- record dilation/effacement/station

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32
Q

what are the benefits and risks of anmiotomy (AROM)?

A
  • benefits: augment labor, allows assessment of meconium status
  • risks: cord prolapse, prolonged rupture associated with chorioamnionitis
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33
Q

what is the reference point for fetal POSITION?

A

the occiput

  • occiput posterior = occiput is facing backwards
  • left occiput transverse = occiput is facing toward the moms left hip (face is looking right)
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34
Q

what are signs of second stage of labor?

A

mother usually has increase in bloody show and desire to bear down with each contraction

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35
Q

how long is the average primip second stage without epidural?

A

2 hours

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36
Q

how long is the average primip second stage WITH epidural?

A

3 hours

37
Q

how long is the average mulip second stage without epidural?

A

1 hour

38
Q

how long is the average multip second stage WITH epidural?

A

2 hours

39
Q

what are the 7 cardinal movements of labor?

A
  1. engagement
  2. descent
  3. flexion
  4. internal roation
  5. extension
  6. external rotation
  7. expulsion
40
Q

defined as presenting part at “zero” station

A

engagement

41
Q

brought about by the force of uterine contractions and maternal valsalva efforts

A

descent

42
Q

OA - baby’s chin to chest thus changing the presenting part from occipitofrontal to smaller suboccipitobregmatic

A

flexion

43
Q

occurs usually at the ischial spines
- fetal head enters pelvis in transverse diameter, rotates so the occiput turns anteriorly or posteriorly toward the pubic symphysis

A

internal rotation

44
Q

crowning occurs when the largest diameter of the fetal head is encircled by the vaginal introitus

  • station is +5
  • head is born by rapid extension
A

extension

45
Q

the delivered head now returns to its original position at the time of engagement to align itself with the fetal back and shoulders

A

external roatation

46
Q

the anterior shoulder then delivers under the pubic symphysis, followed by the posteriors shoulder and the remainder of the body

A

expulsion

47
Q

what position should the mother avoid during second state?

A

supine

48
Q

when should fetal monitoring occur during second stage?

A

continuously

  • monitor q 15 minutes in second stage with NO risk
  • monitor q 5 minutes WITH risk factors
49
Q

how do you assess for nuchal cord?

A

index finger

  • if loose: can manually reduce over infants head
  • if tight: need to clamp x2 and cut
50
Q

what is the most common episiotomy performed?

A

midline

  • greater risk of extension into third or fourth degree
  • less postpartum pain
51
Q

what are the risks or mediolateral episiotomy?

A
  • greater blood loss
  • more difficult to repair
  • more postpartum pain
  • increase risk of dyspareunia (painful intercourse)
52
Q

finger to the right hand are used to extend the head while counter pressure is applied to the occiput by the left hand to allow for a more controlled delivery

A

modified Ritgen maneuver

53
Q

superficial laceration involving vaginal mucosa and/or perineal skin

A

first degree

54
Q

laceration extending into muscles of the perineal body but does not involve the anal sphincter

A

second degree

55
Q

laceration extends into or completely through the anal sphincter but not into rectal mucosal

A

third degree

56
Q

involves the rectal mucosa

A

fourth degree

57
Q

what is diagnosed if the placenta is has not been delivered within 30 minutes?

A

retained placenta

- usually occurs between 2-10 minutes

58
Q
  • gush of blood from the vagina
  • lengthening of the umbilical cord
  • fundus of the uterus rises up
  • a change in shape of the uterine fundus from discoid to globular
A

classic signs of placental separation

59
Q

that should you actively do in the third stage of labor

A

apply counter pressure between the symphysis and fundus

  • do NOT pull on cord until classic signs are noted
  • inappropriate pulling may result in uterine inversion :((
60
Q

what is the most common cause of postpartum hemorrhage?

A

uterine atony during the fourth stage

- retained placenta or un-repaired lacerations can also cause hemorrhage

61
Q

what is the goal of cervical ripening?

A

facilitate the process of cervical softening, thinning and dilating in hopes to reduce the rate of failed induction

62
Q

process by which labor is started by artificial means

A

induction

63
Q

artificial stimulation of labor that has already begun

A

augmentation

64
Q
  • abruptio placentae
  • chlorioamnionitis
  • fetal demise
  • preeclampsia, eclampsia
  • PROM
  • post-term pregnancy
A

indications for induction

65
Q
  • unstable fetal presentation
  • acute fetal distress
  • placenta previa or vasa previa
  • previous classical cesarean or transfundal uterine surgery
A

contraindications to induction

66
Q

what is considered an unfavorable bishop score?

A

<6

67
Q

what is considered a favorable bishop score?

A

> 8, probability of vaginal delivery after labor induction is similar to that of spontaneous labor

68
Q

what score does cervical dilation get on bishop score?

A 
closed = 0
1-2 = 1
3-4 = 2
>5cm = 3
69
Q

what score does cervical effacement get on bishop score?

A 
0-30 = 1
40-50 = 1
60-70 = 2
>80 = 3
70
Q

what score does station get on bishop score?

A

-3 = 0
-2 = 1
-1-0 = 2
>+1 = 3

71
Q

what score does cervical consistency get on bishop score?

A 
firm = 0
med = 1
soft = 2
72
Q

what score does cervical position get on bishop score?

A 
posterior = 0
midline = 1
anterior = 2
73
Q
  • cervidil (PGE2, vaginal insert, contraind in pt w/ previous c-section)
  • cytotec (PGE1, orally or vaginally, cannot be readily removed, contraind in pt w/ previous c-section)
  • foley bulb catheter (inflate 30-80cc)
  • laminara japonicum (dilation occurs by swelling of the laminara rods)
A

cervical ripening agents, ONLY used to augment, never to induce labor

74
Q

synthetic oxytocin

  • IV adiministered, diluted in normal saline
  • only FDA approved drugs for induction and augmentation
  • uterine response ensues 3-5 minutes after infusion, steady level acheived in the plasma by 40 minutes
  • dosed 1-30 mu/min
A

pitocin infusion

75
Q
  • uterine tachysystole (5+ contractions in 10 mins)
  • antidiuretic effect (can lead to severe water intoxication)
  • uterine muscle fatigue (nonresponsiveness)
A

complications of pitocin

76
Q

what is the normal uterine blood flow at term?

A

700-900 mL/min

77
Q

what can you give if hypotension occurs due to anesthesia during labor?

A

IV bolus of LR and vasopressor (ephedrine)

- will typically restore maternal blood pressure and uterine flow

78
Q

uterine contractions and cervical dilation result in visceral pain from what spinal levels?

A

T10-T12 through L1

79
Q

descent of fetal head and pressure from pelvic floor, vagina and perineum generate somatic pain via what?

A

pudendal nerve (S2-S4)

80
Q

what refers to partial or complete loss of pain sensation below T10 level?

A

regional anesthesia

- epidural or spinal

81
Q

what are nonpharmacoloigic anesthesia options

A
  • lamaze
  • back massage
  • hydrotherapy
  • acupuncture
82
Q

when are parenteral anesthesia options more effective?

A

in the early first stage of labor, when pain is more visceral and less intense
- they have very little efficacy for relief of labor pain

83
Q

do opioids cross placental barrier?

A

yes

- can lead to neonatal respiratory depression

84
Q

what is the most effective form of pain relief and is used by 60% of women in labor

A

epidural (loss of pain sensation below T8-10)

- catheter is placed in epidural space which allows for continuous infusion of anesthetic agents

85
Q

where is the epidural space?

A

between L2-3, L3-4, L4-5

86
Q

single shot analgesia which provides excellent pain relief for limited procedures (30-250 minutes depending on drugs used)
- limited use in labor sing it’s a single shot

A

spinal

87
Q
  • maternal coagulopathy
  • heparin use within 12 hours
  • untreated maternal bacteremia
  • increased intracranial pressure caused by mass lesion
  • skin infection over site of needle placement
A

contraindications for regional anesthesia

88
Q

what can aid in operative vaginal delivery in women who do not have regional anesthesia?

A

pudendal block

- complications include intravascular injection, hematomas, and infections

89
Q

what is the most common general anesthesia induction agent used?

A

propofol

  • results in loss of maternal consciousness, MUST be accompanied by airway management
  • carries 16-fold increase in risk of mortality compared to regional anesthesia
  • all inhaled anesthetics readily cross placenta and have been associated with neonatal respiratory depression

EndoRepro 2 Exam 1 (25 decks)

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