[CLMD] Normal Labor and Delivery [Moulton] Flashcards
What is the definition of labor?
Progressive cervical dilation resulting from regular uterine contractions that occur at least every 5 minutes and last 30-60 seconds
What is false labor?
aka?
Irregular contractions without cervical change
AKA= Braxton-Hicks contractions
Cranial bones consist of:
Occipital bone
(2) Parietal bones
(2) Frontal bones
Anatomica characteristics of the FETAL Head
What diameter has the LONGEST length (hardest to deliver)?
Supraoccipitomental (13.5cm)
Anatomica characteristics of the FETAL Head
Which (2) diameters have the SHORTEST length (easiest to deliver)?
Submentobregmatic diameter
Suboccipitobregmatic diameter
What is the most common/has best prognosis for delivery pelvic shape of the maternal pelvis?
GYNECOID
What pelvis shape is classic male type of pelvis shape and has a poor prognosis for delivery?
ANDROID
What pelvis shape resembles an ape pelvis and has a good prognosis for delivery?
ANTHROPOID
What is the least common pelvic shape that has a poor prognosis for delivery?
PLATYPELLOID
Define:
Fetal lie
Reference is maternal spine in relation to fetus spine
Determines if fetus is longitudinal, transverse or oblique
Define:
Fetal presentation
Presenting part to the pelvis
(Vertex, breech, transverse or compound)
What are leopold maneuvers?
A series of 4 maneuvers used to determine the positioning of the fetus
- Fundus
- Spine
- Presenting to pelvis
- Head
What is the difference between a longitudinal vs transverse lie fetus?
Dilation
Where do you check for dilation?
What is the range?
Internal os
Closed - 10 cm
Effacement
What is it?
What is normal?
Range?
Thinning of the cervix occurs and is reported as a % change in length
3-5cm
Thick - 100%
Station
What is it?
When is the station “zero”?
Range?
Degree of descent of the presenting part of the fetus
When the bony portion of the head reaches the level of the ischial spine
-5 to +5cm
How many stages of labor are there?
4
Which stage of labor has two substages?
First stage
(Latent phase, Active phase)
What occurs in the FIRST stage of labor?
Onset of true labor to complete cervical dilation
Includes two substages (Latent and active phase)
What occurs in the SECOND stage of labor?
Complete cervical dilation to delivery of infant
What occurs in the THIRD stage of labor?
Delivery of infant to delivery of placenta
What occurs in the FOURTH stage of labor?
Delivery of placenta to stabilization of patient
Describe the latent phase of the FIRST stage of labor
B/w onset of labor and SLOW cervical dilation
What characterizes the ACTIVE phase of the FIRST stage of labor?
Faster rate of dilation
+
Cervix is dilated to 6cm
For vaginal examinations, what are the three key measurements you want to take?
Dilation, effacement, station
DES
example: 4/50/-2 = 4cm dilated/50% effaced/-2cm station
Describe how you determine FETAL POSITION
The reference point is always relative to the OCCIPUT
Whereever the fetal occiput is, name the position for where it points:
eg: Occiput is toward the left on a horizontal angle…LOT (left occiput transverse)
How does an epidural affect the time it takes for delivery?
And epidural usually extends the duration of labor by an hour
What are the 7 cardinal movements of labor?
Engagement
Descent
Flexion
Internal rotation
Extension
External rotation
Expulsion
“Every Descent Family In England Eats Eggs”
What is an episiotomy?
Surgical incision to assist in delivery
What is the modified ritgen maneuver?
Method of delivering baby
(Fingers of the right hand are used to extend the head while counterpressure is applied to the occiput by the left hand to allow for a more controlled delivery)
Describe what the following perineal lacerations involve:
First degree
Second degree
Third degree
Fourth degree
First degree = Superficial
Second degree = Extends to muscles of perineal body, does NOT involve anal sphincter
Third degree = Extends into or through anal sphincter but NOT rectal mucosa
Fourth degree = Involves rectal mucosa
When is a retained placenta diagnosed?
If placenta has not been delivered within 30 MINUTES
What are contraindications to INDUCTION of labor?
Unstable fetal presentation
Acute fetal distress
Placental previa or vasa previa
Previous classical C-section
HIV w/ high viral load
What is the bishop score?
Assesses how favorable a cervix is for delivery
0= least favorable
13= most favorable
Bishop score <6 is unfavorable
Bishop score >8 favorable
What is the most commonly used cervical ripening agent?
Cervidil (DINOPROSTONE)
Vaginal insert, easy to remove
What is the only FDA approved drug for both INDUCTION and AUGMENTATION?
Pitocin
(synthetic oxytocin)
