Cook Lecture

Question 1

Rule used to date pregnancy

Answer 1

Nadgele’s Rule

Question 2

what does gravida refer to?

Answer 2

of pregnancies

Question 3

what does parity refer to?

Answer 3

of births

Question 4

How do you calculate EDD?

Answer 4

count back 3 months from LMP + 7 days

Question 5

How does pseudo-gestational sac differ from the actual gestational sac?

Answer 5

lacks echogenic rim
can shape during exam
located in middle of uterine cavity

Question 6

What two things are diagnostic of IUP?

Answer 6

yolk sac and embryo

Question 7

what do you screen for at 15-24 weeks?

Answer 7

neural tube defects, trisomy 21, fetal anomalites, short cervix

Question 8

what do you screen and administer at 24-28 weeks?

Answer 8

gestational DM and anemia

give anti-D immmune globin to Rh(-)

Question 9

what do you screen for and administer at 28-36 weeks?

Answer 9

STI, GBS (35-37 wks), fetal growth restriction (fundal height), non-cephalic presentations
give T-dap and flu vaccine

Question 10

what is the “power”?

Answer 10

uterine contractions (frequency, duration, intensity)

Question 11

in the active phase of labor what is the normal frequency of contractions?

Answer 11

2-5 min

Question 12

how do you calculate the size of the fetus?

Answer 12

Leopold maneuvers or US

Question 13

Fetal macrosomnia is fetal size of

Answer 13

4500 g or greater

Question 14

Lie refers to

Answer 14

axis of baby

Question 15

Presentation refers to

Answer 15

fetal part over pelvic inlet (cephalic, breech, shoulder)

Question 16

Attitude refers to

Answer 16

degree of flexion or extension of the head

Question 17

Flexion of the fetal head is important for

Answer 17

engagement

Question 18

What does synclitism refer to?

Answer 18

parallelism between the planes of the fetal head and the maternal pelvis

Question 19

“frontom”

Answer 19

brow

Question 20

“mentum”

Answer 20

face

Question 21

“breech”

Answer 21

sacrum

Question 22

“cephalic”

Answer 22

occiput

Question 23

what does station refer to?

Answer 23

distances from ischial spine to outlet

Question 24

what is considered a fully dilated cervix?

Answer 24

10 cm

Question 25

what is effacement?

Answer 25

thickness of cervix → given as percentage

Question 26

What is the reference point for station?

Answer 26

0 @ ischial spines

Question 27

at what cervical dilation does the birthing process speed up?

Answer 27

~6 cm

Question 28

How can epidural affect labor?

Answer 28

MAY prolong 2nd stage by 15 min or so

Question 29

T or F: it matter when a woman receives epidural during labor

Answer 29

False → no difference in whether you get in latent vs active phase

Question 30

5 components of fetal heart tracings

Answer 30

baseline, variability, acceleration, decelerations, contractions

Question 31

normal fetal heart range

Answer 31

110-160

Question 32

If there is moderate FHR variabilty, what does this proove?

Answer 32

baby is not acidotic

Question 33

If there is no variability what does this say about the baby?

Answer 33

nothing → may or may not be acidotic

Question 34

what is considered moderate FHR variability?

Answer 34

6-25 beats around baseline

Question 35

what is significant about marked FHR variability?

Answer 35

unclear about acidosis

Question 36

what is an acceleration on external fetal monitoring?

Answer 36

15 beat increase above baseline for 15 seconds

Question 37

early decelerations on external fetal monitoring indicate

Answer 37

uterine contraction → head compression → vagal stimulation → heart rate slows

Question 38

late decelerations on external fetal monitoring indicate

Answer 38

utero-placental insufficiency

Question 39

variable decelerations on external fetal monitoring indicate

Answer 39

umbilical cord compression

Question 40

EFM for 20 minutes showing baseline between 110-160 with 2 accelerations (15 seconds above baseline for at least 15 seconds each)

Answer 40

reactive

Question 41

6 B's of postpartum HPI

Answer 41

baby, bleeding, breast/bottle feeding, birth control, bowel/bladder function, boinking

Question 42

Definition of postpartum hemorrhage

Answer 42

> 500 cc vaginal | > 1000 cc C-section

Question 43

Causes of postpartum hemorrhage

Answer 43

``` Uterine atony genital tract trauma retained products of conception abnormal placentations coagulation abnormalities [Tone, Trauma, Tissue, Thrombin] ```

Question 44

sign that may indicate shoulder dystocia or impaction of posterior fetal shoulder on the sacral promontory

Answer 44

turtle sign

Question 45

risk factors for shoulder dystocia

Answer 45

maternal obesity, DM, multiparity, posterm gestation, history of macrosomic birth and shoulder dystocia, labor induction, epidural, operative vaginal delivery

Question 46

what is a C section?

Answer 46

birth via laparotomy + hysterotomy

Question 47

what are some indications for C- section?

Answer 47

breech, abnormal placenta, hx of uterine incision, non reassuring FHT, arrest of labor