Cook Lecture Flashcards
Rule used to date pregnancy
Nadgele’s Rule
what does gravida refer to?
of pregnancies
what does parity refer to?
of births
How do you calculate EDD?
count back 3 months from LMP + 7 days
How does pseudo-gestational sac differ from the actual gestational sac?
lacks echogenic rim
can shape during exam
located in middle of uterine cavity
What two things are diagnostic of IUP?
yolk sac and embryo
what do you screen for at 15-24 weeks?
neural tube defects, trisomy 21, fetal anomalites, short cervix
what do you screen and administer at 24-28 weeks?
gestational DM and anemia
give anti-D immmune globin to Rh(-)
what do you screen for and administer at 28-36 weeks?
STI, GBS (35-37 wks), fetal growth restriction (fundal height), non-cephalic presentations
give T-dap and flu vaccine
what is the “power”?
uterine contractions (frequency, duration, intensity)
in the active phase of labor what is the normal frequency of contractions?
2-5 min
how do you calculate the size of the fetus?
Leopold maneuvers or US
Fetal macrosomnia is fetal size of
4500 g or greater
Lie refers to
axis of baby
Presentation refers to
fetal part over pelvic inlet (cephalic, breech, shoulder)
Attitude refers to
degree of flexion or extension of the head
Flexion of the fetal head is important for
engagement
What does synclitism refer to?
parallelism between the planes of the fetal head and the maternal pelvis
“frontom”
brow
“mentum”
face
“breech”
sacrum
“cephalic”
occiput
what does station refer to?
distances from ischial spine to outlet
what is considered a fully dilated cervix?
10 cm
what is effacement?
thickness of cervix → given as percentage
What is the reference point for station?
0 @ ischial spines
at what cervical dilation does the birthing process speed up?
~6 cm
How can epidural affect labor?
MAY prolong 2nd stage by 15 min or so
T or F: it matter when a woman receives epidural during labor
False → no difference in whether you get in latent vs active phase
5 components of fetal heart tracings
baseline, variability, acceleration, decelerations, contractions
normal fetal heart range
110-160
If there is moderate FHR variabilty, what does this proove?
baby is not acidotic
If there is no variability what does this say about the baby?
nothing → may or may not be acidotic
what is considered moderate FHR variability?
6-25 beats around baseline
what is significant about marked FHR variability?
unclear about acidosis
what is an acceleration on external fetal monitoring?
15 beat increase above baseline for 15 seconds
early decelerations on external fetal monitoring indicate
uterine contraction → head compression → vagal stimulation → heart rate slows
late decelerations on external fetal monitoring indicate
utero-placental insufficiency
variable decelerations on external fetal monitoring indicate
umbilical cord compression
EFM for 20 minutes showing baseline between 110-160 with 2 accelerations (15 seconds above baseline for at least 15 seconds each)
reactive
6 B’s of postpartum HPI
baby, bleeding, breast/bottle feeding, birth control, bowel/bladder function, boinking
Definition of postpartum hemorrhage
> 500 cc vaginal
> 1000 cc C-section
Causes of postpartum hemorrhage
Uterine atony genital tract trauma retained products of conception abnormal placentations coagulation abnormalities [Tone, Trauma, Tissue, Thrombin]
sign that may indicate shoulder dystocia or impaction of posterior fetal shoulder on the sacral promontory
turtle sign
risk factors for shoulder dystocia
maternal obesity, DM, multiparity, posterm gestation, history of macrosomic birth and shoulder dystocia, labor induction, epidural, operative vaginal delivery
what is a C section?
birth via laparotomy + hysterotomy
what are some indications for C- section?
breech, abnormal placenta, hx of uterine incision, non reassuring FHT, arrest of labor
