Ex1 OB 1 Part 2 Flashcards
gravid
pregnant
gravidity
total # of pregnancies (abnormal or normal)
parity
state of having given birth to an infant or infant > 500g+, alive or dead
Abortion
expulsion or extraction of placenta + products of conception weighing < 500g
Mom gave birth to triplets. What is her G/P?
G1P1
G3P1A1
3 pregnancies including the current pregnancy
Previously given birth to 1 infant
Previously experienced loss of embryo or fetus < 500g
After delivery of G3P1A1
G3P2A1
Maternal description used by OB
GTPAL
GTPAL: G stands for
total # pregnancies
GTPAL: T stands for
Full term pregnancies (37-40 weeks)
GTPAL: P stands for
preterm deliveries (20-36 weeks)
GTPAL: A stands for
abortions + miscarriages (before 20 weeks)
GTPAL: L stands for
living children
G4,P2,0,1,2
This is her 4th pregnancy, she’s had 2 term pregnancies, no preterm, 1 miscarriage and 2 live babies.
human conceptus from fertilization through the 8th week of pregnancy
Embryo
human conceptus from the 8th week until delivery
fetus
gestational age
estimated age of fetus *calculated from 1st day of last (normal) menstrual period (LMP), assuming 28-day cycle
neonate descriptions
Clinically viable
Immature infant
Premature infant
Clinically viable neonate
gestational age: 23-24w
+
Weight > 600g
Immature infant
completed 20-27+6 weeks
+
Weight = 500-1000g
Premature infant
Gestation: 28-36+6weeks
+
Weight = 1,000-2,500g
When is an infant considered full term?
37 weeks
Preterm infant
born prior to the 37th week of gestation (259 days)
mature infant
a live-born infant who has 37 weeks of gestation and usually weighs over 2,500 g
post mature infant
one who has completed 42 weeks of gestation or more
low birth weight infant
any live-born infant weighing 2,500 g or less
small-for-date infant
under grown infant who is significantly undersize (< 2 SD) for the period of gestation
oversize infant
> 4,000g
excessive size infant
macrosomia ( > 4,500g)
delivery
mode of expulsion of fetus + placenta
baby dropped also means
lightening: settling of fetal head into brim of pelvis
lightening occurs
> 2 weeks before labor in first pregnancy
-may not occur in women with previous deliveries until early labor
s/s lightening
Flattening of upper abdomen may be noticed, along with decreased heart burn and shortness of breath, but increased pelvic discomfort + frequent urination
irregular, painless uterine contractions which occur w/ slowly increasing frequency during last 4-8weeks
braxton-hicks contractions
braxton hicks contractions during early 3rd trimester
must be distinguished from true labor
braxton hicks contractions in late 3rd trimester
common cause of “false labor”
do cervical changes occur with braxton hicks?
no
cervical changes seen around labor
cervical softening, effacement, dilation
-occur days-weeks before true onset of labor
cervix is how dilated when labor starts?
Often 1-3cm
Significant event that occurs prior to labor
bloody show
bloody show
- full cervical effacement, canal completely obliterated, bloody mucus plug w/in canal released
- 1week to 1 hour prior to true labor
Labor begins when
Braxton Hicks contractions increase in:
- Strength (25-60 mmHg)
- Coordination
- Frequency (15-20 min apart)
How is labor divided?
3 stages
First stage of labor
interval between onset of labor + full cervical dilation; divided into 2: latent + active phase
Second stage of labor
interval between full cervical dilation + delivery of infant
Third stage of labor
period between delivery of infant + delivery of placenta
First stage of labor: length of time
nulliparous: 8-12h
multiparous: 5-8h
Latent Phase of labor
- 1st stage of labor
- Variable duration in which progressive cervical effacement and minor dilation (2-3 cm) occurs
Active phase of labor
More frequent contractions (3-5 min apart) which last up to 1 minute in duration
Leads to progressive cervical dilation up to 10 cm
when does mom feel a desire to bear down?
Second stage of labor, with each contraction
how is progress of 2nd stage of labor measured?
Descent of fetal head in relation to mom’s ischial spines
Stations: -3 to +3
Contractions during second stage of labor occur how often + last how long?
1.5-2 minutes apart
Last 1-1.5minutes
Average length of second stage of labor
primigravid women: 30m-3h
multigravid: 5-30m
3rd stage of labor usually lasts how long?
2-10 minutes on average
up to 30min
Why do we tell mom to take slow, deep breaths during delivery?
Hypocarbia can cause uterine vasoconstriction –> decreases placental perfusion –> risk to fetus (promotes fetal acidosis)
Which time period puts mom at highest risk for cardiomyopathy?
Immediately after delivery - CO is maximal (+80% above prelabor values)
tocodynamometer
transducer that measures uterine contractions/activity
Normal fetal heart rate
120-160 bpm
increased baseline FHR may be due to
- prematurity
- mild fetal hypoxia
- chorioamnionitis
- maternal fever
- maternally administered drugs
- hyperthyroidism
decreased baseline FHR may be due to
- post term pregnancy
- fetal heart block
- fetal asphyxia
baseline variability
interplay between sympathetic (acceleration) + parasympathetic (deceleration) nervous systems which creates a baseline variability in heart rate (difference in the beat-to-beat intervals resulting in variability of the fetal heart rate tracing)
Baseline variability is measured how
beat-to-beat from R wave to R wave
Minimal variability
< 5 bpm
Moderate variability
6-25 bpm
Marked variability
> 25 bpm
What is considered normal variability in the fetus?
Moderate variability (6-25 bpm)
single most important indicator of an adequately oxygenated fetus
Variability
Prominent sign of fetal asphyxia
Sustained decreased baseline variability
What is meant by a flat strip?
Bad Variability
*may need C/S if other options don’t work
Accelerations in FHR
-increases of 15 bpm or+
Lasting > 15s
FHR accelerations occurring periodically
normal oxygenation, related to fetal movement + response to uterine movement
Normal fetuses have ____ accelerations
15-40 accelerations per hour
FHR Accelerations decrease with
- fetal sleep
- drugs (opioids, magnesium, atropine)
- fetal hypoxia
Loss of variability may be d/t
anticholinergic block (atropine) bc fetal tachycardia
“wake up the baby”
OB RN may rock the mothers abdomen or have her move in bed.
- press on baby’s head thru cervix w/ finger
- give mom fluids/bolus
nonreassuring patterns
absence of both baseline variability + acceleration
-may be s/s fetal compromise
Early decelerations
- concomitantly with uterine contractions + provide mirror image on graphic monitoring
- head compression
- 20beats or less than FHR baseline
- does not req. intvn
late decelerations
- occur 10-30s after onset of uterine contraction
- resolve 10-30s after contraction has ended
late decelerations are caused by
decrease in uterine blood flow during contraction which leads to fetal hypoxia
*vigorous efforts should be made to eliminate late decels!
late decelerations tx
- correct moms HOTN
- ensure adequacy of left uterine displacement
- admin of O2 via face mask to mom
if late decels are not able to be corrected, what is next option?
emergency C/S
prolonged deceleration
*very bad.
drop of more than 30bpm, lasts for longer than 2minutes
If a prolonged deceleration occurs, what should you expect?
If no epidural –> prepare for GETA
variable decelerations are associated with
umbilical cord compression
or
decreased umbilical blood flow
prolonged variable deceleration
> 30 minutes
Severe variable deceleration
decrease of 60 bmp from baseline
OR
any FHR < 70 bmp for > 60s
-may require emergency delivery
Category I FHR tracing
- Normal = no management required
- Baseline FHR 110-160 bmp
- Moderate baseline variability
- No late or variable decels
- Early decels may be present or absent
- Accelerations may be present or absent
Vagal stimulation of baby
head compression or stretching of neck during uterine contractions
indeterminate
all tracings that are not Category I or III
Category II FHR tracing
“Indeterminate”
Fetal tachycardia, absence of accelerations after stimulation, prolonged decels > 2 min but < 10 min
Not predictive of abnormal fetal acid-base balance
Require continued monitoring + reevaluation
Category III FHR Tracing
Abnormal and associated with abnormal fetal acid-base balance at the time of observation
Sinusoidal FHR patter, absent variability, recurrent late decels, bradycardia
Require prompt intervention
Category III FHR Intvn
Intrauterine resuscitation with change in maternal position, discontinuation of labor augmentation, treatment of maternal hypotension, supplemental O2
If FHT does not improve, emergency Cesarean section
Cord compression usually seen during ______
2nd stage of labor
mnemonic for FHR
VEAL CHOP
VEAL CHOP
Variable::cord compression
Early::head compression
Acceleration::Ok
Late::Placental insufficiency
