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Intrapartum Flashcards

1
Q

face presentation with chin towards mother’s symphysis

A

mentum anterior (MA)

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2
Q

face presentation with chin towards mother’s perineum

A

mentum posterior (MP)

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3
Q

face presentation that makes vaginal birth very unlikely

A

mentum posterior (MP)

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4
Q

inlet with a short anteroposterior diameter and a wide transverse diameter is characteristic of this pelvic type

A

platypelloid

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5
Q

first portion of the fetus to enter to pelvis is the:

A

presentation

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6
Q

occurs as the result of the untwisting of the neck after birth of the head

A

Restitution

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7
Q

positional changes the fetus undergoes to accommodate itself to the maternal pelvis

A

mechanisms of labor

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8
Q

BPD has passed through the inlet

A

engagement

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9
Q

top of the head is at the level of the ischial spines

A

engagement

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10
Q

To determine the position of the fetus you would, identify the:

A

sagittal suture

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11
Q

Three types of presentation:

A

breech, shoulder, cephalic

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12
Q

evidence is conflicting on whether epidurals increase risk of:

A

C/S

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13
Q

___-___% of women with epidurals develop fevers

A

11-14%

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14
Q

According to Friedman, active labor is defined as the point when:

A

rate of cervical dilation increases sharply

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15
Q

According to Friedman, prolonged latent phase labor is defined as > ___ hrs in nulliparous and > ___ hrs multiparous women

A

> 20 hrs in nulliparous and > 14 hrs multiparous women

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16
Q

Active labor begins when the:

A

RATE of cervical dilation sharply increases.

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17
Q

medication usually used for early labor rest since other medications such as sleeping pills have no pain relieving properties.

A

Narcotic analgesics (morphine)

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18
Q

Friedman’s criteria for normal latent phase for nulliparas

A

< 20 hrs

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19
Q

Friedman’s criteria for normal active phase for nulliparas

A

1.2 cm/hr

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20
Q

Friedman’s criteria for normal latent phase for multiparas

A

< 14 hrs

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21
Q

Friedman’s criteria for normal active phase for multiparas

A

1.5 cm/hr

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22
Q

Friedman’s criteria for arrest of 1st stage (latent + active) of labor

A

no progress x 2 hrs

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23
Q

Friedman’s criteria for normal 2nd stage for nulliparas

A

1 cm/hr descent

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24
Q

Friedman’s criteria for normal 2nd stage for multiparas

A

2 cm/hr descent

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25
Q

Friedman’s criteria for arrest of 2nd stage of labor

A

no progress x 1 hr

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26
Q

Contemporary research normal progress of active labor

A

0.5 cm/hr

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27
Q

Contemporary research on diagnosing and managing slow labor does not provide clear recommendations for:

A

appropriate timing of interventions

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28
Q

narcotic used in labor with the longest half-life

A

Demerol

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29
Q

reflex that results in a surge of oxytocin that enhances contraction strength and pushing effectiveness in second stage labor

A

Ferguson Reflex

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30
Q

evidence-based technique for perineal management during birth that decreases or minimizes genital tract trauma is:

A

working with the woman to facilitate a gentle, controlled birth of the baby.

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31
Q

prenatal perineal massage will reduce risk of genital tract trauma…T or F?

A

true

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32
Q

max dose of Hemabate during severe PPH

A

8 doses q15 min

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33
Q

Pit should never be given IV because:

A

it can cause severe hypotension

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34
Q

dosage/route for Hemabate

A

250 mcg IM

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35
Q

1st line medication for PPH

A

Pitocin

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36
Q

Pitocin can cause this adverse effect

A

water intoxication

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37
Q

dosage range for Cytotec

A

600-1000 mcg

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38
Q

SE of Cytotec:

A

maternal fever + shivering

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39
Q

2nd line med for GBS prophylaxis for patient with Low Risk PCN allergy

A

Cefazolin 2 gm loading dose then…

1 gm q8 hrs

40
Q

2nd line med for GBS prophylaxis for patient with High Risk PCN allergy

A

Request clindamycin susceptibility on GBS swab culture
Susceptible: clindamycin 900 mg q 8 hrs
Resistant: Vancomycin 20 mg/kg q8 hrs (max 2 gm)

41
Q

Dosage for Procardia for PTL

A

20-30 mg PO in divided doses

Then…10-20 mg PO q3-8 hrs

42
Q 
SE of \_\_\_\_\_\_\_\_\_\_:
**peripheral vasodilator**
transient nausea
flushing
HA
palpitations
dizziness
hypotension
tachycardia
43
Q

Do not give Procardia with these meds:

A

terb or MgSO4

44
Q 
Contraindications for \_\_\_\_\_\_\_\_\_\_:
preload-dependent cardiac disorder
left ventricular dysfunction
congestive heart failure
hemodynamic instability
45
Q

Dosage of Indocin for PTL

A

50-100 mg loading dose PO or rectally

Then…25-50 mg PO q6 hrs x 48 hrs

46
Q 
SE of \_\_\_\_\_\_\_\_\_:
GI: N+V
reflux
gastritis
platelet dysfunction
47
Q

Fetal Effects of ________:
premature closing of ductus arteriosus
oligohydramnios

48
Q 
Contraindications for \_\_\_\_\_\_\_\_\_:
platelet dysfunction
bleeding diathesis
hepatic dysfunction
GI ulcerative dx
asthma (if sensitive to ASA)
> 48 hrs of use
> 32 wks gestation
49
Q

Dosage of MgSO4 for PTL

A

Loading dose 4-6 gm IV over 20-30 min

Then…2 gm/hr IV infusion

50
Q

MOA of ________:

COX inhibitor that reduces prostaglandin production by COX

51
Q

MOA of _______:

Unknown but probably competes with Ca+ at cell membrane which reduces Ca+ available for myometrial ctx

52
Q 
SE of \_\_\_\_\_\_\_\_\_\_\_:
flushing
nausea
blurred vision
HA
lethargy
muscle weakness
hypotension
Rare: pulmonary edema, respiratory/cardiac arrest
53
Q

Fetal Effects of __________:
neuroprotective
decreased FHR variability
decreased neonatal tone

54
Q 
Contraindications for \_\_\_\_\_\_\_\_\_\_\_:
impaired renal function
myasthenia gravis
cardiac conduction defects
toxicity: loss of patellar reflex, decreased urine output, respiratory rate < 12 (risk increases w/ creatinine > 1.0)
55
Q

MOA of __________:
beta-agonist binds to beta-2 receptors causing chain reaction resulting in depletion of intracellular Ca+ thereby blocking myometrial receptors (can become desensitized w/ prolonged use thereby diminishing effectiveness)

56
Q

Dosage for Terb

A

0.25 mg SQ q20-30 min (max 4 doses)
Then…0.25 mg SQ q3-4 hrs
*May be given by continuous IV infusion

57
Q 
SE of \_\_\_\_\_\_\_\_\_\_:
tachycardia
peripheral vasodilation
hypotension
bronchial relaxation
pulmonary edema
hyperglycemia
MI
58
Q

Fetal Effects of _______:
tachycardia
neonatal hypoglycemia

59
Q 
Contraindications for \_\_\_\_\_\_\_\_\_\_\_:
cardiac disease
HTN
poorly controlled DM/GDM
Caution in PPH
> 72 hrs
Do not give PO
60
Q

ACOG states ____ may be used for short term inpatient use for PTL

61
Q 
Symptoms of \_\_\_\_\_\_\_\_\_\_:
Diffuse swelling
swelling appears to shift independent of movement
unresponsive
thready pulse rate of 180
shallow rapid respiration
pale, cool skin.
A

subgaleal hemorrhage

62
Q

Order of Cardinal Movements (DFIERE)

A 
Descent
Flexion
Internal Rotation
Extension 
Restitution
External Rotation
63
Q

denominator for breech presentation

64
Q

bony landmark on the presenting part used to denote the position of a fetus

A

denominator

65
Q

anterior parietal bone (meaning the parietal bone that is in the anterior part of the pelvis) descends first and the sagittal suture is closest to the sacrum

A

anterior asynclitism

66
Q

posterior parietal bone (meaning the parietal bone that is in the posterior part of the pelvis) descends first and the sagittal suture is closest to the symphysis pubis

A

posterior asynclitism

67
Q

abrupt decrease in FHR of >15 bpm lasting > 15 sec and < 2 min

A

variable decel

68
Q

the most favorable diameter of the head to present in labor

A

suboccipitobregmatic

69
Q

most common position for fetus to enter pelvis for birth

70
Q

BP should be assessed q____ min in 2nd stage

71
Q

optimal timing for administration of pudendal anesthesia in a multiparous woman

A

just prior complete dilation

72
Q

largest group of muscles in the pelvic musculature

A

levator ani

73
Q

FHR variability is controlled by:

A

autonomic (parasympathetic/sympathetic) nervous system

74
Q 
Risk Factors for \_\_\_\_\_\_\_\_\_\_\_\_:
maternal obesity
excessive weight gain
late term/post term gestation
GDM
fetal macrosomia (>4000 gm)
precipitous 2nd stage
operative vag delivery
prolonged 2nd stage (increased risk of forceps/vacuum)
A

Shoulder Dystocia

75
Q

Risk Factors for ____________:

preterm birth

A

Retained Placenta

76
Q

Order of medications for PPH (ACOG):

A

Pitocin 10-40 units IM; up to 60 units IV
Methergine 0.2 mg IM q2-4 hrs (if BP normotensive)
Hemabate 250 mcg q15-90 min up to 8 doses (DO NOT give to asthma pt.)
Cytotec 600-1000 mcg x 1 dose PO, SL or rectally

77
Q

Hemodynamic changes in initial PP period:

A

elevated cardiac output (60-80%) up to 48 hrs after birth

78
Q 
Risk Factors for \_\_\_\_\_\_\_\_\_\_\_\_:
preterm birth
hx uterine curettage
preeclampsia
augmented labors
birth in dorsal position
nulliparity
use of Methergine
A

Retained Placenta

79
Q

Steps for Shoulder Dystocia:

A 
McRoberts position
Suprapubic pressure
Rubin's maneuver
Delivery of posterior arm
Gaskin maneuver
Woods' Screw (Rotational) maneuver
Zavanelli maneuver
80
Q

Length of time before transferring to OR for shoulder dystocia:

81
Q

Length of 3rd stage should be less than ____ min

82
Q

at the onset of labor, ___________ invade the myometrium, cervix, chorio-decidua, and amnion

A

leukocytes

83
Q

pulses of oxytocin occurs ___x per 30 min in 1st stage and ___x per 30 min in 2nd stage

A

4x per 30 min in 1st stage and 7x per 30 min in 2nd stage

84
Q

restitution is rotation of the fetal head ____ degrees to left or right

85
Q

External rotation allows the bisacromonial diameter to align with the _________ diameter of the outlet

A

anteroposterior

86
Q

birth of the shoulders occurs by ___________ to accomodate the Curve of Carus

A

lateral flexion

87
Q

birth of the shoulders occurs by ___________ to accommodate the Curve of Carus

A

lateral flexion

88
Q

deep, somatic pain is usually:

A

dull, aching

89
Q

superficial somatic pain is usually:

90
Q

physiological urge to push occurs at station:

91
Q

Friedman’s average length of 2nd stage for nullipara

92
Q

Friedman’s average length of 2nd stage for multipara

93
Q

fFN is not typical between ___-___ wks gestation

A

24 & 34 wks

94
Q

90% of placentas are spontaneously expelled within ___ min of birth

95
Q

maternal position that makes cord traction contraindicated

A

upright/squatting

Comps (6 decks)

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