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Midwifery > Intrapartum > Flashcards

Intrapartum Flashcards

1
Q

Increased rate of low birth weight babies is born to which ethnicity?

A

African American

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2
Q

The anatomic part of the fetus that first descends into the pelvis is what?

A

Presenting part

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3
Q

The relationship between the denominator of the presenting part and the maternal pelvis is what?

A

Position

Cephalic, breech, shoulder, face

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4
Q

If a woman has suspected ROM, frank bleeding or inspection for herpetic lesions is necessary, what would you do prior to a digital examination?

A

Sterile speculum exam

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5
Q

What are the 4 P’s of labor?

A

Power of contractile efforts
Passenger
Passageway
Psyche

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6
Q

When the saggital suture is closer to the symphysis pubis, which asynclitism is that?

A

Posterior

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7
Q

When the saggital suture is closer to the sacrum, which asynclitism is that?

A

Anterior (think about there being an A in both Anterior and sAcrum)

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8
Q

Latent labor is when?

A

Onset of labor until 6cm

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9
Q

Active labor is when?

A

6-10cm

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10
Q

What is considered adequate labor when a woman has an IUPC placed?

A

200-250 MVU’s in a 10 minute period averaged over 30 minutes

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11
Q

An abnormal latent phase is more than how many hours in labor (for nullipara and multipara)?

A

Nullipara >20 hours

Multipara >14 hours

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12
Q

An abnormal active phase is more than how many hours in labor (for nullipara and multipara)?

A

Nullipara >12

Multipara >6

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13
Q

A diagnosis of prolonged active phase is made when the cervix dilates < __/hr over ___ hours OR there is a complete cessation of cervical dilation over ____ hours.

A

<0.5cm/hr, 4 hour

2 hour

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14
Q

Maternal fever, infection, chronic fetal hypoxia and excessive fetal movement can all cause what in regards to FHR?

A

Tachycardia

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15
Q

Cord compression, rapid descent, vagal stimulation, anesthesia/medications and placental insufficiency can all cause what in regards to FHR?

A

Bradycardia

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16
Q

In regards to the FHR, what is a sign of fetal well being and cannot be produced by an acidotic fetus?

A

Accelerations

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17
Q

The onset to nadir of a variable deceleration is

A

<30 seconds

15 seconds-2 minutes

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18
Q

Cardinal movements?

A

Every- engagement, darn- descent, fellow- flexion, in- internal rotation, Egypt- extension, really- restitution, eats- external rotation, dates-delivery

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19
Q

A 3A perineal laceration is when?

A

<50% of external anal sphincter torn

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20
Q

A 3B perineal laceration is when?

A

> 50% of external anal sphincter torn

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21
Q

A 3C perineal laceration is when?

A

Both the external anal sphincter and internal anal sphincters are torn

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22
Q

A fourth degree laceration includes both internal/external sphincters along with tearing of what?

A

The rectal mucosa

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23
Q

What are the three parts of active management of the third stage?

A

Controlled cord traction, use of uterotonic agent, fundal massage after delivery of placenta

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24
Q

What are the four signs of placental separation?

A

Sudden increase in vaginal bleeding, lengthening of umbilical cord, uterine change in shape and uterus rises in abdomen

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25
Q

What is the IM dose of methergine to be given PP if needed? Who is it contraindicated in?

A

0.2mg IM every 2 to four hours

Women with hypertension

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26
Q

What is the IM dose of Hemabate to be given PP if needed? Who is it contraindicated in?

A

250mcg

Women with asthma

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27
Q

When the cord is inserted into the fetal sac and not directly into the placental bed, it is called what?

A

Velamentous cord insertion

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28
Q

What is battledore cord insertion?

A

Peripheral cord insertion, otherwise called marginal insertion

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29
Q

Which calcium channel blocker which acts as a non specific muscle relaxant is used as a tocolytic in PTL?

A

Nifedipine

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30
Q

What is the standard dosing of betamethasone for lung maturity and how long should you attempt to delay birth after administration?

A

12mg IM in two doses 24 hours apart

Delay until 24 hours post administration

31
Q

A marginal placenta previa is when the edge of the placenta is within ____cm of cervical os.

A

1 cm

32
Q

What is the most common type of breech presentation?

A

Frank breech

33
Q

Adherence to myometrium due to partial or total absence of decidua is placenta _______?

A

Accreta

34
Q

Further extension into the myometrium with penetration into the uterine wall is placenta _______?

A

Increta

35
Q

Further extension through the uterine wall to the serosa layer is placenta ________?

A

Percreta

36
Q

What is the largest group of muscles in the musculature?

A

Levator Ani

37
Q

What is the cardinal movement responsible for the birth of the fetal head in the cephalic position?

A

Extension

38
Q

The most favorable diameter of the fetal head to present in labor is the _____.

A

suboccipitobregmatic

39
Q

What is the most common position the fetus enters the pelvis for birth?

A

LOA

40
Q

What medication do you treat a woman with that is GBS positive and has a true PCN allergy?

A

Vancomycin

41
Q

Which mechanism of labor (MOL) brings the AP diameter of the fetal head into alignment with the AP diameter of the maternal pelvis?

A

Internal rotation

42
Q

Which MOL occurs with the biparietal diameter of the fetal head has passed through the pelvic inlet?

A

Engagement?

43
Q

Which MOL is essential to further descent once engagement as occurred and is where the smaller suboccipitobregmatic diameter becomes the widest fetal head diameter that traverses the maternal pelvis?

A

Flexion

44
Q

Flexion occurs as the fetal head meets _____.

A

Resistance

45
Q

Which MOL occurs throughout labor and is a requisite to and occurs simultaneously with the other cardinal movements?

A

Descent

46
Q

Rotation of the head 45 degrees turning the head back to where it is at a right angle with the shoulders is which MOL?

A

Restitution

47
Q

Which MOL occurs as the fetus’ shoulders rotate 45 degrees causing the head to rotate another 45 degrees?

A

External rotation

48
Q

The birth of the head occurs by which MOL in OA births?

A

Extension

49
Q

An arbitrarily chosen point on the presenting part of the fetus that is used to describe fetal position is called what?

A

Denominator

50
Q

What is the denominator for vertex, breech and face?

A

Occiput
Sacrum
Mentum/Chin

51
Q

Pre eclampsia without SF and gestational HTN patients should be induced at what gestation?

A

37 weeks

52
Q

Pre e with SF patients should be induced at what gestation?

A

34 weeks

53
Q

Chronic HTN patients should be induced at what gestation?

A

38 weeks

54
Q

Three of the smallest diameters of the fetal head are?

A

Suboccipitobregmatic, submentobregmatic and biparietal diameter, all 9.5cm

55
Q

The occipitomental diameter is how big?

A

12.5 cm

56
Q

The occipitofrontal diameter is how big?

A

11.5 cm

57
Q

When the cephalic prominence is felt on the same side as the fetal small parts, the head is ______.

A

flexed

58
Q

When the cephalic prominence is felt on the same side as the fetal back, the head is ______.

A

extended

59
Q

When the cephalic prominence is not palpable on one side or the other, it is often called _______.

A

Military attitude

60
Q

Medications such as Procardia XL, terbutaline, magnesium sulfate and Indocin do what to the uterus?

A

Relax it

61
Q

Medications such as cytotec and pitocin do what to the uterus?

A

Contract it

62
Q

What hormone initiates labor?

A

Prostaglandins

63
Q

What bishops score is considered favorable and unfavorable?

A

<4 unfavorable

> 6 favorable

64
Q

Intermittent auscultation can occur how often in the active phase of labor?

A

every 15-30 minutes

65
Q

A prolonged second stage is what for nullip (unmedicated/epidural) and multip (unmedicated/epidural)?

A

4 hours, epidural nullip
3 hours, unmedicated nullip
3 hours, epidural multip
2 hours, unmedicated multip

66
Q

What is the most common cause of protracted descent in the 2nd stage?

A

Persistent OP position

67
Q

What is the most common sign of uterine rupture?

A

Fetal distress

68
Q

What can you do during a shoulder dystocia to flatten out the sacrum and rotate the symphysis pubis superiorly?

A

McRoberts maneuver

69
Q

How long does it take lidocaine to take effect?

A

2-5 minutes

70
Q

What are the guidelines for intermittent auscultation during the second stage?

A

every 5-15 minutes

71
Q

What causes pain in the second stage of labor?

A

pressure on the bony pelvis, urethra, bladder, and rectum

72
Q

What is the most favorable diameter of the fetal head to present in labor?

A

suboccipitobregmatic

73
Q

What is the most common position in which the fetus enters the pelvis for birth?

A

LOA

Midwifery (10 decks)

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