Intrapartum Flashcards
Increased rate of low birth weight babies is born to which ethnicity?
African American
The anatomic part of the fetus that first descends into the pelvis is what?
Presenting part
The relationship between the denominator of the presenting part and the maternal pelvis is what?
Position
Cephalic, breech, shoulder, face
If a woman has suspected ROM, frank bleeding or inspection for herpetic lesions is necessary, what would you do prior to a digital examination?
Sterile speculum exam
What are the 4 P’s of labor?
Power of contractile efforts
Passenger
Passageway
Psyche
When the saggital suture is closer to the symphysis pubis, which asynclitism is that?
Posterior
When the saggital suture is closer to the sacrum, which asynclitism is that?
Anterior (think about there being an A in both Anterior and sAcrum)
Latent labor is when?
Onset of labor until 6cm
Active labor is when?
6-10cm
What is considered adequate labor when a woman has an IUPC placed?
200-250 MVU’s in a 10 minute period averaged over 30 minutes
An abnormal latent phase is more than how many hours in labor (for nullipara and multipara)?
Nullipara >20 hours
Multipara >14 hours
An abnormal active phase is more than how many hours in labor (for nullipara and multipara)?
Nullipara >12
Multipara >6
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.
<0.5cm/hr, 4 hour
2 hour
Maternal fever, infection, chronic fetal hypoxia and excessive fetal movement can all cause what in regards to FHR?
Tachycardia
Cord compression, rapid descent, vagal stimulation, anesthesia/medications and placental insufficiency can all cause what in regards to FHR?
Bradycardia
In regards to the FHR, what is a sign of fetal well being and cannot be produced by an acidotic fetus?
Accelerations
The onset to nadir of a variable deceleration is
<30 seconds
15 seconds-2 minutes
Cardinal movements?
Every- engagement, darn- descent, fellow- flexion, in- internal rotation, Egypt- extension, really- restitution, eats- external rotation, dates-delivery
A 3A perineal laceration is when?
<50% of external anal sphincter torn
A 3B perineal laceration is when?
> 50% of external anal sphincter torn
A 3C perineal laceration is when?
Both the external anal sphincter and internal anal sphincters are torn
A fourth degree laceration includes both internal/external sphincters along with tearing of what?
The rectal mucosa
What are the three parts of active management of the third stage?
Controlled cord traction, use of uterotonic agent, fundal massage after delivery of placenta
What are the four signs of placental separation?
Sudden increase in vaginal bleeding, lengthening of umbilical cord, uterine change in shape and uterus rises in abdomen
What is the IM dose of methergine to be given PP if needed? Who is it contraindicated in?
0.2mg IM every 2 to four hours
Women with hypertension
What is the IM dose of Hemabate to be given PP if needed? Who is it contraindicated in?
250mcg
Women with asthma
When the cord is inserted into the fetal sac and not directly into the placental bed, it is called what?
Velamentous cord insertion
What is battledore cord insertion?
Peripheral cord insertion, otherwise called marginal insertion
Which calcium channel blocker which acts as a non specific muscle relaxant is used as a tocolytic in PTL?
Nifedipine
What is the standard dosing of betamethasone for lung maturity and how long should you attempt to delay birth after administration?
12mg IM in two doses 24 hours apart
Delay until 24 hours post administration
A marginal placenta previa is when the edge of the placenta is within ____cm of cervical os.
1 cm
What is the most common type of breech presentation?
Frank breech
Adherence to myometrium due to partial or total absence of decidua is placenta _______?
Accreta
Further extension into the myometrium with penetration into the uterine wall is placenta _______?
Increta
Further extension through the uterine wall to the serosa layer is placenta ________?
Percreta
What is the largest group of muscles in the musculature?
Levator Ani
What is the cardinal movement responsible for the birth of the fetal head in the cephalic position?
Extension
The most favorable diameter of the fetal head to present in labor is the _____.
suboccipitobregmatic
What is the most common position the fetus enters the pelvis for birth?
LOA
What medication do you treat a woman with that is GBS positive and has a true PCN allergy?
Vancomycin
Which mechanism of labor (MOL) brings the AP diameter of the fetal head into alignment with the AP diameter of the maternal pelvis?
Internal rotation
Which MOL occurs with the biparietal diameter of the fetal head has passed through the pelvic inlet?
Engagement?
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?
Flexion
Flexion occurs as the fetal head meets _____.
Resistance
Which MOL occurs throughout labor and is a requisite to and occurs simultaneously with the other cardinal movements?
Descent
Rotation of the head 45 degrees turning the head back to where it is at a right angle with the shoulders is which MOL?
Restitution
Which MOL occurs as the fetus’ shoulders rotate 45 degrees causing the head to rotate another 45 degrees?
External rotation
The birth of the head occurs by which MOL in OA births?
Extension
An arbitrarily chosen point on the presenting part of the fetus that is used to describe fetal position is called what?
Denominator
What is the denominator for vertex, breech and face?
Occiput
Sacrum
Mentum/Chin
Pre eclampsia without SF and gestational HTN patients should be induced at what gestation?
37 weeks
Pre e with SF patients should be induced at what gestation?
34 weeks
Chronic HTN patients should be induced at what gestation?
38 weeks
Three of the smallest diameters of the fetal head are?
Suboccipitobregmatic, submentobregmatic and biparietal diameter, all 9.5cm
The occipitomental diameter is how big?
12.5 cm
The occipitofrontal diameter is how big?
11.5 cm
When the cephalic prominence is felt on the same side as the fetal small parts, the head is ______.
flexed
When the cephalic prominence is felt on the same side as the fetal back, the head is ______.
extended
When the cephalic prominence is not palpable on one side or the other, it is often called _______.
Military attitude
Medications such as Procardia XL, terbutaline, magnesium sulfate and Indocin do what to the uterus?
Relax it
Medications such as cytotec and pitocin do what to the uterus?
Contract it
What hormone initiates labor?
Prostaglandins
What bishops score is considered favorable and unfavorable?
<4 unfavorable
> 6 favorable
Intermittent auscultation can occur how often in the active phase of labor?
every 15-30 minutes
A prolonged second stage is what for nullip (unmedicated/epidural) and multip (unmedicated/epidural)?
4 hours, epidural nullip
3 hours, unmedicated nullip
3 hours, epidural multip
2 hours, unmedicated multip
What is the most common cause of protracted descent in the 2nd stage?
Persistent OP position
What is the most common sign of uterine rupture?
Fetal distress
What can you do during a shoulder dystocia to flatten out the sacrum and rotate the symphysis pubis superiorly?
McRoberts maneuver
How long does it take lidocaine to take effect?
2-5 minutes
What are the guidelines for intermittent auscultation during the second stage?
every 5-15 minutes
What causes pain in the second stage of labor?
pressure on the bony pelvis, urethra, bladder, and rectum
What is the most favorable diameter of the fetal head to present in labor?
suboccipitobregmatic
What is the most common position in which the fetus enters the pelvis for birth?
LOA
