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Women's Health EOR > Intrapartum Care > Flashcards

Intrapartum Care Flashcards

1
Q

Labor

A

Physiologic process in which a fetus is expelled from the uterus

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2
Q

T/F: a woman is not in labor until the contractions bring about demonstrable effacement and dilation of the cervix

A

True

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3
Q

Dilation

A

How open the internal os is

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4
Q

Complete dilation

A

10 cm

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5
Q

Effacement

A

Difference between the internal and external os
Thinning of the cervix

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6
Q

Station

A

Degree of descent of the presenting part of the fetus measured in cm from the ischial spines

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7
Q

Amount of station

A

-4: 4 cm above the ischial spine
0: at the level of the ischial spine
+4: 4 cm below the ischial spine

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8
Q

In order to diagnose labor, there must be __

A

Cervical change

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9
Q

Braxton Hicks contractions

A

Contractions without cervical change

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10
Q

Ways to diagnose labor

A

Ferning
pH measurement of fluid
Presence of amniotic pooling in the vagina
US to measure amniotic fluid index

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11
Q

Spontaneous rupture of membranes

A

Rupture of membranes during labor

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12
Q

Premature rupture of membranes

A

Rupture of membranes before the onset of labor

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13
Q

When are women screened for group B strep?

A

35 weeks

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14
Q

If the group B strep swab is positive?

A

PCN
If PCN allergy, give vanc

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15
Q

When should a woman be treated even if her group B strep swab comes back negative?

A

Group B strep has been colonized in a urine culture
Previous OB hx of group B strep or neonatal sepsis

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16
Q

Stages of labor

A

Stage 1: from onset of labor to complete cervical dilation
Stage 2: from complete cervical dilation to expulsion of fetus
Stage 3: from delivery of infant to delivery of placenta
Stage 4: from delivery of placenta to 1 hour postpartum

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17
Q

Friedman’s labor curve

A

Good guideline for expected progression in labor but is not used as frequently anymore

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18
Q

Duration of labor for nulliparous vs multiparous

A

Nulli: 10-12 hours
Multi: 6-8 hours

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19
Q

Latent phase of first stage of labor

A

From onset of labor with slow cervical dilation to 4 cm

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20
Q

Active phase of first stage of labor

A

From 4 cm to complete dilation

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21
Q

Protracted dilation

A

Taking longer to dilate

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22
Q

Arrest of descent

A

Baby is not coming down into the pelvis

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23
Q

Factors affecting stages of active labor

A

Power: uterine contractions are poor or uncontrolled
Passenger: fetus’s head and its ability to pass through the birth canal
Pelvis: mom’s pelvis is too small for the fetus to pass

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24
Q

Breech

A

Baby’s head is up and not in the pelvis where it should be

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25
Q

A c-section is recommended for all babies over ___, or ___ if the mother is diabetic

A

5000 g; 4500 g

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26
Q

Fetal variables that can affect labor

A

Fetal presentation
Degree of flexion or extension of the neck
Relationship between the fetal presenting part to the right or left side of the birth canal
Number of fetuses
Presence of fetal anomalies

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27
Q

Fetal presentation

A

What part of the baby is entering the pelvis first

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28
Q

In vertex position, ___ is the reference point, and in breech position, ___ is the reference point

A

Occiput; sacrum

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29
Q

Diagnosis of fetal presentation and position

A

Leopold maneuvers
Vaginal exam
US

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30
Q

Leopold maneuvers

A

Abdominal palpation to determine fetal lie, weight estimate, position, and presentation

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31
Q

T/F: any position other than vertex usually results in a c-section

A

True

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32
Q

A ___ pelvic outlet is an indication for c-section

A

Small

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33
Q

Cephalopelvic disproportion

A

Passenger is too large for the pelvis

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34
Q

How can activity be assessed?

A

Observation
Palpation of the fundus
External tocodynamometry
IUPC (intrauterine pressure catheter)

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35
Q

What is considered adequate labor?

A

3-5 contractions in a 10 minute period

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36
Q

If labor is not progressing…

A

Insert IUPC to adequately monitor contraction
If under 200 MVU in 10 minutes, then start Pitocin

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37
Q

How to intervene to increase the force of already present contractions

A

Pitocin
Artificial rupture of membranes

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38
Q

Induction of labor

A

Attempt to begin labor in a non-laboring patient

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39
Q

Ideal time to deliver baby

A

39 weeks (ARRIVE trial)

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40
Q

Indications to induce labor

A

Multiple gestation
Maternal HTN, DM, HIV
H/O fetal demise or PROM

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41
Q

CI to induce labor

A

Previa and vasa previa
Transverse fetal lie
Umbilical cord prolapse
Prior c-section
Active herpes lesion
Prior myomectomy

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42
Q

Bishop score

A

6 or less: unfavorable outcomes
Over 8: probable success

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43
Q

Methods to induce labor

A

Cervidil
Cytotec

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44
Q

Characteristics of Cervidil

A

Removable device
12 hours
Expensive

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45
Q

Characteristics of Cytotec

A

Tablet
4 hours
Cheap

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46
Q

T/F prostaglandins used for cervical ripening increase the likelihood of delivery within 24 hours

A

True

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47
Q

Balloon catheter (Cook)

A

Gently helps cervix ripen w/o causing overstimulation

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48
Q

Pitocin

A

Identical version of oxytocin leading to uterine contractions

49
Q

SE of Pitocin

A

Tachysystole
Uterine rupture
Hypotension

50
Q

Tachysystole

A

Over 5 contractions in 10 minutes

51
Q

Why is tachysystole a problem?

A

Force of contractions can take blood supply away from the baby, so baby’s HR can go down if contractions are too fast

52
Q

Pros and cons of amnihook

A

Pros: if you do it after labor, it can make labor shorter
Cons: increased risk of infection and poor outcomes if water is broken before they are in labor

53
Q

Characteristics of epidural anesthesia

A

Epidural catheter placed in L3-L4
Initial bolus of anesthetic given then a continuous infusion started

54
Q

Complications of epidural

A

Maternal hypotension
Spinal HA
Maternal respiratory depression

55
Q

CI of epidural

A

Bleeding disorder
Patient refusal

56
Q

Characteristics of spinal anesthesia

A

One time dose placed directly into the spinal canal
Used for c-section

57
Q

Pudendal block

A

Provides perineal anesthesia for pelvic floor pressure pain

58
Q

When can general anesthesia be used?

A

Used for c-section in emergent or urgent settings

59
Q

Complications of general anesthesia in labor

A

Maternal aspiration
Risk of hypoxia to mother and fetus

60
Q

How long do you have to get the baby off after blood flow is cut off?

A

4 minutes

61
Q

Normal FHR baseline

A

110-160 bpm

62
Q

What criteria is needed to set a baseline?

A

Must last for 2 minutes

63
Q

T/F: fluctuations in the baseline FHR is regular in its amplitude and frequency

A

False - it is irregular

64
Q

Variability in FHR

A

Absent: amplitude range is undetectable
Minimal: range is detectable but 5 bpm or fewer
Moderate (normal): range 6-25 bpm
Marked: range greater than 25 bpm

65
Q

Acceleration of FHR

A

Visually apparent abrupt increase in the FHR

66
Q

Acceleration peak before and after 32 weeks gestation

A

Before 32 weeks: acceleration has a peak of 10 bpm above baseline with a duration of 10 seconds
After 32 weeks: acceleration has a peak of 15 bpm above baseline with a duration of 15 seconds

67
Q

Prolonged acceleration

A

Lasts 2 minutes or more but less than 10 minutes in duration

68
Q

If an acceleration lasts ___, it’s a change in baseline

A

10 minutes or more

69
Q

Deceleration

A

Visually apparent usually symmetrical gradual decrease and return of the FHR associated with a uterine contraction

70
Q

Early vs late deceleration

A

Early: the nadir of the deceleration occurs at the same time as the peak of the contraction
Late: the deceleration is delayed in timing, with the nadir of the deceleration occurring after the peak of the contraction

71
Q

If the deceleration lasts more than ___, it is a change in baseline

A

10 minutes

72
Q

T/F: sinusoidal pattern is extremely dangerous and insinuates anemia

A

True

73
Q

What usually causes early decelerations?

A

Head compression

74
Q

Late decelerations are the result of ___

A

Uteroplacental insufficiency

75
Q

Interventions for late decelerations

A

Position change
Stop Pitocin
Check cervix
Consider c-section

76
Q

What causes variable decelerations?

A

Cord compression

77
Q

Intervention for variable deceleration

A

Amnioinfusion: infusion of saline into amniotic sac

78
Q

Category 1 FHR

A

Baseline rate 110-160
Variability: moderate
Decelerations: none

79
Q

Outcome of category 1 FHR

A

Baby will typically be fine

80
Q

Category 2 FHR

A

Characterized by intermediate FHR patterns of tachy or bradycardia, minimal or absent baseline variability not accompanied by recurrent decelerations, marked baseline variability, no accelerations, and periodic or episodic decelerations

81
Q

Category 3 FHR

A

Recurring late decelerations
Recurrent variable decelerations
Bradycardia
Sinusoid pattern

82
Q

Outcome of category 3 FHR

A

Baby needs to come out via c-section right away

83
Q

Contraction stress test

A

Evaluates the fetal response to a transient reduction in fetal oxygen delivery during uterine contractions

84
Q

For the contraction stress test, use ___ to achieve ___ in ___

A

Pitocin; 3; 10 minutes

85
Q

Indications for contraction stress test

A

Growth restricted baby

86
Q

Cardinal movements of labor

A

Changes in the fetal head position during its passage through the canal

87
Q

Engagement

A

Passage of the widest diameter fetal presenting part below the place of the pelvic inlet

88
Q

Descent

A

Downward passage of the presenting part through the body pelvis

89
Q

Flexion

A

Complete flexion allows the fetal head’s smallest diameter to fit through the pelvis

90
Q

Internal rotation

A

Rotation of the fetal head from occiput transverse to occiput anterior or posterior position

91
Q

Extension

A

Occurs when the occiput is just past the level of the symphysis

92
Q

External rotation/restitution

A

As the head is delivered, it rotates back to its original position prior to internal rotation

93
Q

Expulsion

A

Delivery of the fetus

94
Q

Delivery of the shoulders

A

Downward traction allows release of the anterior shoulder and the fetus is delivered
Then posterior shoulder is delivered

95
Q

Indications of second stage

A

Pelvic/rectal pressure

96
Q

Molding

A

Alteration of the fetal cranial bones in relation to each other as a result of compressive forces of the maternal bony pelvis

97
Q

Caput

A

Localized edematous area on the fetal scalp caused by pressure on the scalp by the cervix

98
Q

Perineal lacerations

A

1st degree: extends through the vagina and perineal skin
2nd degree: extends into soft tissue of perineum
3rd degree: through anal sphincter
4th degree: through rectal mucosa

99
Q

Episiotomy

A

Surgical incision of female perineum

100
Q

Complications of episiotomy

A

Vaginal bleeding
Pain
Sexual dysfunction
Infection

101
Q

Midline vs mediolateral episiotomy

A

Midline: straight through the perineum
Mediolateral: through the side

102
Q

Indications for use of forceps or vacuum in operative vaginal delivery

A

Prolonged second stage of labor
Maternal exhaustion
Hasten delivery for fetal compromise

103
Q

How much time is usually between fetal and placental delivery?

A

Usually 30 minutes

104
Q

3 signs of placental separation

A

Lengthening of umbilical cord
Gush of blood
Fundus becomes more globular and more anteverted against abdominal hand

105
Q

What must be closely monitored in the 4th stage?

A

BP
Uterine blood loss
Pulse rate

106
Q

What can cause uterine inversion?

A

Aggressive removal of the placenta

107
Q

Repair of uterine inversion

A

Give med to relax uterus
Place fist in uterus to fix the shape
Give them Pitocin to contract the uterus into position

108
Q

Shoulder dystocia

A

Difficulty in delivery of the anterior shoulder due to impaction of the anterior shoulder on the pubic symphysis

109
Q

Complications of shoulder dystocia

A

Fracture of clavicle
Brachial plexus injury
Hypoxic brain injury
Death

110
Q

Management of shoulder dystocia

A

Call for help
Episiotomy
McRoberts maneuver
Suprapubic pressure
Delivery of posterior arm

111
Q

McRoberts position

A

Sharp flexion of maternal hips to open symphysis more horizontally

112
Q

Umbilical cord prolapse

A

Prolapse of umbilical cord in front of fetal head

113
Q

Why is an umbilical cord prolapse dangerous?

A

Cut off bloodflow to fetus

114
Q

T/F: umbilical cord prolapse is an indication for a c-section

A

True

115
Q

MCC for postpartum hemorrhage

A

uterine atony (receptors get flooded and uterus doesn’t react to oxytocin anymore)

116
Q

Treatment of postpartum hemorrhage

A

Removal of placental fragments or repair lacerations
IV access
Type and cross match for blood
Medications for uterine atony

117
Q

Meds for uterine atony

A

Pitocin
Methergine
Cytotec
Hemabate

118
Q

CI for uterine atony drugs

A

Pitocin: hypotension
Methergine: hypertension
Hemabate: can’t use in asthmatics

Women's Health EOR (11 decks)

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