Intrapartum care Flashcards
In a woman who had complications from Group B strep in her previous pregnancy, what are the guidelines for management in the subsequent pregnancy?
Intrapartum antibiotic prophylaxis. A 35-37 week culture is not needed in a woman where the previous pregnancy resulted in an early-onset Group B strep infection in the neonate.
What are variable decelerations during labor often a sign of?
Cord compression
What are late decelerations associated with?
Uteroplacental insufficiency
What are early decelerations caused by?
Fetal head compression (normal) - there is a vagal response in the fetus that causes heart rate to slow during a contraction
What is the cause of bloody show?
Cervical dilation - the cervix becomes highly vascularized during pregnancy
What is the most common cause of preterm labor?
Idiopathic - no identifiable cause
Are vacuum-assisted deliveries contraindicated in women with a prior history of C-section?
No, vacuum-assisted deliveries are acceptable care
What is the benefit vacuum-assisted delivery over forceps?
Decreased risk for maternal lacerations.
What is the definition of prolonged latent phase of labor?
When it exceeds 20 in a nulliparous woman and 14 hours in a multiparous woman.
When is the active phase of labor considered protracted?
If cervical dilation is less than 1.2 cm/hr in a nulliparous woman and 1.5 cm/hr in a multiparous woman when the cervix is at least 6 cm
When is the active phase of labor considered to be arrested?
When there is an absence of cervical change for greater than 2 hours in the setting of adequate uterine contractions when the cervix is at least 6 cm
What cervical dilation is considered the threshold for active labor?
6 cm
What is malposition vs. malpresentation as it relates to labor?
Malposition is when the infant is rotated not in the optimal occiput anterior position (e.g. occiput transverse, occiput posterior). Malpresentation is when the infant is not in the vertex position (e.g. breech)
What is the definition of arrest of labor?
No cervical change for >4 hours with adequate contractions or no cervical change for >6 hours with inadequate contractions. (Note, this only applies if the woman is at or >6 cm dilated)
What are risk factors for shoulder dystocia?
Fetal macrosomia, maternal obesity, excessive pregnancy weight gain, gestational diabetes, and post-term pregnancy
