intrapartum care, abnormal labor obstet emerg,

Question 1

what is labor

Answer 1

contractions and cervical dilation effacement

Question 2

fetal presentation

Answer 2

part of fetal body closest to birth canal

Question 3

Lie

Answer 3

orientation of long axis of fetus relative to long axis of uterus

Question 4

position

Answer 4

relation of presenting part (head or bottom) relative to maternal pelvis

Question 5

vertex presentation position can be

Answer 5

occiput - anterior/posterior

Question 6

Breech presentation often position

Answer 6

sacraum

Question 7

Face presentation positive is

Answer 7

Mentum (chin)

Question 8

Station is the level of presenting part relative to ischial spines

Answer 8

-3–1 is ABOVE - spine

positive below

Question 9

first stage of labor can be

Answer 9

latent or active

Question 10

The latent phase of labor (1st)

Answer 10

0-3 cm

Question 11

The active phase of labor

Answer 11

3-10cm

Question 12

Second stage of labor

Answer 12

Full dilatation and delivery

Question 13

Third stage

Answer 13

Delivery of fetus and delivery of placenta

Question 14

fourth stage

Answer 14

Placenta -> immediate post partum

Question 15

Check rupture of membranes

Answer 15

Ferning - due to estrogen

Question 16

what is the Ph when membranes have ruptured

Answer 16

7-7.5 turns nitraxine paper yellow to dark blue

Question 17

two ways to monitor fetal heart rate

Answer 17

1) intermittent auscultation

2) continuous electronic fetal monitoring

Question 18

Normal fetal hrt rate

Answer 18

110-160 bpm

Question 19

FHR accelerations are

Answer 19

> = 15 bpm x >15s

Question 20

EFM assessment

Answer 20

doesnt tell you how strong contractions are

tells you frequency and duration

Question 21

What is a variable deceleration?

Answer 21

abrupt decrease in FHR
> 15 bpm below baseline > 15s
response to cord compression

Question 22

Complicated variable decelerations are

Answer 22

< 70bpm > 60s, loss variability, slow return to baseline, tachy/bradycardia

Question 23

late decelerations

Answer 23

Gradual decrease and return to baseline

Uteroplacental insufficiency and some degree of hypoxia

Question 24

late decelerations occur when relative contractions?

Answer 24

after BEGINNING, peak, and end of contraction

Question 25

If decelerations coincide with beginning, peak and end of contraction they are

Answer 25

EARLY decelerations, associated with fetal head compression, benign and inconsequential

Question 26

Initial management of atypical tracing:

Answer 26

intrauterine resuscitation improve uterine blood flow umbilical circularion and maternal O2 saturation

Question 27

What do you do in initial management of atypical tracing

Answer 27

STOP oxytocin | REPOSITION To left or right lateral

Question 28

Delivery is indicated when fetal scalp sample Ph is

Answer 28

< 7.2

Question 29

Dystocia

Answer 29

abnormal labor/difficult childbirth Active stage- > 4 hrs of < 0.5cm/hr cervical dilatation 2nd stage: > 1 hr with no fetal descent durin active pushing

Question 30

4 Ps of inadequate progress

Answer 30

Power passenger passage psyche

Question 31

POWER

Answer 31

contractions moderate-strong 45 seconds 2-3 mins (consider artificial rupture or oxytocin)

Question 32

Placenta previa

Answer 32

PAINLESS vag bleeding AVOID digital exam Risk for PPH

Question 33

placental abruption

Answer 33

PAINFUL bleed | LARGELY clinical diagnosis

Question 34

vasa previa

Answer 34

vilamentous cord insertion vessels insert into membrane before reaching placental body FETAL vessels bleed due to FETAL blood

Question 35

Vasa previa associated with what type of pattern on FHR?

Answer 35

sinusoidal pattern

Question 36

Unique features of uterine rupture

Answer 36

``` Profound fetal bradycardia severe constant abdominal pain PGE contraindicated (dont want to increase contractions) ```

Question 37

To avoid uterine inversion MUST NOT

Answer 37

put pressure on fundus to deliver placenta

Question 38

Contraindications for assisted vaginal delivery

Answer 38

``` Baby is non-cephalic face/brow delivery Unengaged head incomplete cerivcal dilatation Low success rate ```

Question 39

Contraindications specific to vaccum

Answer 39

premature babies - | bleeding disorder -

Question 40

Indications for C-sections

Answer 40

``` Dystocia maternal disease previous uterine surgery fetal distress, malpresentation previa, abruption ```

Question 41

classical c-SECTION has a risk of

Answer 41

greater blood loss | higher risk of rupture in future

Question 42

Risk of C-sections

Answer 42

``` Infection hemorrhage atelectasis injury to surrounding structures DVT/PE longer recovery ```

Question 43

what is NOT a contraindication to VBAC?

Answer 43

Multiple gestation !

Question 44

Mode of induction of labor

Answer 44

- prostaglandins | - Mechanical foley catheter

Question 45

Most common presenting signs of AFE?

Answer 45

profound systemic hypotension Hemorrhage DIC cyanosis, dyspnea or respiratory arrest

Question 46

Three directives for managing AFE

Answer 46

1) rapid initiation of oxygenation 2) circulatory support 3) correction of coagulopathy CPR immediately if cardiac arrest