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obstetrics gyne > intrapartum care, abnormal labor obstet emerg, > Flashcards

intrapartum care, abnormal labor obstet emerg, Flashcards

1
Q

what is labor

A

contractions and cervical dilation effacement

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2
Q

fetal presentation

A

part of fetal body closest to birth canal

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3
Q

Lie

A

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

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4
Q

position

A

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

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5
Q

vertex presentation position can be

A

occiput - anterior/posterior

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6
Q

Breech presentation often position

A

sacraum

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7
Q

Face presentation positive is

A

Mentum (chin)

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8
Q

Station is the level of presenting part relative to ischial spines

A

-3–1 is ABOVE - spine

positive below

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9
Q

first stage of labor can be

A

latent or active

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10
Q

The latent phase of labor (1st)

A

0-3 cm

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11
Q

The active phase of labor

A

3-10cm

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12
Q

Second stage of labor

A

Full dilatation and delivery

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13
Q

Third stage

A

Delivery of fetus and delivery of placenta

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14
Q

fourth stage

A

Placenta -> immediate post partum

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15
Q

Check rupture of membranes

A

Ferning - due to estrogen

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16
Q

what is the Ph when membranes have ruptured

A

7-7.5 turns nitraxine paper yellow to dark blue

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17
Q

two ways to monitor fetal heart rate

A

1) intermittent auscultation

2) continuous electronic fetal monitoring

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18
Q

Normal fetal hrt rate

A

110-160 bpm

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19
Q

FHR accelerations are

A

> = 15 bpm x >15s

20
Q

EFM assessment

A

doesnt tell you how strong contractions are

tells you frequency and duration

21
Q

What is a variable deceleration?

A

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

22
Q

Complicated variable decelerations are

A

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

23
Q

late decelerations

A

Gradual decrease and return to baseline

Uteroplacental insufficiency and some degree of hypoxia

24
Q

late decelerations occur when relative contractions?

A

after BEGINNING, peak, and end of contraction

25
Q

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

A

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

26
Q

Initial management of atypical tracing:

A

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

27
Q

What do you do in initial management of atypical tracing

A

STOP oxytocin

REPOSITION To left or right lateral

28
Q

Delivery is indicated when fetal scalp sample Ph is

A

< 7.2

29
Q

Dystocia

A

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

30
Q

4 Ps of inadequate progress

A

Power
passenger
passage
psyche

31
Q

POWER

A

contractions moderate-strong
45 seconds
2-3 mins

(consider artificial rupture or oxytocin)

32
Q

Placenta previa

A

PAINLESS vag bleeding
AVOID digital exam
Risk for PPH

33
Q

placental abruption

A

PAINFUL bleed

LARGELY clinical diagnosis

34
Q

vasa previa

A

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

35
Q

Vasa previa associated with what type of pattern on FHR?

A

sinusoidal pattern

36
Q

Unique features of uterine rupture

A 
Profound fetal bradycardia
severe constant abdominal pain
PGE contraindicated (dont want to increase contractions)
37
Q

To avoid uterine inversion MUST NOT

A

put pressure on fundus to deliver placenta

38
Q

Contraindications for assisted vaginal delivery

A 
Baby is non-cephalic
face/brow delivery
Unengaged head
incomplete cerivcal dilatation
Low success rate
39
Q

Contraindications specific to vaccum

A

premature babies -

bleeding disorder -

40
Q

Indications for C-sections

A 
Dystocia
maternal disease
previous uterine surgery 
fetal distress, malpresentation
previa, abruption
41
Q

classical c-SECTION has a risk of

A

greater blood loss

higher risk of rupture in future

42
Q

Risk of C-sections

A 
Infection
hemorrhage
atelectasis 
injury to surrounding structures
DVT/PE
longer recovery
43
Q

what is NOT a contraindication to VBAC?

A

Multiple gestation !

44
Q

Mode of induction of labor

A
  • prostaglandins

- Mechanical foley catheter

45
Q

Most common presenting signs of AFE?

A

profound systemic hypotension
Hemorrhage DIC
cyanosis, dyspnea or respiratory arrest

46
Q

Three directives for managing AFE

A

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

obstetrics gyne (15 decks)

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