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Clin Med II - Exam 5 > Keppler - Lecture 4 > Flashcards

Keppler - Lecture 4 Flashcards

1
Q

sequence of uterine contractions resulting in effacement and dilation of the uterine cervix, combined w. voluntary maternal expulsive efforts resulting in delivery of a fetus

A

labor

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2
Q

objective scoring system for determining a pt’s likelihood of successful induction of labor

A

bishop score

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3
Q

t/f: bishop score defines when active labor starts

A

f!

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4
Q

labor progressing at a slower pace than normal

A

protracted labor

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5
Q

either arrest of dilation after dx of active labor, or failure of descent of he fetal head during second stage of labor

A

arrested labor

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6
Q

less than 3 hr from onset of labor to delivery

A

precipitous labor

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7
Q

green/brown staining of amniotic fluid when fetus defecates prior to delivery

A

meconium

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8
Q

what 2 adverse fetal outcomes is meconium associated w. (2)

A

fetal intolerance of labor

respiratory distress w. aspiration

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9
Q

how do you know if someone is in labor

A

tocometer

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10
Q

stages of labor (2)

A

latent

active

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11
Q

stage 1 of labor

A

latent phase

PLUS

active phase

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12
Q

what are the 5 factors in the bishop’s score

A

dilation

position of cervix

effacement

station

cervical consistency

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13
Q

bishop score measures

A

success of spontaneous labor vs induced labor

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14
Q

bishop score 8 or higher indicates

A

equal success of spontaneous labor and induced labor

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15
Q

can the bishop score be used to determine if a pt is in labor

A

no!

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16
Q

basic definition of active labor (according to Keppler)

A

regular painful contractions plus cervical change

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17
Q

toco monitor measures

A

surface tension of the skin

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18
Q

friedman labor curve vs zhang curve

A
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19
Q

what patient population might be more likely to follow the zhang curve

A

higher BMI

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20
Q

2 types of fetal head orientation

A

presentation

orientation

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21
Q

presentation is __

orientation is __

A

presenting part

which way presenting part is facing (ex occiput vs sacrum)

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22
Q

ideal fetal head orientation

A

occiput anterior (OA)

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23
Q

categories of fetal monitoring

A

I-III

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24
Q

category I of fetal monitoring

A

normal baseline

no pathologic decels

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25
Q

stage III of fetal monitoring

A

bradycardia

absent variability w. pathologic decels

or sinusoidal pattern

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26
Q

stage II of fetal monitoring

A

everything that is not I or III

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27
Q

nl for fetal heartbeat

A

110-160 bpm

5-25 beat to beat variability w./w.o accels or early decels

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28
Q

consequence of category III fetal monitoring

A

fetal acidemia

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29
Q

when should you be concerned about fetal monitoring

A

category II and III

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30
Q

why aren’t there more flashcards about fetal monitoring

A

he’s too smart for me and it went way over my head

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31
Q

when is general anesthesia used

A

reserved for cesarean sections w. limited indications

32
Q

2 types of regional anesthesia

A

epidural

pudendal block

33
Q

which type of regional anesthesia is mc

A

epidural

pudendal rarely used

34
Q

epidural numbs the pt from

A

~ umbilicus down

35
Q

2 indications for local anesthesia

A

episiotomy

laceration repair postpartum

36
Q

pharm anesthesia

37
Q

complications of labor

don’t need to memorize these, just for reference

A

labor arrest/protraction

lacerations

episiotomy

cord complications

abnormal fetal heart rate tracing

bleeding complications

shoulder dystocia

placenta

infxn

operative delivery

38
Q

protracted labor

A

~ 1 cm/hr or more

39
Q

3 p’s of labor complications

A

pelvis

passenger

powers

40
Q

what does “powers” refer to

A

contractions

41
Q

hormone that you can give as an infusion to gradually increase contractions

A

pitocin/oxytocin

basically same-same

42
Q

options to mediate arrested/protracted labor

A

augment (oxytocin)

AROM

internal pressure catheter (IUPC)

rotate fetal head

wait

operative delivery

43
Q

grading of lacerations

A

1st -4th degree

44
Q

mc place for a laceration

45
Q

do we repair 1st degree lacerations

A

only for bleeding

very common, most women

46
Q

are episiotimies best practice

47
Q

2 reasons Keppler does episiotomies

A

maternal benefit

baby benefit

48
Q

4 cord complications

A

nuchal → around the neck

cord prolapse

marginal cord insertion

vasa previa

49
Q

ride of shame

A

cord prolapse

50
Q

category 1 fetal heart tracking might have __

but does not have __

A

accels/early decels

pathologic decels

51
Q

if fetal heart tracing has pathologic decels it is

A

category II or III

52
Q

late deceleration

A

nader falls after contraction

53
Q

type of pathology behind late deceleration

54
Q

what category fetal heart tracing is this

A

category III:

bradycardia, absent variability w. pathologic decels, sinusoidal pattern

55
Q

4 bleeding complications of labor

A

bloody show

placental abruption

placenta or vasa previa

postpartum bleeding

56
Q

in terms of treatment, shoulder dystocia is a

A

medical emergency

57
Q

4 infections related to labor

A

chorioamnionitis

postpartum endometritis

surgical wound infxn

covid?

58
Q

3 types of operative delivery

A

forceps

vacuum

cesarean

59
Q

3 indications for operative delivery

A

maternal exhaustion

expedite delivery for fetal benefit

reduce maternal risks from trial of labor

60
Q

2 examples of maternal risks from trial of labor

A

prior uterine surgery

CVD

61
Q

process of delivering a fetus and products of conception thru coordinated uterine contractions combined w. maternal expulsive efforts

62
Q

stage of labor that involves progressive dilation of the uterine cervix from entry to the active phase to complete (10 cm) dilation

A

first stage

63
Q

which stage of labor starts at complete dilation and culminates w. delivery of the placenta

64
Q

which stage of labor starts at delivery of the newborn and culminates w. delivery of the placenta

65
Q

2 purposes of fetal monitoring

A

confirm fetal wellbeing

guide interventions to decrease fetal harm in labor

66
Q

why were fetal heart rate categories conceived

A

provide objective guidelines to assess fetal wellbeing

67
Q

complications in labor include (4)

A

bleeding

cord complications

protracted/arrested labor

infxn

68
Q

You are managing a patient in active labor. Her pain is controlled with an epidural and the fetal heart rate is being continuously monitored with a Category 1 tracing. Which of the following, if present, would change the fetal heart tracing to Category 2?

a. baseline frequency of 165 beats/min
b. early decelerations
c. temporary increase in heart rate lasting 15 sec, at least 15 beats
d. moderate variability

A

a. baseline frequency of 165 bpm

69
Q

A 23 year old G1P0 at 39 weeks is admitted in active labor at 5 cm cervical dilation. In 3 hours her cervix is dilated to 7 cm dilation. After 6 hours, she is dilated to 8 cm. Which of the following best describes her labor progress?

  1. Her labor is progressing normally
  2. Her labor is protracted
  3. Her labor is arrested
  4. She is in the second stage of labor
A
  1. her labor is protracted
70
Q

A 26 y/o G4P1021 at 41 0/7 weeks gestation presents for a post-dates induction of labor. You examine her cervix and note she’s 4 cm dilated, 50% effaced, at -1 station. Her cervix is soft and anterior. You calculate a Bishop score of 9. What is the significance of this finding?

  1. She is guaranteed to have a vaginal delivery
  2. Her induction is more likely to fail
  3. Her induction is more likely to be successful using nipple stimulation
  4. Her induction is as likely to result in a vaginal delivery as if she presented in spontaneous labor
A
  1. her induction is as likely to result in a vaginal delivery as if she presented in spontaneous labor
71
Q

A patient has arrest in the active phase of labor. You are considering what factors are contributing to her stalled labor. Which of the following is not one of the three “Ps”?

  1. Passenger
  2. Powers
  3. Pitocin
  4. Pelvis
72
Q

Which of the following most accurately indicates that a patient admitted with contractions is in the first stage of active labor?

  1. She is dilated to 5 cm
  2. She is having enough pain to request an epidural
  3. Her fetal heart rate pattern shows accelerations
  4. The slope of cervical change over time is increasing
A
  1. the slope of cervical change over time is increasing
73
Q

The orientation of the fetal head is assessed based on the location of which feature of the fetal cranium?

  1. The parietal bones
  2. The frontal suture
  3. The occipital bone
  4. The funny bone
A
  1. occipital bone
74
Q

Which of the following characteristics of a fetal heart rate being monitored in labor is not found in a category I tracing?

  1. Late decelerations
  2. Early decelerations
  3. Accelerations
  4. Moderate variability
A
  1. late decelerations
75
Q

Which of the following is not an indication for making an episiotomy?

  1. Maternal exhaustion
  2. Category 2 or 3 fetal heart rate tracing
  3. Maternal history of cardiovascular disease
  4. To decrease extension of a laceration to a more severe grade
A
  1. to decrease extension of a laceration to a more severe grade

Clin Med II - Exam 5 (23 decks)

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