Keppler - Lecture 4 Flashcards by Alice Richards

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

labor

How well did you know this?

Not at all

Perfectly

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

bishop score

How well did you know this?

Not at all

Perfectly

t/f: bishop score defines when active labor starts

How well did you know this?

Not at all

Perfectly

labor progressing at a slower pace than normal

protracted labor

How well did you know this?

Not at all

Perfectly

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

arrested labor

How well did you know this?

Not at all

Perfectly

less than 3 hr from onset of labor to delivery

precipitous labor

How well did you know this?

Not at all

Perfectly

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

meconium

How well did you know this?

Not at all

Perfectly

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

fetal intolerance of labor

respiratory distress w. aspiration

How well did you know this?

Not at all

Perfectly

how do you know if someone is in labor

tocometer

How well did you know this?

Not at all

Perfectly

stages of labor (2)

latent

active

How well did you know this?

Not at all

Perfectly

stage 1 of labor

latent phase

PLUS

active phase

How well did you know this?

Not at all

Perfectly

what are the 5 factors in the bishop’s score

dilation

position of cervix

effacement

station

cervical consistency

How well did you know this?

Not at all

Perfectly

bishop score measures

success of spontaneous labor vs induced labor

How well did you know this?

Not at all

Perfectly

bishop score 8 or higher indicates

equal success of spontaneous labor and induced labor

How well did you know this?

Not at all

Perfectly

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

no!

How well did you know this?

Not at all

Perfectly

basic definition of active labor (according to Keppler)

regular painful contractions plus cervical change

How well did you know this?

Not at all

Perfectly

toco monitor measures

surface tension of the skin

How well did you know this?

Not at all

Perfectly

friedman labor curve vs zhang curve

How well did you know this?

Not at all

Perfectly

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

higher BMI

How well did you know this?

Not at all

Perfectly

2 types of fetal head orientation

presentation

orientation

How well did you know this?

Not at all

Perfectly

presentation is __

orientation is __

presenting part

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

How well did you know this?

Not at all

Perfectly

ideal fetal head orientation

occiput anterior (OA)

How well did you know this?

Not at all

Perfectly

categories of fetal monitoring

I-III

How well did you know this?

Not at all

Perfectly

category I of fetal monitoring

normal baseline

no pathologic decels

How well did you know this?

Not at all

Perfectly

stage III of fetal monitoring

bradycardia absent variability w. pathologic decels or sinusoidal pattern

stage II of fetal monitoring

everything that is not I or III

nl for fetal heartbeat

110-160 bpm 5-25 beat to beat variability w./w.o accels or early decels

consequence of category III fetal monitoring

fetal acidemia

when should you be concerned about fetal monitoring

category II and III

why aren't there more flashcards about fetal monitoring

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

when is general anesthesia used

reserved for cesarean sections w. limited indications

2 types of regional anesthesia

epidural pudendal block

which type of regional anesthesia is mc

epidural *pudendal rarely used*

epidural numbs the pt from

~ umbilicus down

2 indications for local anesthesia

episiotomy laceration repair postpartum

pharm anesthesia

fentanyl

complications of labor *don't need to memorize these, just for reference*

labor arrest/protraction lacerations episiotomy cord complications abnormal fetal heart rate tracing bleeding complications shoulder dystocia placenta infxn operative delivery

protracted labor

~ 1 cm/hr or more

3 p's of labor complications

pelvis passenger powers

what does "powers" refer to

contractions

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

pitocin/oxytocin *basically same-same*

options to mediate arrested/protracted labor

augment (oxytocin) AROM internal pressure catheter (IUPC) rotate fetal head wait operative delivery

grading of lacerations

1st -4th degree

mc place for a laceration

perineal

do we repair 1st degree lacerations

only for bleeding *very common, most women*

are episiotimies best practice

no!

2 reasons Keppler does episiotomies

maternal benefit baby benefit

4 cord complications

nuchal → around the neck cord prolapse marginal cord insertion vasa previa

ride of shame

cord prolapse

category 1 fetal heart tracking might have \_\_ but does not have \_\_

accels/early decels pathologic decels

if fetal heart tracing has pathologic decels it is

category II or III

late deceleration

nader falls after contraction

type of pathology behind late deceleration

placental

what category fetal heart tracing is this

**category III:** bradycardia, absent variability w. pathologic decels, sinusoidal pattern

4 bleeding complications of labor

bloody show placental abruption placenta or vasa previa postpartum bleeding

in terms of treatment, shoulder dystocia is a

medical emergency

4 infections related to labor

chorioamnionitis postpartum endometritis surgical wound infxn covid?

3 types of operative delivery

forceps vacuum cesarean

3 indications for operative delivery

maternal exhaustion expedite delivery for fetal benefit reduce maternal risks from trial of labor

2 examples of maternal risks from trial of labor

prior uterine surgery CVD

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

labor

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

first stage

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

stage 2

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

stage 3

2 purposes of fetal monitoring

confirm fetal wellbeing guide interventions to decrease fetal harm in labor

why were fetal heart rate categories conceived

provide objective guidelines to assess fetal wellbeing

complications in labor include (4)

bleeding cord complications protracted/arrested labor infxn

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. baseline frequency of 165 bpm

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

2. her labor is protracted

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

4. her induction is as likely to result in a vaginal delivery as if she presented in spontaneous labor

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

3. pitocin

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

4. the slope of cervical change over time is increasing

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

3. occipital bone

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

1. late decelerations

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

4. to decrease extension of a laceration to a more severe grade