Labor Flashcards
Indication for induction of labor:
Postterm labor, DM, IUGR, nonreassuring fetal test and preeclampsia
How high Bishop score is needed to achieve successful induction of labor?
5 or higher
What to do with patient with a bishop score lower than 5 that need induction?
Cervical ripening: prostaglandin E2 (PGE2) gel, PGE2 pessary (Cervidil), or PGE1M (misoprostol)
Contraind for use of prostaglandin?
maternal: asthma and glaucoma
obstetric: prior cesarean delivery and nonreassuring fetal testing
What other procedures can be made to induce labor and what are the precaution here?
amniotomy (puncture of amniotic sac to release fluid)
caution: ensure no prolapse of umbilical cord
Augmentation is done how?
With oxytocin and amniotomy. Same indication + inadequate contractions or a prolonged phase of labror.
What is normal range of fetal heart?
110-160 bpm
What can cause fetal HR above 160 bpm?
The concern is infection, hypoxia or anemia.
What types of decelerations is it?
Early, variable and late
What is the decelerations caused by?
- Early: Result of increased vagal tone secondary to head compression during a contraction.
- Variable: result of umbilical cord compression
- Late: These are result of uteroplacental insufficiency
Which of the decelerations is most worrisome and why?
late because they may degrade into bradycardias as labor progresses
What are the cardinal movements of labor?
Engagement, descendent, flexion, internal rotation, extension and external rotaion (also called restitution or resolution)
How long is the avarage first stage?
10-12hr in nulliparous
2-12 hr in multiparous.
When is latent phase and what characterize it?
Onset to cervical dilation of 6 cm. Characterized by slow cervical changes.
When is active phase?
From latent until complete dilation.
What is the third phase of 1st stage called?
Deceleration or transition phase. Cervix 8-10 cm with strong contractions frequently.
What affect the transit time during active phase of labor?
Power, passenger, pelvis
What is considered prolonged stage 2?
longer than 3hrs in nulliparous.
longer than 2 hours without epidural and 3hrs with epidural in multiparous
Why is stage 2 prolonged with epidural?
little urge to push, less sensation and even a strong motor block and so have less ability to push.
If prolonged deceleration is caused by hypertonus or tachysystole, what to administer?
Terbutaline to relax the uterus
Indication for epiosotomy?
Need to hasten delivery and impending or ongoing shoulder dystocia.
When is stage 3?
From infant is delivered and completed with delivery of placenta.
What can be given to hasten placental delivery and decrease blood loss?
oxytocin
The 4 degrees of perineal laceration:
1st: Vaginal mucosa
2nd: Perineal body
3rd: Anal sphincter
4th: Anal mucosa
