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Repro. Med 4 > Labor > Flashcards

Labor Flashcards

1
Q

During labor, contractions that occur in a ____ pattern and produce ____ change (effacement and dilation)

A

regular

cervical

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2
Q

True labor is described as….

The contractions come in a regular pattern about __-__ minutes apart; each contraction lasts __-___ seconds.

A

3-5 min

30-60 sec

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3
Q

During labor…

  1. Cervix will dilate from __-__ cm
  2. Cervix will efface (thin) from ___-___% effaced
  3. Fetal head will move from its original station to +__ and out.
A

1-10 cm
0-100%
3+

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4
Q

What is involved in effacement?

A

thinning + softening of cervix

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5
Q

In the first delivery, effacement is completed, followed by ____.

In subsequent pregnancies, ___ has begun prior to labor, ___ usually waits till labor has ensued. which happens faster?

A

dilation

dilation
effacement

Dilation

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6
Q

Fetal station is defined as where the head is in relation to the _____
Described as -__ to +___

A

ischial spines

3 (for both)

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7
Q

____ occurs when the widest diameter of the presenting part (usually the head) has passed through the pelvic inlet.

“____” is a perception that often accompanies this

A

engagement

Lightening

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8
Q

____ is described according to where the occiput of the fetal head is

A

fetal head position

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9
Q

What are the stages of labor?

A

1st stage: Dilation/Effacement
2nd stage: Pushing/Delivery
3rd Stage: Placental delivery

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10
Q

What are the 2 phases of the 1st stage of labor?

A

Latent phase: early effacement and dilation from 0-4 cm

Active phase: rapid effacement, most dilation occurs most painful 6-fully dilated

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11
Q

What is Friedman’s curve?

A

a graph depicting the progression of labor

** outdated

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12
Q

In the second stage, there is ____ to delivery of the fetus.
The mother experiences ___ and desire to ____

A

Full dilation

Pressure and desire to bear down

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13
Q

In the second stage, there is ____ to delivery of the fetus. The mother experiences ___ and desire to ____

A

Full dilation

Pressure and desire to bear down

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14
Q

what happens to the fetal head during the second stage of labor

A

Molding of the fetal head

Caput-localized swelling of the fetal head

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15
Q

____ are movements of the fetus that enable it to adapt to the pelvis and to move through the pelvis.

A

6 cardinal movements

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16
Q

what tools can be used in instrumental deliveries

A

Forceps

Vacuum

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17
Q

what are the indications for instrumental deliveries?

A

maternal exhaustion
dystocia
non-reassuring fetal status in second stage of labor

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18
Q

what are the benefits and risks of instrumental deliveries?

A

Benefits: avoid C-section
Risks: fetal + maternal injury

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19
Q

what is an episiotomy

A

cutting the posterior vaginal opening. done if there is concern for baby fitting or needs to come out quick.

not done much anymore
repair with sutures

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20
Q

how are vaginal lacerations graded?
how are they repaired
what are complications of 3/4th degree tears?

A

1-4
reabsorbable sutures
urinary/defecation issues

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21
Q

how long does the 3rd stage of labor usually take?

A

2-10 minutes to deliver the placenta

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22
Q

what are signs of placental separation in the 3rd stage of labor?

A

gush of blood
lengthening of umbilical cord
fundus rises up
uterus becomes firm

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23
Q

When does the placenta commonly separate?

A

right after baby is delivered

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24
Q

how long should you wait before considering manual removal of the placenta?

A

20-30 min

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25
Q

____ is a surgical procedure used to deliver a baby through incisions in the mother’s abdomen and uterus.

A

Cesarean section

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26
Q

what are common indications for C-section?

A

too small, too slow, too dangerous

  • cephalo-pelvic disproportion
  • Fetal malpresentations
  • Previous C-section
  • Fetal distress
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27
Q

what % of deliveries are via C-section?

A

32.2%

28
Q

what are reasons for the high rate of C-sections in the US?

A 
Bigger babies
more prior C-section
Fewer VBACs
Medicolegal concerns
Maternal requests
29
Q

What is an absolute indication for C-section ?

A

if the uterine incision is above the lower uterine segment.

30
Q

if a woman has had a prior C-section, there is a ___-___% risk of incision will rupture if the previous incision was above the lower uterine segment during the next labor

A

1-9%

31
Q

why would a C-section incision occur above the lower uterine segment?

A

very premature delivery

32
Q

Any woman with >___ prior C/S’s should be scheduled for repeat C/S with no option for labor.

A

2

33
Q

what is malpresentation?

A

baby isn’t in optimal position for birth

  • breech (most common)
  • transverse lie
  • shoulder presentation
34
Q

___% of babies are breeach at 28 weeks at 36 weeks only __% of babies are breech

A

25%

4%

35
Q

____ is a procedure in which caregivers attempt to externally manipulate a fetus from breech to vertex

A

ECV: External Cephalic Version

36
Q

On who is ECV: External Cephalic Version easiest to perform?

A 
small fetus
thin mom
posterior placenta
plenty of fluid
no engaged
37
Q

___ is the Creation of labor via use of cervical ripening agents or uterine contraction agents prior to natural labor beginning. Can be for fetal or maternal indications.

A

Induction

38
Q

What scoring system is used to determine if the cervix is “favorable” for induction

A

Bishops

39
Q

what are maternal indications for labor induction?

A
  • fetal demise
  • severe HTN dz
  • medical issues (DM, Renal, pulm)
  • risk of precipitous labor or distance from hosptial
40
Q

what are fetal indications of labor induction?

A
  • Post-term pregnancy
  • Maternal HTN
  • DM
  • PROM
  • Chorioamnionitis
  • Oligohydramnios
  • IUGR
  • Rh sensitization
41
Q

what are contraindications to labor induction?

A
  • Placenta previa
  • Abnormal lie or presentation
  • Prior classic incision
  • Maternal HIV infection
  • Active genital herpes
  • Severe Pelvic abnormalities
  • Invasive cervical cancer
42
Q

what are methods of induction?

A

membrane stripping
amnitomy
Pitocin
Vaginal prostaglandins

43
Q

____ is inflammation of the fetal membranes (amnion and chorion) due to a bacterial infection.

A

Chorioamnionitis

44
Q

Chorioamnionitis typically results from ____ ascending into the uterus from the vagina and is most often associated with ____ labor.

A

bacteria

prolonged

45
Q

when should you suspect Chorioamnionitis?

A

at least 2

  • fever
  • uterine tenderness
  • fetal tachycardia
  • Foul smelling amniotic fluid
46
Q

what risks can occur from a Chorioamnionitis?

A
  • Dysfunctional labor patterns (due to infxn of the contractile tissue)
  • Postpartum hemorrhage
  • Maternal infxn/sepsis/endometritis
  • Neonatal Sepsis and death
47
Q

what increases the risk of Chorioamnionitis occurring

A
  • Known vaginal infxns/ STD’s
  • Water broken >20 hours
  • Frequent cervical exams
  • Internal monitoring
  • PPROM or PTL
48
Q

how do you tx Chorioamnionitis

A

IV abx
fetal monitoring
prompt delivery

49
Q

Normal blood loss is about __-__ ml

A

300 - 500 ml

50
Q

Early PPH presents w/ Blood loss >__ ml. in the first __ hours after a vaginal delivery or greater than ____ ml after a cesarean birth

A

500 ml
24 hr
1000 ml

51
Q

___ is a hemorrhage that occurs after the first 24 hours

A

Late PPH:

52
Q

___ is a hemorrhage that occurs after the first 24 hours

A

Late PPH

53
Q

what are causes of early hemorrhage?

A
  • Uterine Atony
  • Cervical or Uterine Lacerations
  • Retained Placental Fragments

Also (Inversion of the Uterus, Placenta Accreta, Vulvar or Vaginal Hematomas)

54
Q

what are RF for lacerations during birth?

A
  • Instrumented or Precipitous delivery
  • Large or malpresented baby
  • Contracted (small) Pelvis
55
Q

what are S/S of lacerations?

A
  • bright red blood with a steady trickle and the uterus remains firm
  • maternal hypovolemia with firm uterus
56
Q

what should you do if a laceration is suspected?

A
  • type and cross early
  • meticulous inspection
  • suture bleeders
  • vaginal packing
  • blood replacement
57
Q

___ is failure of the myometrium to contract. This happens, the distensible uterus fills with blood because of the lack of pressure on the open vessels of the placental site.

A

Uterine atony

58
Q

what are predisposing factors for uterine atony

A 
prolonged labor
trauma due to obstetrical procedures
overdistention of uterus
grand multiparity
excessive use of analgesia/anesthesia
intrapartum stimulation with pitocin
59
Q

how do you treat Uterine Atony (EXTRA)

A
  • Bimanual Uterine Massage
  • Pitocin and Prostaglandins
  • Uterine packing
  • Hysterectomy
60
Q

___ is characterized by the slow, abnormal progression of labor. (EXTRA)

A

Labor dystocia

61
Q

labor dystocia is an imbalance of what 3 things (EXTRA)

A

Power (uterine contractions, maternal pushing efforts)
Passage (birth canal)
Passenger (fetus)

62
Q

External monitoring can tell you how ___ contractions are.

Internal monitoring can also tell you how ___ contractions are.
EXTRA

A

frequent

strong

63
Q

What can cause a power imblance in labor dystocia

EXTRA

A

IV epidural

64
Q

What can you do to improve the power imbalance in labor dystocia
(EXTRA)

A

Pitocin
nipple stimulation
amniotomy

65
Q

___% of women have atypical pelvic structures (EXTRA)

A

50%

66
Q

What are “passage” issues that contribute to labor dystocia? (EXTRA)

A

Android pelvis

  • Ischial spines
  • pubic arch
  • Sacrum
67
Q

how do you tx labor dystocia? (EXTRA)

A

depends on cause

  • allow more time
  • C-section
  • vacuum or forcep delivery

Repro. Med 4 (7 decks)

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