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CK OB > Labor > Flashcards

Labor Flashcards

1
Q

____ is a process whereby over time regular uterine contractions bring about progressive
effacement and dilation of the cervix, resulting in delivery of the fetus and expulsion of the
placenta

A

Labor

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2
Q

Increasing frequency of contractions is associated with the _______

A

formation of gap junctions between uterine myometrial cells.

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3
Q

Labor

These events are correlated with increasing levels of ______ and _____ along with multiplication of specific receptors

A

oxytocin and prostaglandins

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4
Q

How does the uterine change during labor

A

The contractile upper uterine segment, containing mostly smooth muscle
fibers, becomes thicker as labor progresses, exerting forces that expel the fetus down the birth canal. The lower uterine segment, containing mostly collagen fibers, passively thins out with contractions of the upper segment

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5
Q

What is the physiology of cervical effacement

A

Cervical softening and thinning occur as increasing levels of oxytocin and prostaglandins lead to breakage of disulfide linkages of collagen fibers, resulting in
increasing water content.

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6
Q

In early labor (latent phase), the rate of dilation is slow, but at______ of dilation, the rate accelerates to a maximum rate in the active phase of labor.

A

6 cm

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7
Q

Cardinal Movements of Labor

  • _______: movement of the presenting part below the plane of the pelvic inlet.
  • ______: movement of the presenting part down through the curve of the birth canal.
  • _____: placement of the fetal chin on the thorax.
A

Engagement

Descent

Flexion

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8
Q

4 steps before expulsion

• ______ rotation of the position of the fetal head in the mid pelvis from transverse to anterior-posterior.
• ______ movement of the fetal chin away from the thorax
• _____: rotation of the fetal head outside the mother as the head passes
through the pelvic outlet.
• _____: delivery of the fetal shoulders and body.

A

Internal rotation:

Extension

External rotation

Expulsion

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9
Q

Stage 1—Latent phase

Effacement
Begins:________
Ends: ________

A

onset of regular uterine contractions

acceleration of cervical dilation

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10
Q

Fn of stage 1 latent phase

A

Prepares cervix for dilation

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11
Q

stage 1

______ hours in primipara
______ hours in multipara

A

<20

<14

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12
Q

Stage 1—Active phase
Dilation

Begins: ______
Ends: ______

A

acceleration of cervical dilation

10 cm (complete)

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13
Q

Fn of stage 1 active phase

A

Rapid cervical dilation

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14
Q

Rate of stage 1 active phase

_____cm/hours primipara
_____ cm/hours multipara

A

> 0.7

> 1.0

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15
Q

Stage 2
Descent

Begins:_____
Ends: delivery of baby

A

10 cm (complete)

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16
Q

Duration of descent

____ hours in primipara
___ hours in multipara
Add 1 hour if epidural

A

<3

<2

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17
Q

Duration of expulsion

A

<30 minutes

18
Q

Preadmission

The parturient is not admitted to the maternity unit until cervical dilation is at least ____cm,
unless______ has occurred. Fetal presentation is confirmed to be cephalic

A

3

premature membrane rupture

19
Q

First stage

_______ is performed in the active phase when the fetal head is well applied to the cervix

A

Amniotomy

20
Q

For the first 2 hours postpartum, the parturient is observed closely for _____ and ____

A

excessive bleeding and development of preeclampsia

21
Q

What is the Dx

  • Pregnant with regular uterine contractions
  • Cervix dilated 2 cm
  • No cervical change in 14h
A

Prolonged Latent Phase

22
Q

Causes of prolonged latent phase

A

Latent-phase abnormalities are most commonly caused by injudicious analgesia. Other causes are contractions, which are hypotonic (inadequate frequency

23
Q

Mx of prolonged latent phase

A 
This involves (a) therapeutic rest with narcotics or sedatives, (b) oxytocin
administration or (c) amniotomy
24
Q

______ is never appropriate management for prolonged latent phase.

A

Cesarean delivery

25
Q

What is the Dx

  • Pregnant with regular uterine contractions
  • Cervix dilated 8 cm
  • No cervical change in 4 h
A

Active Phase Arrest

26
Q

Causes of Active Phase Arrest

A

Active-phase abnormalities may be caused by either abnormalities of the passenger
(excessive fetal size or abnormal fetal orientation in the uterus), abnormalities of the pelvis (bony pelvis size), or abnormalities of powers (dysfunctional or inadequate uterine contractions).

27
Q

Mx of Active Phase Arrest

A

This is directed at assessment of uterine contraction quality

28
Q

If contractions are hypotonic,
_______is administered. If contractions are hypertonic, give ____ sedation. If
contractions are adequate, proceed to _________

A

IV oxytocin

morphine

emergency cesarean section.

29
Q

dx?

  • Pregnant with regular uterine contractions
  • 10 cm dilation at +1 station
  • No descent change in 3 h
A

Second-Stage Arrest

30
Q

mx of prolonged second stage of labor

A

If the head is not engaged, proceed to emergency cesarean. If the head is engaged,
consider a trial of either obstetric forceps or a vacuum extractor delivery.

31
Q

If the placenta does not separate, in spite of

IV oxytocin stimulation of myometrium contractions, think of

A

abnormal placental implantation

(e.g., placenta accreta, placenta increta, and placenta percreta

32
Q

mx of Prolonged Third Stage

A

May require manual placental removal or rarely even hysterectomy.

33
Q

Umbilical cord prolapse is an obstetric emergency because

A

if the cord gets compressed, fetal

oxygenation will be jeopardized, with potential fetal death.

34
Q

types of UC prolapse

A

Prolapse can be occult (the cord has not come through the cervix but is being compressedbetween the fetal head and the uterine wall), partial (the cord is between the head and the dilated cervical os but has not protruded into the vagina), or complete (the cord has protruded
into the vagina).

35
Q

mx of uc prolapse

A

Do not hold the cord or try to push it back into the uterus. Place the patient in
knee-chest position, elevate the presenting part, avoid palpating the cord, and perform immediate cesarean delivery

36
Q

dx??

  • Second stage of labor
  • Head has delivered
  • No further delivery of body
A

Shoulder Dystocia

37
Q

Shoulder Dystocia mx

A

Includes suprapubic pressure, maternal thigh flexion (McRobert’s maneuver), internal rotation of the fetal shoulders to the oblique plane (Wood’s “corkscrew” maneuver),
manual delivery of the posterior arm, and Zavanelli maneuver (cephalic replacement

38
Q

Obstetric Laceration types

  • First degree: involve only the _____ Suture repair is often not needed.
  • Second degree: involve the _____ but do not involve the anal sphincter. Suturing is necessary.
  • Third degree: involve the ______ but not the rectal mucosa. Suturing is necessary to avoid anal incontinence.

• Fourth degree: involve all the way from the vagina through to the rectal mucosa.
Complications of faulty repair or healing include rectovaginal fistula

A

vaginal mucosa.

vagina and the muscles of the perineal body

vagina, the perineal body, and the anal sphincter

39
Q

This is a surgical incision made in the perineum to enlarge the vaginal opening and assist in childbirth. It is one of the most common female surgical procedu

A

Episiotomy

40
Q

Episiotomy indications

A

shoulder dystocia, non-reassuring fetal monitor tracing, forceps or vacuum extractor vaginal delivery, vaginal breech delivery, narrow birth canal.

CK OB (15 decks)

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