Labor and delivery Flashcards
what are signs of false labors
irregular contractions
interval may stay the same
walking may make less
adbominal cramping
mild sedation reduces
what is repetitive uterine contraction associated with progressive cervical changes
labor
what are signs of true labor
regular contractions
interval decreases
walking makes worse
abdomen and or back pain
mild sedation has no effect
If GBS is present prior to birth what is the treatment
Penicillin G for at least 2 doses (4hrs apart) until delivery of baby
if allergic - treat with appropriate alternative abs (depends on sensitivity and risk of anaphylaxis)
what is assessed on PE with a birthing person
vitals
fetal position and presentation (Leopolds)
contraction (CTX): frequency, duration and strength
pelvic exam: cervical exam findings, confirm rupture of membranes
what is the initial assessment of fetal wellbeing
Fetal Heart rate (FHR)
presentation/position/attitude
size
what is the method to assess fetal well-being
HR
What are the methods for fetal monitoring
external: intermittent auscultation, continuous electronic fetal monitoring
internal: fetal scalp electrode
combo is common practice
What is EFM
electronic fetal monitoring: record heartbeat of the fetus and contractions of the uterus during labor - may be external or internal
what is the upper and lower portions on a fetal monitor looking at
upper: tracing fetal HR
lower: tracing contractions
what may affect fetal heart rate during labor
fetal conditions
tests done during labor
birthing person conditions
medications or anesthesia given during labor
uterine contractions
pushing during second stage of labor
what are the 5 essential components of fetal heart race tracing
baseline
variability
accelerations
decelerations
changes or trends over time
how is mean fetal heart rate calculated
rounded to increments of 5 beats per minute during a 10-min segment - excluding accelerations and decelerations
what is a normal fetal baseline HR
110-160bmp
what is considered fetal bradycardia
less than 110 bpm
what is considered fetal tachycardia
over 160bpm
what is the fluctuations in FHR baseline that are irregular in amplitude and frequency
variability
based on at least 10-20 minutes of tracing
what are variable decelerations associated with on fetal monitoring
cord compression
what is seen with head compression on fetal monitoring
early decelerations
what is seen with placental insufficiency on fetal monitoring
late decelerations
what are early deceleration
symmetrical gradual decrease in FHR (>30 sec) and return to baseline with CTX.
nadir is at the same time as the peak of the CTX
what is variable deceleration
abrupt decrease in FHR below baseline which may or may not be associated with CTX
onset to nadir is < 30 sec
what is late deceleration
symmetrical gradual decrease in FHR (>30 sec) and return to baseline with CTX.
nadir is AFTER the peak of CTX
What is tachysystole
excessive uterine activity > 5 contractions in 10 minutes, averaged over 30 minutes
how is uterine contraction strength measured
montevideo units (MVU) - sum of intensity of each CTX in 10 minutes
adequate uterine activity is a CTX pattern that generates >200MVU
What are the three P’s of labor
passenger
power
passage
what is cord presentation
umbilical cord falls between presenting part of cervix with our without membrane rupture
what is cord prolapse
umbilical cord falls through cervix next to or before presenting part with membrane rupture
what is an obstetric emergency that requires immediate delivery by cesarean section
cord prolapse
what are the breech presentations
frank, complete fottling
what are the risk factors for breech presentation
gestational age before term
hydramnios
uterine relaxations associated with great parity
hydrocephaly and anecephaly
what is fetal station
how far down fetal head is in the pelvis
narrowest section lies between two bony landmarks of pelvis called ischial spines
what is zero station
geometric plane that extends though the spines and up to the pubic one is called the mid-pelvis
what is fetal lie
relation of fetal spine to birthing person’s spine
what is fetal position
relationship of head to the birthing persons pelvis
what is fetal attitude
relationship of fetal head and fetal spine
what power
uterine contractions
what is the myocmetrium
interwoven bundles of smooth muscle cells in a spiral arrangement
matrix of collagen and gycosaminoglyans
gap conjucntions allow for rapid transmission of signals
what is cervical effacement
thinning of cervix
what is cervial dilation
enlargement of cercival opening
what is the smallest diameter of fetal head when in correct position for delivery
10cm
if a patient has a Bishop score <6, what is recommended before induction of labor
cervical ripening
mechanical, surgical or pharmacological
what is Johnsons formula
fetal weight in grams - 155 x (fundal height in cm - k_
estimation of fetal size
what are the stages of labor
prodrome, active phase
delivery of head
delivery of placenta
recovery
what is “lightning”
dropping - notices more room to breathe and eat; increased urination and defication
What are the movements of Labor
Every Darn Fetus Is Extremely Eager to Exit
Engagement
Descent
Flexion
Internal rotation
Extension
External rotation
Expulsion
what is the third stage of labor
starts after delivery of baby - ends with delivery of placenta
what are signs of third stage of labor
gush of blood
cord appears to lengthen
uterus becomes globular
uterus rises anteriorly
what is active management of the third stage of labor
administration of uterotonic (oxytocin) soon after delivery of anterior shoulder
application of fundal pressure after delivery of placenta
controlled traction on umbilical cord
what is the expectant management of the third stage of labor
wait for spontaneous expulsion of the placenta
what is the 4th stage of labor
uterine involution
fundus is firm and midline about the seize of grapefruit immediately after delivery
rises to umbilicus for about 12 hours
drops 1cm each day for 10 days until back in the pelvis
what is dystocia
abnormal (difficult) labor
what are power causes of dystocia
uterine contraction dysfunction, reduced birthing person strength (exhaustion, pain)
what are the passenger causes of dystocia
abnormalities of size, presentation, position
what are the passage causes of dystocia
abnormalities of pelvic size or architecture
what are some indications for a c-section
placental abruption, previa
failure to progress/descend
worsening birthing person disease
malpresentation
multiple gestation
