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OB/GYN SHELF > LABOR AND DELIVERY > Flashcards

LABOR AND DELIVERY Flashcards

To know and recall the pertinent maneuveurs and complications that arise in labor and delivery. This may overlap with other decks.

1
Q

Within how long after delivery should Rhogam be given to an Rh- mother?

A

within 72 hours of labor

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2
Q

What is active management of the third stage of labor?

A

Early cord clamping, controlled cord traction, immediate admin of prophylactic uterotonics

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3
Q

What is the following describing:
Definition: measurement (in cm) of the presenting part above and below the maternal ischial spine

A

Station

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4
Q

What station: the presenting part is at the level of the ischial spines

A

0

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5
Q

What station:
1, 2, and 3 cm above the level of the ischial spines, respectively

A

-1, -2, -3

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6
Q

What station: 1, 2, and 3 cm below the level of the ischial spines, respectively

A

+1, +2, +3

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7
Q

What generally takes place in each of the three/four stages of birth?

A

Stage 1: cervical dialation and effacement
Stage 2: Fetal expulsion
Stage 3: placental expulsion or afterbirth
Stage 4: 1-2 hour postpartum period

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8
Q

What stage are we in:
Coordinated, regular, rhythmic contractions of high intensity; occur approximately every 10 minutes. They occur every 2–3 min. These contractions are responsible for cervical dilation.

A

Stage 1

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9
Q

What stage are we in: Coordinated and regular contractions of high intensity; occur approximately every 4–10 min and are responsible for fetal expulsion. Towards the end of the stage, they occur very often (every 2–3 minutes) and are of higher intensity (≥ 200 Montevideo units).

A

Stage 2

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10
Q

In the first stage of labor, we delineate it into latent and active phases. What constitutes the latent phase?

A

Occurs during the onset of labor and ends at 6 cm of cervical dilation

Characterized by mild, infrequent, irregular contractions with a gradual change in cervical dilation (< 1 cm/hour)

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11
Q

When do we consider the first stage the ‘active phase’?

A

Occurs after the latent phase at ≥ 6 cm of cervical dilation and ends with complete (∼ 10 cm) cervical dilation.

Characterized by an increase in the rate of cervical dilation (1–4 cm/hour)

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12
Q

How long is the latent phase in a nulliparous woman?

A

≤ 20 hours

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13
Q

How long is the latent phase in a multiparous woman?

A

≤ 14 hours

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14
Q

How long is the active phase in a nulliparous woman?

A

4–6 hours

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15
Q

How long is the active phase in a multiparous woman?

A

2-3 hours

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16
Q

How long is the 2nd stage of labor in a nulliparous woman?

A

< 2 hours (< 3 hours in patients who received an epidural)

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17
Q

How long is the 2nd phase of labor in a multiparous woman?

A

< 1 hour (< 2 hours in patients who received an epidural)

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18
Q

How long is the third stage of labor?

A

normally 30 minutes for nulli or multiparous women

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19
Q

How do we define fetal heart rate decelerations?

A

Description: a temporary decline in the FHR of > 15 bpm for a maximum duration of 3 minutes

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20
Q

What are early decelerations normally indicative of?

A

Compression of the head during a contraction triggering a vagal response

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21
Q

What are late decelerations indicative of?

A

Uteroplacental insufficiency (leads to fetal hypoxia and acidosis)

22
Q

What are variable decelerations indicative of?

A

Umbilical cord compression/prolapse

23
Q

What are prolonged decelerations indicative of?

A

Same as those for late and variable deceleration, but protracted and more severe
Continued uterine contractions, inferior vena cava syndrome, peridural anesthesia, rapid decrease in the mother’s blood pressure

24
Q

What is the CTG showing?

A

This is showing early decelerations. Remember that EARLY decels indicate normal head compression in labor. These are not a big red flag.

Note: Contractions and decelerations begin and end together (red dashed line overlay), with the peaks of the contractions coinciding with the nadirs of the decelerations (red arrow overlay). The decelerations are gradual, with ≥ 30 s from onset to nadir. These findings are characteristic of early decelerations.

25
Q

What is this CTG showing?

A

This is showing late decelerations. Recall that late decerlations are normally indicative of uteroplacental insufficiency.

26
Q

What is the CTG showing?

A

As the decelerations here occur with < 50 % of uterine contractions over a 20-minute time period, they are termed intermittent variable decelerations. Recall that variable decels can be indicative of umbilical cord compression/ prolapse.

27
Q

What is this CTG concerning for?

A

This CTG shows deceleration with minimal variability.
This is a highly concerning CTG that should prompt emergency cesarean delivery.

28
Q

What is cephalic presentation?

A

Head overlies the meternal pelvic inlet

29
Q

What type of presentation:
Both hips and knees are flexed with the feet close to the buttocks.

A

Complete breech

30
Q

What type of presentation:
one foot/leg is stretched to be delivered first.

A

Single Footling breech

31
Q

What type of presentation:
both feet/legs are stretched to be delivered first.

A

Footling breech

32
Q

What position is the baby in:

A

Right occiput anterior position

33
Q

What position is the baby in:

A

Left occiput anterior position

34
Q

degree of extension/flexion of the fetal head during cephalic presentation

A

Fetal attitude

35
Q

What attitude: maximally flexed; most common attitude

A

Vertex presentation

36
Q

If a baby’s attitude is partitally extended, what presentation do we expect to see?

A

Brow

37
Q

If a baby’s attitude is maximally extended, what presentation do we expect to see?

A

Face

38
Q

What are the different components of orientation in utero?

A

Fetal Lie (longitudinal, transverse, oblique)
Fetal Presentation (cephalic, breech)
Fetal Position (occiput post, occiput ant)
Fetal Attitude (vertex, brow, face)
Fetal Station (-3-2-1,0,+1+2+3)

39
Q

How is PPH defined in terms of volume?

A

PPH= post partum hemmorage and is defined as:

> 500 cc blood loss after vaginal delivery

> 1000 cc blood loss with cesarean delivery

40
Q

What is primary PPH?

A

Occurs within 1st 24 hours post delivery

41
Q

What are the causes of primary PPH?

A

TONE: ATONY (80%)

TRAUMA: laceration, hematoma, inversion, rupture

TISSUE: retained placenta or placenta accreta

THROMBIN: coagulopathy

42
Q

What is secondary PPH?

A

PPH occuring after 24hrs-6/12 weeks after delivery

43
Q

What are causes of secondary pph?

A

retained products of conception, inherited coag defects, and subinvolution of the placenta site

44
Q

What are risks for atony?

A

polyhydramnios/multiple gestations, prolonged/augmented with oxytocin labor, history of pph

45
Q

How do we reduce the incidence of PPH?

A

Active management of the third stage of labor:
Fundal massage, gentle cord traction, IV/IM oxytocin

46
Q

How might we manage uterine atony post delivery?

A

FIRST:
Drain the bladder
Methergine (NOT FOR HTN)
Hemabate (NOT FOR ASTHMA)
Oxytocin
Misoprostol

If not working NEXT:
Uterine tamponade with packing or backir balloon

If not working NEXT:
Surgical managment with b-lynch suture to maually compress the uterus
uterine aa ligation

If not working NEXT:
Hysterectomy

47
Q

A 38 wga pt presents with concern for a gush of fluids from her vagina. She denies contractions, pain, or bleeding. What is the most likley dx and first step in management?

A

PROM (prelabor rupture of membranes). Admit her to the hospital for induction of labor.

48
Q

Preterm labor refers to labor before _______

A

37 weeks

49
Q

What are risk factors for preterm labor?

A
50
Q

How do we prevent preterm labor in pts with a hx of it?

A
51
Q

What can increase the liklihood of a false positive nitrazine test?

A

Semen or blood can increase the false positive liklihood due to pH canges. If there is no ferning and her amniotic fluid index is normal but her nitrazine test is positive, you should suspect that its a flase positive.

52
Q

In a general case of PPROM, what drugs are indicated right off the bat?

A

Corticosteroids and antibitoics. Tocolytics would be indicated to allow for admin of corticosteroids.

OB/GYN SHELF (16 decks)

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