Labor and Delivery Flashcards
preterm vs term vs post term
< 37
37-42
> 42
what are adequate contractions
3-5 ctx/10 min + > 200MVU
What are the different “fetal lies”
longitudinal, transverse, oblique
What is fetal presentation
first part in vagina (cephalic/vertex vsbreech)
what determines fetal position?
location of occiput:
OP
ROP LOP
ROT LOT
ROA LOA
OAWhat is the leopoid maneuver
used to determine prentation, position, engagement
What is the MC pelvic type that also has the best px
gynecoid
what type is MC seen in asians and can lead to deep transverse arrest
Platypelloid
What are indications to induce labor
posterm
PROM (>34 wks)
PreE
nonreassuring fetal testing
What are the different methods to induce labor
prostaglandins (cytotec)
ocytocin (Pitocin)
amniotomy (AROM)
What are CI to PGE
amternal asthma or glaucoma, > 1 prior C/S
What is augmentation of labor?
increasing contractions in an already laboring pt
what is the bishop score
assess progresssion of labor:
- Dilation: diameter of internal os (range 0-10 cm)
- Effacement: thinning out of cervix (range 0-100%)
- Station: 0 station (midpoint) is ischial spines, measure in cm above/below (range -5 to +5 cm)
- Position: advancement of cervix as labor progresses (range posterior to anterior)
- Consistency: softening of cervix as labor progresses (Hegar or Ladin sign)
Management for the following bishop scores:
0-4
5-9
10+
0-4 = cytotec 5-9 = pitocin 10+ = expectant management
What are the 4 stages of labor
1: onset to complete dilation
2: dilation to delivery
3: delivery to delivery of placenta
4: placental delivery to 2 hrs post partum
latent phase 1 vs active phase 1
latent = 0-4 cm dilation and slow active = > 40 cm and fast
What is considered active phase arrest and is an indication for C/S
no change in dilation or station for 2 hrs during active pahse (>4cm)
when is stage 2 considered prolonged?
> 2 hrs nulliparous, > 1 hr if multiparous (add 1 hr if have epidural)
what is the ritgen maneuver?
pressure on fetal head to help pass shoulders through
When is the placenta considered to be retained? What is tx management of this?
stage 3 lasts greater than 30 mins
manual extraction + abx
what are signs of placental seperation?
gush of blood, lengthening of cord, change in shape of uterine fundus
If too much traction is applied to the cord, what could happen
cord avulsion, uterine inversion
what is an episitomy
incision in perineum to facilitate delivery
2 types, median and mediolateral
What are the cardinal movements of the fetus?
- Engagement (0 station)
- Flexion
- Descent
- Internal rotation
- Extension
- External rotation
- Expulsion
What is an operative vaginal delivery?
usage of forceps or vacuum to deliver fetus
complication with use of forceps
CV VII palsy
complication with use of vacuum
cephalohematoma and shoulder dystocia
what conditions are necessary for an operative vaginal delivery
experienced operator (most important), full dilation, ruptured membranes, engaged w/ >2 station, knowledge of fetal position, anesthesia, empty bladder, no evidence of cephalopelvic distortion
diff btwn 1st, 2nd, 3rd, 4th degree perineal lacerations
1st degree: superficial tear
2nd degree: extends into perineal body
3rd degree: extends into anal sphincter
4th degree: extends into rectum
MC reason for C/S
primary C/S = failure to progress in labor
overall = previous C/S
only true CI to vaginal birth after C/S (VBAC)
previous vertical/classical C/S
MC complication of TOLAC
rupture of uterine scar
**Rupture sx: sudden onset severe abd pain ± vaginal bleed, subjective “pop” sensation
anesthesia indicated for operative vaginal delivery, direct needle towards jxn of ischial spine and sacrospinous ligament
pudental block
anesthesia indicated for episiotomy and laceration repairs
local anesthesia
epidural can lengthen stage ___ of labor
2
anesthesia more commonly used during C/S
spinal anesthesia
