Labor and Delivery

Question 1

What hormonal changes occur during labor

Answer 1

increase in prostaglandins, estrogen, and oxytocin

Question 2

What are Leopold’s Maneuver

Answer 2

Four palpitations of the fetus through the abdominal wall to deremine where the feturs lies, it's presentation, and position
Fundal grip
Umbilical grip
Pawlick's grip
Pelvic grip

Question 3

Definitions of Lie, Presentation, and Position

Answer 3

Lie-relation of the long axis of the fetus with the maternal long axis
Presentation-determined by the presenting part (breech or cephalic)
Position-relation of the fetal presenting part to the right or the left

Question 4

What are the 3 identifiable parts on a fetus’s skull to help determine what way the baby is facing

Answer 4

Sagittal suture

Anterior and posterior fontanel

Question 5

7 cardinal movements of labor

Answer 5

Engagement
Descent
Flexion-chin meets chest
Internal rotation-head rotates to look at coccyx
Extension
External rotation-after head is born
Expulsion

Question 6

First stage of labor (latent and active phases)

Answer 6

Latent-cervical effacement and early dilation; may take 12-18 hours; no complications and occurs at home

Active- rapid cervical dilation about 1cm/hr
Need to manage maternal vital signs, IV access, frequent voiding, pain management (analgesics and anesthetics), pelvic exams, contractions, fetal HR, rupture of membranes

Question 7

Nonpharm pain options for labor

Answer 7

Cont labor support
warm water baths
intradermal water injections
maternal movement and positioning
touch and massage
acupuncture

Question 8

Pharm pain options for labor

Answer 8

Parenteral opiods
Epidural analgesia
paracervical block
nitrous oxide

Question 9

Second stage of labor

Answer 9

voluntary maternal effort (pushing)
“laboring down”-delayed pushing, decrease hard labor and increase duration of second stage; start when pt feels the urge to push

Options to help with delivery: episiotomy (not common), spontaneous vaginal delivery, vacuum extractors

Question 10

Third stage of labor

Answer 10

Signs of placental seperation (uterus rises in abdomen, gush of blood, lengthening of umbilical cord)

Active management of 3rd stage: early cord clamping, controlled cord traction, uterine massage, Pitocin, or manual removal

Evaluate placenta: two umbilical arteries, one umbilical vein, cotyledons, intact membraneN

Question 11

Indications for c section delivery

Answer 11

failure to dilate or failure to descend are MC

Question 12

Breastfeeding

Answer 12

do within 1 hour of delivery
recommended nutrition for first 4-6 months
Advantages: mom: decreased breast cancer, wt loss, attachment, quicker to amenorrhea
Baby: better immunity, decreased DM, GI illness, HTN

Question 13

Cervical ripening/induction

Answer 13

dilators or French foley balloon

Misoprostol

Question 14

Electronic fetal monitoring

Answer 14

Baseline FHR 110-160bpm

Variability: most reliable indicator of fetal status; suggests adequate fetal CNS oxygenation (absent, minimal, moderate, marked)

Accelerations: increase in FHR above baseline >15bpm x 15 sec; reassuring for fetal well being

Decelerations: Early (mirror image of contraction, not concerning)
variable (varies when slowing of FHR begins, abrupt fall and rapid return; most common deceleration seen)
late (slowing that begins after contraction starts, more ominous)

Question 15

Category 1 EFM

Answer 15

normal, moderate variability, may have accelerations, but no decerlations

Question 16

Catergory 3 EFM

Answer 16

minimum to absent variability +
sinusoidal
recurrent late decels
recurrent variable decls
bradycardia