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Gen Med: Ob/gyn > Labor and Delivery > Flashcards

Labor and Delivery Flashcards

1
Q

When does normal delivery occur?

A

Greater than 36 wks

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2
Q

Define labor

A
  1. Sequence of uterine contractions

2. Results in cervical effacement & dilatation

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3
Q

Define delivery

A

Expulsion of fetus & placenta

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4
Q

What is the role of estrogen in labor?

A
  1. Estrogen from the ovaries induces oxytocin receptors on uterus
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5
Q

What is the role of oxytocin in labor?

A
  1. Comes from the fetus and the pituitary gland
  2. Stimulates the uterus to contract
  3. Stimulates the placenta to make prostaglandins
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6
Q

What is the role of prostaglandins in labor?

A

Stimulates more contractions of the uterus

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7
Q

What needs to be assessed when a woman presents to the hospital for labor?

A
  1. Onset & freq of contractions?
  2. Membrane status?
  3. Bleeding?
  4. Fetal movement?
  5. Allergies?
  6. Meds?
  7. Oral intake (time/amount)?
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8
Q

Define quickening

A
  1. Settling of fetal head into pelvis

2. Occurs ≈ 2 wks up to just prior to labor

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9
Q

Define braxton hicks contractions

A
  1. +/- painless, irreg. contractions
  2. Occur last 4-8 wks of pregnancy
  3. NO cervical changes
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10
Q

when does cervical softening, effacement and dilatation occur?

A

Days – weeks before labor onset

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11
Q

What does a bloody show or membrane rupture indicate?

A

Beginning of labor

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12
Q

How are most babies born?

A

Most infants present w/vertex or head down presentation

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13
Q

What other presentations may be possible?

A
  1. Breech
  2. Transverse
  3. Face
  4. Compound
    A. Arm or leg
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14
Q

Define bloody show

A
  1. Blood tinged mucus
    A. (was plugging cervical os)
  2. Often precedes true labor
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15
Q

What is the ‘water breaking’?

A

Rupture of the amniotic sac

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16
Q

What is included in the cervical exam during labor?

A
  1. Dilatation
  2. Effacement
  3. Station
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17
Q

Define dilatation, when is a woman fully dilated?

A
  1. Opening of cervical os

2. Assessed in cm; fully dilated is 10 cm

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18
Q

Define effacement

A
  1. Cervical softening & thinning out

2. Expressed as percentage (up to 100%)

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19
Q

Define station

A
  1. Location of presenting part (usually the head) in relation to maternal ischial spines
    A. Level of ischial spines is denoted as “0” station
    B. Stations above the spines expressed in (-) numbers (-1 cm, -2cm)
    C. Stations below the spines expressed in (+) numbers (+1cm, +2 cm)
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20
Q

What is the first stage of labor? When does it occur?

A
  1. Interval between onset of labor & full cervical dilatation
  2. Begins at onset of true regular contractions
    A. ≈ 6-20 hr in nulliparous women
    B. ≈2-14 hr in multiparous women
    C. Cervix dilates ≈ 1.0 – 1.5 cm / hr
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21
Q

How is the first stage of labor evaluated?

A
  1. Evaluated by rate of change of cervical effacement, dilatation & descent of fetal head
  2. Frequency of contractions vary
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22
Q

What are the 3 phases of the first stage of labor?

A
  1. Latent
    2, Active
  2. Transition
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23
Q

What is the latent phase?

A
  1. Minimal discomfort w/ contractions q 5-20 min

2. Cervix dilates 3-4 cm

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24
Q

What is the active phase?

A
  1. Contractions more severe, q 3-4 min
  2. Cervix dilates 4-7 cm
  3. Pain control may be necessary
    A. IV pain meds
    B. Epidural
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25
What is the transition phase?
1. Contractions very strong, q 2-3 min & last 60-90 sec | 2. Cervix dilates 8-10 cm
26
When does the second stage of labor begin?
Begins at full dilatation & ends w/delivery of infant
27
What is going on in the second stage?
1. "Pushing stage” 2. Lasts 30 min – 3 hrs (avg 50 min) if nulliparous 3. Usually 5-60 mins (average 20 min) if multiparous
28
How is the second stage determined?
1. Baby’s head visible at introitus | 2. Head engaged
29
What are the 7 mechanisms of labor?
``` 1. Vertex Presentation A. Engagement B. Flexion/Descent C. Descent/Flexion D. Internal rotation E. Extension F. External rotation G. Expulsion ```
30
When is the third stage of labor?
1. Begins after baby delivered & includes separation & expulsion of placenta A. Separation occurs 2-10 min pp B. Placenta expulsion ≥ 30 min
31
What may occur during third stage?
1. Repair lacerations/episiotomy | A. 2-0 to 3-0 absorbable
32
What are the signs of placental separation?
1. Uterus higher & firmer, globular 2. Umbilical cord lengthens 3. Gush of blood
33
What dx studies are used prior to labor?
``` 1. UA A. Protein, glucose, nitrates, WBC’s 2. Hct or Hb 3. Blood type, Rh type, Ab screen 4. Fetal Monitoring A. Used to assess fetal response to labor B. External fetal monitor C. Internal fetal monitor ```
34
How does an external fetal monitor work?
1. Attached to maternal abd A. Assesses fetal heart rate B. Fetal hr is graphed on the top, contraction are plotted on the bottom, and time is between
35
How does an internal fetal monitor work? When can it be used?
1. Electrode attached to infant’s head (fetal scalp electrode) A. Gives more accurate fetal heart rate B. Cervix must be dilated at least 2 cm & membranes ruptured to attach
36
What is an internal contraction monitor?
1. Small catheter (Intrauterine pressure catheter or IUPC) placed in uterus A. Gauges strength of contractions
37
Which is more precise, internal contraction monitor or internal fetal monitor?
Combined w/internal fetal monitor, IUPC gives more precise reading of baby’s HR & uterine contractions
38
What does a fetal hr acceleration indicate?
1. Accelerations > of 15 bpm x 15 sec above baseline | A. Denotes fetal well being
39
What does an early deceleration of of fetal hr indicate?
1. Early decelerations mirror contractions 2. Denotes fetal head compression 3. Often present as approaching 2nd stage of labor 4. Considered benign
40
What does a late deceleration of of fetal hr indicate?
1. Fetal HR drops during 2nd half of contraction 2. Denotes uteroplacental insufficiency 3. Always worrisome-investigate!
41
How is labor managed?
1. Regular cervical exams 2. Continued BP, temp, pulse readings 3. Analgesia A. Provides comfort B. Prevents fatigue 4. Head delivered A. Suction nose & mouth 5. Body delivered A. Cord clamped & cut B. APGAR C. Dry & keep warm
42
When is the APGAR performed?
Infant suctioned, kept warm & assessed for APGAR scores at 1, 5 & 10 min post delivery
43
What management methods may be employed to reduce bleeding?
1. Uterine massage or Oxytocin may be used during 3rd stage of labor to reduce bleeding A. Stimulates contractions
44
What is A in the APGAR score?
1. Activity/muscle tone A. 0: absent B. 1: arms and legs flexed C. 2: active movement
45
What is P in the APGAR score?
1. pulse A. 0: absent B. 1: less than 100 bpm C. 2: Greater than 100 bpm
46
What is G in the APGAR score?
1. Grimace (reflex irritability) A. 0: absent B. 1: grimace C. 2: sneezes, coughs, pulls away
47
What is the second A in the APGAR score?
1. Appearance A. 0: blue-grey, pale all over B. 1: pink except for extremities C. 2: pink all over
48
What is the R in the APGAR score?
1. Respiration A. 0: absent B. 1: slow, irregular C. 2: good crying
49
What are the risks of a C-section?
1. Thrombolic events 2. Increased bleeding 3. Infection
50
What are the most frequent indications for a C-section?
1. Repeat C-Section 2. Dystocia 3. Breech presentation 4. Multiple births 5. Others: Cord prolapse, uterine rupture, placenta problems, fetal distress
51
What are the advantages of a low transverse incision?
1. Less blood loss | 2. Lower likelihood of uterine rupture
52
What is the classic type of C-section incision?
Vertical incision through length of uterus
53
When is labor induction considered?
Considered when prolonged labor might expose mom or baby to complications
54
What are the indications for induction?
1. Prolonged pregnancy greater than 41 wk 2. DM 3. Rh isoimmunization A. Trauma during pregnancy 4. Preeclampsia 5. PROM w/out labor 6. Chronic HTN 7. Placental insufficiency 8. Suspected intrauterine growth restriction (IUGR)
55
What are absolute contraindications for induction?
1. Cephalopelvic disproportion 2. Placenta previa 3. Uterine scar from previous C-section 4. Myomectomy
56
When is and What is used for early induction?
``` 1. Minimal dilatation or effacement A. Prostaglandin gel put directly on cervix to soften -Dinoprostone(Cervidil or Prepidil) -Misoprostol (Cytotec) B. Repeat in 12 hrs prn ```
57
when is and What is used for late induction?
1. Cervix dilated > 1 cm w/some effacement | A. Oxytocin (Pitocin) IV, titrate level until strong contractions q 3 min
58
What is amniotomy?
1. Artificial rupture of membranes (ROM) | A. Can induce labor
59
What physiologic changes occur in the uterus post partum?
1. Immed. after delivery, uterus below umbilicus 2. After 2 days, uterus shrinks or involutes 3. After 2 weeks, uterus descends into pelvic cavity 4. After 4 weeks, back to antenatal size
60
Define lochia
1. Sloughing of residual tissue | 2. Can last 4-5 weeks
61
When does return of menses occur?
1. Bottle feeding moms 6-8 weeks | 2. Nursing moms considered anovulatory & may remain amenorrheic during lactation
62
When is the first post partum visit for mom?
6 wks
63
What is included in the post partum hx?
1. Bleeding 2. Breast or bottle feeding 3. Pelvic pain 4. Contraception 5. Bowel/bladder function 6. Emotional well being
64
What is included in the post partum pe?
1. Perineum should be healed | 2. Uterus should be back to normal size
65
What dx studies are indicated post partum?
1. Determined by Hx A. Bleeding: CBC B. GDM: Glucose
66
What education needs to occur in the post-partum period?
1. Contraceptive counseling 2. Vitamin supplementation for nursing moms 3. Post partum depression

Gen Med: Ob/gyn (13 decks)

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