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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
Q

What is the transition phase?

A
  1. Contractions very strong, q 2-3 min & last 60-90 sec

2. Cervix dilates 8-10 cm

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26
Q

When does the second stage of labor begin?

A

Begins at full dilatation & ends w/delivery of infant

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27
Q

What is going on in the second stage?

A
  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
Q

How is the second stage determined?

A
  1. Baby’s head visible at introitus

2. Head engaged

29
Q

What are the 7 mechanisms of labor?

A 
1. Vertex Presentation
A. Engagement
B. Flexion/Descent
C. Descent/Flexion
D. Internal rotation
E. Extension
F. External rotation
G. Expulsion
30
Q

When is the third stage of labor?

A
  1. Begins after baby delivered & includes separation & expulsion of placenta
    A. Separation occurs 2-10 min pp
    B. Placenta expulsion ≥ 30 min
31
Q

What may occur during third stage?

A
  1. Repair lacerations/episiotomy

A. 2-0 to 3-0 absorbable

32
Q

What are the signs of placental separation?

A
  1. Uterus higher & firmer, globular
  2. Umbilical cord lengthens
  3. Gush of blood
33
Q

What dx studies are used prior to labor?

A 
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
Q

How does an external fetal monitor work?

A
  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
Q

How does an internal fetal monitor work? When can it be used?

A
  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
Q

What is an internal contraction monitor?

A
  1. Small catheter (Intrauterine pressure catheter or IUPC) placed in uterus
    A. Gauges strength of contractions
37
Q

Which is more precise, internal contraction monitor or internal fetal monitor?

A

Combined w/internal fetal monitor, IUPC gives more precise reading of baby’s HR & uterine contractions

38
Q

What does a fetal hr acceleration indicate?

A
  1. Accelerations > of 15 bpm x 15 sec above baseline

A. Denotes fetal well being

39
Q

What does an early deceleration of of fetal hr indicate?

A
  1. Early decelerations mirror contractions
  2. Denotes fetal head compression
  3. Often present as approaching 2nd stage of labor
  4. Considered benign
40
Q

What does a late deceleration of of fetal hr indicate?

A
  1. Fetal HR drops during 2nd half of contraction
  2. Denotes uteroplacental insufficiency
  3. Always worrisome-investigate!
41
Q

How is labor managed?

A
  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
Q

When is the APGAR performed?

A

Infant suctioned, kept warm & assessed for APGAR scores at 1, 5 & 10 min post delivery

43
Q

What management methods may be employed to reduce bleeding?

A
  1. Uterine massage or Oxytocin may be used during 3rd stage of labor to reduce bleeding
    A. Stimulates contractions
44
Q

What is A in the APGAR score?

A
  1. Activity/muscle tone
    A. 0: absent
    B. 1: arms and legs flexed
    C. 2: active movement
45
Q

What is P in the APGAR score?

A
  1. pulse
    A. 0: absent
    B. 1: less than 100 bpm
    C. 2: Greater than 100 bpm
46
Q

What is G in the APGAR score?

A
  1. Grimace (reflex irritability)
    A. 0: absent
    B. 1: grimace
    C. 2: sneezes, coughs, pulls away
47
Q

What is the second A in the APGAR score?

A
  1. Appearance
    A. 0: blue-grey, pale all over
    B. 1: pink except for extremities
    C. 2: pink all over
48
Q

What is the R in the APGAR score?

A
  1. Respiration
    A. 0: absent
    B. 1: slow, irregular
    C. 2: good crying
49
Q

What are the risks of a C-section?

A
  1. Thrombolic events
  2. Increased bleeding
  3. Infection
50
Q

What are the most frequent indications for a C-section?

A
  1. Repeat C-Section
  2. Dystocia
  3. Breech presentation
  4. Multiple births
  5. Others:
    Cord prolapse, uterine rupture, placenta problems, fetal distress
51
Q

What are the advantages of a low transverse incision?

A
  1. Less blood loss

2. Lower likelihood of uterine rupture

52
Q

What is the classic type of C-section incision?

A

Vertical incision through length of uterus

53
Q

When is labor induction considered?

A

Considered when prolonged labor might expose mom or baby to complications

54
Q

What are the indications for induction?

A
  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
Q

What are absolute contraindications for induction?

A
  1. Cephalopelvic disproportion
  2. Placenta previa
  3. Uterine scar from previous C-section
  4. Myomectomy
56
Q

When is and What is used for early induction?

A 
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
Q

when is and What is used for late induction?

A
  1. Cervix dilated > 1 cm w/some effacement

A. Oxytocin (Pitocin) IV, titrate level until strong contractions q 3 min

58
Q

What is amniotomy?

A
  1. Artificial rupture of membranes (ROM)

A. Can induce labor

59
Q

What physiologic changes occur in the uterus post partum?

A
  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
Q

Define lochia

A
  1. Sloughing of residual tissue

2. Can last 4-5 weeks

61
Q

When does return of menses occur?

A
  1. Bottle feeding moms 6-8 weeks

2. Nursing moms considered anovulatory & may remain amenorrheic during lactation

62
Q

When is the first post partum visit for mom?

A

6 wks

63
Q

What is included in the post partum hx?

A
  1. Bleeding
  2. Breast or bottle feeding
  3. Pelvic pain
  4. Contraception
  5. Bowel/bladder function
  6. Emotional well being
64
Q

What is included in the post partum pe?

A
  1. Perineum should be healed

2. Uterus should be back to normal size

65
Q

What dx studies are indicated post partum?

A
  1. Determined by Hx
    A. Bleeding: CBC
    B. GDM: Glucose
66
Q

What education needs to occur in the post-partum period?

A
  1. Contraceptive counseling
  2. Vitamin supplementation for nursing moms
  3. Post partum depression

Gen Med: Ob/gyn (13 decks)

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