Labor and delivery Flashcards
what is a bishop score? What makes it up?
Favorability of cervix for delivery
1. dilation (width)
2. effacement (thinning)
3. Station presenting fetus to ischial spine -2,-1,0,+1,+2
0 being the ischial spine
4. Consistency -soft/hard
5. position of the cervix-posterior or anterior
What are some indicated reasons to induce labor?
ROM, IUFD, preeclampsia, chorioamnionitis, oligohydramnios, Rh factor
Contraindications to induce?
nonreassuring fetal status NRFS, hypoxia, non cephalic lie (breech, transverse), vertical uterine scar, placenta previa
What should you do to prevent a placental rupture if you have a patient who had placenta previa in the second trimester present in labor?
Do an ultrasound to determine where the placenta is before inserting anything into her vagina. Many patients have early previa that resolves. If still an issue do a c-section.
How do you determine a stress test from a non stress test?
contractions either induced or natural
How do you interpret fetal NST and stress test?
NST-FHR will accelerate with movement, you want the test to be reactive (HR) a few times during a 20 min period. If nonreactive at 40 min may indicate; sleep, narcotics, CNS depression acidosis, immature autonomics.
What’s the next step after a non reactive NST?
A biophysical profile (BPP) takes other variables into account. A modified version includes the amniotic fluid volume (5-25) into account along with the NST.
When is amniotic fluid low, naturally and abnormally? High?
natural-near term, or past term
abnormal-oligohydramnios from ROM, suggestive of fetal growth restriction (smoking, RX, twins),
Polyhydramnios-duodinal atresia, TEF, diabetes
What do early late and variable decelerations indicate?
early- reassuring
late Insufficiency, hypoxia, meconium,
abruption=concerning
variable-Cord compression (nuchal, prolapse, knot), though it can be normal if it returns to baseline; maybe secondary to oligohydramnios
Name the cardinal movements involved with the first and second stage of labor
stage 1 labor onset until full cervical dilation engagement decent flexion internal rotation (face down)
stage 2 dilation to expulsion “pushing” 20-50 mins
extension
external rotation
expulsion
What chemical release facilitates labor following ROM or sexual activity?
Prostaglandin release which ripens the cervix and can allow the fetal head to compress the cervix. It also stimulates uterine contractions.
You deliver your first baby which comes out green what do you need to worry about?
Meconium aspiration syndrome, try to thin out the meconium with amnioinfusion during labor
You saw your attending physician invert a woman uterus, how can you prevent yourself from doing the same?
Hold down the uterus while trying to remove the placenta. usually takes about 2-5 mins but don’t pull to hard or you could also rupture an accreta
What’s the fourth stage of labor?
1hr after delivery
What are the four degrees of vaginal lacerations?
- vaginal membrane
- perineal body and skin
- anal sphincter
- rectal mucosa
What is dystocia and what are the three important components of it?
Change with fetal presentation and the birth canal
power-weak contractions or effort
passage-contracted pelvis, or blocking tissues
passenger-big baby, abnormal presentation, multiple kids
What are protraction and arrest disorders related to the friedman curve?
Protraction disorder-slow dilation and decent in active phase
Arrest disorder-NO dilation or decent for 2-4hrs in active phase
Interventions for first stage dystocia include what?
oxytocin-power
decrease epidural-power
change position-passage/power
What the hell are montevideo units?
measure of contraction force via intrauterine catheter
>200 adequate for most labor progression
Second stage dystocia can last as long as 4hrs. Failure to descend can be from passage size or presentation. What can you do as a provider to facilitate a vaginal birth?
vacuum extraction indicated during second stage arrest or exhaustion. C/I if not 2+ station, unknown position of 3 tries rule. Same rules for forceps
What are the signs of shoulder dystocia and why is this an issue? Where should you press to help with the delivery?
Turtle sign come out and then draw back
press on pubic symphysis not funds
complicaitons-brachial plexus injury, fractured clavicle or hypoxia, death, erbs palsy
What a VBAC, yes the VBAC not the WAYBACK
vaginal birth after c-section
Rupture risk is low with transverse scar, but not vertical
How long does the postpartum period last?
6 wks
Your patient comes to the clinic 6 days after delivery with a fever of 100.8. She says it was 100.6 about 6 hrs prior and thinks she might be getting a cold. What are the primary concerns that you need to rule out?
7 Ws
wind-atelectasis, pneumonia water-UTI womb-endometritis wound-cellulitis, hematoma walking-DVT weaning-acute mastitis wonder drug-drug fever
