labor and delivery Flashcards
preterm delivery is when
before 37 wks gestation
most common cause of neonatal deaths not resulting in congenital malformations
preterm delivery
low birth wt infants born prematurely often have what (3)
significant developmental delays, Cerebral palsy, lung disease
best test to examin the length of the cervix
-normal length?
ultrasonography
4 cm
a length of what of the cervix at when increases the risk to deliver prematurely
a length of 2 cm at 24 wks gestation
marker for preterm labor
cervicovaginal secretions for fetal fibronectin, a glycoprotein
- absence means a low rik of delivery within 2 weeks
if the cervical length and the fetal fibronectin are
- abnormal
- normal
- abnormal: 50% chance of delivery before 34 wks gestation
- normal: 11% chance of delivery before 34 wks gestation
2 labs to get for preterm labor
vaginal cultures and UA with culture & sensitivity
define preterm labor
regular uterine contractions(>4 to 6 hr) between 20 and 36 weeks with (1 of the following):
- cervical dilation of 2 or greater at presentation
- cervical dilation of 1 cm or greater on serial exams
- cervical effacement of greater than 80%
tocolytic (mediated by calcium)
-what to give in toxicity
mag sulfate
give calcium gluconate
CCB in pregnancy
- side effects
tocolytic;
- maternal hypotension and tachycardia
17 alpha hydroxyprogesterone caproate
weekly injections from 16-36 wks
major risk of PROM and PPROM
infection (chorioamnionitis and endometritis)
4 tests for rupture of membranes
sterile spectulum, nitrazine paper, fern test,
ultrasonography(check amniotic fluid index)
avoid what in PROM
digital exam
ropelike, soft, elongated mass
cord prolapse- EMERGENCY. immediate delivery
test to check for lung maturity
amniocentesis.
dilatation
opening of cervical os (cm)
effacement
cervical softening and thinning out (%)
station
location of the presenting part(usually head) in relation of ischial spines
0 station; + and - means what
0 is level at the ischial spines
- above spines is -
- below spines is +
first stage of labor usual length (hours)
- ends at full dilation
nulliparous: 6-20 hours
multiparous: 2-14 hours
second stage of labor
- full dilation and ends with delivery of infant
nulliparous: 30 min to 3 hours
multiparous: 5 to 60 minutes
third stage of labor
is the expulsion of the placenta. usually 5 minutes
fourth stage of labor
hour after delivery critical in assessing and treating tears lacerations, and hemorrhage
order what 3 labs on admission
UA for protein, glucose, and hematocrit
cervix has to be dilated to what for an internal fetal monitor
2 cm and membranes ruptured
good accelerations is what
15 bpm for 15 seconds above the nml baseline heart rate
early decels
woman approaching second stage of labor and considered benign
think what with variable decels
cord compression
what to do with a non-reassuring fetal heart rate
stop oxytocin, change position, give O2 via mask, measure fetal scalp pH
after crowning, what to do to protect the perineal musculature
apply pressure from the coccygeal region upward will extend the head at the proper time
signs of placental separation
umbilical cord lengthening
fresh show of blood flow
fundus rising
uterus becoming firm and globular
cord contains what vessels
3; two arteries and one vein
what to give to reduce blood loss in 3rd stage
oxytocin; stimulates contractions
what is dystocia
abnormal labor; when cervix fails to dilate progressively over time and the fetus fails to descend
foul smelling lochia, increased bleeding, pain, fever, enlarged and soft uterus
subinvoluted uterus
IV ergonovine, methylergonovine, prostaglandins, oxytocin
first line tx for early postpartum hemorrhage
subinvoluted uterus tx
oral agents that increase uterine contractions(ergonovine, methylergonovine); antibx
endometritis occurs when
after C section or when membranes are ruptured more than 24 hrs before delivery
endometritis findings and they occur when
fever higher than 101; uterine tenderness; 2-3 days postpartum
adnexal tenderness, peritoneal irritation, and decreased bowel sounds
may occur with endometritis
WBC with endometritis
over 20,000
common organism with endometritis
-get what test
anaerobic streptococci
-UA
endometritis tx
clinda plus gentamycin first line
ampicillin added if no response in 24-48 hrs
flagyl if sepsis present
what reduces incidence of endometritis
single dose of antibiotic at the time of cord clamping
puerperium
- at 2 days
- at 2 weeks
2 days: uterus shrinks or involutes
2 weeks: descends into the pelvic cavity
when is the uterus back to the nml size
6 weeks
what is lochia
bleeding that occurs AFTER delivery; lasts 4-5 weeks
menses resume when in a non breast feeding mother
6-8 weeks
APGAR
activity, pulse, grimace, appearance, respirations
activity 0, 1, 2
0: absent
1: arms and legs flexed
2: active movement
pulse 0, 1, 2
0: absent
1: < 100 bpm
2: > 100 bpm
grimace 0, 1, 2
0: no response
1: grimace
2: sneeze, cough, pull away
appearance 0, 1, 2
0: blue-gray pale all over
1: pink except extremities
2: pink all over
respirations 0, 1, 2
0: absent
1: slow, irregular
2: good, crying
most common cause of C sections
cephalopelvic disproportion
primary cause of neonatal morbidity and mortality
preterm labor
nitrazine turns blue
alkaline pH of amniotic fluid
+ fern test
amniotic fluid dries up
turtle sign
recoil of perineum. think shoulder dystocia
AFI under 5 and over 25 on u/s
under 5 is oligohydraminos
over 25 is polyhydraminos
40 fold increase in perinatal mortality
oligohydraminos
musculoskeletal abnormalities such as club foot, facial distortion
think oligohydraminos complications
