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reproductive system > labor and delivery > Flashcards

labor and delivery Flashcards

1
Q

preterm delivery is when

A

before 37 wks gestation

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2
Q

most common cause of neonatal deaths not resulting in congenital malformations

A

preterm delivery

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3
Q

low birth wt infants born prematurely often have what (3)

A

significant developmental delays, Cerebral palsy, lung disease

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4
Q

best test to examin the length of the cervix

-normal length?

A

ultrasonography

4 cm

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5
Q

a length of what of the cervix at when increases the risk to deliver prematurely

A

a length of 2 cm at 24 wks gestation

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6
Q

marker for preterm labor

A

cervicovaginal secretions for fetal fibronectin, a glycoprotein
- absence means a low rik of delivery within 2 weeks

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7
Q

if the cervical length and the fetal fibronectin are

  • abnormal
  • normal
A
  • abnormal: 50% chance of delivery before 34 wks gestation

- normal: 11% chance of delivery before 34 wks gestation

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8
Q

2 labs to get for preterm labor

A

vaginal cultures and UA with culture & sensitivity

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9
Q

define preterm labor

A

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%
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10
Q

tocolytic (mediated by calcium)

-what to give in toxicity

A

mag sulfate

give calcium gluconate

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11
Q

CCB in pregnancy

- side effects

A

tocolytic;

- maternal hypotension and tachycardia

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12
Q

17 alpha hydroxyprogesterone caproate

A

weekly injections from 16-36 wks

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13
Q

major risk of PROM and PPROM

A

infection (chorioamnionitis and endometritis)

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14
Q

4 tests for rupture of membranes

A

sterile spectulum, nitrazine paper, fern test,

ultrasonography(check amniotic fluid index)

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15
Q

avoid what in PROM

A

digital exam

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16
Q

ropelike, soft, elongated mass

A

cord prolapse- EMERGENCY. immediate delivery

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17
Q

test to check for lung maturity

A

amniocentesis.

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18
Q

dilatation

A

opening of cervical os (cm)

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19
Q

effacement

A

cervical softening and thinning out (%)

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20
Q

station

A

location of the presenting part(usually head) in relation of ischial spines

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21
Q

0 station; + and - means what

A

0 is level at the ischial spines

  • above spines is -
  • below spines is +
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22
Q

first stage of labor usual length (hours)

A
  • ends at full dilation
    nulliparous: 6-20 hours
    multiparous: 2-14 hours
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23
Q

second stage of labor

A
  • full dilation and ends with delivery of infant
    nulliparous: 30 min to 3 hours
    multiparous: 5 to 60 minutes
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24
Q

third stage of labor

A

is the expulsion of the placenta. usually 5 minutes

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25
Q

fourth stage of labor

A

hour after delivery critical in assessing and treating tears lacerations, and hemorrhage

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26
Q

order what 3 labs on admission

A

UA for protein, glucose, and hematocrit

27
Q

cervix has to be dilated to what for an internal fetal monitor

A

2 cm and membranes ruptured

28
Q

good accelerations is what

A

15 bpm for 15 seconds above the nml baseline heart rate

29
Q

early decels

A

woman approaching second stage of labor and considered benign

30
Q

think what with variable decels

A

cord compression

31
Q

what to do with a non-reassuring fetal heart rate

A

stop oxytocin, change position, give O2 via mask, measure fetal scalp pH

32
Q

after crowning, what to do to protect the perineal musculature

A

apply pressure from the coccygeal region upward will extend the head at the proper time

33
Q

signs of placental separation

A

umbilical cord lengthening
fresh show of blood flow
fundus rising
uterus becoming firm and globular

34
Q

cord contains what vessels

A

3; two arteries and one vein

35
Q

what to give to reduce blood loss in 3rd stage

A

oxytocin; stimulates contractions

36
Q

what is dystocia

A

abnormal labor; when cervix fails to dilate progressively over time and the fetus fails to descend

37
Q

foul smelling lochia, increased bleeding, pain, fever, enlarged and soft uterus

A

subinvoluted uterus

38
Q

IV ergonovine, methylergonovine, prostaglandins, oxytocin

A

first line tx for early postpartum hemorrhage

39
Q

subinvoluted uterus tx

A

oral agents that increase uterine contractions(ergonovine, methylergonovine); antibx

40
Q

endometritis occurs when

A

after C section or when membranes are ruptured more than 24 hrs before delivery

41
Q

endometritis findings and they occur when

A

fever higher than 101; uterine tenderness; 2-3 days postpartum

42
Q

adnexal tenderness, peritoneal irritation, and decreased bowel sounds

A

may occur with endometritis

43
Q

WBC with endometritis

A

over 20,000

44
Q

common organism with endometritis

-get what test

A

anaerobic streptococci

-UA

45
Q

endometritis tx

A

clinda plus gentamycin first line
ampicillin added if no response in 24-48 hrs
flagyl if sepsis present

46
Q

what reduces incidence of endometritis

A

single dose of antibiotic at the time of cord clamping

47
Q

puerperium

  • at 2 days
  • at 2 weeks
A

2 days: uterus shrinks or involutes

2 weeks: descends into the pelvic cavity

48
Q

when is the uterus back to the nml size

A

6 weeks

49
Q

what is lochia

A

bleeding that occurs AFTER delivery; lasts 4-5 weeks

50
Q

menses resume when in a non breast feeding mother

A

6-8 weeks

51
Q

APGAR

A

activity, pulse, grimace, appearance, respirations

52
Q

activity 0, 1, 2

A

0: absent
1: arms and legs flexed
2: active movement

53
Q

pulse 0, 1, 2

A

0: absent
1: < 100 bpm
2: > 100 bpm

54
Q

grimace 0, 1, 2

A

0: no response
1: grimace
2: sneeze, cough, pull away

55
Q

appearance 0, 1, 2

A

0: blue-gray pale all over
1: pink except extremities
2: pink all over

56
Q

respirations 0, 1, 2

A

0: absent
1: slow, irregular
2: good, crying

57
Q

most common cause of C sections

A

cephalopelvic disproportion

58
Q

primary cause of neonatal morbidity and mortality

A

preterm labor

59
Q

nitrazine turns blue

A

alkaline pH of amniotic fluid

60
Q

+ fern test

A

amniotic fluid dries up

61
Q

turtle sign

A

recoil of perineum. think shoulder dystocia

62
Q

AFI under 5 and over 25 on u/s

A

under 5 is oligohydraminos

over 25 is polyhydraminos

63
Q

40 fold increase in perinatal mortality

A

oligohydraminos

64
Q

musculoskeletal abnormalities such as club foot, facial distortion

A

think oligohydraminos complications

reproductive system (11 decks)

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