labor and delivery

Question 1

premature rupture of membranes

Answer 1

• rupture of membranes before onset of labor

Question 2

preterm, premature rupture of membranes

Answer 2

• rupture before 37 weeks

Question 3

prolonged premature rupture of membranes

Answer 3

• PROM that occurs more than 18 hours before labor

- increased risk of infection

Question 4

diagnosis of premature rupture of membranes

Answer 4

• sterile speculum exam
• pooling
• • nitrizine
• ferning

Question 5

amnisure

Answer 5

• IDs placental alpha macroclobulin 1

- used for PROM

Question 6

amnio dye test

Answer 6

• amniocentesis to inj indigo carmine dye into amniotic sac
• woman puts on tampon
• look for leakage
• used for PROM

Question 7

components of labor

Answer 7

• dilation
• effacement
• fetal station
• cervical position
• consistency of cervix

Question 8

dilation

Answer 8

• how open cervix is at level of internal os

- 0-10 cm

Question 9

effacement

Answer 9

• length of cervix

Question 10

fetal station

Answer 10

• relation of fetal head to ischial spine of maternal pelvis

- -3 to +3

Question 11

bishop score

Answer 11

• made up of 5 components of labor

- if score > 8 means cervix is favorable for induction

Question 12

vertex presentation

Answer 12

• aka cephalic

- head down

Question 13

breech presentation

Answer 13

• buttock down

Question 14

transverse presentation

Answer 14

• neither head nor buttock down

- back or belly

Question 15

compound presentation

Answer 15

• vertex with fetal extremity

- usu with hand

Question 16

labor

Answer 16

• contractions that cause cervical change

- change in effacement or dilation

Question 17

false labor

Answer 17

• aka prodromal labor

- irregular contractions -> little or no cervical change

Question 18

signs of labor

Answer 18

• bloody show
• N/V
• palpability of contractions
• pt discomfort

Question 19

labor induction agents

Answer 19

• prostaglandins
• oxytocin
• mechanical dilation of cervix
• artificial rupture of membranes

Question 20

common indications for induction

Answer 20

• post dates
• preeclampsia
• PROM
• non-reassuring fetal testing
• IUGR

Question 21

pitocin

Answer 21

• synthesized version of oxytocin

- causes uterine contractions

Question 22

augmentation of labor

Answer 22

• increases already present contractions
• similar indications for induction of labor
• can use pitocin or amniotomy

Question 23

cervical change

Answer 23

• indirect measure of adequacy of contraction

Question 24

intrauterine pressure catheter

Answer 24

• directly measure change in pressure during contraction
• measured in montevideo units
• done for 10 min

Question 25

what is a normal baseline fetal HR

Answer 25

- 110-160

Question 26

variable FHR

Answer 26

- fluctuations in baseline FHR | - expect moderate variability

Question 27

accelerations in FHR

Answer 27

- increased FHR | - at 32 weeks expect accelerations to be 15X15

Question 28

early deceleration

Answer 28

- symmetrical gradual decrease and return of FHR - assoc with contraction - usu means pt is about to deliver

Question 29

late decelerations

Answer 29

- decel with nadir occuring after peak contraction - slowly returns to baseline - suggests placenta compression

Question 30

variable decelerations

Answer 30

- abrupt decrease in FHR | - suggests cord compression

Question 31

prolonged decelerations

Answer 31

- last 2+ minutes

Question 32

fetal scalp electrodes

Answer 32

- small electrodes attached directly to fetal scalp - senses dif of depolarization - c/i in maternal hepatitis, HIV, fetal thrombocytopenia

Question 33

fetal scalp pH

Answer 33

- fetal blood obtained through small nick in fetal scalp | - directly assesses hypoxia and acidemia

Question 34

pulse ox

Answer 34

- fetal pulse ox placed intrauterine along fetal cheek

Question 35

cardinal movements of labor

Answer 35

- engagement- presenting part enters pelvis - descent - flexion- allows smallest diameter to present - internal rotation- usu LOT to LOA - extension - external rotation/ restitution

Question 36

stage 1 of labor

Answer 36

- onset to complete dilation of cervix | - takes longer in nulliparous pt

Question 37

stage 2 of labor

Answer 37

- complete cervical dilation to delivery - repetitive early and variable decels common - prolonged if > 2 hours in nulliparous, > 1 hour in multiparous

Question 38

stage 3 of labor

Answer 38

- delivery of infant to delivery of placenta | - usu lasts 5-30 min

Question 39

signs of placental separation

Answer 39

- cord lengthening - gush of blood - uterine fundal rebound as placenta detaches

Question 40

what are the 3 P's

Answer 40

- affect transit time during active phase of labor - powers (of contraction) - passenger (Size of fetus) - pelvis/passage

Question 41

episiotomy

Answer 41

- incision made in perineum to facilitate delivery | - midline vs mediolateral

Question 42

1st degree perineal laceration

Answer 42

- superficial | - confined to vaginal mucosal layer

Question 43

2nd degree perineal laceration

Answer 43

- into body of perineum

Question 44

3rd degree perineal laceration

Answer 44

- into anal sphincter

Question 45

4th degree perineal laceration

Answer 45

- into rectum

Question 46

indications for operative vaginal delivery

Answer 46

- prolonged second stage - maternal exhaustion - need to hasten delivery

Question 47

tools used for operative vaginal delivery

Answer 47

- forceps- blades placed around fetal head | - vacuum extraction- vacuum cup on fetal scalp

Question 48

retained placenta

Answer 48

- placenta that is not delivered in 30 min - manual removal - curettage if manual removal fails

Question 49

risk factors for retained placenta

Answer 49

- preterm, previable deliveries - precipitous delivery - placenta accreta- invaded endometrial stroma