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Clin Med > Labor and Delivery > Flashcards

Labor and Delivery Flashcards

1
Q

Premature rupture of membranes (PROM)

A

rupture of membranes before the onset of labor

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2
Q

Preterm, premature rupture of membranes (PPROM)

A

rupture of membranes before 37wks

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3
Q

Prolonged PROM

A

when PROM occurs more than 18hrs before labor, puts mother and fetus at risk for infection

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4
Q

Rupture of Membranes Dx

A

SSE showing pooling, +nitrizine and ferning

  • Amnisure: rapid test that identifies placental alpha-microglobulin-1 via immunoassay
  • Amino dye test: amniocentesis used to inject dilute idigo carmine dye into the amniotic sac to look for leakage from cervix onto tampon
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5
Q

Components of Cervical Exam

A 
Dilation 
Effacement 
Fetal Station 
Cervical Position 
Consistency of Cervix
  • determine if patient is in labor, phase of labor and how labor is progressing
  • Bishop score >8= cervix favorable for induced labor
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6
Q

Dilation

A

how open cervix is at level of internal os (0-10cm)

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7
Q

Effacement

A

subjective measurement of length of cervix (0-100%)

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8
Q

Fetal Station

A

relation of fetal head to ischial spines of maternal pelvis (-3 to +3)

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9
Q

Vertex

A

head down (cephalic)

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10
Q

Breech

A

buttocks down

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11
Q

Transverse

A

laying across

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12
Q

Compound presentation

A

vertex presentation with fetal extremity

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13
Q

Fetal position in vertex presentation

A

based on relationship of fetal occiput to the maternal pelvis
-determined by palpating sutures and fontanelles

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14
Q

Labor

A

regular uterine contractions that cause cervical changes in either effacement or dilation

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15
Q

Prodromal labor

A

false labor

irregular contractions that yield little/no cervical change

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16
Q

Signs of Labor

A

bloody show, N/V, palpability of contractions, patient discomfort

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17
Q

Induction agents

A

prostaglandins, oxytocin, mechanical dilation of the cervix, artificial rupture of membranes

Pitocin: synthesized version of the octapeptide oxytocin that is normally released from the posterior pituitary that causes uterine contractions

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18
Q

Indications to Induce Labor

A 
post dates 
preeclampsia 
PROM 
non reassuring fetal testing 
IUGR
  • Bishop score 5 or less may lead to failed induction up to 50% of the time
  • cervical ripening with PGE2 gel
  • cervidil or misprostol
  • mechanical foley
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19
Q

Augmentation of Labor

A

intervening to increase the already present contractions

indications similar to those for IOL, plus inadequate contraction or prolonged phase of labor

Pitocin or amniotomy

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20
Q

Cervical change

A

indirect measure of adequacy of contraction

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21
Q

Intrauterine pressure catheter (IUPC)

A

directly measures chance in pressure during contractions

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22
Q

Electronic fetal monitoring

A

standard of care

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23
Q

Baseline fetal heart rate

A

110-160BMP

Tachy >160
Brady <110

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24
Q

Variability: fluctuations in the baseline of FHR

A
  • Absent -amplitude undetected
  • Minimal- amplitude range 5BPM or less
  • Moderate-amplitude range between 6-25 BPM
  • Marked- amplitude range greater than 25BPM
25
Q

Accelerations

A

increased in FHR (onset to peak <3secs)

at 32wks: accelerations must be 15x15

26
Q

Early Decelerations

A

symmetrical gradual decrease and return of FHR associated with uterine contraction

27
Q

Late Deceleration

A

deceleration with nadir occurring after peak of contraction then slowly return to baseline

28
Q

Variable deceleration

A

abrupt decrease in FHR

29
Q

Prolonged deceleration

A

Lasts 2 minutes or more

30
Q

FHR interpretation

A

Category I: normal
Category II: monitor
Category III: abnormal+ must intervene

31
Q

Fetal Scalp Electrode (FSE)

A
  • small electrode attached directly to fetal scalp
  • senses potential differences created by depolarization of fetal heart
  • C/I maternal hepatitis/HIV, fetal thrombocytopenia
32
Q

Intrauterine pressure catheter (IUPC)

A
  • catheter threaded past fetal head into uterine cavity to measure pressure changes during uterine contraction
  • measured in Montevideo units in a 10min period
33
Q

Fetal Scalp pH

A

fetal blood is obtained from small nick in fetal scalp to directly asses fetal hypoxia and acidemia

non reassuring: <7.20
>7.25 normal

34
Q

Cardinal Movements of Labor

A 
Engagement
Descent 
Flexion 
Internal rotation
Extension 
External rotation (restitution)
35
Q

Engagement

A

fetal presenting part enters pelvis

36
Q

Descent

A

head descends into pelvis

37
Q

Flexion

A

allows smallest diameter to present

38
Q

Internal rotation

A

rotation from an OT position, usually

to OA

39
Q

Extension

A

vertex passes beneath pubic symphysis

40
Q

External Rotation

A

once head is delivered

restitution

41
Q

Labor progression

A

Assessed by:
1. the progress of cervical effacement

  1. cervical dilation
  2. descent of fetal presenting part
42
Q

Stage 1 of Labor

A

onset of labor until complete dilation of cervix

nulliparous: 10-12 hours
mutiparious 6-8hrs

43
Q

Latent phase (stage 1)

A

from onset of labor to 3-4cm

44
Q

Active phase (stage 1)

A

from latent phase to beyond 9cm , slow of cervical change against time increases

1cm/hr nulliparous
1.2cm/hr for multiparous

45
Q

the 3 Ps

A

affect transit time during active phase of labor

  • powers -strength and frequency of uterine contractions
  • passenger- size and position of fetus
  • passage/pelvis size and shape (maternal)
46
Q

cephalopevic disproportion

A

passenger is too large for pelvis

47
Q

Stage 2 of labor

A

complete cervical dilation to delivery of infant

  • Prolonged if:
  • > 2hrs in nulliparous pt (3hrs with epidural)
  • > 1hr in multiparous pt (2hrs with epidural)

*Repetitive early and variable decels are common *Repetitive late decels, bradycardia or loss of variability are non-reassuring

48
Q

Stage 3 of labor

A

from delivery of the infant until delivery ofthe placenta completed (5-30 mins)

49
Q

3 signs of placental separation

A
  1. cord lengthening
  2. gush of blood
  3. uterine fundal rebound as placenta detaches
50
Q

Episiotomy

A

incision made in the perineum to facilitate delivery

51
Q

Median Episiotomy (midline)

A

vertical midline incision

from the posterior fourchette into the perineal body

52
Q

Mediolateral Episiotomy

A

oblique incision from 5 or 7

o’clock on perineum cut laterally

53
Q

Operative Vaginal Delivery indications

A

Prolonged second stage, maternal exhaustion, or the need to hasten delivery

Necessary conditions:
full dilation
ruptured membranes
engaged head
at least 2 station
knowledge of fetal position
no evidence of CPD
adequate anesthesia
 empty bladder
54
Q

Operative Vaginal Delivery

Types:

A

Forceps and Vacuum Extraction

55
Q

Retained Placental

A

Placenta not delivered within 30 minutes after
infant

  • Risk Factors:
  • preterm, pre-viable deliveries
  • precipitous delivery
  • placenta accreta (placenta invaded endometrial stroma
  • Manual removal - hand placed intrauterine,
    fingers used to shear placenta from surface of
    uterus

*Curettage if manual extraction fails

56
Q

1st degree perineal laceration

A

superficial, confined to vaginal mucosal layer

57
Q

2nd degree perineal laceration

A

into the body of the perineum

58
Q

3rd degree perineal laceration

A

into the anal sphincter

59
Q

4th degree laceration

A

into the rectum

Clin Med (2 decks)

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