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ENRP Exam 1 > Labor and Delivery > Flashcards

Labor and Delivery Flashcards

1
Q

labor

A

progressive cervical dilation resulting from regular uterine contractions that occur at least every 5 minutes and last 30-60 seconds

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2
Q

false labor

A

also called Braxton-Hicks contractions

irregular contractions without cervical change

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3
Q

which pelvic shapes have good prognosis for delivery?

A

gynecoid (50% of females)

anthropoid (20% of females)

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4
Q

which pelvic shapes have bad prognosis for delivery?

A

android (30% of females)

platypelloid (3% of females)

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5
Q

typical obstetric exam

A 
fetal lie (longitudinal vs transverse vs oblique)
fetal presentation (breech vs vertex)
cervical exam
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6
Q

leopold maneuvers

A

series of 4 maneuvers for palpating fetal lie and presentation in the uterus

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7
Q

cervical dilation

A

check at the level of internal os

ranges from closed to 10 cm dilation

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8
Q

cervical effacement

A

thinning of cervix occurs and is reported as a % change in length

range is thin = 100% effaced

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9
Q

cervical station

A

degree of descent of the presenting part of the fetus

measured in cm from presenting part to ischial spines

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10
Q

cervical consistency and position

A

used to calculate Bishop score??

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11
Q

first stage of labor

A

onset of true labor to complete cervical dilation

latent phase and active phase

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12
Q

first stage latent phase

A

the period between onset of labor and is characterized by slow cervical dilation

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13
Q

first stage active phase

A

associated with faster rate of dilation and usually begins when cervix is dilated to 6 cm

*admit for labor at this stage

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14
Q

duration of first stage

A

6-18 hours for primapara (1.2 cm/hour)

2-10 hours for multipara (1.5 cm/hour)

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15
Q

management of first stage

A 
maternal position - may ambulate or encourage left lateral recumbent position
IV fluids
Labs - CBC and T&S
obtain vitals q1-2 hrs
provide adequate analgesia
fetal monitoring 
uterine activity
vaginal exams
amniotomy
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16
Q

fetal monitoring during first stage

A

external monitoring
q30 mins for uncomplicated pregnancy
q15 mins for complicated pregnancy

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17
Q

how is uterine activity monitored?

A

external tocodynamometer

internal pressure catheter - useful with oxytocin augmentation

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18
Q

amniotomy

A

artificial rupture of membranes

*breaking the mother’s water

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19
Q

benefits of amniotomy

A

augment labor

allow assessment of meconium status

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20
Q

risk of amniotomy

A

cord prolapse

prolonged rupture is associated with chorioamnionitis

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21
Q

second stage of labor

A

characterized by descent of the presenting part through the maternal pelvis and culminates delivery

mother has desire to bear down during each contraction

increased bloody show

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22
Q

duration of second stage

A

primapara w/ epidural = 2 hrs
primapara w/o epidural = 3 hours
multipara w/ epidural = 1 hour
multipara w/o epidural = 2 hours

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23
Q

cardinal fetal movements of labor

A 
engagement
descent
flexion
internal rotation
extension
external rotation
expulsion
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24
Q

management of second stage

A 
avoid supine position 
bearing down
continuous fetal monitoring
vaginal exams
delivery of fetus
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25
episiotomy indications
likelihood of spontaneous laceration seems high | to expedite delivery by enlarging the vaginal outlet
26
most commonly performed episiotomy
midline
27
describe the modified Ritgen maneuver for head delivery
fingers of the right hand are used to extend the head while counterpressure is applied to the occiput by the left hand allows for more controlled delivery
28
first degree perineal laceration
superficial lac involving vaginal mucosa and/or the perineal skin
29
second degree perineal laceration
lac extending into the muscles of the perineal body but does not involve the anal sphincter
30
third degree perineal laceration
lac extends into or completely through the anal sphincter but not into the rectal mucosa
31
fourth degree perineal laceration
lac involves the rectal mucosa
32
third stage of labor
interval between delivery of infant and delivery of placenta typically lasts 2-10 minutes
33
what is the dx if the placenta is not delivered within 30 minutes?
retained placenta
34
classic signs of placental separation
gush of blood from the vagina lengthening of the umbilical cord fundus of the uterus rises up change in shape of the uterine fundus from discoid to globular
35
management of third stage
look for lacerations monitor uterine bleeding repair episiotomy or spontaneous lacerations inspect the placenta
36
management of fourth stage of labor
monitor patient closely vitals uterine fundal checks and assess for vaginal bleeding postpartum hemorrhage commonly occurs during this time
37
risk factors for postpartum hemorrhage
uterine atony retained placenta unrepaired lacerations
38
cervical ripening
facilitating the process of cervical softening, thinning, and dilating to reduce the rate of failed inductions
39
induction of labor
the process by which labor is induced by artificial means
40
augmentation of labor
artificial stimulation of labor that has already begun
41
indications for induction
``` abruptio placentae chorioamnionitis fetal demise preeclampsia/eclampsia gestational HTN premature rupture of membranes postterm pregnancy maternal conditions unstable fetal presentation acute fetal distress placental previa or vasa previa previous C-section or uterine surgery ```
42
components of Bishop score
``` cervical dilation cervical effacement station cervical consistency cervical position ```
43
bishop score < 6
unfavorable
44
bishop score > 8
probability of vaginal delivery after labor induction is similar to that of spontaneous labor
45
cervical ripening agents
dinoprostone (prost E2) misoprostol (prost E1) mechanical dilation
46
what is the only drug that is FDA approved for labor induction and augmentation?
pitocin
47
pitocin complications
uterine tachysystole antidiuretic effect uterine muscle fatigue increased risk of postpartum hemorrhage 2˚ to atony
48
major concern for use of obstetric analgesia
may decrease uterine blood flow if hypotension occurs *IVFs given prior to regional anesthesia to mitigate risk
49
uterine contraction pain pathway
T10-L1
50
pelvic floor, vagina and perineum pain pathway
S2-S4
51
regional anesthesia
partial or complete loss of pain sensation below T10 level lidocaine + narcotic epidural spinal
52
anesthesia options in labor
``` nonpharmacologic methods parenteral regional local general ```
53
nonpharmacologic methods of anesthesia
``` lamaze emotional support back massage hydrotherapy acupuncture ``` *these don't work just take the drugs you dumb bitch
54
parenteral anesthesia
morphine, fentanyl, meperidine and nalbuphine more effective in the first stage of labor
55
risk of parenteral anesthesia
opioids can cross placental barrier = neonatal respiratory depression *give that baby some Narcan
56
epidural
most effective form of pain relief for labor catheter is placed in the epidural space for continuous infusion of anesthetic agents
57
benefits of regional anesthesia
highly effective mother remains alert and awake mother remembers the experience rarely requires local anesthesia for lacerations
58
side effects of regional anesthesia
``` hypotension (10%) spinal headaches (1-2%) fever spinal hematoma spinal abscess ```
59
contraindications for regional anesthesia
``` maternal coagulopathy heparin use untreated maternal bacteremia increased ICP skin infection over site of needle placement ```
60
local anesthesia
lidocaine to perineum prior to episiotomy or lac repair | pudendal block
61
general anesthesia
propofol most commonly used - must have airway management used for emergent cases of rapid delivery
62
risks of general anesthesia
16 fold increased risk of maternal mortality | inhaled anesthetics cross placenta = neonatal respiratory depression

ENRP Exam 1 (20 decks)

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