Labor and Delivery (Moulton) Flashcards
Labor
progressive cervical dilation resulting from regular uterine contractions that occur at least every 5 mins and last 30-60 seconds
Braxton-Hicks contractions
false labor; irregular uterine contractions with no cervical dilation
What is the longest anterior-posterior diameter of the head?
Supra-occipitomental (13.5cm)
What is the best diameter of the fetal head?
Sub-occipitobregmatic (9.5cm); the head is well flexed
What is the most favorable pelvic shape for vaginal delivery?
Gynecoid; classic female pelvis; head generally rotates into OA position
**Anthropoid also favorable “ape” pelvis
Which pelvis shapes are unfavorable for vaginal delivery?
Android - narrow pubic arch; fetal head forced to be in OP position
Platypelloid - short AP; fetal head has to engage in the transverse diameter
How is the pelvic outlet assessed?
measuring the ischial tuberosity and pubic arch (8.5 cm is adequate)
Infrapubic angle
> 90 degrees is adequate
Fetal lie
maternal spine in reference to fetus spine; can be longitudinal, transverse or oblique
Fetal presentation
the fetal presenting part in reference to the pelvis; can be vertex, breech, transverse or compound
Leopold maneuvers
series of 4 maneuvers
1. palpate mom’s fundus
2. palpate for fetal spine and fetal small parts
3. palpate for what fetal part is presenting in the pelvis
4. palpate of cephalic prominence (chin or occipital protuberance)
Dilation
level of the cervical internal os; can range from closed to 10cm (completely dilated)
Effacement
thinning of the cervix; ranges from thick to 100% effaced
What is the normal non-pregnant cervix length?
3-5cm
Station
degree of descent of the presenting part of the fetus; measured in cm from presenting part to the ischial spine; when reaches the ischial spine station is “zero”; ranges from - 5cm to +5cm
Station of “zero”
when the fetal part reaches ischial spine during delivery
the 4 stages of labor
stage 1: onset of true labor (latent and active)
stage 2: phase between complete cervical dilation to delivery
stage 3: phase between delivery of infant to delivery of the placenta
stage 4: phase between delivery of placenta to stabilization of the patient
Latent phase of stage 1
early labor - slow cervical dilation
Active phase of stage 1
faster rate of cervical dilation; cervix is dilated to 6 cm (most is 10cm); admit for labor at this stage
Management of first stage of labor
mom is to lie left lateral recumbent position; IV fluids (maybe oxytocin); labs, monitoring, and analgesia, continuous external fetal monitoring (does not allow you to assess strength of contractions) - need internal pressure catheter
What are the normal durations of the first stage of labor and dilation?
Duration: Primiparas 6-18 hrs, Multiparas 2-10 hrs
Dilation: Primiparas 1.2 cm/hr, Multiparas 1.5cm/hr
The 7 cardinal movements of labor
Every Descent Family In England Eats Eggs
1. Engagement - at “zero” station
2. Descent
3. Flexion
4. Internal rotation
5. Extension - station “+5cm”
6. External rotation
7. Expulsion - anterior shoulder then posterior shoulder
What is the most common position for spontaneous and operative deliveries
maternal position of dorsal lithotomy
Episiotomy
enlarging the vaginal outlet; in cases when expedited delivery is indicated; midline episiotomy is most common - less postpartum pain
Modified Ritgen Maneuver
fingers of the right hand are used to extend the head while counterpressure is applied to the occiput by the left hand to allow for a more controlled delivery
Perineal lacerations
1st degree - superficial lesion; vaginal mucosa and/or perineal skin
2nd degree - extending to the muscles but does not involve the anal sphincter
3rd degree - extends completely through the anal sphincter but not rectal mucosa
4th degree: involves rectal mucosa
First degree perineal laceration
superficial lesion; vaginal mucosa and/or perineal skin
Second degree perineal laceration
extending to the muscles but does not involve the anal sphincter
Third degree perineal laceration
extends completely through the anal sphincter but not rectal mucosa
Fourth degree perineal laceration
involves rectal mucosa
Retained placenta diagnosis
if placenta has not been delivered within 30 mins after fetal delivery during the 3rd stage of labor
Classic signs of placental separation
Gush of blood from the vagina
Lengthening of umbilicord
Fundus of the uterus rises up
Change in the shape of fundus from discord to globular
***DO NOT pull on cord unless these signs are noted
Why should you NOT pull on umbilical unless classic placental signs are noted during the 3rd stage of labor?
inappropriate pulling may result in uterine inversion
What is something you need to watch for during the 4th stage of labor?
Postpartum hemorrhage; monitor pt closely (BP & pulse); vaginal and uterine checks
A bishop score of what is unfavorable for induction of labor?
< 6
A bishop score of what is favorable for induction of labor?
> 8
Pitocin complications
uterine tachysystole (most common); ADH effect (severe water intoxication - convulsions and coma); uterine muscle fatigue
Visceral pain of uterine contractions
T10-T12 through L1
Somatic pain from descent of fetal head through pelvis out the vagina
S2-S4
Regional anesthesia
partial or complete loss of pain sensation below T10
Indication for general anesthesia during delivery
Propofol is most common agent; loss of maternal consciousness; need for airway management; increased risk for maternal mortality; indicated in emergent cases with need for rapid delivery
