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ENRP Exam I > Labor and Delivery (Moulton) > Flashcards

Labor and Delivery (Moulton) Flashcards

1
Q

Labor

A

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

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2
Q

Braxton-Hicks contractions

A

false labor; irregular uterine contractions with no cervical dilation

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3
Q

What is the longest anterior-posterior diameter of the head?

A

Supra-occipitomental (13.5cm)

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4
Q

What is the best diameter of the fetal head?

A

Sub-occipitobregmatic (9.5cm); the head is well flexed

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5
Q

What is the most favorable pelvic shape for vaginal delivery?

A

Gynecoid; classic female pelvis; head generally rotates into OA position
**Anthropoid also favorable “ape” pelvis

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6
Q

Which pelvis shapes are unfavorable for vaginal delivery?

A

Android - narrow pubic arch; fetal head forced to be in OP position

Platypelloid - short AP; fetal head has to engage in the transverse diameter

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7
Q

How is the pelvic outlet assessed?

A

measuring the ischial tuberosity and pubic arch (8.5 cm is adequate)

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8
Q

Infrapubic angle

A

> 90 degrees is adequate

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9
Q

Fetal lie

A

maternal spine in reference to fetus spine; can be longitudinal, transverse or oblique

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10
Q

Fetal presentation

A

the fetal presenting part in reference to the pelvis; can be vertex, breech, transverse or compound

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11
Q

Leopold maneuvers

A

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)

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12
Q

Dilation

A

level of the cervical internal os; can range from closed to 10cm (completely dilated)

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13
Q

Effacement

A

thinning of the cervix; ranges from thick to 100% effaced

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14
Q

What is the normal non-pregnant cervix length?

A

3-5cm

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15
Q

Station

A

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

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16
Q

Station of “zero”

A

when the fetal part reaches ischial spine during delivery

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17
Q

the 4 stages of labor

A

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

18
Q

Latent phase of stage 1

A

early labor - slow cervical dilation

19
Q

Active phase of stage 1

A

faster rate of cervical dilation; cervix is dilated to 6 cm (most is 10cm); admit for labor at this stage

20
Q

Management of first stage of labor

A

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

21
Q

What are the normal durations of the first stage of labor and dilation?

A

Duration: Primiparas 6-18 hrs, Multiparas 2-10 hrs
Dilation: Primiparas 1.2 cm/hr, Multiparas 1.5cm/hr

22
Q

The 7 cardinal movements of labor

A

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

23
Q

What is the most common position for spontaneous and operative deliveries

A

maternal position of dorsal lithotomy

24
Q

Episiotomy

A

enlarging the vaginal outlet; in cases when expedited delivery is indicated; midline episiotomy is most common - less postpartum pain

25
Q

Modified Ritgen Maneuver

A

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

26
Q

Perineal lacerations

A

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

27
Q

First degree perineal laceration

A

superficial lesion; vaginal mucosa and/or perineal skin

28
Q

Second degree perineal laceration

A

extending to the muscles but does not involve the anal sphincter

29
Q

Third degree perineal laceration

A

extends completely through the anal sphincter but not rectal mucosa

30
Q

Fourth degree perineal laceration

A

involves rectal mucosa

31
Q

Retained placenta diagnosis

A

if placenta has not been delivered within 30 mins after fetal delivery during the 3rd stage of labor

32
Q

Classic signs of placental separation

A

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

33
Q

Why should you NOT pull on umbilical unless classic placental signs are noted during the 3rd stage of labor?

A

inappropriate pulling may result in uterine inversion

34
Q

What is something you need to watch for during the 4th stage of labor?

A

Postpartum hemorrhage; monitor pt closely (BP & pulse); vaginal and uterine checks

35
Q

A bishop score of what is unfavorable for induction of labor?

A

< 6

36
Q

A bishop score of what is favorable for induction of labor?

A

> 8

37
Q

Pitocin complications

A

uterine tachysystole (most common); ADH effect (severe water intoxication - convulsions and coma); uterine muscle fatigue

38
Q

Visceral pain of uterine contractions

A

T10-T12 through L1

39
Q

Somatic pain from descent of fetal head through pelvis out the vagina

A

S2-S4

40
Q

Regional anesthesia

A

partial or complete loss of pain sensation below T10

41
Q

Indication for general anesthesia during delivery

A

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

ENRP Exam I (24 decks)

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