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Women's Health Final > Labor and Delivery (NOT FINISHED) > Flashcards

Labor and Delivery (NOT FINISHED) Flashcards

1
Q

What is the weird word for the postpartum period up to 6 weeks after delivery that Herrick and Shamblen insisted we know?

A

Puerperium

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2
Q

Uterine activity that results in progressive dilation and effacement of the cervix

A

Labor

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3
Q

Opening of the cervical os

A

Dilation (estimated in cm)

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4
Q

Thinning of the cervix described as a percentage of a normal ____ long cervix

A

Effacement

4 cm

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5
Q

Placement of the presenting part in the maternal pelvis in relation to the ischial spines

A

Station

Usually divided into thirds

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6
Q

Fully dilated is ______ cm

A

10cm

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7
Q

The evaluation for rupture of membranes includes a ____________ which attempts to visualize a pool of fluid and obtain a specimen of vaginal fluid for testing

A

STERILE speculum exam

Must be sterile b/c you don’t want to introduce bacteria into the amniotic sac

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8
Q

Direct testing methods for determining if membranes have ruptured

A

“Fern” testing
Amniosure testing
Nitrazine paper (no one uses this anymore except the old docs)

Supportive test: Amniotic fluid index (AFI) by U/S

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9
Q

Amniotic fluid is mostly just a bunch of…

A

Baby piss

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10
Q

How does the nitrazine paper testing work

A

It’s essentially ph testing

Normal vaginal pH is 3.5-4.5 (b/c of lactobacilli)

Paper will turn blue in presence of alkaline amniotic fluid

93.3% sensitive

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11
Q

What can cause false positives on nitrazine paper?

A

Urine

Blood

Semen

BV

Trichomoniasis

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12
Q

What is fern testing?

A

Air dried sample of vaginal fluid on a slide —> characteristic “fern” pattern if membranes have ruptured

Very specific but not very sensitive

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13
Q

Does a patient whose membranes have ruptured need to be admitted to the hospital if she’s not in active labor?

A

YES

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14
Q

The part of the baby coming 1st through the birth canal

A

Presentation

Ex:
Cephalic
Breech

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15
Q

Position of the long axis of the fetus with respect to the long axis of the mother’s body

A

Lie (ie Transverse lie)

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16
Q

Station is typically measured in _______ compared to the ________

A

1/3’s (occasionally 1/5’s)

Ischial spine

(Ischial spine = 0)

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17
Q

When the baby’s head is at +3…

A

You can see the baby’s scalp by spreading the labia majora

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18
Q

Evaluation of labor should include…

A

Review of medical/obstetric hx

Obtain mom’s description of her contractions

Vital signs

Cervical exam

Fetal evaluation

Status of membranes

Contraction activity

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19
Q

Describe Stage 1 of labor

A

Contractions accomplish complete dilation and effacement

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20
Q

What are the subdivisions of Stage 1 of labor?

A

Latent - slower, less predictable; typically 0-5cm dilation

Active - faster, more predictable; typically 5-10cm dilation (admit them at this point)

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21
Q

Describe Stage 2 of labor

A

“The pushing stage”

Uterine contractions and maternal effort cause expulsion of the fetus

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22
Q

Describe Stage 3 of labor

A

“The medical student stage”

The placenta becomes detached from uterine wall and is expelled

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23
Q

Describe Stage 4 of labor

A

~2 hours post delivery of placenta, many hemodynamic changes

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24
Q

Name that labor stage:

Contractions accomplish complete dilation and effacement

A

Stage 1

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25
Q

Name that labor stage:

Uterine contractions and maternal effort cause expulsion of the fetus

A

Stage 2

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26
Q

Name that labor stage:

The “pushing” stage

A

Stage 2

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27
Q

Name that labor stage:

The placenta becomes detached from the uterine wall and is expelled

A

Stage 3

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28
Q

Name that labor stage:

The “med student” stage

A

Stage 3

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29
Q

Normal length of first stage of labor varies between ______ but not by ______

A

Parity - Multiparas will USUALLY deliver faster than nulliparas (never delivered a baby)

Race/ethnicity

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30
Q

Second stage of labor varies by…

A

Both race and parity

Caucasians typically longer, African Americans shortest, Hispanics in the middle

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31
Q

Signs of second stage of labor

A

Maternal urge to push (defecate)

Nausea

Emesis

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32
Q

Changes in the position of the fetal head in relationship to fetal body as it navigates the maternal pelvis

A

Cardinal movements of labor

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33
Q

What is the narrowest diameter of the fetal head?

A

The suboccipital or Bregmatic diameter (~9.5cm)

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34
Q

What are the six cardinal movements of labor?

A 
Engagement
Flexion
Descent
Internal Rotation
Extension 
External Rotation
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35
Q

What is Engagement?

A

Passage of the widest diameter of the presenting part to a level below the plane of the pelvic inlet

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36
Q

When does the fetus present the smallest diameter of its head?

A

During flexion (second cardinal movement of labor)

With head completely flexed, the bregmatic diameter is presented

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37
Q

When does the greatest rate of descent occur?

A

During the latter portions of 1st stage of labor and during 2nd stage of labor

This is the third cardinal movement of labor

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38
Q

What happens during the internal rotation (4th) cardinal movement of labor?

A

Rotation of the presenting part from its original position (usually transverse) to anteroposterior position (ideally) as it passes through the pelvis

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39
Q

When does extension occur during the cardinal movements of labor?

A

5th cardinal movement

Once the fetus descends to the level of the intro it’s, the head extends beneath maternal pubic symphysis and head is delivered

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40
Q

What is the last cardinal movement of labor?

A

The head rotates 45 degrees to line up with shoulders which are oblique in maternal pelvis

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41
Q

Interval between delivery of the fetus and delivery of the placenta

A

Third stage of labor

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42
Q

What is the major complication during the third stage of labor?

A

HEMORRHAGE

Others:
Retention of the placenta
Uterine inversion

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43
Q

How long does the third stage of labor typically last?

A

30 min or less, but often aided by labor attendant

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44
Q

What are some potential causes of hemorrhage during the third stage of labor?

A

Infection
Prolonged labor
Large or multiple fetuses

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45
Q

What is the big thing you want to avoid with assisted removal of the placenta?

A

Avoid uterine eversion

If uterus is not yet firm and you pull on the cord like a dumbass med student —> EMERGENCY —> immediate shock —> death

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46
Q

What are the signs of separation of the placenta?

A
  1. Uterus rises in the abdomen
  2. Globular configuration
  3. Gush of blood
  4. Lengthening of umbilical cord

Not clinically important but your preceptor will think you’re hot shit if you can recite these…

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47
Q

What occurs during the fourth stage of labor?

A

Interval btwn delivery of the placenta and the subsequent 2 hours postpartum

MAJOR HEMODYNAMIC CHANGES with maternal CV system

“Transfusion” from the now contracted uterus

Particularly critical time for women with CV or pulm diseases

48
Q

What are the 3 P’s for monitoring the progress of labor?

A

Power (maternal efforts and uterine contractions)

Passenger (size/position of fetus)

Passage (size/shape of maternal pelvis)

49
Q

Uterine contractions increase in frequency and intensity due to increases in _________

A

Prostaglandins

50
Q

Power of uterine contractions comes from increased sensitivity of the uterine muscle fibers to …

A

Circulating oxytocin, produced by the hypothalamus and secreted by pituitary

51
Q

What is considered adequate labor in terms of contractions?

A

3-5 contractions in 10 min averaged over 30 min

52
Q

How is uterine power quantified?

A

Using an internal monitor

Adequate labor = 200 MVu

53
Q

Maternal expulsion efforts are affected by…

A

Maternal strength

Consciousness/sedation

Pain

Regional anesthesia (epidural or spinal)

54
Q

________ measures the frequency and duration of contractions but not intensity

A

External tocodynamometer

Intensity can be masked by patient body habits or maternal movements such as cough

55
Q

_______________ measures frequency, duration, and intensity of contractions

A

Internal tocodynamometry

56
Q

What method is used to directly and more precisely measure the intensity or strength of contractions?

A

Internal tocodynamometry with an intrauterine pressure catheter (IUPC)

57
Q

What is a macroscopic infant?

A

> 4500 grams

“A large passenger” may affect progression of labor

58
Q

What are some possible presentations a fetus may have?

A

Cephalic (vertex)

Breech (Frank, complete, footling)

Brow, face compound

Shoulder

Transverse lie

59
Q

What are Leopold’s Maneuvers?

A

Used to external manipulate a baby with a non-Cephalic presention to try to get them into Cephalic

60
Q

Relation of the fetal presenting part to the right or left side of the maternal pelvis

A

Position

61
Q

With is the most common fetal presenting position?

A

Left occiput anterior (LOA)

62
Q

What are the three passageway considerations?

A

Inlet

Midpelvis

Outlet

63
Q

What are the boundaries of the pelvic inlet?

A

Pubic symphysis (top)

Sacral promontory (posterior)

Pectinate lines (lateral)

64
Q

What are the boundaries of the midpelvis?

A

Midpoint of symphysis (top)

Midpoint of sacral curve (posterior)

Ischial spines (lateral)

65
Q

What are the boundaries of the outlet?

A

Inferior border of symphysis (anterior)

Tip of sacrum (posterior)

Ischial tuberosities (lateral)

66
Q

What are the four basic female pelvic types?

A

Gynecoid

Anthropoid

Android

Platypelloid

67
Q

Which pelvic type is most common and best for delivering bebes

A

Gynecoid

Wide forepelvis
Straight side walls
Wide subpubic arch

68
Q

Which pelvic type is most unfavorable for delivery?

A

Android

69
Q

Which pelvic type will usually prolong labor and will commonly lead to occiput posterior presentation?

A

Anthropoid

70
Q

Which pelvic type is least common?

A

Platypelloid

71
Q

Describe true labor

A

Regular intervals, gradually increasing in frequency

Increasing intensity

Cervical dilation occurs

Back and abdominal discomfort

Labor pattern not altered by analgesia

72
Q

Describe false labor

A

Irregular intervals and duration, Braxton hicks contractions

Intensity usually varies (up and down)

No cervical change over reasonable time

Back and abdominal discomfort

Usually relief from sedation or hydration

73
Q

What are the different options for fetal monitoring?

A

Intermittent auscultation

Continuous electronic fetal monitoring (CEFM)
• External - ultrasonographic transducer on abdomen
• Internal - scalp electrode ECG

74
Q

What are we trying to measure with fetal monitoring?

A

Baseline fetal HR (should be 110-160bpm)

Variability in HR (absent, minimal, moderate, or marked)

Periodic changes (accelerations/decelerations)

Contraction pattern

75
Q

What kind of variability in HR do you want to see with fetal monitoring?

A

Moderate (6-25 bpm change around baseline)

Absent variability = hypoxia = bad

76
Q

Early decelerations in fetal HR mirror…

A

Shape of contraction, due to head compression

This is physiologic

77
Q

Variable fetal HR decelerations are due to …

A

Cord compression

Variable timing with relation to the contraction, shape and severity also variable

78
Q

Late decelerations in fetal HR are due to…

A

Fetal hypoxia

Can be the result of placental insufficiency, maternal hypotension, or hypoxia

An ominous sign

79
Q

What are the indications for basic antepartum testing?

A

To evaluate a fetus who is at a higher than normal risk for intrauterine fetal complications that can lead to placental insufficiency and fetal acidosis

80
Q

What are the different components of basic antepartum testing?

A

Fetal kick counts

Non-stress testing

Contraction stress testing

Biophysical profile

81
Q

What do we want to see on a non-stress test?

A

2 accelerations within 30 min associated with movement

82
Q

What are the parameters included in the biophysical profile?

A

U/S evaluation of:
• Amniotic fluid assessment - Deepest Vertical Pocket of 2 cm
• Gross fetal movement
• Tone (Flexion/extension of fetal joints)
•Fetal “breathing” activity sustained for 30 sec

Each of thesis is counted as +2 if present and 0 if absent

Max score is 10

83
Q

What is considered a negative (reassuring) result for contraction stress test?

A

Three contractions in 10 min with no late decelerations

84
Q

What is considered positive (non-reassuring) during the contraction stress test?

A

Late decelerations or significant variable decelerations with greater than 50% of the contractions in a 10 min period

85
Q

What is considered an equivocal result for the contraction stress test?

A

Late decelerations with less than 50% of the contractions in 10 min

86
Q

What classification of obstetric laceration:

Involves the vaginal mucosa or perineal skin but not the underlying tissue

A

First degree

87
Q

What classification of obstetric laceration:

Involves the underlying subQ tissue but not the rectal sphincter or rectal mucosa

A

Second degree

88
Q

What classification of obstetric laceration:

Extends through the rectal sphincter but not into the rectal mucosa

A

Third degree

89
Q

What classification of obstetric laceration:

Extends into the rectal mucosa

A

Fourth degree

90
Q

What is an episiotomy?

A

A surgical incision of the perineum and the posterior vaginal wall during the second stage of labor to quickly enlarge the opening for the baby to pass

91
Q

What can be used to induce labor?

A

Prostaglandin gel or other device

Misoprostol (Cytotec)

Pitocin (mimics oxytocin)

“Stripping” membranes

Amniotomy (artificial rupture of membranes)

92
Q

What is uterine tachysystole?

A

Contraction frequency 5+ contractions in 10 min averaged over 30 min

Risk of induction

93
Q

What are the complications of uterine tachysystole?

A

Can cause decreased oxygen exchange and risk of fetal hypoxia/acidosis

94
Q

What are the risks of labor induction?

A

Uterine tachysystole —> fetal hypoxia/acidosis

Increased risk of cesarean delivery, esp with “unfavorable cervix”

Umbilical cord prolapse with amniotomy w/ unengaged presenting part

Intra-amniotic infection b/c of multiple exams or prolonged labor time

95
Q

What is the scoring system used to determine if a mother is a good candidate for induction of labor?

A

Modified Bishop scoring system

Points 0-3 for
• Dilation
• Effacement
• Station
• Cervical consistency
• Position of the cervix
96
Q

Bishop score of 9-13

A

Highest likelihood of successful induction

97
Q

Bishop score of 0-4

A

Highest likelihood of failed induction

98
Q

What are the benefits of labor induction?

A

Ending a pregnancy when fetal or maternal risk of continuing the pregnancy is increased (IUGR, pre-eclampsia, etc)

Convenience in scheduling (mom or doc)

Often controversial

99
Q

What are the different options for OB anesthesia?

A

Psychoprophylaxis (Lamaze, relaxation, hypno-birthing)

Intravenous narcotics or tranquilizers

Epidural

Spinal (used for cesareans)

Inhaled NO

General (if complications)

100
Q

What anatomic changes occur during the puerperium?

A

Uterus involuted from 1000gm to 50-100gm

Cervix loses marked vascularity, glandular hypertrophy

Ovarian function is quiescent; ovulation may be delayed from 6-12 weeks

Hormonal changes affecting most of the other systems

Vaginal vault decreases in size but walls are thin, inelastic, and can be dry until ovulation resumes

101
Q

Puerperium management usually includes…

A

Hospitalization x1-2 days for vaginal birth, x2-4 days for C/S

Physical activity

Sexual activity

Work

Postpartum exam at 4-6 weeks (discuss family planning)

Breastfeeding pros and cons and lactation counseling

Psychosocial changes

102
Q

When does breast milk come in?

A

Colostrum after 1st day

Mature milk after 3rd-5th day

103
Q

Monozygotic twins are also called…

A

Identical twins

104
Q

Dizygotic twins are also called…

A

Fraternal twins

105
Q

What type of twins:

Identical genotype

A

Monozygotic

106
Q

What type of twins:

Separate genotype

A

Dizygotic

107
Q

What type of twins:

No genetic predisposition

A

Monozygotic

108
Q

What type of twins:

Genetic predisposition

A

Dizygotic

109
Q

What type of twins:

No increased risk with fertility treatment

A

Monozygotic

110
Q

What type of twins:

Increased risk with fertility treatment

A

Dizygotic

111
Q

What are the three types of monozygotic twins?

A

Monoamniotic/monochorionic

Monoamniotic/dichorionic

Diamniotic/dichorionic

112
Q

Which type of twin gestation is least high risk?

A

Dizygotic twins

But they do have risks:
• Preterm labor and delivery
• Intrauterine growth restriction
• Increased risk of fetal anomalies
• Increased risk of C/S
113
Q

Why are monozygotic twin gestations more risky?

A

Twin-twin transfusion

Cord entanglements

Increased risk of growth restriction and preterm birth

114
Q

Condition where arteriovenous malformations occur in the placenta of a monochorionic/diamniotic pregnancy

A

Twin to twin transfusion syndrome

One becomes anemic and one becomes polycythemic

One becomes fluid overloaded and polyhydramnios, the other becomes oligohydramnios

115
Q

When does twin to twin transfusion syndrome usually present?

A

In the second trimester

Serial U/S eval every 2 weeks beginning at 16 weeks should be considered

Women's Health Final (2 decks)

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