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Ob/Gyn Clerkship > Labor and Delivery Pearls > Flashcards

Labor and Delivery Pearls Flashcards

1
Q

Define the baseline FHR pattern.

A

The mean FHR rounded to increments of 5 bpm during a 10 minute segment; must be a minimum of 2 minutes in any 10 minute segment

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2
Q

Define baseline variability in the FHR pattern.

A

Fluctuations in the FHR of two cycles per minute or greater

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3
Q

How is baseline variability quantified?

A

Amplitude of peak-to-trough in bpm

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4
Q

What are the 4 definitions of baseline variability?

A

Absent
Minimal
Moderate (normal)
Marked

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5
Q

Define absent baseline variability.

A

Amplitude range undetectable

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6
Q

Define minimal baseline variability.

A

Amplitude range detectable but less than or equal to 5 bpm

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7
Q

Define moderate (normal) baseline variability.

A

Amplitude range 6-25 bpm

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8
Q

Define marked baseline variability.

A

Amplitude range >25 bpm

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9
Q

Define acceleration of FHR.

A

Increase in the FHR from the most recently calculated baseline

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10
Q

How is the duration of a FHR acceleration defined?

A

Time from initial change in FHR from the baseline to the return to baseline

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11
Q

Define FHR acceleration from 32 weeks and beyond.

A

Acme of 15+ bpm above baseline, duration of 15+ seconds, but less than 2 minutes

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12
Q

Define FHR acceleration before 32 weeks.

A

10 bpm or more above baseline, duration of 10+ seconds, but less than 2 minutes

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13
Q

Defined prolonged acceleration.

A

Longer than 2 minutes but shorter than 10 minutes

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14
Q

Define baseline change in FHR.

A

If an acceleration lasts 10 minutes or longer, it is a baseline change

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15
Q

Define FHR bradycardia.

A

Baseline FHR <110 bpm

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16
Q

Define early deceleration.

A

Deceleration associated with a uterine contraction; gradual (onset to nadir 30 seconds or more) decrease with return to baseline; nadir of the deceleration occurs at the same time as the peak of the contraction

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17
Q

Define late deceleration.

A

Deceleration associated with a uterine contraction, gradual (onset to nadir 30 seconds or more) decrease with return to baseline; onset, nadir, and recovery occur after the beginning, peak, and end of the contraction, respectively

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18
Q

Define FHR tachycardia.

A

Baseline FHR >160 bpm

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19
Q

Define variable acceleration.

A

Abrupt (onset to nadir less than 30 seconds) decrease in the FHR below the baseline; decrease is 15+ bpm, with a duration of 15+ seconds but less than 2 minutes

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20
Q

Define prolonged deceleration.

A

Visually apparent decrease in the FHR below the baseline; deceleration is 15 bpm or more, lasting 2 minutes or more but less than 10 minutes from onset to return to baseline

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21
Q

Define a reactive nonstress test.

A

2+ accelerations occur in 20 minutes.

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22
Q

Define a non-reactive stress test.

A

No accelerations noted over 40 minutes.

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23
Q

How is a contraction stress test performed?

A

Administer pitocin or stimulate nipples until 3 contractions in 10 minutes

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24
Q

Define a positive (non-reassuring) contraction stress test.

A

Late decelerations following 50% or more of the contractions

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25
Q

Define a negative (reassuring) contraction stress test.

A

No late or significant variable decelerations

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26
Q

Define an equivocal-suspicious pattern of a contraction stress test.

A

Intermittent late or significant variable decelerations

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27
Q

Define an equivocal-hyperstimulatory contraction stress test

A

Decelerations with contractions more frequent than q2 minutes or lasting >90 seconds

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28
Q

Define an unsatisfactory contraction stress test.

A

Tracing is uniterruptable or contractions are fewer than 3 in 10 minutes

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29
Q

How is a biophysical profile assessed and scored?

A

2 points for each of the following in a 30 minute period:

  1. NST
  2. Fetal breathing (1+ episodes of breathing lasting 30+ seconds)
  3. Fetal movements (3+ discrete body or limb movements)
  4. Fetal tone (1+ episode of extension of extremity with return to flexion or opening or closing of the hand)
  5. AFI (amniotic fluid index) (single vertical pocket >2cm)
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30
Q

How is a biophysical profile interpreted?

A

8-10: reassuring
6: equivocal - deliver if mature; if not, administer steroids and repeat in 24 hours
4 or less: delivery unless extremely preterm

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31
Q

What are the components of a modified biophysical profile (BPP)?

A

BPP = NST + AFI

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32
Q

Define the phases/stages of labor.

A

First: onset of labor to complete dilation
*Latent: cervical effacement; variable
*Active: rapid dilation, relatively fixed time
Second: complete dilation to delivery
Third: delivery of infant to delivery of placenta

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33
Q

Define fetal lie.

A

Axis of the fetus (longitudinal, transverse, oblique)

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34
Q

Define presentation.

A

Fetal part at the cervix (cephalic, breech, shoulder)

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35
Q

Define attitude.

A

Flexed or extended

36
Q

Define position/point of direction.

A

Named for occiput, sacrum, acromion, or mentum in relation to maternal pelvis.

37
Q

Describe Leopold’s maneuver.

A
  1. Feel the top of the uterus; identify the fetal pole in the fundus
  2. With the hands on either side of the uterus, determine the location of the back and small parts
  3. Lower uterine segment between thumb and first finger - determines engagement
  4. Fingers pointed toward patient’s feet to determine position
38
Q

List the cardinal movements of labor.

A
  1. Engagement
  2. Descent
  3. Flexion
  4. Internal rotation
  5. Extension
  6. External rotation/restitution
  7. Expulsion
39
Q

Define engagement.

A

Biparietal diameter has passed pelvic inlet, 0 station

40
Q

___ often begins with engagement in multiparous women.

41
Q

Define flexion.

A

Brings shorter AP diameter into pelvis from resistant forces of pelvic walls, pelvic floor, etc.

42
Q

Define internal rotation.

A

Fetus faces maternal spine

43
Q

Define extension.

A

Head extends under pubic bone

44
Q

How is membrane ruptured diagnosed?

A
  1. Pooling
  2. +Nitrazine with pH > 6.5 (dark blue) - amniotic fluid pH 7.0-7.5, normal vaginal pH 3.5-4.5
  3. Ferning (due to NaCl, proteins, and carbs)
  4. AFI (amniotic fluid index)
45
Q

What can cause a false positive nitrazine?

A

Blood, semen, bacterial vaginosis

46
Q

Define the degrees of perineal laceration.

A

1st - fourchette, perineal skin, and vaginal mucosa
2nd - involves fascia and muscles of perineal body
3rd - involves anal sphincter
4th - involves rectal mucosa

47
Q

List the 4 main causes of postpartum hemorrhage.

A
  1. Atony
  2. Retained placenta
  3. Lacerations
  4. Uterine inversion
48
Q

4 medical agents for postpartum hemorrhage?

A
  1. Oxytocin
  2. Methergine (Ergonovine and Methylergonovine)
  3. Hemabate (Carboprost Prostaglandin F2a)
  4. Cytotec (misoprostol) - 1000 mcg rectally
49
Q

When is methergine contraindicated in postpartum hemorrhage?

50
Q

When is hemabate contraindicated in postpartum hemorrhage?

51
Q

What is the Bishop score used for?

A

To determine if cervical ripening is needed; should be calculated for all inductions

52
Q

What qualities get a Bishop score of 0?

A 
Dilation: closed
Effacement: 0-30
Station: -3
Consistency: firm
Position: posterior
53
Q

What qualities get a Bishop score of 1?

A 
Dilation: 1-2
Effacement: 40-50
Station: -2
Consistency: medium
Position: mid
54
Q

What qualities get a Bishop score of 2?

A 
Dilation: 3-4
Effacement: 60-70
Station: -1
Consistency: soft
Position: anterior
55
Q

What qualities get a Bishop score of 3?

A 
Dilation: 5+
Effacement: 80+
Station: +1, +2
Consistency: n/a
Position: n/a
56
Q

Modified Bishop Score - add 1 point for ___ and ___? Deduct 1 point for ___, ___ ___, or ___?

A

Add 1: preeclampsia, each prior vaginal delivery

Deduct 1: postdates, nulliparity, preterm, prolonged PROM

57
Q

Interpret the Bishop score.

A

0-4: 45-50% failure
5-9: 10% failure
10-13: 0% failure
>8 probability of vaginal delivery similar to spontaneous labor

58
Q

List 6 cervical ripening agents.

A
  1. Cervidil (prostaglandin E2/dinoprostone)
  2. Cytotec (prostaglandin E1/misoprostol)
  3. Transcervical catheter
  4. Extra-amniotic saline infusion (EASI)
  5. Hygroscopic dilators
  6. Oxytocin
59
Q

What is the dose of Cervidil given for cervical ripening?

A

One 10mg insert q 12 hrs, max 3 doses (also available as Prepidil gel)

60
Q

What is the dose of Cytotec given for cervical ripening?

A

25 mcg (1/4 of 100 mcg pill) vaginally q 4 hrs

61
Q

Define tachysystole.

A

More than 5 contractions in 10 minutes or 7 contractions in 15 minutes

62
Q

How is tachysystole or uterine tetany corrected?

A

Decrease or discontinue uterine stimulant, IV fluids, maternal repositioning, maternal oxygen, consider terbutaline if it persists

63
Q

List 5 tocolytics.

A
  1. Magnseium sulfate
  2. Indomethicin (Indocin)
  3. Nifedipine (Procardia)
  4. Terbutaline (Brethine)
  5. Atosiban (Antocin)
64
Q

MOA - Magnesium sulfate?

A

Decreases calcium needed for uterine contraction

65
Q

MOA - Indomethicin?

A

Cyclooxygenase inhibitor

66
Q

MOA - Nifedipine?

67
Q

MOA - Terbutaline?

A

Betamimetic

68
Q

MOA - Atosiban?

A

Pitosin antagonist

69
Q

What medications are indicated in pre-term labor and why?

A
  1. Steroids for fetal lung maturity
  2. Tocolytic medication to allow administration of steroids
  3. Fetal fibronectin - used between 24 and 32 weeks to determine probability of pre-term labor
70
Q

What are the 2 steroids that can be given for fetal lung maturity? What are the doses?

A

Betamethasone - 12mg IM q 25 hrs x 2 doses

Dexamethasone 6 mg IM q 12 hrs x 4 doses

71
Q

Fetal fibronectin has a high ___ predictive value. What can cause a false positive?

A

Negative; blood and semen

72
Q

Only women with prior ___ incisions can attempt VBAC. Rupture rate is <1%.

A

Low transverse uterine

73
Q

What are the types of uterine incisions?

A

Classical, Low Vertical, or Low Transverse

74
Q

What are the types of skin incisions?

A

Midline Vertical vs. Pfannenstiel

75
Q

Define labor.

A

Uterine contractions resulting in progressive effacement and dilation of the cervix.

76
Q

3 signs of placental separation?

A
  1. Lengthening of cord
  2. Gush of blood
  3. Change in uterine shape
77
Q

Normal length of first stage, active phase, and second stage for a primipara?

A

First - 8 hours
Active - 1.2 cm/hour
Second - 2 hours

78
Q

Normal length of first stage, active phase, and second stage for a multipara?

A

First - 4-6 hours
Active - 1.5cm/hour
Second - 1-1.5 hours

79
Q

List the 7 descriptors of fetal position.

A
  1. Lie
  2. Presentation
  3. Point of direction
  4. Asynclitism
  5. Attitude
  6. Station
  7. Leopold’s Maneuvers
80
Q

What are the 4 governing forces of labor?

A

Powers, Passages, Passenger Psyche

81
Q

List the bones of the pelvis.

A

Sacrum, coccyx, innominate, ilium, ischium

82
Q

What are the three planes of the pelvis through which the fetus must navigate?

A

Inlet, Midplane, Outlet

83
Q

What are the 4 types of pelvis?

A

Gynecoid, Android, Anthropoid, Platypelloid

84
Q

List the 3 types of abnormal Friedman’s curves.

A
  1. Prolonged latent phase
  2. Protracted active phase
  3. Secondary arrest of labor
85
Q

List the steps/options in managing postpartum hemorrhage.

A
  1. Massage and express clots.
  2. Check for retained placenta.
  3. Check for lacerations and hematomas.
  4. Simultaneously give pitocin or methergine or prostaglandin
  5. Hysterectomy

Ob/Gyn Clerkship (10 decks)

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