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Women's Health - OB > Labor & Birth > Flashcards

Labor & Birth Flashcards

1
Q

cervical effacement

A

Thinning of cervix measured by %

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2
Q

station =

A

Position of baby’s head in relationship to maternal ischial spines (-3 to +3cm, 0 = ischial spine)

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3
Q

Stages of labor

A

1st Stage: Beginning of painful contractions to 10 cm cervical dilation
2nd Stage: Full dilation, pushing and expulsion of the baby
3rd Stage: Delivery of the placenta

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4
Q

What are the 4 P’s of labor that effect ability of baby to be delivered?

A 
Passenger = baby
Powers = uterine contractions
Passage= maternal pelvis
Psyche = mother’s emotional state
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5
Q

Latent vs Active labor

A

Latent Labor : Onset of labor contractions until 6cm dilated and regular, painful conractions

Active Labor: 6cm dilated with cervical change and regular, painful contractons until fully dilated (10cm)

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6
Q

Most common cause of C-section

A

labor protractions

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7
Q

Standard procedures of labor and delivery

A

Fetal monitoring
IV access
2nd stage Pitocin
Antibiotics for GBS

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8
Q

Ways to induce pregnancy and ripen cervix

A

Misoprostil
Foley bulb
Pitocin
Artificial rupture of membrane

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9
Q

What to look for on fetal monitoring during delivery?

A

.

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10
Q

early decelerations indicate

A

vagal response to head compression

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11
Q

Indications of fetal tachycardia

A

.

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12
Q

late decelerations

A

.

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13
Q

no variability on fetal monitoring

A

.

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14
Q

Longest phase of labor

A

latent phase

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15
Q

LOA fetal position

A

Left occiput anterior position

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16
Q

What is Leopold’s maneuver?

A

way to determine position and presentation of fetus in uterus, which in conjunction with correct assessment of the shape of the maternal pelvis can indicate whether delivery is going to be complicated or if C-section is necessary

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17
Q

What is Leopold’s maneuver?

A

way to determine position and presentation of fetus in uterus, which in conjunction with correct assessment of the shape of the maternal pelvis can indicate whether delivery is going to be complicated or if C-section is necessary

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18
Q

When is preeclampsia treated?

A

MILD: IV drip magnesium inpatient to decrease seizure risk, hydralazine or labetalol for acute BP control, steroids for lung maturity

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19
Q

What qualifies as preeclampsia?

A

1) HTN
Mild > 140/90 OR increase of 30 systolic and 15 diastolic from prepregnancy
Severe >160/110

2) Proteinuria
Mild > 300mg/24 hr
Severe > 5g/24 hr or 4+ on dipstick

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20
Q

Define eclampsia and how to treat

A

Severe preeclampsia (>160/110 and urine protein > 5g/24hr) with addition of seizures

Severe preclampsia and eclampsia are indications for prompt delivery regardless of gestational age

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21
Q

What qualifies as pregnancy-induced HTN?

A

new onset of HTN after 20 weeks gestation without any other associated symptoms

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22
Q

What anti-HTN can be used in pregnancy?

A

1st line: Methyldopa

Alternatives: labetalol, hydralazine

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23
Q

When is a bimanual exam done in pregnancy?

A

.

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24
Q

What do we need to monitor for pruritus during pregnancy?

A

.

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25
Q

Cervical color… does it matter?

A

.

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26
Q

What is HELLP syndrome?

A

severe preeclampsia with the addition of Hemolysis, Elevated Liver enzymes, and Low Platelets

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27
Q

What screenings are done in first semester?

A 
PAPP-A
free beta-hCG
Nuchal translucency
CVS (10-13 wks)
U/S
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28
Q

What screenings are done in second semester?

A

Quad screen - estriol, AFP, inhibin A, hCG
Amniocentesis (15-18 wks)
U/S

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29
Q

What screenings are done in third semester?

A 
Gestational DM screen
Culture for GBS
Rhogam in Rh- mothers
H&H
NST
U/S
Biophysical profile
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30
Q

What is hyperemesis and how is it treated?

A

excessive vomiting during pregnancy

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31
Q

Diseases that can occur in the placenta

A

Gestational trophoblastic disease (GTD) = hydatidiform mole (molar pregnancy), trophoblastic tumor, choriocarcinomas

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32
Q

delivery of placenta

A

.

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33
Q

Meds and breastfeeding

A

.

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34
Q

First prenatal visit labs and dx testing

A 
CBC
Blood type and Rh
Rubella titer
Random glucose
Hep B serum antigen
Culture for G&C prn
HIV testing
UA
Coomb's Test (antibodies)
Serologic syphilis testing
Pap smear
Offer all couples screen for cystic fibrosis, sickle cell, other genetic d/o per FHX
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35
Q

What is history and exams are included in every prenatal visit?

A

General health, diet, activity, compliance with vitamins, maternal weight gain, edema, fetal movement

BP, fundal height, U/S for fetal heart tones, UA

36
Q

How often are prenatal visits?

A

Initial visit 6-8 wks after LMP
Every 4 wks until 32 wks
Every 2 wks until 36 wks
Weekly until delivery

37
Q

How are neural tube defects prevented?

A

folic acid

38
Q

What is fundal height?

A

estimates age according to uterine size

12 wks = pubic symphysis
20 wks = umbilicus
38 wks = xiphoid process

39
Q

How and when is oral glucose tolerance test done?

A

Third semester (24-28 wks)

Nonfasting 50-g glucose challenge, followed by serum glucose level 1 hour later. If >130, then 3-hr OGTT

100-g load in morning after overnight fast. serum glucose taken at fasting and then at 1, 2, and 3 hrs after load

40
Q

What qualifies as gestational diabetes?

A

Dx’d if two or more values abnormal: fasting 95, 1 hr 180, 2 hr 155, 3 hr 140

41
Q

How to tell if women is going through preterm labor?

A

regular contractions between 20-36 weeks AND 1 or following: dilation > 2cm at presentation, dilation > 1 cm on serial exam, cervical effacement > 80%

Length of cervix 2 cm at 24 weeks

Sx’s: pressure, menstrual-like cramps, watery or bloody discharge, low back pain

42
Q

What are spontaneous abortions and why do they occur?

A

termination of pregnancy before 20 weeks; premature expulsion of conception products

50% due to chromosomal abnormalities
others - smoking, drug use, infection, maternal systemic dz, immunologic

43
Q

What is next step after abnormal quad screen or U/S?

A

Indication for genetic counseling - chorionic villus sampling or amniocentesis

44
Q

DDX of vaginal bleeding during pregnancy

A

Molar pregnancy before week 20

45
Q

Causes of postpartum hemorrhages

A

.

46
Q

Production of amniotic fluids and amount

A

.

47
Q

Cardiovascular changes during pregnancy

A

.

48
Q

When can gender of fetus be determined?

A

.

49
Q

Causes of intrauterine growth retardation

A

multiple gestation

…

50
Q

Risk of 5th disease to fetus

A

.

51
Q

What is pregnant patient at risk for with trauma and falls?

A

.

52
Q

Stages of labor

A

.

53
Q

Reasons to induce labor

A

.

54
Q

Want to go to PROM with me? What color should I wear?

A

rupture of amniotic membrane before onset of labor > 37 weeks

confirmed with direct visualization of vaginal discharge, use of nitrazine paper, and fern test

55
Q

Vomiting during pregnancy

A

.

56
Q

.

A

.

57
Q

What risks are associated with multiple gestation?

A

mother: spontaneous abortion, preterm birth
fetal: growth restriction, cord accidents, death of one twin, congenital abnormalities, breech, placental abruption or previa

58
Q

How to determine a molar pregnancy (or hydatidiform mole)?

A

complete: empty egg; “grape-like vesicles” or “snowstorm pattern” on U/S
partial: nonviable fetus present

59
Q

What is an incompetent cervix?

A

.

60
Q

How to treat STI’s in pregnancy?

A

.

61
Q

Why and when is Rhogam given?

A

Given to all Rh-negative mothers at 28 weeks as prophylactic protection and within 72 hrs of delivering an Rh-positive infant

Inhibits the production of anti-Rh(+) antibodies that could attack the immune system of Rh+ fetus

62
Q

What does biophysical profile include?

A

five parameters: NST, amniotic fluid, gross fetal movements, fetal tone, fetal breathing

Each parameter gives max 2 points to total of 10

63
Q

What does a normal NST (non-stress test) require?

A

two accelerations of fetal heart rate in 20 min of up to 15 bp form baseline for duration of 15 seconds

Absence of decelerations

64
Q

Which finding on fetal NST is most worrisome?

A

persistent late decelerations, which begin after peak of contraction

decelerations = decline in fetal HR of 15 bpm or lasting more than 15 sec

65
Q

DDX of vaginal bleeding during pregnancy

A

Molar pregnancy before week 20
Abruptio placentae after week 20, painful
Placenta previa after week 20, painless, confirm with U/S

66
Q

Define “station” in association with labor

A

Position of baby’s head in relationship to maternal ischial spines (-3 to +3cm, 0 = ischial spine)

example: +2 means presenting part is 2 cm below spine

67
Q

Stages of labor

A

1st Stage: onset of true contractions to 10 cm full cervical dilation
2nd Stage: Full dilation to delivery, pushing and expulsion of the baby
3rd Stage: Delivery of the placenta

68
Q

What qualifies as preeclampsia?

A

1) HTN
Mild > 140/90 OR increase of 30 systolic and 15 diastolic from pre-pregnancy
Severe >160/110

2) Proteinuria
Mild > 300mg/24 hr
Severe > 5g/24 hr or 4+ on dipstick

69
Q

Which finding on fetal NST is most worrisome?

A

persistent late decelerations, which begin after peak of contraction

decelerations = decline in fetal HR of 15 bpm or lasting more than 15 sec

70
Q

When abnormal decelerations on internal fetal monitor ECG, what is indicated?

A

stop oxytocin (if applicable), change maternal position, administer oxygen via face mask, and measure fetal scalp pH

71
Q

Cause of late decelerations on fetal ECG during delivery?

A

uteroplacental insufficiency

72
Q

Why is oxytocin sometimes used in third stage of labor?

A

to reduce blood loss by stimulating contractions

73
Q

Ways to induce pregnancy

A

prostaglandin gel on cervix to soften it
Misoprostil
Foley bulb
IV Pitocin (oxytocin) - increase contractions
Artificial rupture of membrane = Amniotomy

74
Q

Causes of postpartum hemorrhages

A

Early (24 hrs of delivery): subinvolution of uterus
retained products of conception
endometriosis

75
Q

Treatment of postpartum hemorrhage

A

Uterine massage and compression

IV access and prepare blood components

Treat subinvolution of uterus by increasing contractions - IV oxytocin, ergonovine, methylergonovine, or prostaglandins

76
Q

Why is oxytocin sometimes used in third stage of labor?

A

to reduce blood loss by stimulating contractions

77
Q

Indications of C-section

A

repeat c-section
dystocia or failure to progress
breech position
fetal distress

78
Q

Puerperium

A

postpartum; 6-week period after delivery

79
Q

Normal bleeding that occurs 4-5 weeks postpartum

A

Lochia

80
Q

What is an incompetent cervix?

A

pressure of baby may cause cervix to open before labor

81
Q

What is hyperemesis gravidarum and how is it treated?

A

severe vomiting, dehydration, and weight loss, vitamin deficiency

tx: promethazine or cyclizine

82
Q

Production of amniotic fluids and amount

A

placenta originally produces amniotic fluid, then lungs and kidneys take over as fetus breaths and swallows it

83
Q

Risk of 5th disease to fetus

A

“slapped cheek” appearance

84
Q

What is pregnant patient at risk for with trauma and falls?

A

mixing of blood

85
Q

Reasons to induce labor

A

prolonged pregnancy, DM, PROM, chronic HTN, preeclampsia, Rh isoimmunization, intrauterine growth retardation

86
Q

Signs and treatment of morning sickness

A

Normal nausea during pregnancy; no vomiting

Tx: ginger, small/freq meals, Acupuncture

87
Q

What is an incompetent cervix? Possible tx?

A

pressure of baby may cause cervix to open before labor

tx: progesterone supplements

Women's Health - OB (5 decks)

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