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Ob-Gyn > Labor & Delivery > Flashcards

Labor & Delivery Flashcards

1
Q

Latent Phase of Labor

  • -cervical dilation?
  • -duration of latent phase (nullipara, multipara)?
A

Latent Phase of Labor

  • -cervical dilation less than 4cm
  • -nullipara duration 18-20 hrs
  • -multipara duration less than 14 hrs
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2
Q

Active Phase of Labor

  • -length of cervical dilation?
  • -rate of cervical dilation (nullipara, multipara)?
  • -protraction vs arrest of active phase? re: dilation rate
A

Active Phase of Labor

  • -cervical dilation greater than 4cm
  • -nullipara dilation rate 1.2cm/hr
  • -multipara dilation rate 1.5 cm/hr
  • -protraction: less than normal dilation rate
  • -arrest: no progress for 2 hours
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3
Q

Normal fetal HR?
Cause of early decelerations?
–mirror images of contractions, gradual decline (> 30s)
Cause of variable decelerations?
–abrupt decline (30s), offset from uterine contractioins
Cause of late decelerations?

A 
Normal fetal HR: 110-160 bpm
Early decelerations
--caused by fetal head compressions
Variable decelerations
--caused by cord compression
Late Decelerations
--uteroplacental insufficiency, fetal hypoxia and acidosis
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4
Q

First stage of labor: onset of labor to complete dilation

Second stage: complete dilation to infant delivery
–normal duration (nullipara, multipara)?

Third stage: infant delivery to placental delivery
–normal duration (nullipara, multipara)?

A

First stage of labor: onset of labor to complete dilation

Second stage: complete dilation to infant delivery

  • -nullipara normal duration less than 2 hrs (3 hrs if epidural)
  • -multipara normal duration less than 1 hr (2 hrs if epidural)

Third stage: infant delivery to placental delivery
–nullipara/multipara normal duration less than 30 min

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5
Q

Adequate uterine contractions

  • -frequency?
  • -duration?
  • -palpation?
  • -montevideo units per 10min?
A

Adequate uterine contractions

  • -frequency: 2-3 min
  • -duration: 40-60 sec
  • -firm on palpation
  • -200 montevideo units per 10min
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6
Q

Four signs of placental separation:

  1. gush of blood
  2. lengthening of the cord
  3. globular-shaped uterus
  4. uterus rising to what area?
A

Four signs of placental separation:

  1. gush of blood
  2. lengthening of the cord
  3. globular-shaped uterus
  4. uterus rising to anterior abdominal wall
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7
Q

What is a common complication of uterine inversion?

3 steps for treatment of uterine inversion?

A

Common complication: hemorrhage

Treatment of uterine inversion:

  1. halothane for uterine relaxation
    - -alternatives: terbutaline, Mg sulfate
  2. manual uterine replacement
  3. uterotonic agent, eg oxytocin
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8
Q

What glucocorticoid is used to enhance fetal lung maturity?

Between what weeks of pregnancy is it successful at accelerating fetal lung maturity?

A

Betamethasone

24-34 weeks

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9
Q 
Birth Injury Syndrome 1:
--decreased Moro and biceps reflexes
--intact grasp reflex
--"waiter's tip": arm adducted and internally rotated; forearm pronated; wrist flexed
Dx? Injury to what nerves?
Birth Injury Syndrome 2:
--intact Moro, biceps reflexes
--absent grasp reflex
--"claw hand"
--ptosis, miosis
Dx? Injury to what nerves?
A

1) Erb-Duchenne palsy; C5-C6

2) Klumpke Palsy; C8-T1

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10
Q

Group B Strep prophylaxis: IV penicillin G

Indications:

  1. positive GBS cultures
  2. GBS bacteriuria during current pregnancy
  3. hx of infant with early onset GBS
  4. unknown GBS status and…
    - -intrapartum fever
    - -labor prior to how many weeks of gestation?
    - -ROM greater than how many hours?
A

Group B Strep prophylaxis: IV penicillin G

Indications:

  1. positive GBS cultures
  2. GBS bacteriuria during current pregnancy
  3. hx of infant with early onset GBS
  4. unknown GBS status and…
    - -intrapartum fever
    - -labor prior to 37 weeks of gestation
    - -ROM greater than 18 hours
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11
Q

1) implantation of the placenta over the internal cervical os

2) invasion of the placenta into the uterine wall; inability of placenta to separate from wall after delivery
* invasion thru the myometrium
* *invasion thru the serosa

A

1) placenta previa

2) placenta accreta
* placenta increta (myometrium)
* *placenta percreta (serosa)

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12
Q
  • unengaged fetal presentation
  • transverse fetal lie
  • footling breech presentation
A

Umbilical cord prolapse

  • -painless
  • -cord is presenting part
  • -compromised fetal blood flow and oxygenation
  • -deep, recurring variable decelerations

Tx: immediate cesarean delivery

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13
Q

Incompetent Cervix / Cervical Insufficiency

  • -painless dilation and effacement of cervix in 2nd trimester of pregnancy
  • -dilation often in excess of contractions

Risk Factors: hx of cervical surgery; hx of obstetric trauma/lacerations, uterine anomalies, DES exposure

Dx via what method?
Tx?

A

Incompetent Cervix / Cervical Insufficiency

Dx via transvaginal ultrasound

Tx: cerclage

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14
Q

Antepartum Bleeding DDx

  1. painless antepartum hemorrhage; no rapid fetal deterioration; low-lying placenta
  2. premature placental separation; bleeding of maternal origin with abdominal pain, uterine tenderness, increase uterine tone
  3. fetal blood vessels traverse fetal membranes across lower uterine segment; fetal vessels tear during ROM; painless antepartum hemorrhage; rapid fetal deterioration with exsanguination
  4. intense abdominal pain; vaginal bleeding; palpate fetal parts on abdominal exam; cessation of uterine contractions; abnormal fetal heart traacing
A

Antepartum Bleeding DDx

  1. Placenta previa
  2. Placental abruption
  3. Vasa previa
  4. Uterine rupture
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15
Q

Management of breech presentation…

…before 37 weeks?

…after 37 weeks?

A

Management of breech presentation

Observation
–before 37 weeks?

External cephalic version
–after 37 weeks?

*C-section if ECV fails

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16
Q

Postpartum Hemorrhage DDx
1. myometrium doesn’t contract to cut off uterine spiral arteries; soft, enlarged, boggy uterus

  1. genital tract laceration
  2. during delivery of placenta, a shaggy, reddish bulging mass is noted at the introitus around the placenta
  3. PPH after first 24 hrs; eschar over placental bed falls off with lack of myometrial contraction
  4. uterine cramping and bleeding; fever; foul-smelling lochia
A

Postpartum Hemorrhage DDx

  1. Uterine atony
    Tx: uterine massage, IV oxytocin
  2. Genital tract laceration
  3. Uterine inversion
  4. Subinvolution of placental site
    Tx: methylergonovine maleate (Methergine)
  5. Retained POC
17
Q

Tx Options for Postpartum Hemorrhage

  1. 1st line tx for uterine atony (1 physical, 1 medical)
  2. ergot alkaloid; induces myometrial contraction; contraindicated in HTN
  3. causes sm mm contraction; contraindicated in asthmatic pts
  4. induces uterine contractions; can be placed rectally; prostaglandin analog
A

Tx Options for Postpartum Hemorrhage

  1. uterine massage, oxytocin
  2. Methylergonovine Maleate (Methergine)
  3. Prostaglandin F2-alpha
  4. Misoprostol
18
Q

Management of Placental Abruption

  1. maternal vital signs stable; fetal monitoring reassuring
    - -reassuring fetal monitoring includes HR: 110-160; long term variability > 2 cycles/min; beat-to-beat variability 6-25 bpm
  2. maternal vital signs unstable; or fetal monitoring non-reassuring
A

Management of Placental Abruption
–premature placental separation; bleeding of maternal origin with abdominal pain; uterine tenderness; increased uterine tone

  1. Trial of vaginal delivery
    - -if mother and fetus are stable
  2. Emergency C-section
    - -if mother or fetus are not stable
19
Q

Birth Injury Syndrome: clavicular crepitus with absent ipsilateral Moro reflex; contralateral Moro reflex intact; bilateral biceps and grasp reflexes are intact and symmetric

Dx?
Common association?

A

Clavicular Fracture
–clavicular crepitus on one side with absent ipsilateral Moro reflex; contralateral Moro reflex intact bilateral biceps and grasp reflexes are intact and symmetric

Associated with maternal diabetes mellitus

20
Q

Arrest of Labor (Stages 1, 2)

Cervical dilation = 6+cm with ruptured membranes AND…
1. no cervical dilation, adequate contractions for how long?
OR
2. no cervical dilation, inadequate contractions for how long?

A

Arrest of Labor (Stages 1,2)

Cervical dilation = 6+cm with ruptured membranes AND…

  1. no cervical dilation despite adequate contractions for 4+ hours

OR

  1. no cervical dilation despite inadequate contractions for 6+ hours

–> indication for C-section

21
Q

Epidural anesthesia –> afferent/efferent bladder nerve block
–thus, catheterization required

NB: tinnitus, perioral numbness, metallic taste, dizziness, palpitations are signs of intravascular injection of anesthesia

If nerve block persists, what type of incontinence may develop?

A

Overflow incontinence

  • -constant involuntary dribbling
  • -incomplete emptying
22
Q

Post-Operative Fever DDx

What POD range?
What Dx?

Wind

Water

Walking

Wound

A

Post-Operative Fever DDx

Wind

  • -POD 1: atelectasis
  • -POD 3: pneumonia

Water
–POD 3: UTI

Walking
–POD 5: DVT

Wound

  • -POD 7: wound infection
  • -POD 10-15: deep abscess
23
Q

Presentation: cardiogenic shock, hypotension, respiratory failure, hypoxemia, DIC, bleeding, coma, seizures
–during delivery or shortly after

Risk Factors: advanced maternal age; gravida more than 5; C-section or instrumental delivery; placenta previa or abruption; preeclampsia

Dx?

A

Amniotic Fluid Embolism
–AF enters maternal circulation –> inflammatory response, vasospasm –> cardiogenic shock, hypoxemic respiratory failure, DIC, bleeding –> seizures, coma

Supportive Tx: O2, intubation, ventilation, vasopressors

Ob-Gyn (11 decks)

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