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Special Pops - Women's Health > Labor & Delivery > Flashcards

Labor & Delivery Flashcards

1
Q

How long is an ovulated egg viable in the ampulla?

A

18-24 hours

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2
Q

How long are sperm viable in the ampulla?

A

48-72 hours

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3
Q

When does implantation of a fertilized egg occur?

A

5-7 days after fertilization

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4
Q

When does hCG secretion begin after fertilization?

A

7-8 days after fertilization

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5
Q

What is the process of implantation?

A
  1. Apposition (blastocyst differentiates, placenta formed)
  2. Adhesion (binds to endometrium)
  3. Invasion (cells invade endometrium and establishes a blood supply)
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6
Q

Does the placenta belong to mother or fetus?

A

Fetus

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7
Q

How long does the corpus luteum produce progesterone in pregnancy?

A

First 7-9 weeks of pregnancy

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8
Q

Functions of placenta

A
  • Exchange of O2 and CO2
  • Waste removal
  • Nutrients
  • Produces hCG
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9
Q

Amount of hCG in early pregnancy

A
  • Amount doubles every 2 days until 10 weeks gestation

- If NOT, the pregnancy may be compromised

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10
Q

GI changes in pregnancy

A
  • Slowed emptying

- Increased acidity

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11
Q

Renal changes in pregnancy

A
  • GFR increases by 50%
  • Cr is lower than normal (hydration change, 0.33-0.59)
  • Hydronephrosis in late pregnancy
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12
Q

Cardiac changes in pregnancy

A
  • Blood volume increases 50%
  • HCT falls until about 28 wks
  • Increase in clotting factors
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13
Q

What is Naegele’s rule?

A
  • Estimated due date
  • Add 7 days to the 1st day of LMP
  • Subtract 3 months
  • Add 1 year
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14
Q

How is gestation divided?

A
  • Trimester 1: 1-12 weeks
  • Trimester 2: 13-27 weeks
  • Trimester 3: 28-40 (42) weeks
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15
Q

How can the 1st trimester be divided?

A
  • Embryonic (organogenesis, most sensitive to teratogens)

- Fetal (8 wks after fertilization or 10 wks after onset of LMP)

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16
Q

When is the embryo most sensitive to teratogens?

A

Embryonic period of 1st trimester (2-10 weeks gestation)

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17
Q

What is the difference between gestational and conception age?

A

2 weeks!

-Gestational refers to weeks after LMP

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18
Q

Normal pregnancy is how many weeks gestational/conceptional?

A
  • 40 weeks gestational (after LMP)
  • 38 weeks conceptional
  • But almost always referred to as gestational anyway
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19
Q

Define embryo

A

1-8 weeks gestation

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20
Q

Define fetus

A

After 8 weeks gestation

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21
Q

Define term

A

37 weeks or beyond

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22
Q

When is a fetus typically viable?

A
  • 23 to 24 wks gestation

- 600 g or more weight

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23
Q

When does medical abortion (miscarriage) occur?

A
  • Less than 20 weeks gestation

- Less than 500 g weight

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24
Q

Define preterm vs. premature

A
  • Preterm is birth before 37 wks

- Premature is birth b/w 28-37 wks, weight 1000-2500 g

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25
Define low birth weight
Full term but less than 2500 g weight
26
Define macrosomia
Large baby weighing more than 4500 g (9.9 lbs)
27
Define gravidity
Number of pregnancies (live or dead)
28
Define parity
Number of birth events of 20+ wks gestation OR 500+ g
29
Define elderly primigravida
1st pregnancy over 35 yo
30
Define nulligravida
No pregnancies
31
Define nullipara
No births
32
FPAL system
- Alternative to GPA system classifying pregnancies/births | - Full term births, Preterm births, Abortions, Living children
33
Why is folic acid given during pregnancy?
To prevent spina bifida
34
FDA pregnancy drug categories
- A: adequate, human studies have not shown increased risk - B: animal studies have revealed no evidence of harm - C: animal studies have shown adverse effect - D: human studies have demonstrated a risk to fetus - X: positive evidence of fetal abnormality
35
S/S of pregnancy
- Amenorrhea - NV (as early as 2 wks, resolves typically 13-16 wks gestation) - Breast changes - Skin changes - Pelvic organ changes
36
What should be done at every prenatal visit?
- Weight - BP - Fetal heart - Dipstick urine for gluc and protein - Measure fundal height
37
How to treat hyperemesis gravidum
- Frequent small meals - Sea bands (accupressure) - Emetrol - Acupuncture - Ginger root - Vit B6 - IV hydration - Phenergan suppositories
38
What is triple screen in pregnancy?
hcG Estriol Alpha-fetoprotein (AFP)
39
What is the MC cause of abnormal triple screen?
Wrong gestational age (it is most accurate at 16-18 wks)
40
When is triple screen most accurate?
16-18 wks gestation
41
What is nuchal fold on US screening for in pregnancy?
Down syndrome
42
What is amniocentesis used to screen for in pregnancy?
Confirms karotype disorders like Down syndrome and Trisomy 18
43
What determines the presenting part in a delivery?
Vertex (head) or breech (gluteus)
44
What can cause a breech delivery?
- Premature labor - Abnormal amniotic fluid - Uterine anomalies - Pelvic tumors - Abnormal placenta - Multiparity - Abnormal fetal muscular tone and mobility
45
Range of cervical dilation
0 cm (closed) to 10 cm (fully dilated)
46
Define station
- Descent of presenting part in relation to ischial spines - At ischial spines = 0 - Above spines = -1, 2, 3 - Below spines = +1, 2, 3 - Each station grade represents about 2 cm distance
47
Progress in labor may be:
- Effacement - Dilation - Station - Or any combo
48
What is the Friedman curve?
"Fairly predictable" curve of how labor progresses
49
Stages of labor
- First stage (latent and active phases) - Second stage - Third stage
50
Describe first stage of labor
- Onset of labor to full dilation of cervix | - Divided into latent (most variable) and active phases
51
Which part of the first stage of labor is most variable?
Latent phase (mostly effacement and descent occur)
52
Describe second stage of labor
Full dilation of cervix to delivery of infant
53
Describe third stage of labor
Delivery of infant to delivery of placenta
54
How long is the first stage of labor for primiparas (first baby)? At what rate is the active phase dilation?
- 6-18 hours | - 1.2 cm/hour
55
How long is the first stage of labor for multipara (second baby)? At what rate is the active phase dilation?
- 2-10 hours | - 1.5 cm/hour
56
How is labor measured?
- Cervical dilation - Cervical effacement/thinning - Station
57
Define uneffaced
- 0% effacement | - Long or thick cervix
58
Purposes of amniotomy
- Provide info on volume of fluid and presence of meconium - Increase uterine contractility - Allow for internal fetal/uterine monitoring
59
Cardinal movements of labor
1. Engagement (of head into lower pelvis) 2. Flexion 3. Descent 4. IR 5. Extension 6. ER
60
When is the smallest diameter of the head presented in labor?
- Head flexed | - Face toward mother's right
61
How to tell posterior fontanelle from anterior fontanelle?
``` Posterior = triangular Anterior = diamond ```
62
In a normal vaginal delivery, once the head is out what should be done?
- Suction (mouth before nose) | - Check for nuchal cord
63
How to perform normal vaginal delivery
- Once head is out, suction mouth and nose - Check for nuchal cord - Pull down to deliver anterior shoulder - Pull up to deliver posterior shoulder - Dry and stimulate baby - Clamp and cut cord
64
What should umbilical cord be inspected for?
2 arteries | 1 central vein
65
What related to the fetus can cause labor to stall?
- Presentation not vertex - Presentation not LOA - Vertex did not flex - No IR
66
What related to the pelvis can cause labor to stall?
- Narrow pubic arch | - Narrow spines
67
What related to propulsion can cause labor to stall?
Contractions inadequate (strength, duration, frequency)
68
How to help progress labor?
- Augment with oxytocin | - Consider rupturing membranes
69
Maternal indications for inducing labor
- Preeclampsia - DM - Heart disease
70
Fetal indications for inducing labor
-Prolonged pregnancy -Rh incompatibility -Fetal abnormality ETC ETC
71
How long is too long of a latent phase?
- Nulliparas 20 hr or more | - Multiparas 14 hr or more
72
How long is too long of an active phase dilation rate?
- Nulliparas 1 cm/hr or less | - Multiparas 2 cm/hr or less
73
Define arrest of dilatation
No dilation in 2 hours or more
74
Define arrest of descent
No change in station for 2 hours or more
75
MC fetal indications for C section
- Non-reassuring fetal heart pattern - Malpresentation (e.g. breech) - Cord prolapse - Congenital anomalies
76
MC maternal-fetal indications for C section
Failure to progress in labor
77
MC maternal indications for C section
Previous C section
78
Which C section incision matters for subsequent deliveries?
Internal
79
Indications for vacuum or forceps extraction in labor
- Fetal distress w/head on perineum - Maternal exhaustion - Second stage over 2 hrs - Medical problems where pushing is CI - Must exclude CPD
80
Baseline fetal HR?
120-160 bpm and should vary
81
Pain relief options in first stage of labor
- Breathing (lamaze) - Ambulation - Narcotics
82
Pain relief options in second stage of labor
Epidural
83
Pain relief options in third stage of labor
- Spinal | - Local
84
Define postpartum
The 6 weeks after delivery
85
What occurs in the first 24 hrs postpartum?
- Rapid decrease in uterine size - Bleeding (lochia) - First breast milk (colostrum)
86
Advantages of lactation postpartum
- Helps contract uterus - Bonding w/infant - Convenient, economical - Perfect nutrition
87
Disadvantages of lactation postpartum
- May interfere with work - Uncomfortable for some people - Unable to measure intake - Unable to take certain meds
88
What is the amount of milk produced in lactation related to?
How much is removed each feeding
89
Define engorgement
- Without breast feeding, milk will engorge ducts and stop production - Takes 2-3 days

Special Pops - Women's Health (11 decks)

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