Labor/Delivery Lecture Flashcards
Parturition
act of giving birth to young; childbirth
progesterone withdrawal
fetal lung maturity
fetal adrenal glands
baby ready, may signal mother’s posterior pituitary gland so she begins to release her own oxytocin
initiates labor
cervical dilatation 0-10cm
*longest by far, 7-14 hours average
EARLY/LATENT- ACTIVE- TRANSITION
first stage of labor
10 cm-birth of baby
average 1-3 hours
second stage of labor
birth to delivery of placenta
10-15 mins of average, may be up to 30 mins
third stage of labor
effacement (shortening and thinning)
dilation
cervical changes during labor
progression in dilation and progression of intensity of contractions
true labor
bloody show presents how many hours before onset of labor
24-48 hours
what exam do you do to determine true vs false labor?
Sterile vaginal exam
How many weeks should the baby be in their down positions?
34 weeks
cervix 0-10 cm, what stage of labor?
first stage
Uterine ctx continue
Uterine fundus at level of umblilicus
“Folding” of placenta at implantation site
Spongy decidua -uterine lining (endometrium) which forms the maternal part of the placenta
Formation of hematoma between placenta and decidua
3rd stage of labor
How long does placental separation usually take?
10-15 mins (but may be up to 30)
- lengthening of umbilical cord
- uterus changes to more globular shape and becomes firm
- uterus rises, placenta descends
- gush of blood occurs
4 traditional signs of placental separation
Pitocin*
Misoprostol
Methergine
Hemabate
these are meds used to help with
post partum hemorrhage
monitor fetal HR every _____ mins in active labor
30 mins
and even every 5-15 mins in second stage of labor
how common are spontaneous abortions?
1/5 women
pregnancy that occurs outside the uterus
always non viable
ectopic pregnancy
occurs in 1/50 pregnancies
usually diagnosed by 8 weeks
ectopic pregnancy
is produced during pregnancy by specialised trophoblast cells, which are only found in the body as a result of a fertilised egg implanting.
Human Chorionic Gonadatropin (HCG)
when do we give Rhogam
if mom is Rh negative, we give Rhogam at 28 weeks and after birth
Anemia
Hemolytic dz of newborn
Hydrops fetalis
Still birth
*higher in caucasian women
RH complications
Biggest cause of pregnancy complications
HTN disorders
ie preeclampsia
Onset of htn and or proteinuria or end-organ dysfunction after 20 weeks of gestation in a previously normotensive woman.
Preeclampsia
140/90 on 2 occasions, at least 4 hours apart, or 160/110
Proteinuria 0.3 gm in 24 H or protein/creatinine ratio (urine dipstick)
Used to diagnose preeclampsia
Eclampsia is diagnosed when what happens?
A seizure
Preeclampsia is a disease of the…
placental vasculature
Prevention and tx of seizures in women with preeclampsia and eclampsia
-fetal neuroprotection before anticipated early preterm
Magnesium Sulfate
Preferred treatment of eclampsia/preeclampsia
delivery!!
Preeclampsia is a serious condition that typically starts after the ____ week of pregnancy
20th
Systolic B/P greater than or equal to 140 and or diastolic greater to or equal to 90 that antedates pregnancy, is present before the 20th week, or persists longer than 12 weeks postpartum.
Chronic HTN
Elevated blood pressure first detected after 20 weeks gestation in the absence of proteinuria or other diagnostic features of preeclampsia.
Gestational HTN
Severe form of preeclampsia:
- Hemolysis (destruction of red blood cells)
- Elevated Liver enzymes
- Low Platelets
HELLP syndrome
pulmonary edema can also be a severe side effect
Cure for HELLP syndrome
Delivery ASAP
What does magnesium do to smooth muscle?
Relaxes
Defined by Glucose Intolerance that begins or is first recognized in pregnancy
-characterized by peripheral insulin resistance and declining B-cell function. Similar to type II diabetes
Gestational diabetes
Increased risk of dystocia
Increased risk of hypoglycemia postpartum for infant
risks of gestational diabetes
Screen for gestational diabetes in asymptomatic women after ___ weeks gestation
24
If pregnant woman has hyperemesis and is throwing up a LOT..what should you check?
Thyroid
VERY high HCG levels, no heart beat but lots of pregnancy symptoms. what could it be?
Molar pregnancy (gestational trophoblastic disease)
occurs when gas exchange and nutrient delivery to the fetus are not sufficient to allow it to thrive in utero.
Intrauterine growth restriction (IUGR)
true or false….
you should get a urinalysis at first prenatal visit
TRUE! (for asymptomatic bacteriuria)
- poor uterine contractions
- malpresentations and malpositions
- disproportion between fetal size and pelvis size
dystocia
High parity
Over-stimulation with oxytocin or other induction agents
Previous C-Section and subsequent long labor
*fetal mortality rate of 50-75%
uterine rupture
Leading cause of maternal mortality worldwide
*greater than 500 cc blood loss after vaginal birth or greater than 1000 cc blood loss after C section
Postpartum hemorrhage
