Labor & Delivery, Maternal Mortality, and Lactation - Test 1 Flashcards
What are the three Ps of labor?
Power
Passenger
Passageway
What are the three functional segments of the uterus?
Active segment
Passive segment
Cervix
Which segment of the uterus is the preferred incision site for a C-section? Why?
Passive segment because this decreases chance of uterine rupture in subsequent pregnancies.
What are the four phases of uterine quiescence and activation? What weeks gestational age are each associated with? What hormones predominate during each phase?
Phase 0 - quiescence
Weeks 0-36
Progesterone inhibits uterine contractions
Phase 1 - myometrial activation
Weeks 36-delivery
Estrogen is the dominant hormone - this activates the uterus —> increase in contraction-associated proteins (prostaglandin and oxytocin receptors, gap-junctions between myometrial cells)
Phase 2 - stimulation
Active phase of labor
Prostaglandins and oxytocin stimulate contractions
Phase 3 - involution
Postpartum phase
Oxytocin stimulates contraction of the uterus and spiral arteries
Describe three functions of prostaglandins during pregnancy. Name a drug inhibits synthesis of prostaglandins and an indication for its clinical use.
Prostaglandins promote cervical ripening, potentiate contractions, and increase oxytocin receptor concentrations.
Indomethacin is an NSAID that inhibits prostaglandin synthetase and can prevent preterm labor.
__________ is given intravenously to both induce labor and prevent postpartum hemorrhage.
Oxytocin
Which hormone upregulates gap junctions and uterine receptors for oxytocin in phase 1?
Estrogen
What clinical exam maneuver is performed to assess fetal lie and presentation?
Leopold’s maneuver
Which fetal lie and presentation do babies most commonly present in?
Well-flexed, vertex
Name the four female pelvis types (with regards to shape) and which fetal head position is most commonly associated with each.
- Gynecoid - most common; usually associated with an occiput anterior head position
- Android - usually associated with occiput posterior head position (difficult birth)
- Platypelloid - associated with occiput transverse position
- Arthropoid
What are normal/expected times for stage 2 (pushing) phase of labor in both nulliparous and multiparous women?
Nulliparous women: >3 hours of pushing or >4 hours with an epidural
Multiparous women: >2 hours of pushing or >3 hours with an epidural
How long after childbirth is delivery of the placenta expected to happen?
Within 30 minutes
Describe both the mechanical and pharmacological methods to articifially ripen the cervix.
Mechanical:
- Foley catheter is inserted through cervix, inflated —> cervical dilation
- Laminaria (seaweed to absorb moisture) is not done anymore
Pharm:
- PGE2 (prostin) or dinoprostone (cervidil) placed into the cervical canal or posterior fornix
- PGE1 (misoprostol aka cytotec)
- Do NOT use in women w/ Hx of prior C-section due to increased risk of rupture
- Oxytocin
The ________ score is a method of quantifying the state of the cervix for delivery.
Bishop score
What are the different stages of pain in labor and what are the associated nerves that carry afferent pain signals in each stage?
Labor stage 1
- Latent and active labor
- Pain is due to uterine contractions and cervical dilation
- Visceral pain fibers from lesser and least splanchnics (T10-12) + L1 transmit the pain
Labor stage 2
- Pushing and delivery
- Pain is due to distension of the pelvic floor - carried by pudendal nerve (S2, 3, 4)
What is the major risk of giving opioids to a mom in labor?
Fetal respiratory depression
Which inhaled anesthetic is now often used for management of the pain of labor? What are the side-effects of this?
Nitrous oxide
No side effects
Define post-partum hemorrhage.
Vaginal delivery: loss of 500+ mL of blood –> hypovolemia
C-section: loss of 1000+ mL of blood –> hypovolemia
What are the “four Ts” of postpartum hemorrhage?
Tone
Tissue
Trauma
Thrombin
What are some risk factors for post-partum atony -> hemorrhage?
Too much uterine distension from macrosmia, polyhydramnios, multiple gestations
Retained placental tissue will cause post-partum hemorrhage. What is the management of retained placental tissue?
- Traction on the umbilical cord + drugs (see next flashcard) + fundal massage
- If that fails, manual extraction
- If that fails, dilation and curettage (D&C)
- If that fails, hysterectomy (cuz it’s usually placenta accreta)
Name four drugs that can be helpful in expulsion of retained placental tissue.
Oxytocin
Methylergonovine (methergine)
Carboprost tromethamine (hemabate)
Misoprostol
The least invasive surgical treatment of uterine atony is…?
Balloon tamponade
Intrapartum fever + maternal tachycardia + uterine tenderness or leukocytosis
Increases chance of going into preterm labor
What is your Dx? How do you treat it?
Chorioamnionitis
Treatment: broad-spectrum antibiotics (ampicillin + gentamycin, ampicillin sulbactam, or ticarcillin/clavulanate) and expedite the delivery
Maternal mortality rate has ________ (increased or decreased) in the US over the past few decades and is higher than many other developed countries.
What has been the trend regarding maternal mortality worldwide in the past few decades?
US maternal mortality has increased in the past few decades.
Worldwide maternal mortality has decreased.
Do disparities exist in the US regarding maternal mortality?
Yeah
What is the major hormone that regulates lactation?
Prolactin
What external stimulus is responsible for prolactin release from the pituitary?
Suckling by the baby
What is more effective at increasing lactogenesis: increased feeding frequency, or increased duration of feeding?
Increased frequency
Name two drugs that can suppress lactation and their MOAs.
Bromocriptine and cabergoline (dopamine agonists)
Why are lactating women amenorrheic?
Suckling inhibits GnRH secretion
Are there a shitload of benefits to breastfeeding?
Yeah
How often and for how long is breast feeding recommended?
Every 2-3 hours for 10-15 min each breast
What is a differential diagnosis for lactating mother nipple/breast pain?
Engorgement
Candidal infection
Nipple microtrauma from poor latch
Mastitis
Abscess
What is the treatment for candidal mammary gland infection?
Topical clotrimazole
What is the treatment for mastitis?
Dicloxacillin
Bactrim or clindamyicn if its MRSA
How is a hepatitis B pregnant woman treated in pregnancy w/ regards to her hepatitis infection?
Lamivudine in the 3rd trimester
Name two drugs that can stimulate lactation. What are their MOAs?
Metoclopramide and domperidone (dopamine receptor antagonists)
