Labor & Delivery - PANCE Pearls

Question 1

spontaneous uterine contractions late in pregnancy → not associated with cervical dilation

Answer 1

Braxton-Hick contractions

Question 2

Fetal head descends into the pelvis causing a change in the abdomen shape and a sensation that the baby has become lighter

Answer 2

Lightening

Question 3

sudden gush of liquid or constant leakage of fluid

Answer 3

ruptured membranes

Question 4

passage of blood tinged cervical mucus late in pregnancy. Occurs when the cervix begins thinning (effacement)

Answer 4

Bloody show

Question 5

Contractions of the uterine fundus with radiation to lower back and abdomen →regular and painful contractions of the uterus cause cervical dilation and fetus expulsion

Answer 5

True labor

Question 6

when the fetal presenting part enters the pelvic inlet

Answer 6

engagement

Question 7

flexion of the head to allow the smalled diameter to present to the pelvis

Answer 7

flexion

Question 8

passage of the head into the pelvis (also called “lightening”)

Answer 8

descent

Question 9

fetal vertex moves from occiput transverse position to a position where the sagittal suture is parallel to the anteroposterior diameter of the pelvis

Answer 9

internal rotation

Question 10

vertex extends as it passes beneath the pubic symphysis

Answer 10

extension

Question 11

fetus externally rotates after the head is delivered so that the shoulder can be delivered

Answer 11

external rotation

Question 12

what is the time frame for Stage I of labor?

Answer 12

onset of labor (true regular contractions) to full dilation of the cervix (10cm)

Question 13

what is the time frame for Stage II of labor?

Answer 13

time from full cervical dilation to delivery of the fetus

Question 14

what is the time frame for Stage III of labor?

Answer 14

postpartum to delivery of the placenta (0-30 minutes - usually 5 min)

Question 15

3 signs of placental separation

Answer 15

gush of blood
lengthening of the ubilical cord
anterior-cephalad movement of the uterine fundus

Question 16

when is the APGAR score taken?

Answer 16

1 and 5 minutes after birth

Question 17

What is normal APGAR score and what is critically low?

Answer 17

Normal is >7

critically low is <3

Question 18

What are the componenets of the APGAR score?

Answer 18

appearance, pulse, grimace, activity, respiration

Question 19

term for pink body but blue extremities

Answer 19

acrocyanosis

Question 20

what is a good pulse for APGAR?

Answer 20

> 100

Question 21

What would be the following APGAR score → pink baby, pulse >100, pulls away/sneezes/coughs, flexes arms and legs and resists extension, strong cry

Answer 21

10

Question 22

how long postpartum will it take for the uterus to return to normal size?

Answer 22

6 weeks

Question 23

pink/brown vaginal bleeding postpartum days 4-10 → resolves by 3-4 weeks postpartum

Answer 23

lochia serosa

Question 24

If a woman is not breast feeding when can she expect menses to return?

Answer 24

6-8 weeks

Question 25

How much will a woman bleed if she delivers vaginally? How much if it is by C-section?

Answer 25

>500mL vaginal | >1000mL C section

Question 26

Most common cause of postpartum hemorrhage

Answer 26

uterine atony → uterus cant contract to stop the bleeding

Question 27

Risk factors for postpartum hemorrhage

Answer 27

rapid or prolonged labor, overdistended uterus, C-section

Question 28

clinical manifestation of uterine atony

Answer 28

soft, boggy uterus with dilated cervix

Question 29

clinical manifestation of postpartum hemorrhage

Answer 29

hypovolemic shock, hypotension, tachycardia, pale/clammy skin, decreased capillary refill

Question 30

If you suspect postpartum hemorrhage, what lab test should you get?

Answer 30

CBC → check hemoglobin and hematocrit

Question 31

ways to treat postpartum hemorrhage

Answer 31

``` bimanual uterine massage uterotonic agents (enhance uterine contractions) ```

Question 32

risk factors fro premature rupture of membranes

Answer 32

STD, smoking, prior preterm delivery, multiple gestations

Question 33

What is the Nitrazine paper test?

Answer 33

checking the pH of vagina → turns blue if pH is >6.5 (PROM) → normal amniotic fluid is 7.0-7.3 and vaginal is 3.8-4.2

Question 34

What is the Fern Test?

Answer 34

fern pattern in amniotic fluid due to crystalization of estrogen and amniotic fluid

Question 35

Management for premature rupture of membranes

Answer 35

wait for spontaneous labor and monitor for infections

Question 36

what is considered premature labor?

Answer 36

before 37 weeks gestation

Question 37

What is considered regular labor contractions?

Answer 37

>4-6/hour with progressive cervical changes

Question 38

cervical dilation and effacement values for premature labor

Answer 38

cervical dilation > 3 cm | effacement >80%

Question 39

Presence of ____ between 20-34 weeks strongly suggests preterm labor

Answer 39

fetal fibronectin

Question 40

L:S <2:1 indicates

Answer 40

fetal lung immaturity

Question 41

In preterm labor, how can you enhance fetal lung maturity?

Answer 41

antenatal steroids (Betamethasone)

Question 42

Pharmacotherapy that suppresses uterine contractions for up to 48 hours to delay delivery so steroids can take effect on fetus

Answer 42

tocolytics

Question 43

What do you antibiotically prophylax against in preterm labor?

Answer 43

group B strep ampicillin + PO amoxicillin + azithro cephazolin + PO cephalexin + azithro (PCN allergy)

Question 44

3 categories of labor progression

Answer 44

power → uterine contraction passenger → size & position of the fetus passage → uterus or soft tissue abnormalities

Question 45

one or both of the fetal shoulders is lodged at the pubi symphysis after delivery of the head → can lead to Erb's palsy

Answer 45

should dystocia

Question 46

Nonmalipulative management of shoulder distocia

Answer 46

McRoberts maneurver → first line

Question 47

what is McRoberts maneuver?

Answer 47

increase pelvis opening with hip hyperflexion

Question 48

What is the manipulative method for shoulder dystocia?

Answer 48

Woods "Corkscrew" maneuver → 180 shoulder rotation

Question 49

indication for induction of labor

Answer 49

vaginal delivery when prolonged labor may lead to complications for either mom or fetus and risks are greater than continuing pregnancy

Question 50

Contraindications for induction for vaginal delivery are greater than C-section

Answer 50

prior uterine rupture, prior C-section, active genital herpes infection, umbilical cord prolapse, placenta previa, vasa previs, transverse fetal lie

Question 51

Methods to induce women with unfavorable cervices to promote cervical ripening

Answer 51

prostaglandin gel

Question 52

Methods to later induced women when the cervix is dilated <1 cm with some effacement

Answer 52

IV oxytocin (pitocin)

Question 53

artificial rupture of membrane with small hook if the cervix is partially dilated and there is effecement of the cervix

Answer 53

amniotomy