Labor & Delivery - PANCE Pearls Flashcards
spontaneous uterine contractions late in pregnancy → not associated with cervical dilation
Braxton-Hick contractions
Fetal head descends into the pelvis causing a change in the abdomen shape and a sensation that the baby has become lighter
Lightening
sudden gush of liquid or constant leakage of fluid
ruptured membranes
passage of blood tinged cervical mucus late in pregnancy. Occurs when the cervix begins thinning (effacement)
Bloody show
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
True labor
when the fetal presenting part enters the pelvic inlet
engagement
flexion of the head to allow the smalled diameter to present to the pelvis
flexion
passage of the head into the pelvis (also called “lightening”)
descent
fetal vertex moves from occiput transverse position to a position where the sagittal suture is parallel to the anteroposterior diameter of the pelvis
internal rotation
vertex extends as it passes beneath the pubic symphysis
extension
fetus externally rotates after the head is delivered so that the shoulder can be delivered
external rotation
what is the time frame for Stage I of labor?
onset of labor (true regular contractions) to full dilation of the cervix (10cm)
what is the time frame for Stage II of labor?
time from full cervical dilation to delivery of the fetus
what is the time frame for Stage III of labor?
postpartum to delivery of the placenta (0-30 minutes - usually 5 min)
3 signs of placental separation
gush of blood
lengthening of the ubilical cord
anterior-cephalad movement of the uterine fundus
when is the APGAR score taken?
1 and 5 minutes after birth
What is normal APGAR score and what is critically low?
Normal is >7
critically low is <3
What are the componenets of the APGAR score?
appearance, pulse, grimace, activity, respiration
term for pink body but blue extremities
acrocyanosis
what is a good pulse for APGAR?
> 100
What would be the following APGAR score → pink baby, pulse >100, pulls away/sneezes/coughs, flexes arms and legs and resists extension, strong cry
10
how long postpartum will it take for the uterus to return to normal size?
6 weeks
pink/brown vaginal bleeding postpartum days 4-10 → resolves by 3-4 weeks postpartum
lochia serosa
If a woman is not breast feeding when can she expect menses to return?
6-8 weeks
How much will a woman bleed if she delivers vaginally? How much if it is by C-section?
> 500mL vaginal
>1000mL C section
Most common cause of postpartum hemorrhage
uterine atony → uterus cant contract to stop the bleeding
Risk factors for postpartum hemorrhage
rapid or prolonged labor, overdistended uterus, C-section
clinical manifestation of uterine atony
soft, boggy uterus with dilated cervix
clinical manifestation of postpartum hemorrhage
hypovolemic shock, hypotension, tachycardia, pale/clammy skin, decreased capillary refill
If you suspect postpartum hemorrhage, what lab test should you get?
CBC → check hemoglobin and hematocrit
ways to treat postpartum hemorrhage
bimanual uterine massage uterotonic agents (enhance uterine contractions)
risk factors fro premature rupture of membranes
STD, smoking, prior preterm delivery, multiple gestations
What is the Nitrazine paper test?
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
What is the Fern Test?
fern pattern in amniotic fluid due to crystalization of estrogen and amniotic fluid
Management for premature rupture of membranes
wait for spontaneous labor and monitor for infections
what is considered premature labor?
before 37 weeks gestation
What is considered regular labor contractions?
> 4-6/hour with progressive cervical changes
cervical dilation and effacement values for premature labor
cervical dilation > 3 cm
effacement >80%
Presence of ____ between 20-34 weeks strongly suggests preterm labor
fetal fibronectin
L:S <2:1 indicates
fetal lung immaturity
In preterm labor, how can you enhance fetal lung maturity?
antenatal steroids (Betamethasone)
Pharmacotherapy that suppresses uterine contractions for up to 48 hours to delay delivery so steroids can take effect on fetus
tocolytics
What do you antibiotically prophylax against in preterm labor?
group B strep
ampicillin + PO amoxicillin + azithro
cephazolin + PO cephalexin + azithro (PCN allergy)
3 categories of labor progression
power → uterine contraction
passenger → size & position of the fetus
passage → uterus or soft tissue abnormalities
one or both of the fetal shoulders is lodged at the pubi symphysis after delivery of the head → can lead to Erb’s palsy
should dystocia
Nonmalipulative management of shoulder distocia
McRoberts maneurver → first line
what is McRoberts maneuver?
increase pelvis opening with hip hyperflexion
What is the manipulative method for shoulder dystocia?
Woods “Corkscrew” maneuver → 180 shoulder rotation
indication for induction of labor
vaginal delivery when prolonged labor may lead to complications for either mom or fetus and risks are greater than continuing pregnancy
Contraindications for induction for vaginal delivery are greater than C-section
prior uterine rupture, prior C-section, active genital herpes infection, umbilical cord prolapse, placenta previa, vasa previs, transverse fetal lie
Methods to induce women with unfavorable cervices to promote cervical ripening
prostaglandin gel
Methods to later induced women when the cervix is dilated <1 cm with some effacement
IV oxytocin (pitocin)
artificial rupture of membrane with small hook if the cervix is partially dilated and there is effecement of the cervix
amniotomy
