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Obstetrics > Labor & Delivery - PANCE Pearls > Flashcards

Labor & Delivery - PANCE Pearls Flashcards

1
Q

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

A

Braxton-Hick contractions

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2
Q

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

A

Lightening

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3
Q

sudden gush of liquid or constant leakage of fluid

A

ruptured membranes

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4
Q

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

A

Bloody show

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5
Q

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

A

True labor

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6
Q

when the fetal presenting part enters the pelvic inlet

A

engagement

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7
Q

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

A

flexion

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8
Q

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

A

descent

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9
Q

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

A

internal rotation

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10
Q

vertex extends as it passes beneath the pubic symphysis

A

extension

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11
Q

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

A

external rotation

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12
Q

what is the time frame for Stage I of labor?

A

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

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13
Q

what is the time frame for Stage II of labor?

A

time from full cervical dilation to delivery of the fetus

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14
Q

what is the time frame for Stage III of labor?

A

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

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15
Q

3 signs of placental separation

A

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

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16
Q

when is the APGAR score taken?

A

1 and 5 minutes after birth

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17
Q

What is normal APGAR score and what is critically low?

A

Normal is >7

critically low is <3

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18
Q

What are the componenets of the APGAR score?

A

appearance, pulse, grimace, activity, respiration

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19
Q

term for pink body but blue extremities

A

acrocyanosis

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20
Q

what is a good pulse for APGAR?

A

> 100

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21
Q

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

A

10

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22
Q

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

A

6 weeks

23
Q

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

A

lochia serosa

24
Q

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

A

6-8 weeks

25
Q

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

A

> 500mL vaginal

>1000mL C section

26
Q

Most common cause of postpartum hemorrhage

A

uterine atony → uterus cant contract to stop the bleeding

27
Q

Risk factors for postpartum hemorrhage

A

rapid or prolonged labor, overdistended uterus, C-section

28
Q

clinical manifestation of uterine atony

A

soft, boggy uterus with dilated cervix

29
Q

clinical manifestation of postpartum hemorrhage

A

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

30
Q

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

A

CBC → check hemoglobin and hematocrit

31
Q

ways to treat postpartum hemorrhage

A 
bimanual uterine massage 
uterotonic agents (enhance uterine contractions)
32
Q

risk factors fro premature rupture of membranes

A

STD, smoking, prior preterm delivery, multiple gestations

33
Q

What is the Nitrazine paper test?

A

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

34
Q

What is the Fern Test?

A

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

35
Q

Management for premature rupture of membranes

A

wait for spontaneous labor and monitor for infections

36
Q

what is considered premature labor?

A

before 37 weeks gestation

37
Q

What is considered regular labor contractions?

A

> 4-6/hour with progressive cervical changes

38
Q

cervical dilation and effacement values for premature labor

A

cervical dilation > 3 cm

effacement >80%

39
Q

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

A

fetal fibronectin

40
Q

L:S <2:1 indicates

A

fetal lung immaturity

41
Q

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

A

antenatal steroids (Betamethasone)

42
Q

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

A

tocolytics

43
Q

What do you antibiotically prophylax against in preterm labor?

A

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

44
Q

3 categories of labor progression

A

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

45
Q

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

A

should dystocia

46
Q

Nonmalipulative management of shoulder distocia

A

McRoberts maneurver → first line

47
Q

what is McRoberts maneuver?

A

increase pelvis opening with hip hyperflexion

48
Q

What is the manipulative method for shoulder dystocia?

A

Woods “Corkscrew” maneuver → 180 shoulder rotation

49
Q

indication for induction of labor

A

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

50
Q

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

A

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

51
Q

Methods to induce women with unfavorable cervices to promote cervical ripening

A

prostaglandin gel

52
Q

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

A

IV oxytocin (pitocin)

53
Q

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

A

amniotomy

Obstetrics (17 decks)

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