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OB CLERKSHIP > LABOR & PARTURITION > Flashcards

LABOR & PARTURITION Flashcards

1
Q

Definition of Labor

A

Uterine contractions that bring about demonstrable cervical effacement and dilatation

Differentiate from Braxton-Hicks contractions which are
false labor pains that do NOT dilate nor efface the cervix

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2
Q

LABOR is divided into phases, stages & functional divisions

A

PHASES (1-Quiscent, 2- Preparation, 3-Active, 4- Puerperium)

Stages - under Phase 3 (1-cervical dilat, 2-fetal ex, 3-placental ex) under Phase 4 is Stage 4 which is up to 1 hr postpartum

Functional divisions: Friedman’s curve or Latent to active phase - under Stage 1; Cardinal movements of Labor - under stage 2

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3
Q

This Labor Phase is Characterized by uterine quiescence and cervical softening

This is maintaned by what hormone?

A

QUIESCENT PHASE

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4
Q

Why is the cervix softened during the quiescent phase?

What is this sign?

A

Goodell’s sign

Increase in cervical vascularity
Glandular and stromal hypertrophy and hyperplasia

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5
Q

Phase wherein there is cervical ripening & formation of the LUS

A

Phase 2 or Preparation Phase

Increased uterine oxytocin receptors and increased responsiveness to uterotonins

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6
Q

Phase wherein cervical ripening agents are introduced to induce labor

A

Phase 2: Preparation Phase

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7
Q

What is “lightening”

When does this happen?

A

Cervical Ripening + Formation of LUS in Phase 2 —>

Leading to lightening or a feeling that “the baby has dropped” (bumababa ang tiyan)

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8
Q
  • *Normal Latent Phase for
  • Multiparas
  • Primiparas
A

Multiparas: <14 hours
Primiparas: <20 hours

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9
Q 
Active Phase/Acceleration Phase 
Cervical dilatation: 
\_\_\_\_\_\_\_\_\_ division of labor
Normal duration:
Multi: 
Primi:
A

From 4 cm to 5 cm cervical dilatation
Still part of the preparatory division of labor
Normal duration:
Multiparas: <4 hours (cervical dilatation ≥1.5 cm/hr) * Primiparas: <5 hours (cervical dilatation ≥1.2 cm/hr)

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10
Q

Parts of Stage 1 of Labor

A
  1. Latent
  2. Active
  3. Maximum Slope
  4. Deceleration
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11
Q

Phase of maximum slope
______ cm
______ Division of labor
Phase where there is _____

A

6 cm to 7 cm
Dilatation division of labor
Phase where the fastest rate of cervical dilatation

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12
Q 
Deceleration Phase
\_\_\_\_\_\_ cm
\_\_\_\_\_\_ Division of labor
Phase where there is \_\_\_\_\_
Why deceleration phase?
A

From 8 cm to full dilatation (10 cm)
pelvic division of labor, because this is
where the baby starts to rapidly descend (seen as a change in station)

Cervical dilatation starts to decelerate here

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13
Q

How do you measure Station?

A

Remember that station is measured by determining the location of the lowest part of the fetal head using the level of the ischial spines as the reference point (0) and counting in increments of 1 cm above (-) or below (+) it

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14
Q

At what station does Crowning happen?

A

Station +5

baby’s head is protruding just outside the introitus

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15
Q

this stage is where fetopelvic disproportion is apparent

A

2nd stage of labor

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16
Q

Normal duration of 2nd stage of labor

EDFIREERE

A

Multiparas: <30 minutes (descent >2 cm/hr)
Primiparas: <60 minutes (descent >1 cm/hr)

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17
Q

Enumerate the Cardinal Movements of Labor

A
  1. Engagement
  2. Descent
  3. Flexion
  4. Internal Rotation
  5. Extension
  6. External Rotation
  7. Expulsion

(EDFIREERE)

18
Q

Normal Duration of the 3rd Stage of Labor

Multi & Primi

A

<30 mins

19
Q

Define LABOR INDUCTION

What are its components?

A

INITIATION OF UTERINE CONTRACTIONS in a pregnant woman who is not in labor to help her achieve vaginal delivery within 24-48 hours

Components:

  1. Cervical ripening
  2. Induction of uterine contractions
20
Q

Differentiate labor induction from labor augmentation,

A

Labor augmentation, which is ENHANCEMENT OF SPONTANEOUS CONTRACTIONS that are considered INADEQUATE because of DESCENT or FAILED CERVICAL DILATATION

Labor induction: Initiation of uterine contractions in a pregnant woman who is not in labor to help her achieve vaginal delivery within 24-48 hours (Sa labor induction, walang wala pa talaga contractions pero sa labor augmentation, meron na papalakasin/enhance mo lang)

21
Q

Indications for Labor Induction:

A

> 41 weeks AOG - MUST KNOW

>40 weeks AOG - if GDM

22
Q

***Contraindications against Labor Induction
Instead, do CS:
Maternal Factors

A
  1. Prior CS (classic or vertical incision)
  2. Previous uterine surgeries —> may lead to uterine
    dehiscence / uterine rupture (baka bumuka yung tahi)
  3. Contracted pelvis (cephalopelvic disproportion)
  4. Placenta previa or vasa previa (always delivered by CS; doc trinimom relative indication for CS; not an absolute indication)
  5. ACTIVE genital herpes (risk of neonatal infection)
  6. Cervical cancer
23
Q

***Contraindications against Labor Induction
Instead, do CS:
Fetal Factors

A
  1. Macrosomia (in the Philippines: >8 lbs)
  2. Severe hydrocephalus (head will not fit)
  3. Malpresentation (ex. transverse lie, breech, right acromion dorsoposterior)
  4. Umbilical cord prolapse
  5. Non-reassuring fetal status
24
Q

Risks Associated with Labor Induction:

A

Caesarian delivery (2-3x greater risk)
Chorioamnionitis
Uterine rupture
Postpartum hemorrhage from uterine atony

25
Q

How to assess favorability of induction?

A

Bishop Score - developed as a predictor of success for an elective induction

26
Q

A Bishop score of __ conveys a high likelihood of a successful labor induction

A Bishop score of __ or less identifies an unfavorable cervix and may be an indication for cervical ripening

A

o A Bishop score of 9 conveys a high likelihood of a successful labor induction
o A Bishop score of 4 or less identifies an unfavorable cervix and may be an indication for cervical ripening

27
Q

What medical agents are used for CERVICAL RIPENING?
Dosage & Frequency
MOA

A 
Prostaglandin E2 (DINOPROSTONE)
Dosage: 0.5 mg gel applied on the cervix (posterior vaginal fornix)

Give every 6 hours, maximum 3 doses in 24 hours

MOA: 1. Alters the extracellular ground substance of the cervix (cervical ripening)
2. Allows increase in intracellular calcium levels causing contraction (induction)

28
Q

S/E of Dinoprostone

A

Uterine Tachysystole

29
Q

Considerations when Using Cervical Ripening Agents
They should be used in women who are on __________

What should be done?

A

Should not be used in women already receiving oxytocin * Giving of oxytocin should be delayed for 6-12 hours
following administration of PGE2

30
Q

Besides Dinoprostone, what are the other therapeutic agents that could be given the patient for cervical ripening?

A
  1. Evening Primrose Oil - Has linolenic acid which may trigger a prostaglandin response in the body; used in Jose Reyes
  2. Mechanical Agents: Mechanism: introduction of local pressure in the cervix —> stimulates release of native prostaglandins ‘

LAMINARIA (hygroscopic dilator)
Extraamniotic Saline Infusion
Tracervical foley Catheter (30 to 80 mL balloon) with or without EASI (most cost-effective with same outcomes)

31
Q

What to do if Bishop Score is okay and cervical ripening is already done? What form of LABOR INDUCTION CAN BE DONE?

A
  1. Amniotomy

2. Oxytocin

32
Q

When is Amniotomy done?

Which part of labor?

A

Active Phase (at least 4 cm dilation

33
Q

Amniotomy goes hand-in-hand with

A

Oxytocin Administration

Onset of labor is unpredictable and often requires
oxytocin as well

34
Q

Risks for Amniotomy?

A
  1. Increased risk of infection/chorioamnionitis especially if labor is prolonged
  2. Cord prolapse or compression (assess FHR before and immediately after)**
  3. FHR deceleration
  4. Bleeding from placenta previa or low-lying placenta
35
Q

JZM <3
Reasons for early rupture of membranes: _________
Reasons for late rupture of membranes: _________

A

Reasons for early rupture of membranes: hasten labor equating to a shorter active phase/period
Reasons for late rupture of membranes: enhance dilatation of the cervix especially in breech presentation delivery

36
Q

Most commonly used method for induction of labor in a favorable cervix?

A

Oxytocin Administration

37
Q

Oxytocin Drip dosage during Labor Induction

A

Oxytocin drip: 1-2 ampules (containing 10-20 U oxytocin) diluted in 1000 mL of crystalloid solution (NSS) = 10-20 mU/mL oxytocin concentration

38
Q

MOA of Oxytocin

A

Acts on uterine oxytocin receptors —> stimulates voltage gated calcium channels —>increases levels of intracellular calcium —> stimulates myometrial smooth muscle contraction

39
Q

Important to monitor after Oxytocin Administration

A

frequency and strength of contractions while oxytocin is being administered!

40
Q

When should OXYTOCIN DRIP be discontinued?

A

DISCONTINUE when there is:

  1. ) UTERINE TACHYSYSTOLE
    * >5 contractions in 10 minutes, or
    * >7 contractions in 15 minutes

2.) NON -REASSURING FHR PATTERN
Further contractions compromise perfusion in the fetus —> opt for CS instead if ganito

OB CLERKSHIP (9 decks)

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