Labor Trigger Flashcards
if there is risk of hypoxia to mother and fetus, what type of anesthesia is used for delivery
general anesthesia
used in any emergent event as well as in the risk of materla aspiration or maternal/fetal hypoxia
what is fetal attitude
the degree of flexion or extension of the fetal head
what fetal positioning indicates immediately switching from vaginal birth to c section
funic
what 4 things can be determined from teh leopold maneuver
- fetal lie
- estimation of fetal weight
- fetal positioning
- fetal presentation
what pelvic shape is ideal for delivering babies
gynecoid
what are the complications of episiotomy
- increase vaginal bleeding
- increased postpartum pain
- unsatisfactory anatomic results
- sexual dysfunction
- increase risk of infection
what are the two types of episiotomy
midline and mediolateral
what are the complications of shoulder dystocia
- fracture of humerus and clavicle
- brachial plexus injury
- phrenic nerve palsy
- hypoxic brain injury
- death
what is the management for shoulder dystocia
- call for help
- episiotomy
- “McRoberts Maneuver” sharp flexion of maternal hips
- suprapubic pressure
- delivery of posterior shoulder
- symphisiotomy
- “zavanelli” (replace infants head back into pelvis and do a c section)
what is the typical time from fetal delivery to the delivery of the placenta
30 minutes
How is the placenta delivered
one hand on umbilical cord with gentle downward traction
other hand on abdomen supporting uterine fundus
what is the biggest risk factor for aggressive traction during delivery of the placena
uterine inversion
Obstetrical emergency!!!
immediate replacement of the fundus must be done manually or surgically!
what are causes for postpartum hemorrhage
- uterine atony (MCC)
- retained placental fragments
what is the treatment for postpartum hemorrhage
- removal of placental fragments or repair of lacerations
- Additional IV access
- type and cross match for blood
- meds for uterine atony (pitocin, methergine, cytotec, hemabate)
what is fetal HR baseline
mean bpm over a 10 minute window
what is considered absent, minimal, moderate and marked fetal HR variability
absent - 0 bpm of variation (worry)
minimal 1-5 bpm of variation (sleeping/inactive)
moderate 5-25 bpm variation
marked >24 bpm variation (worry)
this describes length of cervix (thickness/difference between internal and external os)
effacement
this describes Degree of descent of presenting part of fetus (cm from ischial spine, measured in 3rds)
station
contractions in the absence of what indicates braxton hicks contractions
in the absence of cervical change
what are the 5 categories of the bishop score?
Dilation
effacement
station
cervical consistency
position of cervix
ferning, nitrazine, cervical leakage, and AFI are all ways to assess what?
membrane status during labor
Contraindications include maternal bleeding disorder or use of LMWH within the past 12 hours
epidural
complications include maternal hypotension and respiratory depression
epidural
also spinal HA!!
what anesthetic type would be likely used in a C section
spinal anesthesia
this causes dissolution of collagen bundles and increases water uptake
cervidil (PGE1) and cytotex (PGE2)
SE of this are fever, V/D
cervidil (PGE1) and cytotex (PGE2)
also tachysystole and uterine rupture.
CI of this are hx of c section, myomectomy, or hysterotomy
cervidil (PGE1) and cytotex (PGE2)
SE includes hypotension, hyponatremia, and amniotic fluid rupture
pitocin
also tachysystole and uterine rupture
the CI to this are fetal distress and hypersensitivity reactions
pitocin
the 3 Ps effect which phase of labor
active phase of stage one of labor
what does external tocodynamometry measure
uterine contraction force (can also be measured w IUCP)
cranial bones getting compressed temporarily to the pelvis is known as what
molding
localized edema on the scalp due to cervix is known as what
caput
If a mom delivers a baby and she suffers a tear through her external anal sphincter, what degree of tear is it?
1st degree: injury to perineal skin and vaginal mucosa only
2nd degree: Injury to perineal body
3rd degree: Injury through external anal sphincter
4th degree: Injury through rectal mucosa
what positioning is used when attempting to deliver a baby with shoulder dystocia
mcroberts position
Passage of widest diameter fetal part below plane of pelvic inlet
which part of labor
engagament
what is the smallest diameter of a babies head
suboccipitobregmatic diameter
Fetal head rotates from occiput transverse to occiput anterior or posterior
what portion of the labor process is this
internal rotation
what type of movement must be performed to aid in the final expulsion of the fetus
downward traction to release the shoulder
Fundus becoming globular and more anteverted against abdominal hand is a sign of what
the 3rd stage of labor
if a mother is 28 weeks pregnant, how high and how long are fetal HR accelerations expected to be?
> 32 weeks = 15 BPM for 15s
< 32 weeks = 10 BPM for 10s
these occur during labor and are considered a vasovagal response of the fetus to head compression
early decelerations (occuring at the same time as contractions)
no intervention needed-> normal4
these occur during labor as a result of uteroplacental insufficiency
late decelerations (beginning at peak of contraction)
requires positioning, O2, stop pitocin and fluid bolus. consider c section
these occur during labor and are considered a result of cord compression
variable decelerations
occur at anytime, consider intervention via amnioinfusion (NS into sac via IUPC)
what suggests fetal anemia on IUCP
sinusoidal waveform (Smooth sine wave)
if a patient has early decelerations, normal FHR and accelerations of 15 bpm, what FHR tracing category.
category 1
if a patient has recurrent variable decelerations, absent FHR variability what FHR tracing category.
category 3
if a patient has early decelerations, normal FHR and accelerations of 29 bpm, what FHR tracing category.
category 2
Evaluate fetal response via pitocin to achieve 3 contractions in 10 minutes.
what is this process called
contraction stress test
