Lecture 12: Normal Labor and Delivery Flashcards

You may prefer our related Brainscape-certified flashcards:
1
Q

On obstetric exam what is fetal lie?

A
  • Reference is maternal spine to fetus spine
  • Determines if infant is longitudinal, transverse, or oblique
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

On obstetric exam what is fetal presentation?

A
  • Presenting part of the pelvis
  • Vertex, breech, transverse, or compound (vertex w/ hand)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which maneuvers are used to determine the fetal lie?

A

Leopold Maneuvers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

On obstetric exam what are the 5 parts of the cervical exam?

A
  • Dilation checked at level of internal os
  • Effacement: thinning of the cervix
  • Station: degree of descent of presenting part of fetus
  • Position and Consistency used to calculate Bishop score
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When the bony portion of the fetal head reaches what level is it considered “zero” station?

A

Level of the ischial spines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the 4 stages of labor?

A
  • First = onset of true labor to complete cervical dilation (latent and active)
  • Second = complete cervical dilation to delivery
  • Third = delivery of infant to delivery of placenta
  • Fourth = delivery of placenta to stabilization of patient
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the latent vs. active phase of the first stage of labor?

A
  • Latent (early labor): period between onset of labor and is characterized by slow cervical dilation
  • Active: faster rate of dilation and usually begins when cervix is dilated to 4cm; admit for labor at this stage in term gestations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is normal rate of cervical dilation (cm/hr) in primiparas and multiparas?

A
  • Primiparas = 1.2 cm per hr
  • Multiparas = 1.5 cm per hr
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is maternal position managed during first stage of labor and can they ambulate?

A
  • Patient may ambulate if: head is engaged and reassuring monitoring is noted
  • If lying in bed, encouraged left lateral recumbent position
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which labs taken during first stage of labor and how often do you monitor vitals?

A
  • Labs = CBC and type and screen
  • Maternal monitoring = obtain vitals q 1-2 hours while in labor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How often should fetus be monitored externally if pregnancy is uncomplicated vs. complicated in the active phase of first stage and in second stage?

A
  • Uncomplicated = q30 minutes (active phase) and q15 (second stage)
  • Complicated = q15 minutes (active phase) and q5 minutes (second stage)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is uterine activity monitored during first stage?

A
  • External tocodyamometer
  • Internal pressure catheter (IUPC) allows to assess the strength of contractions and is helpful w/ oxytocin augmentation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How often during active stage of first phase of labor do you do a vaginal/cervical exam and what is recorded?

A
  • Perform cervical check q 2 hrs
  • Record dilation, effacement, station
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the benefit vs. risks of performing an amniotomy (AROM) during first stage of labor?

A
  • Benefits: augment labor, allows assessment of meconium status
  • Risks: cord prolapse, prolonged ruptured is assoc. w/ chorioamnionitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the 7 cardinal movements of labor in order (mnemonic)?

A
  • Engagement: presenting part at “zero” station
  • Descent
  • Flexion: baby’s chin to chest
  • Internal Rotation: fetal head rotates so OA or OP
  • Extension: station is +5; head born by rapid extension
  • ER: head returns to original position in alignment w/ back and shoulders
  • Expulsion: anterior shoulder delivers, followed by posterior
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which maternal position should be avoided during second stage of labor and what is the most common position to have mother in?

A
  • Avoid the supine position
  • Dorsal lithotomy position is most common
17
Q

Once the fetal head is delivered during second stage what can be done to clear the airway of blood and amniotic fluid?

A

Can bulb suction oral cavity 1st and then nares

18
Q

What are 2 indications for performing an episiotomy; what is the most common type?

A
  • Likelihood of spontaneous laceration seems high
  • To expedite delivery by enlarging the vaginal outlet (if baby is too big)
  • Midline episiotomy is most common
19
Q

What is a 1st vs. 2nd vs. 3rd vs. 4th degree perineal laceration?

A
  • 1st: superficial laceration involving vaginal mucosa and/or perineal skin
  • 2nd: laceration extending into muscles of the perineal body but does not involve anal sphincter
  • 3rd: laceration extends into or completely through the anal sphincter but not into the rectal mucosa
  • 4th: involves the rectal mucosa
20
Q

Retained placenta is diagnosed during the 3rd stage if placenta has not delivered within how long?

A

30 minutes

21
Q

What are 4 classic signs of placental separation which indicate that you should begin to apply pressure on the cord?

A
  • Gush of blood from vagina
  • Lengthening of the umbilical cord
  • Fundus of uterus rises up
  • A change in shape of the uterine fundus from discoid –> globular
22
Q

What is the most common cause of postpartum hemorrhage during the fourth stage?

A

Uterine atony

23
Q

What is induction of labor vs. augmentation of labor?

A
  • Induction is the process by which labor is induced by artificial means
  • Augmentation is the artificial stimulation of labor which has already begun
24
Q

What are 5 contraindications to induction of labor?

A
  • Unstable fetal presentation
  • Acute fetal distress
  • Placental previa or vasa previa
  • Previous classical C-section or transfundal uterine surgery (i.e., myomectomy)
  • Any contraindication to vaginal delivery (i.e., HIV w/ high viral load, active genital HSV outbreaks, etc.)
25
Q

Which Bishop score is considered unfavorable and what is considered favorable?

A
  • <6 is unfavorable
  • >8 the probability of vaginal delivery after labor induction is similar to that of spontaneous labor
26
Q

What is a downside of using Misoprostol vs. Dinoprostone for cervical ripening?

A
  • Misoprostol cannot be readily removed if concerns arise
  • Dinoprostone is a vaginal insert that can be removed
27
Q

What are 2 mechanical dilators which can be used for cervical ripening?

A
  • Foley bulb catheter
  • Laminara Japonicum
28
Q

What is the only FDA approved drug for induction and augmentation?

A

Pitocin (synthetic oxytocin) given IV

29
Q

What are some of the AE’s associated with Pitocin administration?

A
  • Uterine tachysystole = most common AE
  • Antidiuretic effect due to similar structure as ADH
  • Uterine muscle fatigue (nonresponsiveness) will prolonged use
30
Q

What effect may regional anesthesia have on uterine blood flow; what can be done to mitigate this risk?

A
  • May ↓ uterine blood flow if hypotension occurs and is not promptly tx
  • Adequate hydraton (IV bolus) 30-60 min prior may mitigate the risk for hypotension
31
Q

What is an epidural?

A
  • A catheter is placed in the epidural space which allow for continous infusion of anesthetic agents
  • Large bore needle is used to locate epidural space btw L2-L5 interspaces
32
Q

When is parenteral administration of pain meds more effective during labor; what are some downsides?

A
  • More effective in early first stage of labor when pain is more visceral and less intense
  • Have very little efficacy for relief of labor pain (more sedative); also opioids CAN cross the placenta
33
Q

What are 5 contraindications for doing regional anesthesia during labor?

A
  • Maternal coagulopathy
  • Heparin use within 12 hrs
  • Untreated maternal infection
  • ICP due to mass lesion
  • Skin infection over site of needle placement
34
Q

What is the most common induction agent used for general anesthesia in emergent cases w/ need for rapid delivery arise or regional anesthesia has failed?

A

Propofol

35
Q

What is the anesthesia related risk of maternal mortality with general anesthesia vs. regional anesthesia?

A

General anesthesia carries a 16-fold ↑ anesthesia related risk