Lecture 2 - Normal Labor/Delivery Flashcards
labor:
biochemical Connective tissue changes of the ____ occur prior to uterine contractions/cervical dilation
cervix
labor:
increased _____ activity; ie change from _____ (long-lasting low freq activity) to _____ (high intensity, high freq activity)
myometrial;
contractures, contractions
clinically, labor is defined by the triad of regular ____ contractions, progressive cervical ___ and ____, and ____ show
painful;
effacement, dilation;
bloody show (whatever that means)
cervical ____ is painful cervical dilation in absence of uterine contractions in the _____ trimester
insufficiency;
second
braxton-hicks contractions (false labor) are uterine contractions in absence of ____ _____
cervical change
grivada is the number of ____;
para is the number of _____
pregnancies;
deliveries ( > 20 weeks)
successful navigation through the pelvis dependent on the 3 P’s: ____, ____, and ____
powers, passenger, passage
labor physiology:
increased _____ synthesis/release;
increase in ____ gap junction formation;
upregulation of myometrial ____ receptors
prostaglandin;
myometrial;
oxytocin
fetus also involved (ie physical distention of uterus)
____ is the force generated by uterine muscles during contractions. you can use a ___ to measure this
powers;
tocometer (or intrauterine pressure catheter)
adequate labor is defined as ___ contractions in 10 minutes.
3-5
_____ units are calculated by multiplying the avg peak strength of contractions in mm Hg by the number of contractions in 10 minutes. an adequate range is what?
montevideo units;
200-250 units
passenger factors affecting labor:
____ = long axis of fetus relative to longitudinal axis of uterus;
_____ = degree of flexion/extension of fetal head;
____ = fetal part directly over pelvic inlet
lie;
attitude;
presentation
passenger factors affecting labor:
____ = degree of descent of leading edge of presenting part between leading bony edge of fetus and ischial spines;
_____ fetus refers to a lateral deflection of the head, so sagittal suture is deflected anteriorly
station;
asynclitic
pelvimetry:
one can use vaginal examination to determine the ____ _____
diagonal conjugate (not the true conjugate)
1st stage of labor:
interval between onset of labor and full ____ ____;
divided into 3 phases in relation to rate of ____ ____
cervical dilation;
cervical dilation
friedman’s curve of normal labor:
very different between ____ and _____ women
nulliparous, multiparous
the second stage of labor is the interval between ____ and ____
full cervical dilation, delivery
the third stage of labor is the interval between _______ and _____
delivery of fetus, separation/expulsion of placenta
what is the primary complication with the 3rd stage of labor?
retention of placenta more than ___ at term indicates the need for intervention
hemorrhage;
30 minutes
the cardinal movements of labor refers to changes in position of the ____ ____ during passage through the birth canal. Can occur because of assymetry in shape of fetus and maternal bony pelvis
fetal head
cardinal movements:
_____ is when the widest diameter of the presenting part passes below the plane of the pelvic inlet
engagement
what is the largest transverse diameter in a cephalic flexed head engagement?
biparietal diameter (ie diameter between parietal sutures)
cardinal movements:
descent is the downward passage of presenting part through the pelvis; greatest descent occurs during decelleration of the ____ Stage of labor and during the ____ stage
first, second
cardinal movements:
____ occurs passively as head descends to resistance from shape of bony pelvis. this allows the fetus to present the smallest diameter of the ___
flexion;
head
complete flexion occurs (i.e. on to chest)
cardinal movements:
internal rotation is rotation of the presenting part from the orginal position to a ___ position as it passes through the pelvis. its a (passive or active) movement
anteriorposterior;
passive
cardinal movements:
_____ occurs once the fetal head descends into introitus, causing the base of the occiput to contact the inferior margin of the ____ ____
extension;
pubic symphysis
cardinal movements:
after the head extends (Deflexes), it undergoes ____ ____ to the correct anatomic position. is this a passive or active movement>?
external rotation (restitution); passive
the last cardinal movement of labor is _____
expulsion
placental separation:
the ___ phase is the time between delivery of fetus to start of myometrial contractions causing separation.
then, there is the contraction phase, _____, and expulsion.
which is the primary dictator of length of the third stage?
latent;
detachment;
latent phase
post partum hemorrhage chances ____ as duration of placental separation increases. what is the primary influencing factor for the length of the third stage?
increases; gestational age (pre terms = longer third stage term)
active management of the third stage of delivery include giving prophylactic _____ agent ____ delivery of the placenta
uterotonic;
before
what is a commonly used uterotonic agent that is also produced by the mother?
oxytocin
____ ____ are uterotonic agents that last longer and have increased contractions relative to oxytocin, but cause ____ bp, vomiting, and pain
ergot alkaloids;
increased
misoprostol is a _____ analog used for several pregnancy related functions, including hemorrhage, ____ ripening, induction of abortion. main side effect is _____
prostaglandin;
cervical;
diarrhea
___ ____ drainage reduces risk of retained placenta
umbilical cord
_____ _____ are used to diagnose fetal presentation and position
leopold’s maneuvers
