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Clin Med - Repro > Lecture 8 - L & D > Flashcards

Lecture 8 - L & D Flashcards

1
Q

What defines labor?

A

painful contractions that dilate the cervix progressively

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2
Q

How is labor triggered?

A

theory – fetus releases cortisol causing placental formation of androgens, decrease in placental progesterone, and increase in estrogen and PGs

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3
Q

What control uterine growth during pregnancy?

A

estrogen, progesterone, and distention

this is mainly hypertrophy and less cell division

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4
Q

What coordinates contractions?

A

gap junctions that are formed by estrogen and prostaglandins

contractions spread as current flows from cell to cell

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5
Q

How are contractions inhibited during quiescence?

A

progesterone

absence of gap junctions

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6
Q

What happens to the uterus during activation?

A

uterine stretch
activation of HPA axis
formation of oxytocin receptors

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7
Q

How does labor being (chemically)?

A

placental production of CRH –positive feedback loop for cortisol

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8
Q

What is happening hormonally during the stimulation of labor?

A

CRH release –> cortisol
fall in progesterone
rise in estrogen
PG –> cervical softening
gap junctions –> coordinate muscle contractions
fetal membrane activation –> rupture of membranes
oxytocin – contractions

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9
Q

What is the cervix made of?

A

collagen and a small amount of smooth muscle

in response to PG it changes to soft and pliable

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10
Q

What happens to the cervix in response to PG?

A

collegenolysis (becoming more smooth)
increase in hyaluronic acid
decrease in dermatan sulfate
increase in water content

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11
Q

What is the baby supposed to do in response to reaching the pelvic floor?

A

flex the neck

making the smallest diameter –suboccipitobregmatic

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12
Q

What are the 3 things we are checking when examining mom’s cervix?

A

station (of the baby in regards to the ischial spine landmarks)
dilation
effacement

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13
Q

Stage 1 of Labor

A

Dilation and thinning of cervix

latent phase:

  • early labor
  • softening and thinning of the cervix
  • minimal dilation

active phase:

  • more rapid cervical dilation
  • usually starts around 4-6cm

may last up to 24 hours

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14
Q

Effacement

A

typically precedes dilation

thinning out of the cervix

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15
Q

Stage 2 of labor

A

full dilation to delivery of baby

variable in length

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16
Q

Stage 3 of labor

A

delivery of baby to delivery of placenta
usually lasts <30 minutes

the placenta should be delivered 2-5 minutes post baby but up to 30 minutes –any longer you should interveine

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17
Q

Stage 4 of labor

A

puerperium (postpartum period)

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18
Q

What are the 3 Ps of abnormal labor?

A

Power: force of contractions
-administer oxytocin if inconsistent or weak contractions
Passenger: fetal size, presentation
-progress through the cardinal movements
Pelvis: bony pelvis
-cephalopelvic disproportion

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19
Q

What are indications of operative delivery?

A

vacuum and forceps

prolonged 2nd stage of labor
suspicion of immediate/impending fetal compromise
aid after coming head in breech vaginal delivery
shorten 2nd stage of labor for maternal benefit (only if strong valsalva efforts harm the mom- this is the only exception to pull the baby when mom isn’t pushing)

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20
Q

What are the indications of C-section?

A 
labor dystocia
h/o cesarean section 
malpresentation
fetal distress
placent previa
21
Q

What are the different types of insertions for C-section?

A

Classical (prevents them from ever being able to do vaginal delivery)

Low transverse (ideal)

22
Q

How can you aid in cervical ripening?

A

prostaglandin E2 or E1

mechanical:
- insert foley in cervix and apply pressure from inside

23
Q

Bleeding postpartum is normal for how long?

A

5-8 weeks

24
Q

What are anatomic and physiologic changes can you expect postpartum?

A 
Uterus
-decrease in size 
-cervical elasticity changes 
-discharge progression: lochia rubra --> serosa --> alba 
Vagina
gradually regain tone

Return to menstruation
usually 6-8 weeks –> longer if you are breastfeeding (up to 6 months)

CV –urination increases to expel excess plasma volume

Postpartum blues is normal for 2-3 weeks

25
Q

What are the maternal benefits of breastfeeding?

A

decrease postpartum depression
boosts weight loss
uterine involution (suckling –> oxytocin release –> uterine contractions –> minimizes hemorrhage)

26
Q

Colostrum

A

early breast milk production
can start during pregnancy to 2nd day postpartum

evolves to mature milk in the first few weeks

27
Q

What can suppress lactation?

A

Pharm intervention not recommended (bromocripitne, estrogen)

supportive bra
NSAIDs

28
Q

Mastitis

A

often within 2-4 week postpartum

Staph Aureus MC

tx. dicloxacillin

if PCN allergy - cephalosporin or vacno

29
Q

What is pseudoephedrines effect on lactation?

A

suppress lactation (even just a single dose)

30
Q

What is domperiones effect on lactation?

A

boosts lactation

selective dopamine antagonist

31
Q

Can a pregnant pt take NSAIDs?

A

no

there is a risk of premature closure of the infant PDA

32
Q

Can a breastfeeding mom take NSAIDs?

A

yes

33
Q

What medications can a breastfeeding mother not take d/t risk of passing it to baby?

A

narcotics

nitrofurantoin —infants without G6PD may develop hemolytic anemia

34
Q

What is the MC cause of maternal death?

A

hemorrhage

35
Q

What are the common causes of abnormal 3rd trimester bleeding?

A

placenta previa
abruption
preterm labor

36
Q

Placenta previa

A

placenta covers the opening of the cervix

will need C section

37
Q

Placeneta accreta

A

uncommon
typically results from trauma or prior surgery –defective decidual layer

the placenta attaches too deeply to the uterus

tx: total hysterectomy at the time of c-section

if you dont know ahead of labor and they go into vaginal delivery –they won’t deliver the the placenta

38
Q

What is the MC cause of placenta accreta?

A

prior C section

39
Q

Abruptio placentae

A

premature separation of placenta

initiated by hemorrhage to decidua basalis –> decidual hematoma –> separation of decidua from basal plate –> further separation and bleeding –> DIC

Risk factors: 
HTN 
hx abruption 
trauma 
short umbilical cord 
folate deficiency
40
Q

DIC

A

risk of abruptio placenta

basically she bleeds out all of her clotting factors

we treat by giving clotting factors

41
Q

What can cause uterine rupture?

A

prior c section scar opens during next labor

42
Q

Fetal bleeding

A

rupture of fetal umbilical vessel
hard to tell that its not just the mother bleeding
can do Apt test but that might take too long

basically if you have any suspicion that it is fetal blood go straight to surgery

43
Q

What are causes of postpartum hemorrhage?

A

uterine atony
trauma, uterine inversion
retained placental tissue
coagulation disorder

44
Q

Uterine atony

A

reason of postpartum hemorrhage

failure of uterine contraction post delivery

tx: oxytocin, methylgonovine, PG (potocin)

to help contract the uterus and prevent bleeding

given to EVERY WOMEN post delivery of baby

45
Q

What are the most common causes of maternal death?

A

hemorrhage
embolism
HTN crisis
infection

46
Q

How do you dx postpartum maternal infection?

A

> /= 39C

> /=38 + clinical finding (tachycardia, leukocytosis)

more common with C-sections

risk factors: prolonged labor and/or membrane rupture

47
Q

GBS infection

A

some women have this naturally in their flora but it is bad for children so we treat them for the “infection” during their 38th week of pregnancy

treating any earlier wont do anything since the bugs are likely to come back

if the infant gets this it can cause sepsis, PNA, bacteremia, meningitis

48
Q

Postpartum hemorrhage

A

> 1000 mL blood loss with delivery plus sxs of hypovolemia
Intrapartum and up to 24h postpartum

MC cause:
Uterine atony

Clin Med - Repro (18 decks)

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