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Physio OB Midterm > Lie, Presentation, Station > Flashcards

Lie, Presentation, Station Flashcards

1
Q

Fetal lie

Fetal axis is perpendicular
Shoulder presentation

A

Transverse lie

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2
Q

Fetal lie

Fetal and maternal axes cross at 45 degree angle
Unstable and becomes longitudinal or transverse lie during labor

A

Oblique lie

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3
Q

Transverse lie predisposing factor

Uterus could be so lax

A

Multiparity

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4
Q

Transverse lie predisposing factor

Placenta is located inferiorly when it should be located posteriorly

A

Placenta previa

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5
Q

Transverse lie predisposing factor

Baby can move freely

A

Polyhydramios

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6
Q

Transverse lie predisposing factor

Myxoma at lower uterine segment

A

Uterine anomalies

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7
Q

Fetal presentation

Portion of the fetal body that is either foremost within the birth canal or in closest proximity to it

A

Presenting part

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8
Q

Fetal presentation

Presenting part can be Cephalic or breech

A

Longitudinal lie

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9
Q

Fetal presentation

The presenting part is the shoulder

A

Transverse lie

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10
Q

Cephalic presentation

Common presentation
Head is flexed sharply so that the chin is in contact with the thorax

A

Vertex or occiput presentation

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11
Q

Vertex presentation, what is the presenting part?

A

Occipital/posterior fontanelle

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12
Q

Cephalic presentation

Uncommon
Fetal neck may be sharply extended so that the occiput and back come in contact

A

Face presentation

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13
Q

Cephalic presentation

Partially flexed head
Anterior/large fontanelle/ Bergman is presented

A

Sinciput presentation

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14
Q

Sinciput presentation if does not change can lead to

A

Dystopia

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15
Q

Cephalic presentation

Partially extended head, can lead also to dystocia if does not change

A

Brow presentation

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16
Q

Breech presentation

Incidence decrease in gestational age

A

25% at 28 wks AOG
17% at 30 wks AOG
11% at 32 wks AOG
3% at term

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17
Q

Breech presentation

High incidence in

A

Hydrocephalus

Placenta previa

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18
Q

Breech presentation

Thighs flexed, legs extended over anterior surfaces of the body

A

Frank breech presentation

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19
Q

Frank presentation fetal attitude

A

Extended vertebral column

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20
Q

Breech presentation

Thighs are flexed, legs flexed upon thighs
CS delivery unless preterm or small baby

A

Complete breech

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21
Q

Complete breech problem?

A

Cord prolapse

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22
Q

Breech presentation

One or both feet, or one both knees may be lowermost

A

Incomplete breech

Cord prolapse could be also the problem

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23
Q

Fetal attitude or Posture

Characteristic posture

A 
Back- convex
Head- flexed
Thighs- flexed over abdomen
Legs- bent at the knees
Arms- usually crossed over the thorax
Umbilical cord-
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24
Q

Refers to the relationship of an arbitrarily chosen portion of the fetal presenting part to the right or left side of the birth canal

A

Fetal position

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25
Q

Fetal position

Determining points in various presentations

A

Vertex- occiput
Face- chin (mentum)
Breech - sacrum
Shoulder - acromion

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26
Q

Fetal position

Presenting parts may be in left or right position

A

LR occipital
LR mental
LR sacral

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27
Q

Fetal position

Occipital fontanelle

A

Triangular shape

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28
Q

Fetal position

Anterior fontanelle

A

Diamond shape

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29
Q

Fetal position

Normal position

A

LOP

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30
Q

Fetal position

At delivery

A

LOA

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31
Q

Fetal position

Mentum anterior

A

Vaginal

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32
Q

Fetal position

Mentum posterior

A

CS

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33
Q

Of all vertex presentations 2/3 are in the

A

Left occiput position

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34
Q

Of all vertex presentations 1/3 are In the

A

Right occiput position

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35
Q

In shoulder presentation

Portion of the fetus chosen for orientation with the maternal pelvis

A

Acromion (scapula) example

Right acromiodorsoposterior

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36
Q

In shoulder presentation

Acromion or back of the fetus may be directed either

A

Posteriorly or anteriorly

Superiorly or inferiorly

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37
Q

In shoulder presentation

Clinically important when deciding incision type for Caesarian section

A

Transverse lie, with back up or back down

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38
Q

Leopolds maneuvers

Manuevers facing mothers face

A

1st, 2nd, 3rd

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39
Q

Leopolds maneuvers

Facing mothers feet

A

4th manuever

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40
Q

Leopolds maneuvers

Identification of which fetal pole (Cephalic or podalic)

A

1st maneuver or fundal grip

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41
Q

1st maneuver or fundal grip

If there’s large modular mass

A

Breech

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42
Q

1st maneuver or fundal grip

If hard, round, mobile, and ballotable

A

Cephalic

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43
Q

Leopolds manuever

Palms are placed on either side of the maternal abdomen

A

2nd M or umbilical grip

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44
Q

2nd M or umbilical grip

If hard, convex and resistant

A

Back

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45
Q

2nd M or umbilical grip

If numerous small, irregular, mobile parts

A

Fetal extremeties

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46
Q

Leopolds maneuver

Grasping with the thumb and fingers of one hand the lower portion of the maternal abdomen just above the symphis pubis

A

3rd M or pawiks grip

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47
Q

3rd M or pawiks grip

If movable mass will be felt, usually the head

A

Presenting part not engaged

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48
Q

3rd M or pawiks grip

Indicative that the lower fetal pole is in the pelvis

A

Presenting part engaged

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49
Q

Leopolds manuever

Tips of 3 fingers of each hand exerts deep pressure in the direction of the axis of the pelvic inlet

A

4th M or pelvic grip

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50
Q

3rd M or pawiks grip

In Cephalic presentation, the shoulder is felt as a relatively fixed,

A

Knob like part

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51
Q

4th M or pelvic grip

In Cephalic presentation, the part of the fetus that prevents the deep descent of the hand is

A

Cephalic prominence

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52
Q

4th M or pelvic grip

If Cephalic prominence is felt on the same side of the fetal extremeties

A

Flexion attitude

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53
Q

4th M or pelvic grip

If Cephalic prominence is felt on the same side of the fetal back

A

Extension attitude

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54
Q

Leopolds maneuver

When the head has descended into the pelvis, the anterior shoulder may be differentiated readily by the

A

3rd manuever

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55
Q

Vaginal examination

A

Aralin mo, mahirap gawan ng brainscape

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56
Q

Aids fetal position identification, especially in obese women,

A

Sonography and radiography

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57
Q

Used for fetal head position determination during second stage labor

A

Transvaginal sonography

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58
Q

Vertex enters the pelvis with the sagittal suture lying in the transverse pelvic diameter

A

Occiput anterior presentation

59
Q

The fetus enters the pelvis in the 40% of labor

A

LOT position

60
Q

Fetus enters the pelvis in the 20% of labor

A

ROT position

61
Q

Cardinal movement of labor

A 
Engagement
Descent
Flexion
Internal rotation
Extension
External rotation
Expulsion
62
Q

Engagement

The greatest transverse diameter
Is in an occiput presentation
Passes through the pelvic inlet

A

Biparietal diameter

63
Q

Engagement

Fetal head may engage during the

A

Last few weeks of pregnancy or

After labor commencement

64
Q

Engagement

Fetal head is freely movable above the pelvic inlet at labor onset

A

Floating

65
Q

Engagement

Head usually enters the pelvic inlet either

A

Transversely or obliquely

66
Q

Lateral deflection to a more anterior or posterior position in the pelvis

A

Asynclitism

67
Q

Asynclitism

Sagittal suture normally is deflected either

A

Posteriorly toward the promontory

Anteriorly toward the symphysis

68
Q

Asynclitism

Sagittal suture approaches the sacral promontory
Anterior parietal bone presents itself to the examining fingers

A

Anterior Asynclitism

69
Q

Asynclitism

Sagittal suture lies close to the symphysis
Posterior parietal bone will present

A

Posterior Asynclitism

70
Q

Asynclitism

Posterior ear may be easily palpated

A

Extreme posterior Asynclitism

71
Q

Extreme posterior Asynclitism if severe, the condition is a common reason for

A

Cephalopelvic disproportion

72
Q

1st requisite for birth

A

Descent

73
Q

Descent

Engagement may take before the onset of labor, and further descent may not follow until the onset of the second stage.

A

Nulliparas

74
Q

Descent

Descent usually begin with engagement

A

Multiparas

75
Q

Descent in multi paras brought about by

A

Amniotic fluid pressure
Direct pressure of the fundus
Bearing down effort
Extension of fetal body

76
Q

Occurs when the descending head meets resistance,

A

Flexion

77
Q

Resistance that cause flexion are from

A

Cervix
Pelvic wall
Pelvic floor

78
Q

Flexion

The chin is brought into more intimate contact with the

A

Fetal thorax

79
Q

Flexion

Shorter suboccipitobregmatic diameter is substituted for the

A

Longer occipito frontal diameter

80
Q

This movement consist of turning of the head in such manner that the occiput gradually moves.

A

Internal rotation

81
Q

Internal rotation

From the original position

A

Anteriorly toward the symphysis pubis

82
Q

Internal rotation

This is less common

A

Posteriorly toward the hallow of the sacrum

83
Q

Internal rotation

Essential for completion of labor except when the fetus is

A

Unusually small

84
Q

Internal rotation

Completion varies

A

By the time the head reaches the pelvic floor
Shortly after the head reaches the pelvic floor
Rotation does not take place

85
Q

Internal rotation

When the head fails to turn until reaching the pelvic floor, it typically rotates during the

A

Next 1or2 contractions in multiparas

Next 3 to 5 contractions in nulls paras

86
Q

Occurs when the sharply flexed head reaches the vulva after internal rotation

A

Extension

87
Q

Extension

Two forces come into play

Exerted by the uterus
Acts more posteriorly

A

1st force

88
Q

Extension

Two forces come into play

Exerted by resistant pelvic floor and symphis
Acts more anteriorly

A

2nd force

89
Q

Extension

The resultant vector is in the direction of the _________, thereby causing head extension

A

Vulvar opening

90
Q

Extension

The head is as the occiput, bregma, forehead, nose, mouth, and finally the chin pass successively over the

A

Anterior margin of the perineum

91
Q

Extension

Immediately after the delivery

A

Head drop downward

Chin lies over the maternal anus

92
Q

The delivered head next undergoes restitution

A

External rotation

93
Q

External rotation

If rotates toward the left ischial tuberosity

A

Toward left

94
Q

External rotation

If rotates toward the right ischial tuberosity

A

Towards the right

95
Q

External rotation

Restitution of the head to the

A

Oblique position
External rotation
Transverse position

96
Q

Almost immediately after external rotation

A

Expulsion

97
Q

Expulsion

Anterior shoulder
Posterior shoulder

A

Under symphysis pubis

Distend the perineum

98
Q

Occiput posterior presentation

More common

A

ROP>LOP

99
Q

Occiput posterior presentation

Associated with

A

Narrow forepelvis

Anterior placentation

100
Q

Occiput posterior presentation

Internally rotate to the symphysis pubis

A

135 degree

101
Q

Occiput posterior presentation

To rotate promptly

A

Effective contractions
Adequate head flexion
Average fetal size

102
Q

Occiput posterior presentation

Incomplete rotation

A

Poor contractions
Faulty head flexion
Epidural analgesia

103
Q

Occiput posterior presentation

If rotation is incomplete

A

Transverse arrest

104
Q

Occiput posterior presentation

If no rotation toward the symphysis pubis takes place

A

Persistent occiput posterior

105
Q

Fetal head shape changes
Caput succedaneum

Prolonged labors before complete cervical dilatation, the portion of the fetal scalp immediately over the cervical os become

A

Edematous

106
Q

Fetal head shape changes
Caput succedaneum

More commonly, the Caput is formed when the head is in the

A

Lower portion of the birth canal
And when
Rigid vaginal outlet is encountered

107
Q

Fetal head shape changes
Molding

Some molding develops before labor possibly related to

A

Braxton-hicks contraction

108
Q

Fetal head shape changes
Molding

It is overlapping of the parietal bones, prevented by

A

Locking mechanism at the coronal and lamboidal connections

109
Q

Fetal head shape changes
Molding

Results int the

A

Shortened suboccipitobregmatic
And
Lengthened mentovertical

110
Q

Fetal head shape changes
Molding

Resolved within

A

Week following delivery

111
Q

First stage of labor

Preparatory division

A

Cervix dilate little
Connective tissue components change
Amniotomy is discouraged

112
Q

First stage of labor

Onset is when the mother perceives regular contraction

A

Latent phase

113
Q

First stage of labor

Latent phase usually ends once cervix dilate to

A

3-5 cm

114
Q

First stage of labor

Active phase
Acceleration phase
Phase of maximum slope

A

Dilatational division

115
Q

First stage of labor

Deceleration phase of cervical dilatation
Mechanism of labor occurs
Cardinal fetal movements

A

Pelvic division

116
Q

First stage of labor
Prolonged latent phase

Nullipara

A

Exceeding 20 hours

117
Q

First stage of labor
Prolonged latent phase

Multipara

A

Exceeding 14hours

118
Q

First stage of labor
Prolonged latent phase

Factors that affect the duration

A

Excessive sedation

Unfavorable cervical condition

119
Q

First stage of labor
Prolonged latent phase

Those with heavy sedation

A

85% enters active labor
10% false labor
5% requiring oxytocin

120
Q

First stage of labor
Active labor
Nulliparas

Rapid change in the slope of cervical dilatation between

A

3-5 cm

121
Q

First stage of labor
Active labor
Nulliparas

Dilatation plus contraction

A

Active labor

122
Q

First stage of labor
Active labor
Nulliparas

Mean

A

4.9 hours

123
Q

First stage of labor
Active labor
Nulliparas

Max

A

11.7 hours

124
Q

First stage of labor
Active labor
Nulliparas

Min

A

1.2-6.8cm/hr

125
Q

First stage of labor
Active labor
Multiparas

Min

A

1.5cm/hr

126
Q

First stage of labor
Active labor

Descent begins in the later stage of active dilatation commencing at

A

7-8 cm in nulli and rapid after 8cm

127
Q

First stage of labor

Active phase abnormalities

A

25% N

15% M

128
Q

First stage of labor
Active phase abnormalities

Slow rate of cervical dilatation or descent

A

Protraction

N -

129
Q

First stage of labor
Active phase abnormalities

Complete cessation of dilatation or descent

A

Arrest disorder

2 hours with no cervical dilatation - arrest of dilatation
1 hour without fetal descent - arrest of descent

130
Q

First stage of labor
Active phase abnormalities

Average time from admission to complete dilatation

A
  1. 8 hours N

3. 2 hours M

131
Q

First stage of labor
Active phase abnormalities

Lengthens active phase by 1 hour

A

Epidural analgesia

Decreased the rate of cervical dilatation (1.6/hr - 1.4/hr)

132
Q

First stage of labor
Active phase abnormalities

Normal labor

A

> 6 hours to progress from 4-5 cm

> 3 hours to progress from 5-6 cm

133
Q

First stage of labor
Active phase abnormalities

Lengthens 1st stage of labor by 30-60 minutes

A

Maternal obesity

134
Q

First stage of labor
Active phase abnormalities

Increase labor by 45 minutes

A

Maternal fear

135
Q

Second stage of labor

A

Begins with complete cervical dilatation and ends with fetal delivery

136
Q

Second stage of labor

Median duration

A

50minutes N

20 minutes M

137
Q

Second stage of labor

If woman has higher parity how many expulsion efforts to complete the delivery

A

2-3

138
Q

Second stage of labor

May abnormally long

A

Contracted pelvis
Large fetus
Impaired impulsive efforts
Conduction of sedation or analgesia

139
Q

Second stage of labor

Does not interfere

A

Increasing maternal body mass index

140
Q

Third stage of labor

A

Begins with expulsion of fetus to delivery of placenta

141
Q

Duration of labor

N

A

9hours

Upper limit was 18.5 hours

142
Q

Duration of labor

M

A

6 hours

Upper limit was 13.5 hours

143
Q

Fetal lie

Fetal axis is parallel
Cephalic/vertex or breech presentation

A

Longitudinal lie

Physio OB Midterm (6 decks)

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