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Repro > Normal L&D > Flashcards

Normal L&D Flashcards

1
Q

Definition of labor

A

Progressive cervical effacement or dilatation or both resulting from regular uterine contractions that occur at least every 5 minutes and last 30-60 seconds

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2
Q

Definition of lightening

A

When fetal head settles into brim of pelvis
“Baby has dropped”
Primigravids - 2 wks before labor
Multigravids - in early labor

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3
Q

False labor

A

Braxton Hicks

Irregular contractions without cervical change

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4
Q

Cervical effacement

A

Thinning of cervix as it is taken up into the lower uterine segment
Results in the bloody show where mucous plug from cervix mixes with blood

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5
Q

Molding

A

Alteration of the shape of the fetal head during labor

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6
Q

Caput

A

Localized edematous swelling of the fetal scalp

Caused by pressure of cervix on the presenting portion of fetal head

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7
Q

Induction of labor

A

Process whereby labor is initiated by artificial means

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8
Q

Augmentation of labor

A

Artificial stimulation of labor that has begun spontaneously

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9
Q

Stages of labor

A

First - from onset of true labor to complete cervical dilatation
Second - Complete cervical dilatation to birth of baby
Third - From birth of baby to delivery of placenta
Fourth - From delivery of placenta to stabilization of pt (usually 6 hours post partum)

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10
Q

Two phases of the first stage of labor

A

Latent phase - cervical effacement and early dilatation. Considered completed at 3 cm dilatation

Active phase - begins when cervix is 2-4 cm dilated in presence of regular contractions. Consists of an acceleration, max slope, and theoretical deceleration

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11
Q

Management of first stage

A

May ambulate with intermittent monitoring
IV fluids ONLY
High risk necessitates continuous monitoring
If pt on pitocin for induction or augmentation should be monitored extensively

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12
Q

Amniotomy

A

Artificially breaking the bag of water

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13
Q

Six cardinal movements

A 
Descent
Flexion
Internal rotation
Extension
External rotation
Expulsion
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14
Q

Descent

A

Results from force of uterine contraction

Continuous until delivery of fetus

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15
Q

Flexion

A

Natural m. tone of fetus

Resistance from cervix, walls of pelvis, and pelvic floor

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16
Q

Internal rotations

A

When fetal head turns anteriorly towards the symphysis pubis from transverse or oblique diameter
Occurs at pelvic floor when head meets muscular sling

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17
Q

Extension

A

During descent fetal head will extend as it meets the vaginal outlet (which is direct upward and forwar)

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18
Q

Crowning

A

Bulging of the perineum which indicates that the largest diameter of fetal head is encircled by vulvar ring

19
Q

External rotation

A

Rotation of fetal head back to it’s original position at time of engagement to realign itself with it’s back and shoulders

20
Q

Expulsion

A

Usually ant. shoulder under pubic symphysis
Posterior shoulder
Rest of fetus in rapid succession

21
Q

Ritgen’s maneuver

A

Controls delivery of head
Fingers of one hand press posterior to rectum extending the fetal head
Counterpressure is applied to the occiput

22
Q

Two types of episiotomies

A

Midline

Mediolateral

23
Q

Signs of imminent placental delivery

A

Fresh show of blood
Lengthening of umbilical cord
Elevation of fundus
Uterus becomes firm and globular

24
Q

Why should you not pull on the cord?

A

Inversion of uterus

25
Q

Laceration types

A

1st degree - vaginal epithelium or perineal skin
2nd degree - extends into subepithelial tissues of vagina or perineum w/ or w/o perineal body
3rd degree - anal sphincter
4th degree - rectal mucosa

26
Q

What should be watched for in the 1st hour after delivery?

A

Bleeding, hematoma (pelvic or rectal pain)

Increased pulse rate out of proportion to decreased blood pressure

27
Q

Maternal indications for induction of labor

A

Pre-eclampsia
Diabetes
Heart disease

28
Q

Maternal indications for augmentation of labor

A 
Abnormal labor (inadequate contractions)
Prolonged latent phase
Prolonged active phase
29
Q

Fetoplacental indications for induction/augmentation of labor

A 
Prolonged pregnancy
IUGR
Abnormal fetal testing
RH incompatibility
Fetal abnormality
PROM
Chorioamnionitis
30
Q

Absolute maternal contraindication for induction/augmentation

A

Contracted pelvis

31
Q

Which type of c-section is NOT a contraindication for induction/augmentation?

A

Low transverse

32
Q

Relative maternal contraindications for induction/augmentation

A

Prior uterine surgery
Classic C-section
Complete transection of uterus
Overdistended Uterus

33
Q

Fetal contraindications for induction/augmentation

A

Preterm fetus w/o lung maturity
Acute fetal distress
Abnormal presentation
Placenta previa

34
Q

When is it ok to induce prior to 37 weeks?

A

Indicated only if continuation of pregnancy is a risk to mom or baby

35
Q

If there is no medical indication for induction, what MUST be present and documented prior to 39 weeks?

A

Fetal lung maturity

36
Q

What does the BISHOP SCORE indicate?

A 
Whether or not there is a good chance of the induction working
High score (9-13) = high likelihood of vaginal delivery
Low score (<5) = decreased likelihood
37
Q

BISHOP must be taken prior to what?

A

Cervical ripening

38
Q

Prior to induction what needs to be done?

A

BISHOP

Cervical ripening

39
Q

What is used to ripen the cervix?

A

Prostaglanding gel; PGE 2 gel, cervidil, and prepidil

Osmotic dilator - laminaria

40
Q

Induction should not exceed how long?

A

72 hours

41
Q

When to do c-section after an induction

A

If membranes ruptured and no progress after 12 hours may do c-section

42
Q

Complications of induction

A 
Hyperstimulation
Rupture of uterus
Antidiuretic effect can lead to water intoxication, convulsions, coma especially if > 24 hours
Muscle fatigue
Postpartum uterine atony
43
Q

Puerperium

A

Period following delivery to approx 6 weeks postpartum

44
Q

What are the major proteins synthesized in breast milk that are not in cow’s milk?

A

Casein
Lactalbumin
B-lactoglobulin

Repro (14 decks)

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