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OBSTETRICS > NORMAL LABOR > Flashcards

NORMAL LABOR Flashcards

1
Q

What is the process of labor?

A

Labor is the process that leads to childbirth, starting with the onset of regular uterine contractions and ending with delivery of the newborn and expulsion of the placenta.

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2
Q

What does fetal lie describe?

A

Fetal lie describes the relationship of the fetal long axis to that of the mother, with most term labors presenting a longitudinal lie.

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3
Q

What is a transverse lie?

A

A transverse lie occurs when the fetal and maternal axes are perpendicular to each other.

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4
Q

What is a fetal presentation?

A

Fetal presentation is the part of the fetal body closest to or within the birth canal, determined through vaginal examination.

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5
Q

What are the types of cephalic presentations?

A

Cephalic presentations include vertex (occiput), face, sinciput, and brow presentations, depending on head position and neck flexion or extension.

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6
Q

What is the most common fetal presentation at term?

A

The most common fetal presentation at term is occiput (vertex) presentation.

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7
Q

What are the three general breech configurations?

A

The three breech configurations are frank, complete, and footling presentations.

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8
Q

What is fetal attitude or habitus?

A

Fetal attitude refers to the characteristic posture of the fetus in late pregnancy, typically with a convex back and flexed head, thighs, and legs.

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9
Q

What happens to fetal attitude in face presentations?

A

In face presentations, the fetal head is hyperextended, leading to a concave contour of the vertebral column.

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10
Q

What is fetal position?

A

Fetal position refers to the relationship of a defined fetal presenting part (e.g., occiput, chin, sacrum) to the right or left side of the birth canal.

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11
Q

What are common abbreviations for fetal positions?

A

Common abbreviations include OA, ROA, LOA, ROP, LOP, ROT, LOT, and OP, describing occiput positions relative to the maternal pelvis.

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12
Q

What is the presenting landmark in shoulder presentations?

A

The presenting landmark in shoulder presentations is the acromion process of the scapula.

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13
Q

What are the tools to diagnose fetal presentation and position?

A

Tools include Leopold maneuvers, vaginal examination, and sonography.

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14
Q

What is the purpose of the first Leopold maneuver?

A

The first Leopold maneuver assesses the uterine fundus to identify fetal lie and presentation.

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15
Q

What is identified in the second Leopold maneuver?

A

The second Leopold maneuver identifies the position of the fetal back and extremities.

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16
Q

What does the third Leopold maneuver determine?

A

The third Leopold maneuver confirms the fetal presentation by palpating the lower maternal abdomen.

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17
Q

What does the fourth Leopold maneuver assess?

A

The fourth Leopold maneuver assesses the degree of fetal descent into the pelvis.

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18
Q

What are the limitations of Leopold maneuvers?

A

Leopold maneuvers can be difficult to perform in obese patients, with excess amniotic fluid, or when the placenta is anteriorly implanted.

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19
Q

What is the diagnostic accuracy of Leopold maneuvers for fetal malpresentation?

A

Leopold maneuvers have high sensitivity (88%) and specificity (94%) for identifying fetal malpresentation.

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20
Q

How is sonography used in labor?

A

Sonography confirms fetal presentation, position, and helps clarify head position, especially during the second stage of labor.

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21
Q

What are the cardinal movements of labor?

A

Engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion.

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22
Q

What does engagement refer to in an occiput presentation?

A

Passage of the biparietal diameter through the pelvic inlet.

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23
Q

What is the common fetal head position during engagement?

A

The vertex enters the pelvis with the sagittal suture lying in the transverse pelvic diameter.

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24
Q

What is asynclitism?

A

Lateral deflection of the sagittal suture to a more anterior or posterior position in the pelvis.

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25
Q

What defines anterior asynclitism?

A

When the sagittal suture approaches the sacral promontory and more of the anterior parietal bone presents.

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26
Q

What defines posterior asynclitism?

A

When the sagittal suture lies close to the symphysis and more of the posterior parietal bone presents.

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27
Q

What are the forces contributing to fetal descent?

A

Direct myometrial pressure of the fundus, maternal bearing-down efforts, and extension/straightening of the fetal body.

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28
Q

What triggers fetal head flexion during labor?

A

Resistance from the cervix, pelvic walls, or pelvic floor.

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29
Q

What is the significance of fetal head flexion?

A

It allows the shortest suboccipitobregmatic diameter to progress through the birth canal.

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30
Q

What occurs during internal rotation?

A

The occiput rotates toward the anterior axis, usually toward the symphysis pubis.

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31
Q

What happens if internal rotation fails?

A

The fetus may develop transverse arrest or persistent occiput posterior position, leading to dystocia.

32
Q

What is the role of extension in labor?

A

The head extends to avoid impinging on the perineum and follows the vulvar opening.

33
Q

What happens during external rotation?

A

The delivered head undergoes restitution, aligning the shoulders with the anteroposterior diameter of the pelvic outlet.

34
Q

What signals expulsion during labor?

A

The anterior shoulder appears under the symphysis pubis, followed by delivery of the posterior shoulder and body.

35
Q

What percentage of labors begin with an occiput posterior (OP) position?

A

Approximately 20%.

36
Q

What complications may arise from persistent OP position?

A

Transverse arrest, dystocia, and increased likelihood of cesarean delivery.

37
Q

What is caput succedaneum?

A

Edematous swelling of the fetal scalp caused by prolonged labor or resistance in the birth canal.

38
Q

What is molding of the fetal head?

A

Changes in the shape of the fetal head due to external compressive forces during labor.

39
Q

What does severe molding indicate?

A

It can occur in cases of contracted pelves or asynclitism and may influence the mode of delivery.

40
Q

How do molding, caput succedaneum, and cephalohematoma differ?

A

Molding involves head shape changes; caput succedaneum is soft tissue swelling; cephalohematoma is blood collection beneath the periosteum.

41
Q

What is the greatest impediment to understanding normal labor?

A

“The greatest impediment is recognizing its start

42
Q

What are the two methods used to define the start of labor?

A

“One method defines it by when painful contractions become regular

43
Q

What is the first stage of labor according to Friedman?

A

“Friedman divided the first stage of labor into three divisions: preparatory

44
Q

What is the latent phase of labor?

A

“The latent phase begins when the mother perceives regular contractions and ends when cervical dilation reaches 4 cm.”

45
Q

What defines the start of active labor?

A

“Active labor is defined as beginning at 6 cm of cervical dilation according to the American College of Obstetricians and Gynecologists.”

46
Q

How is the active phase of labor divided?

A

“The active phase is subdivided into the acceleration phase

47
Q

What is a prolonged latent phase?

A

“A prolonged latent phase is one exceeding 20 hours in nulliparas and 14 hours in multiparas.”

48
Q

What is the mean duration of active-phase labor in nulliparas?

A

“The mean duration of active-phase labor in nulliparas is 4.9 hours

49
Q

How does the duration of the second stage of labor vary between nulliparas and multiparas?

A

“The median duration of the second stage of labor is approximately 50 minutes for nulliparas and 20 minutes for multiparas.”

50
Q

What is the normal duration of first- and second-stage labor in nulliparas without regional analgesia?

A

“The mean length of first- and second-stage labors is approximately 9 hours in nulliparas without regional analgesia.”

51
Q

What is the definition of true labor?

A

“True labor is defined as the process of childbirth beginning with the latent phase and continuing through delivery of the placenta.”

52
Q

What are the clinical signs that help differentiate true labor from false labor?

A

“Clinical signs include cervical dilation and contraction frequency and intensity

53
Q

What is the role of the Emergency Medical Treatment and Labor Act (EMTALA) regarding labor?

A

“Under EMTALA

54
Q

What is the purpose of cervical assessment during labor?

A

“Cervical assessment measures dilation

55
Q

What is the general approach to the management of first-stage labor?

A

A rational plan for monitoring labor is established based on the needs of the fetus and the mother after completing a general examination, reviewing records, and lab results. Precise statements on anticipated labor duration are avoided.

56
Q

How often should the fetal heart rate be checked during first-stage labor if no abnormalities are present?

A

Fetal heart rate should be checked immediately after a contraction at least every 30 minutes.

57
Q

How often should the fetal heart rate be checked during second-stage labor?

A

Fetal heart rate should be checked every 15 minutes.

58
Q

What is the recommendation for fetal heart rate monitoring in pregnancies at risk?

A

Fetal heart auscultation should be performed every 15 minutes during first-stage labor and every 5 minutes during second-stage labor.

59
Q

How often should maternal temperature, pulse, and blood pressure be evaluated during labor?

A

At least every 4 hours.

60
Q

What should be done if a patient’s membranes have been ruptured for many hours or if there is a borderline temperature elevation?

A

The temperature should be checked hourly.

61
Q

How are uterine contractions typically assessed?

A

Uterine contractions can be quantitatively and qualitatively evaluated manually, by feeling the uterus with the palm of the hand to gauge its intensity, frequency, and duration.

62
Q

How often should pelvic exams be performed during the first stage of labor at Parkland Hospital?

A

Pelvic exams are typically performed at 2- to 3-hour intervals for women in active labor.

63
Q

What is the impact of maternal position during labor?

A

In bed, the woman may assume any position she finds comfortable, often lateral recumbency. Walking may shorten labor and reduce the need for interventions like oxytocin, but evidence is conflicting.

64
Q

What are the findings regarding ambulation during labor?

A

Some studies show that ambulation may shorten labor, reduce the need for analgesia, and lower the rate of operative vaginal deliveries, though results are inconsistent.

65
Q

What should be withheld from a woman during active labor and delivery?

A

Food and liquids with particulate matter should be withheld due to delayed gastric emptying during labor and analgesia administration.

66
Q

Which oral fluids are considered acceptable for women in uncomplicated labor?

A

Clear liquids like water, clear tea, black coffee, carbonated beverages, Popsicles, and pulp-free juices are acceptable.

67
Q

What is the recommended IV fluid regimen during labor?

A

IV fluids with dextrose are recommended, with an infusion rate of 125 to 250 mL/hr for hydration.

68
Q

What are the risks and benefits of amniotomy during labor?

A

Benefits include earlier detection of meconium and the ability to monitor with electrodes. Risks include uterine infection and possible cord prolapse.

69
Q

When should antimicrobial administration be considered during labor with prolonged membrane rupture?

A

Antimicrobials are recommended for intrapartum risk factors, such as rupture of membranes for more than 18 hours or an intrapartum temperature greater than 38.0°C.

70
Q

How should urinary bladder function be monitored during labor?

A

The bladder should be periodically palpated for distention. If distention is present, the woman should be encouraged to void, or catheterization may be performed if necessary.

71
Q

What is the recommended management for second-stage labor when the fetus is descending?

A

Fingers should be used to assess fetal head position, including the sagittal suture and fontanels, and station of the presenting part.

72
Q

What is the typical duration of second-stage labor in nulliparas and multiparas?

A

The median duration is 50 minutes for nulliparas and 20 minutes for multiparas.

73
Q

What are the benefits of delayed pushing in second-stage labor?

A

Delayed pushing for 60 minutes may improve spontaneous birth rates, increase pushing efficiency, and reduce maternal exhaustion.

74
Q

What positions during second-stage labor have been shown to aid in the delivery process?

A

Upright positions, such as standing, sitting, or kneeling, may offer marginally shorter labor durations and fewer episiotomies compared to recumbent positions.

75
Q

What is the recommended management of labor according to active management protocols?

A

Active management includes regular pelvic exams, amniotomy if progress is slow, and oxytocin if necessary. Women are typically attended by midwives during labor.

76
Q

How often are pelvic exams performed for women admitted to Parkland Hospital in active labor?

A

Pelvic exams are performed every 2 hours to assess labor progress.

OBSTETRICS (13 decks)

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