Normal Labor Flashcards by tcarlso 3

What are the components of GTPAL?

Gravidity
Term
Preterm
Abortions
Living children

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What is AROM and SROM?

Artificial or spontaneous Rupture of Membranes

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What is the definition of term?

Delivery after 37 weeks

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What is the definition of preterm?

20-37 weeks

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What is the definition of abortion?

Losses prior to 20 weeks

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What is the definition of labor?

An increase in myometrial activity resulting in effacement and dilatation of the uterine cervix

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True or false: abortions in the GTPAL include spontaneous miscarriages etc

True

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What is the mean duration of a singleton pregnancy?

40 weeks from 1 day of LMP

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What is the range for term babies?

36-42 weeks

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How do you diagnose labor? (3)

Clinically

Regular, painful contractions
Progressive cervical effacement
Bloody show

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What is the definition of post-term?

Continuing beyond 42 weeks

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True or false: factors responsible for the initiation and maintenance of labor at term are not well defined

True

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What is phase 0 of labor? What are the three hormones utilized here?

Functional quiescence through inhibitors:

Progesterone
Prostacyclin
Relaxin

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What is phase 1 of labor?

Cervical softening–slow progressive structural changes of the ECM

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What is phase 2 of labor? What is the major hormone here, and what does it do?

Myometrial changes–myometrial oxytocin receptors increased, causing an increase in uterine irritability and responsiveness to uterotonins

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What is the lightening of labor?

Fetal presenting part descends into the pelvis

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What is cervical ripening, and in what stage of labor does this occur?

Occurs in phase 2

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What hormone produced by the placenta helps induce prostaglandins for contractions? What hormones withdraws at this time?

CRH

Progesterone

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What are the three hormones that have an influence on phase 3 of labor?

oxytocin influence

- prostaglandins/relaxin

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What is phase 4 of labor? What is the major hormone involved?

The puerperium or postpartum interval, where the myometrium becomes rigid and in a state of constant contraction

-oxytocin

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What are the 3 P’s of the mechanics of labor?

Power
Passenger
Passage

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What are the three descriptive characteristics of uterine activity?

Frequency
Intensity
Duration

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What is the classic definition of adequate uterine activity in labor?

3-5 contractions in a 10 minute period

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What is the lie of the fetus? What is the best lie?

Spatial relationship of fetal spine to the maternal spine

Vertically oriented lie is optimal

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What is the presentation of the fetus?

Fetal part the directed overlies the pelvic inlet

What is a compound presentation?

More than 1 fetal part presents

What is malpresentation?

Any presentation that is not cephalic with occiput leading

What are the three major lies of the fetus?

Longitudinal Oblique Transverse

What is longitudinal lie? Transverse? Oblique?

- Longitudinal = maternal spine and fetal spine are parallel - Transverse= maternal spine and fetal spine are perpendicular - Oblique = anywhere in between

What is position?

Description of the relationship between a fetal denominator (head) and the maternal pelvis

What does the middle initial stand for in the description of the position?

Fetal denominator (head)

What do the first and last initials in the description of fetal position stand for?

Maternal pelvic quadrants toward which the fetal denominator points

What is station?

Relationship of the presenting part of the maternal ischial spines

How do you communicate station?

-5 to +5, with the midpoint (0) defined as the plane of the ischial spines, and negative numbers being closer to the mother's pelvic outlet

What is passage?

Bony and soft tissues of the maternal pelvis

What is the diagonal conjugate?

Sacral promontory to *inferior* margin of the pubic symphysis

What is the true (obstetric) conjugate?

-Sacral promontory to *superior* aspect of the pubic symphysis

What is the smallest diameter of the inlet?

True (obstetric) conjugate

What is an anthropoid pelvis?

Oval pelvic opening with the long axis in the sagittal plane

What is a gynecoid pelvis?

Circular pelvis

What is an android pelvis?

Heart-shaped pelvic opening

What is a platypelloid pelvis?

Oval pelvic opening, with the long axis in the coronal plane

What is the limiting factor in the mid cavity of the pelvis?

Interspinous diameter

What is the clinical significance of the pelvis outlet?

Rarely of clinical significance

What is the most common shape of the pelvis opening, and which is the most conducive to birth?

Gynecoid, for both

What is the first stage of labor?

Interval between onset of labor and full cervical dilation

What are the three Friedman phases of the first stage of labor?

Latent Active Descent

What is the latent phase of the first stage of labor? How long does this last?

Between onset of labor and a point at which a change in the slope of the rate of cervical dilation is noted Variable duration, but hours

What is the active phase of the first stage of labor?

-Greater rate of dilatation, with onset at approximately 4 cm (highest slope on the chart)

What is the descent phase of the first stage of labor?

Usually coincides with the second stage of labor--onset between 9-10 cm

When doe active pushing occur in labor?

2nd phase

How long does the second stage of labor last for nulliparous and multiparous women?

``` Nulliparous = 1 hour ish Multiparous = 20 minutes ish ```

True or false: labors past the first labor are usually significantly shorter

Yes

What spinal levels mediate the pain of uterine contractions?

T10-L1

What are the spinal levels that mediate the perineal pain of contractions?

S2-S4

What is combined spinal-epidural analgesia?

Needle advanced into the dural space, but then a catheter is left in place to provide ongoing analgesia

What are the side effects of epidurals? (3)

- Hypotension - Fever - Transient fetal heart deceleration

What are the hemodynamic factors that are an absolute contraindication for epidurals?

- Refractory hypotension - Coagulopathies - Thrombocytopenia

Is increased ICP a contraindication to epidurals

Yes

LMH within what time frame is an absolute contraindication to neuraxial analgesia?

Within 12 hours

What is the effect of spinal analgesia on the second stage of labor?

Increases by an hour for both multiparous and nulliparous women

What is the second stage of labor?

Interval between full cervical dilatation and delivery of the infant

How do the lengths of the Third stage of labor compare for nulliparous and multiparous women

Both are 5-30 minutes

What, generally, are the cardinal movements of labor?

Changes in the the position of the fetal head during passage through the birth canal

What is the order of the cardinal movements of labor?

- Engagement - Descent - Flexion - Internal rotation - Extension - External rotation - Expulsion

What are the labs that should be obtained in the initial assessment of labor? (Blood x2, infectious x3)

- Type and screen - HIV, Hep B, syphilis - AB screen

How often should fetal heart rate be obtained during the *first* stage of labor? What about after a contraction?

q 30 minutes and immediately after a contraction for approx 2 minutes

How often should fetal heart rate be obtained during the *second* stage of labor? What about after a contraction?

q 15 minutes, and after a contraction for approx 2 minutes

True or false: pts should be NPO during labor

False- limit oral intake, but not NPO

What is the role of electronic fetal monitors during labor?

No evidence for routine use

How often should a cervical check be performed, besides at admission? (3)

- q 1-4 hours - When patient feels urge - Prior to analgesia

What are the two major reasons to limit cervical checks?

- Infection | - Discomfort for mom

What indicates that imminent delivery of the placenta? (3)

- Lengthening of the umbilical cord - Gush of blood from the vagina - Change in shape of uterine fundus

What are the two active management factors of placental delivery?

- Oxytocin | - Controlled cord traction

What is the third stage of labor? How long does this usually last?

Delivery of the placenta--10-30 minutes