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OB/GYN > Normal Labor > Flashcards

Normal Labor Flashcards

1
Q

progressive cervical effacement and dilation from regular uterine contractions occurring at least every 3 minutes and last 30-60 sec each

A

labor

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2
Q

Braxton Hicks (false labor)

A

common during weeks 4-8 - irregular/unpredictable uterine contractions

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3
Q

signs of false labor

A
  • Braxton Hicks contractions - irregular, more in abdominal region, repositioning can alter
  • no progression of labor
  • not associated w/ cervical dilation or effacement
  • membranes not ruptured (no bloody show)
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4
Q

hormones that inhibit labor

A

progesterone and relaxin

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5
Q

hormones that stimulate growth

A

estrogen and prostaglandins

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6
Q

hormones that stimulate contractions

A

oxytocin and prostaglandins

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7
Q

most important anatomic factor in labor

A

fetal skull size

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8
Q

largest part of fetal skull

A

supraoccipitomental (13.5cm)

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9
Q

structures of true pelvis

A

pubis anterior, sacrum, coccyx, ischium laterally

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10
Q

false pelvis

A

above true pelvis - supports uterus

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11
Q

fetal head enters this plane 1st

A

pelvic plane

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12
Q

largest plane

A

plane of greatest diameter

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13
Q

MC site of low transverse arrests

A

plane of least diameter

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14
Q

ischial tuberosities B/L - site of low pelvic arrest

A

pelvic outlet

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15
Q

pelvic shapes

classic shape, 50% of women, spacious and cylindrical, widest transverse diameter

A

gynecoid

(most favorable)

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16
Q

pelvic shapes

long narrow inlet w/ wide AP diameter, 20% of women, fetal head traverses in AP diameter

A

anthropoid

“oval shaped”

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17
Q

pelvic shapes

bases on dimensions, most limited for fetal descent, side walls converge, arrest of descent common, 30% of women

A

android

“heart shaped”

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18
Q

pelvic shapes

“flattened” gynecoid pelvis, narrow AP - fetal head must engage in transverse diameter, 3% of women

A

platypelloid

“wider than taller shape”

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19
Q

3 P’s of Labor Determining Transit Time

A
  • Power - uterine activity
  • Passenger - size, lie, presentation, attitude, position, station
  • Passageway - female pelvis types
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20
Q

2 exam types during labor

A
  • obstetric
    • fetal position and lie
    • Leopold maneuvers, US
  • cervical
    • determine phase of labor/progression
    • 5 items
      • dilation
      • effacement
      • station
      • cervical position
      • cervical consistency
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21
Q

dilation

A

how open cervix is at internal os

(closed - 10cm)

  • nulliparous: effacement before dilation
  • multiparous: dilation before effacement
  • rate of dilation
    • nullliparous 1-1.2 cm/hr
    • multiparous 1.5 cm/hr
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22
Q

effacement

A

how thin cervix is between internal and external os

(normally 3-5cm)

measured in % - 100% is paper thin/ready to deliver

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23
Q

station

A

relationship of head to ischial spines

  • zero station - presenting part level w/ spines
  • neg. station - above
  • pos. station - below
  • ranges -5 to +5 (but typically -3 to +3)
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24
Q

cervical position

A

posterior, mid, anterior

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25
Q

cervical consistency

A

firm / soft / in-between

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26
Q

measurement to determine if cervix favorable for spontaneous delivery

A

Bishop score

(8 is favorable)

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27
Q

intervening to increase the already present contractions

A

augmentation

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28
Q

attempt to begin labor in a non-laboring patient

A

induction

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29
Q

maternal indications for induction

A
  • pre-eclampsia
  • hypertension
  • deteriorating/uncontrolled diabetes
  • placental abruption
  • previous still birth
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30
Q

fetal indications for induction

A
  • post dates (usually T+10)
  • IUGR
  • rhesus disease
  • intrauterine death
  • placental insufficiency
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31
Q

induction contraindications

A
  • cephalopelvic disproportion
  • malpresentation (unless face or breech)
  • fetal distress
  • placenta previa
  • cord presentation
  • vasa praevia
  • pelvic tumor
32
Q

cautions for induction

A
  • grand multiparity (6+)
  • previous c-section (risk of uterine rupture)
  • previous precipitate labor (risk of hyperstimulation)
33
Q

First state of labor

A

onset true labor to complete dilation of cervix

34
Q

Second state of labor

A

complete dilation of cervix to birth of baby

(if prolonged may require operative delivery -

forceps or vacuum)

35
Q

Third state of labor

A

birth of baby to delivery of placenta

(oxytocin to reduce blood loss)

36
Q

Fourth stage of delivery

A

delivery of placenta to stabilization of patient

37
Q

2 phases of stage 1 labor

A
  • latent - cervical effacement and early dilation (3-4cm)
  • active - rapid cervical dilation beginning at 4cm w/ active uterine contractions
    • 1cm/hr primiparous
    • 1.2cm/hr multiparous
38
Q

duration of stage 2 labor

A

30min - 3hours

39
Q

normal changes in babies head d/t delivery

A
  • molding - alteration of cranial bones d/t compression
  • caput - localized edema
40
Q

6 cardinal movements of labor

A
  1. engagement
  2. descent
  3. flexion
  4. internal rotation
  5. extension
  6. external rotation
41
Q

6 cardinal movements

widest presenting part drops into pelvic inlet

A

engagement

42
Q

6 cardinal movements

dropping of fetal presenting part further into pelvis

A

descent

43
Q

6 cardinal movements

dropping of chin toward fetal chest to present smallest diameter to maternal inlet

A

flexion

44
Q

6 cardinal movements

presenting parts rotate to AP diameter

A

internal rotation

45
Q

6 cardinal movements

occiput reaches symphysis/vaginal canal shifts upward - crowning when head encircled by vulvular ring

A

extension

46
Q

6 cardinal movements

delivered head returns to original position to align w/ back and shoulders

A

external rotation

47
Q

6 cardinal movements + 1

delivery of rest of fetus - anterior shoulder follows similar rotation under pubis

A

expulsion

48
Q

management of first stage

A
  • patient ambulation or lateral recumbent position
  • IV fluids
  • labs
  • maternal monitoring
  • analgesia
  • fetal monitoring
  • uterine activity
  • vaginal examinations
  • amniotomy
49
Q

management of second stage

A
  • maternal position- avoid supine
  • bearing down
  • fetal monitor: HR continuously or every 5 min
  • vaginal exam: every 30 min
  • delivery:
    • supine or left lateral position
    • episiotomy
    • Ritgen maneuver
    • clear airway when head delivered
    • umbilical cord check
    • anterior shoulder then body delivered
    • cord clamping delayed 1-2 min
50
Q

Ritgen Maneuver

A

upward pressure to chin by posterior hand covered

w/ sterile towel

while suboccipical region of head held against symphasis

51
Q

management of third stage

A
  • inspect vagina and cervix for lacerations & repair
  • IV Pitocin - prevent hemorrhage
  • deliver placenta
    • signs of separation
      • fresh show of blood
      • umbilical cord lenghthens
      • fundus rises
      • uterus becomes firm & globular
  • uterine massage - prevent atonicity
  • examine placenta for full removal and abnormalities
52
Q

management of fouth stage

A
  • monitor HR, BP, uterine blood loss to prevent post-partum hemorrage
  • patient massaging uterus
53
Q

period following delivery of baby and placenta to 6 weeks postpartum

A

puerperium

54
Q

normal aspects of puerperium

A
  • organs and physiology return to pre-preg. state
  • uterus involution - cervix firms
  • uterine discharge
    • lochia rubra
    • lochia serosa
    • lochia alba
    • r/o endometriosis if foul-smelling lochia
  • menstrual flow returns in 6-8 weeks
55
Q

APGAR

A
  • appearance (color)
  • pulse (HR)
  • grimace (muscle tone)
  • activity (reflex irritability)
  • respirations (RR)
56
Q

APGAR scoring scale

A

0 1 2

color blue centerpink all pink

HR 0 <100 >100

resp. none weak cry vigorous cry

tone none some flex all flexed

reflex none some motion crying, withdrawal

57
Q

APGAR score interpretation

A

scored at 1 and 5 minutes

  • 8-10: no concerns
  • 4-7: watch closeley and repeat at 10 min**
  • 0-3: resuscitate
58
Q

how to stimulate breathing after delivery

A

flick soles or rub back

59
Q

procedure if evidence of meconium passed

A

intubate and suction trachea before stimulating baby

60
Q

when do you initiate positive pressure ventilation

A

gasping, apnea, HR < 100 bpm

descision made in first 30-60 seconds after birth

61
Q

fetal heart rates during labor

(normal, tachycardia, bradycardia)

A

110-160

>160

<110

62
Q

steps in fetal monitoring baseline assessment

A
  • determine baseline FHR
    • variability - changes in freq/amp w/ baseline
    • normal short-term variability 6-25/min
      • below 5 - fetal distress
  • changes related to contractions
    • no change
    • acceleration
    • deceleration (early, late, variable, prolonged)
63
Q

fetal heart rate monitoring -

prolonged flat baseline indicates

A

short term variability

fetal acidosis

64
Q

fetal heart rate monitoring -

normal is 3-10 cycles per min, abnormal indicates

A

long term variability

metabolic derangement

65
Q

fetal heart rate monitoring -

early deceleration indicates

A

fetal head engagement

66
Q

fetal heart rate monitoring -

late deceleration indicates

A

uteroplacental insufficiency

(repeated represents fetal hypoxia and acidosis)

67
Q

fetal heart rate monitoring -

variable decelerations indicate

A

umbilical cord compression

68
Q

non-pattern signs of fetal distress -

prolonged fetal tachycardia indicates

A

maternal fever and infection

69
Q

non-pattern signs of fetal distress -

early meconium passage (before membrane rupture) increases risk of

A

fetal aspiration

70
Q

non-pattern signs of fetal distress -

late meconium passage (2nd stage of labor) indicates

A

umbilical cord compression or hypertonic uterus

71
Q

amniocentesis

when performed and what it tests

A

16-20 weeks via 22ga needle w/ US guidance

  • fetal chromosome abnormalities
  • AFP for neural tube defects
  • prenatal infections
  • 3rd trimester to assess lung maturity
  • remove excessive fluid in polyhydramnios or twins

20mL fluid used

72
Q

similar to amniocentesis

what it is, when it’s done

A

chorionic villus sampling

  • week 10 (earlier than amnio)
  • sample from placenta through cervix or abdomen
  • slightly less sensitive for genetic abnormalities
73
Q

procedures to close cervix

A
  • cerclage
    • circumferential suture at 13-16 weeks
  • McDonald
    • simple purse-string suture near cervicovaginal junction
74
Q

4 indications for operative vaginal delivery

(forceps, suction, c-section)

A
  • prolonged 2nd stage labor
  • suspicion of immediate impending compromise
  • stabilize head after breech delivery
  • shorten 2nd stage for mom’s benefit
75
Q

birth via laparotomy then hysterotomy

A

cesarean section

1’ - first time hysterotomy

2’ - uterus w/ 1+ prior hysterotomy incisions

76
Q

reasons for increasing c-section

A
  1. fewer children - more nulliparas births
  2. avgerage maternal age rising
  3. more electronic fetal monitoring
  4. more breech fetuses
  5. decrease in forcep and vacuum deliveries
  6. more inductions
  7. rise in obesity
  8. increases for preeclampsia
  9. VBAC has decreased
  10. more elective c-sections

OB/GYN (7 decks)

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