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OB > NORMAL LABOR > Flashcards

NORMAL LABOR Flashcards

1
Q

Criteria for Diagnosis

A
  1. Uterine contractions (1 in 10 mins; 4 in 20 mins) by direct observation or by electronic fetal monitor
    - at least 200 Montevideo units (MVU)
  2. Documented progressive changes in cervical dilatation and effacement
  3. Cervical EFFACEMENT > 70-80%
  4. Cervical DILATATION > 3 cm
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2
Q

Bishop Score

A

used to predict labor induction

<5 - unfavorable
>9 - successful induction

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3
Q

Latent Phase

A

Onset of labor to about 3-5 cm dilatation

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4
Q

Factors that affect Latent Phase duration

A

excessive sedation or epidural anesthesia
unfavorable cervical condition
false labor

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5
Q

Active Phase

A

From 3-5 cm dilatation up to full dilatation

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6
Q

Factors that affect Active Phase duration

A

Epidural anesthesia - prolonged labor curve to 1 hr
Maternal obesity - prolonged to 30-60 minutes
Maternal fear - prolonged to 45 minutes

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7
Q

Cardinal Movements

A 
Engagement
Descent
Flexion
Internal Rotation
Extension
External Rotation (Restitution)
Expulsion
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8
Q

Engagement

A

BPD passes through the pelvic inlet

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9
Q

Descent

A

First requisite for birth of the newborn

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10
Q

Four forces of Descent

A

pressure of the amniotic fluid
direct pressure of the fundus upon the breech with contraction
bearing down efforts of maternal abdominal muscles
extension and straightening of the fetal body

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11
Q

Flexion

A

descending head meets resistance (cervix, pelvic walls and pelvic floor)

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12
Q

Internal Rotation

A

occiput movers toward the symphysis pubis

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13
Q

Extension

A

2 forces

  1. uterus exertion – acts more posteriorly
  2. resistant pelvic floor and symphysis - acts more anteriorly
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14
Q

External Rotation

A

rotation of the fetal body

bring bisacromial diameter into relation with the anteroposterior diameter of the pelvic outlet

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15
Q

Expulsion

A

anterior shoulder appears under the symphysis pubis

after delivery of the shoulders the rest of the body quickly passes

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16
Q

Goals of 3rd Stage Labor

A

delivery of an intact placenta
avoidance of uterine inversion
avoidance of post-partum hemorrhage

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17
Q

Signs of Placental Separation

A
  1. globular and firmer fundus (Calkin’s sign)
  2. sudden gush of blood
  3. lengthening of umbilical cord
  4. rise of uterus into the abdomen
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18
Q

EINC

A
  1. Immediate and thorough drying
  2. Early skin-to-skin contact
  3. Properly timed cord clamping
  4. Non-separation for early breastfeeding (for 6 hrs)
    - eye care
    - immunization
    - rooming in
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19
Q

Indications for Episiotomy

A
  1. Expedite delivery in the 2nd stage of labor
  2. When spontaneous delivery is likely
  3. Maternal or fetal distress
  4. Breech position
  5. Assisted forces
  6. Large baby
  7. Maternal exhaustion
20
Q

Perineal Lacerations

A

1st -4th degree

21
Q

1st Degree of Perineal Laceration

A

Fourchette, perineal skin and vaginal mucous membrane but NOT the underlying fascia and muscle

22
Q

2nd Degree of Perineal Laceration

A

Skin and mucous membrane + fascia and muscles of the perineal body

23
Q

3rd Degree of Perineal Laceration

A

Lacerations extend through skin, mucous membrane, perineal body and anal sphincter

24
Q

4th Degree of Perineal Laceration

A

Extension of laceration through the rectal mucosa to expose lumen of the rectum

25
Q

Functional Divisions of Labor

A

Preparatory
Dilatational
Pelvic Division

26
Q

Preparatory Division

A

similar to phase 1
latent phase + acceleration phase
little dilatation of the cervix
sedation and analgesia - capable of arresting this labor division

27
Q

Dilatational Division

A

active phase
rapid dilatational rate of cervix (maximum dilatation =maximum slope)
UNAFFECTED by anesthesia and sedation

28
Q

2 Phases of Dilatational Division

A

Latent Phase

Active Phase

29
Q

Latent Phase

A

corresponds to the PREPARATORY division

30
Q

Active Phase

A

corresponds to the DILATATIONAL division

31
Q

Division of Active Phase

A

Acceleration Phase
Phase of Maximum Slope
Deceleration Phase

32
Q

Prolonged Latent Phase

A

nulliparas - 20 hrs

multiparas - 14 hrs

33
Q

Threshold for active labor

A

uterine contractions and cervical dilatation of 3-5 cm or more

34
Q

Protraction

A

slow rate of cervical dilatation or descent

  • nulliparas - < 1.2 cm dilatation/hr
  • multiparas < 1.5 cm dilatation/hr or 2 descent per hour
35
Q

Pelvic Division

A

active phase
deceleration + 2nd stage of labor
cardinal movements of fetus occurs

36
Q

Acceleration

A

4-5 cm

predictive of outcome labor

37
Q

Maximum Slope

A

7-9 cm

descent of nullipara occurs here

38
Q

Deceleration

A

8-9 cm

heralds entry into the pelvic division of labor

39
Q

Arrest of Dilatation

A

2 h without cervical change

40
Q

Arrest of Descent

A

1 h without fetal descent

41
Q

Injury to only the vaginal epithelium or perineal skin

A

1st degree perineal laceration

42
Q

injury to perineum that spares the anal sphincter complex but involves the perineal muscles - bulbospongiosus and superficial transverse perineal muscles

A

2nd degree perineal laceration

43
Q

< 50 percent external anal sphincter (EAS) tear

A

3a

44
Q

> 50 percent EAS tear

A

3b

45
Q

EAS plus internal anal sphincter (lAS) tears

A

3c

46
Q

Laceration of the perineal body, entire anal sphincter complex and anorectal mucosa

A

4th degree perineal laceration

OB (16 decks)

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