Normal Labor, Abnormal Labor, L+D Path

Question 1

Stage 1 labor

Answer 1

Includes latent and active labor
Latent is from onset of contractions to 4cm dilation. Lasts 28h for primip, 14h for multip.
Active is from 4cm to 10 cm dilated.

Question 2

How long does latent labor last for primip or multip

Answer 2

28 h for primi, 14h for multi

Question 3

How fast is dilation for primip and multip during active stage 1?

Answer 3

1.2cm/h for primi 1.5cm/h for multi

Question 4

Stage 2 labor

Answer 4

From 10cm to delivery

Question 5

Stage 3

Answer 5

From delivery to placental delivery

Question 6

Stage 4 labor

Answer 6

All things after placental delivery

Question 7

Four states of cervical change

Answer 7

Dilation, effacement, softening, position

Question 8

What causes cervical change?

Answer 8

Breakage of disulfide bonds in collagen stimulated by PGE2 when fetal head or balloon engages cervix.

Question 9

Four cardinal fetal movements

Answer 9

First flexion, then internal rotation, then extension and external rotation.

Question 10

Components of the bishop score?

Answer 10

Dilation, effacement, station, consistency, position.

Higher score leads to vaginal delivery. Lower score is for c-section

Question 11

Prolonged latent labor time course?

Answer 11

Longer than 20 hours for primi and longer than 14 hour for multi

Question 12

What usually causes prolonged latent phase?

Answer 12

Opioids, but if not that then passenger, power, pelvis

Question 13

How to diagnose prolonged latent phase?

Answer 13

Place IUPC, normal contractions occur 3 in 30 minutes and >40mmhg.

Question 14

How to treat prolonged latent phase?

Answer 14

If due to opioids rest and wait. If not, place a balloon and dilate, C/s if fails. Augment labor with pitocin.

Question 15

Arrested/prolonged active labor

Answer 15

Stage when cervix goes from 4 cm to 10 cm.

Arrested active is when cervix dilates less than 1.2 cm/h for primip and less than 1.5 cm/h for multip.

Question 16

How to treat arrested or prolonged active labor?

Answer 16

Augment with pitocin, otherwise c/s

Question 17

Prolonged stage II

Answer 17

Phase where 10cm dilated to delivery.

Considered prolonged when greater than 3 hours if epidural or greater than 2 hours with no epidural.

Question 18

What causes prolonged stage II

Answer 18

Usually passenger or pelvis issue

Question 19

How to treat prolonged stage II

Answer 19

Augment with pitocin, if baby is at advanced station (1 or 2) then use vacuum or forceps. If baby is not, then C/s

Question 20

Prolonged stage III caused by?

Answer 20

Usually power issue, tired uterus, placenta isn’t delivered.

Question 21

How to treat prolonged stage III?

Answer 21

Uterine massage, pitocin, manual manipulation.

Question 22

Risk of prolonged stage III?

Answer 22

Usually high risk of post partum hemorrhage.

Question 23

Rupture of membranes pathogenesis

Answer 23

Sac ruptures, rush of fluid, can happen spontaneously within 1 hour of delivery of can happen artificially/pathologically.

Question 24

How to diagnose rupture of membranes?

Answer 24

Speculum exam shows pooling of fluid at the back of vagina, nitrazine test turns blue, ferning on microscopy

Question 25

pROM pathogenesis

Answer 25

Premature rupture of membranes caused by ascending infection at term, no contractions present

Question 26

How to treat pROM?

Answer 26

Antibiotics. Amp/gent and deliver baby (augment)

Question 27

ppROM pathogenesis

Answer 27

Preterm premature ROM, ascending infection baby isn’t at term and there are no contractions

Question 28

How to treat ppROM?

Answer 28

If baby is >36 weeks, deliver (though this is technically pROM).
If

Question 29

What to never do during pROM or ppROM?

Answer 29

Never do digital exam, will spread infection into uterus

Question 30

Prolonged ROM

Answer 30

If >18h from ROM to delivery. Increased risk of GBS

Question 31

How to treat prolonged ROM?

Answer 31

PPX with amox (i think he meant amp)

Question 32

Chorioamionitis

Answer 32

Ascending infection with baby in

Question 33

Endometritis

Answer 33

Ascending infection with baby out

Question 34

How does patient with chorio/endometritis present?

Answer 34

With pROM and fever

Question 35

How to diagnose chorio/endometritis?

Answer 35

Rule out other infeciton (UTI/PNA/etc) so get urine, CXR

Question 36

How to treat chorioamnionitis/endometritis

Answer 36

Broad spectrum antibiotics = Zozyn

Question 37

Pathogenesis of preterm labor? Risk factors?

Answer 37

Unknown. Risk factors include smoking, young, multiparous, ppROM, uterine anatomy issues

Question 38

How does patient in preterm labor present?

Answer 38

With contractions but gestational age less than term (20-36)

Question 39

How to treat preterm labor

Answer 39

Delay delivery (give mag, beta agonists (like terbutaline) CCB(nifedapine), prostaglandins), develop baby steroids until L:S>2.

Question 40

When to manage emergently?

Answer 40

When patient is preeclamptic, there is fetal demise, pROM, and placental abruption.

Question 41

What time is considered post-dates?

Answer 41

GA greater than 40, greater than 42 weeks from LMP.

Question 42

Problems with post dates baby?

Answer 42

Macrosomia causing shoulder dystocia, dysmature baby

Question 43

How to treat post-dates?

Answer 43

Deliver, give pitocin if sure post dates. If not sure, get an NST, AFI, and u/s for bpp.