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OBGYN > Normal Labor and Delivery > Flashcards

Normal Labor and Delivery Flashcards

1
Q

How is rupture of membranes (ROM) evaluated?

A

Premature (PROM)= prior to onset of labor
Preterm, premature (PPROM) = prior to 37 weeks gestation
Pool test = see fluid in vagina
Nitrazine test = amniotic fluid is alkaline, turns nitrazine paper blue
Fern test = estrogens in amniotic fluid causes fern pattern under microscope
US to look at fluid around fetus (decreased fluid is indicative)
Amnisure = rapid molecular test of fluid to identify placental alpha-microglobulin-1

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2
Q

Why is (P)PROM dangerous?

A

Puts mother and fetus at risk for infection

Consider prophylactic abx

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3
Q

What are the components of the cervical exam

A

Dilation (0-10 cm)
Effacement (how short the cervix becomes in percentage)
Fetal station (relation to ischial spine, -5 to +5 cm)
Cervical position (posterior, mid, anterior)
Consistency of cervix (firm, medium, soft)

Bishop score > 8 = favorable for spontaneous labor

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4
Q

What is compound presentation?

A

Vertex presentation with fetal extremity (like arm)

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5
Q

What is normal labor?

A

Contractions with cervical change

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6
Q

How can labor be induced and augmented?

A

Induction with prostaglandins, oxytocin (Pitocin*), mechanical dilation, artificial ROM (AROM)

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7
Q

What are indications for induction of labor?

A 
Postterm pregnancy
Preeclampsia 
DM
Nonreassuring fetal testing
Intrauterine growth restriction
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8
Q

What agents can be used for cervical ripening?

A

Prostaglandin E2
-Gel
-Pessary (cervidil)
PGE1M (misoprostol)

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9
Q

What are contraindications for cervical ripening with prostaglandins?

A

Maternal asthma and glaucoma
Prior C-section and nonreassuring fetal testing

Use mechanical dilator in this setting

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10
Q

What must you be careful of when performing AROM?

A

Prolapse of umbilical cord - do not elevate fetal head

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11
Q

What can be used to augment labor?

A

Pitocin and amniotomy

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12
Q

What are indications for labor augmentation?

A

Inadequate contractions - measured through intrauterine pressure catheter
Prolonged phase of labor

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13
Q

What is normal fetal heart rate?

A

110-160

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14
Q

What must you watch for when monitoring fetal heart rate?

A

Baseline > 160 concerning for distress 2/2 infection, hypoxia, anemia
Prolonged fetal decel > 2 min duration with HR

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15
Q

What are the types of decels?

A

Early - begin and end at the same time as contractions, due to increased vagal tone secondary to head compression
Variable - occur at any time, drop precipitously, due to umbilical cord compression
Late - begin at peak of contraction, slowly return to baseline after contraction = most worrisome, due to uteroplacental insufficiency

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16
Q

What are the kinds of fetal variability?

A

Look at difference between peak and trough in one box)

Absent (25/min)

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17
Q

What is normal fetal heart accel?

A

10 beats over baseline for at least 10 seconds if 32 weeks (at least 2 in 20 min)

18
Q

What are contraindications for fetal scalp eletrode monitoring for babies that are difficult to trace externally, or in presence of repetitive decels?

A

Maternal hepatitis and HIV because it requires breaking the skin barrier

19
Q

What are the categories of fetal heart tracings?

A

I: normal baseline, moderate variability, no variable/late decels
II: indeterminate, variable and late decels, brady and tachycardia, minimal variability, or even absent variability
III: abnormal, absent fetal heart variability, recurrent late/variable decels, bradycardia
- sinusoidal pattern of fetal anemia

20
Q

What are the values of uterine pressure measured by IUPC?

A

Baseline 10-15

During contractions, can increase by 20-30 early, 40-60 late in labor

21
Q

What are the cardinal movements of labor?

A 
Engagement
Descent
Flexion
Internal rotation
Extension
External rotation (restitution/resolution)
22
Q

What are the stages of labor?

A

Stage 1 = onset of labor, until dilation and effacement is complete
Stage 2 = full dilation to delivery of neonate
Stage 3 = afterbirth, ends with delivery of placenta

23
Q

What are the expected milestones in stage 1 of labor?

A

10-12 hours in nulliparous, 6-8 hours in multip
At least 1 cm/hr dilation in nullip, 1.2 cm/hr dilation in multip
Adequate contractions of > 200 montevideo units

24
Q

What is active phase arrest?

A

No change in cervival dilation or station for 2 hours
Indication for c-section
(Can wait up to 4 hours)

25
Q

What are stage 2 labor milestones?

A
26
Q

What are signs of nonreassuring fetal heart tracing?

A

Repetitive late decels
Bradycardia
loss of variability

27
Q

What should be done in setting of nonreassuring fetal heart tracing?

A

O2 mask
Turned onto left side to reduce IVC compression (increase uterine perfusion)
D/c oxytocin
Administer tertbutaline (tocolytic) if thought to be due to hypertonus or tachysystole
C-section if station cannot be determined, or if station

28
Q

What maneuver can be done if delivery needs to be expedited?

A

Modified Ritgen proceture
Apply upward pressure from behind anus
Can lead to greater perineal lacs

29
Q

What are operative vaginal deliveries?

A

Assistance with forceps or vacuum suction

30
Q

What is cephalopelvic disproportion

A

If fetus is too large for pelvis

Requires c-section

31
Q

What are the dangers of vacuum assisted delivery?

A

Scalp lac, cephalohematoma, subgaleal hemorrhage (emergency, between periosteum and galeal aponeurosis)

32
Q

What are stage 3 labor milestones?

A

Placental separation 5-10 min after delivery (nl

33
Q

What is important to keep in mind during placental delivery?

A

Prevent cord avulsion

Prevent uterine inversion by keeping suprapubic pressure

34
Q

What is a cause of retained placenta?

A

Placenta accreta = may require curretage

35
Q

What are the degrees of lacs?

A

1st: mucosa or skin
3rd: involve anal sphincter
4th: enters anal mucosa

Care for buttonhole 4th degree lac which can spare anal sphincter

36
Q

What is the most common indication for c-section?

A

Failure of labor to progress*
CPD
Poor contractions (can try pitocin/AROM first)
breech position, transverse lie, shoulder, placenta previa, fetal distress, cord prolapse
prior C-section*
maternal disease (HIV, active genital herpes, cervical cancer)

37
Q

When can vaginal birth after c-section (VBAC) be attempted?

A

Kerr (low transverse) or Kronig (low vertical) hysterotomy without extension into cervix or upper uterine segment

38
Q

What is the greatest risk during trial of void after c-section (TOLAC)?

A

Rupture of prior uterine scar

39
Q

What are common analgesics used during labor?

A

IM morphine sulfate
Pudendal block
Local for episiotomy/repair of lac
Epidural (at L3-L4 level) during active phase
Spinal anesthesia (more commonly for c-section)

40
Q

What medications should not be used during labor?

A

Sedating meds because can cross placenta and cause resp depression in infant

41
Q

What are common complications of epidural and spinal anesthesia?

A

Maternal hypotension (due to decreased SVR) = decreased placental perfusion and fetal bradycardia
Maternal respiratory depression
Spinal headache

42
Q

What are reasons for emergency c-section?

A 
Placental abruption
Fetal bradycardia
Umbilical cord prolapse
Uterine rupture
Hemorrhage from previa

OBGYN (28 decks)

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