Normal Labor and Delivery Flashcards
What are the 4 components of the leopold maneuvers?
First: fundus
Second: sides
Third: presenting part
Fourth: pubic symphysis
What is the premature rupture of membranes (PROM)?
Rupture of membranes before the onset of labor
What is the preterm, premature rupture of membranes (PPROM)?
Rupture of membranes before 37 weeks
What is prolonged PROM?
When PROM occurs > 18 hrs before labor, putting the mother and fetus at inc risk of infection
How do you dx rupture of membranes?
SSE showing pooling, nitrazine, ferning
What is the amnisure?
Rapid test that identifies placental alpha-microglobulin-1 via immunoassay
What is the amnio dye test and what is a finding indicating rupture?
Amniocentesis used to inject dilute indigo carmine dye into the amniotic sac to look for leakage from cervix onto a tampon; if tampon turns blue, it is a sign of rupture
What are the 5 components of a cervical exam?
Dilation, effacement, fetal station, cervical position, consistency of cervix
What bishop score is consistent w/a cervix favorable for induced labor?
Score >8
What is dilation?
How open the cervix is at level of internal os (0-10 cm)
What is effacement?
Subjective measurement of length of cervix (0-100%)
What is fetal station?
Relation of fetal head to ischial spines of maternal pelvis (-3 to +3)
Describe the vertex, breech, and transverse fetal positions.
Vertex: head down (cephalic)
breech: buttocks down
transverse: neither down
Describe the face or brow fetal position.
Fetus is cephalic w/an extended head
Describe compound presentation.
Vertex presentation w/a fetal extremity
Describe the fetal position in vertex presentation.
Based on relationship of fetal occiput to the maternal pelvis; position determined by palpation of sutures and fontanelles
Define labor.
Regular uterine contractions that cause cervical change in either effacement or dilation
Define prodromal (false) labor.
Irregular contractions that yield little or no cervical change
What are 5 possible signs of labor?
(1) bloody show
(2) nausea
(3) vomiting
(4) palpability of contractions
(5) pt discomfort
What are 4 induction agents to induce labor?
(1) prostaglandins
(2) oxytocin
(3) mechanical dilation of cervix
(4) artificial rupture of membranes
What are 5 indications to induce labor?
(1) post-dates
(2) preeclampsia
(3) PROM
(4) nonreassuring fetal testing
(5) IUGR-intrauterine growth restriction
What is pitocin?
Synthesized version of the octapeptide oxytocin normally released from the posterior pituitary that causes uterine contractions
What is the augmentation of labor?
Intervening to inc the already present contractions
What do you use to tell if a contraction is a true contraction and what does it measure?
Intrauterine pressure catheter (IUPC): used to directly measure changes in the pressure during contractions
What is the baseline fetal heart rate range?
110-160 bpm
What are the 4 types of variability in baseline fetal HR and what type do you want the fetus to be in (what is normal)?
Absent: amplitude range undetectable
Minimal: amplitude range 5 bpm or less
Moderate: amplitude range b/w 6-25 bpm where you want the fetus to be
Marked: amplitude >25 bpm
What must accelerations be at 32 weeks?
15x15
Define early deceleration.
Symmetrical gradual dec and return of FHR associated w/uterine contraction
Define late deceleration.
Deceleration w/nadir occurring after peak of contraction then slowly returning to baseline
Define variable deceleration.
Abrupt dec in FHR
Define prolonged deceleration.
Deceleration lasts 2+ mins
What does the ultrasound transducer measure?
Fetal heart rate
What does the tocodynamometer measure?
Uterine activity
What are 4 devices used in fetal monitoring?
(1) fetal scalp electrode (FSE)
(2) intrauterine pressure catheter (IUPC)
(3) fetal scalp pH
(4) pulse oximetry
What is a FSE and what are the C/I to using it?
Small electrode that is attached directly to the fetal scalp and senses potential differences created by depolarization of fetal heart; C/Is: maternal Hepatitis or HIV, fetal thrombocytopenia
What is an IUPC and what units is it measured in?
Catheter threaded past fetal head into uterine cavity to measure pressure changes during uterine contractions; measured in Montevideo units in a 10 min period
Describe how to obtain a fetal scalp pH and what it is used for.
Fetal blood is obtained from small nick in fetal scalp to directly assess fetal hypoxia and acidemia
What is a reassuring pH value and a non-reassuring pH value?
Reassuring pH: >7.25
Non-reassuring pH: <7.20
Where is a fetal pulse oximetry placed and what is a normal value?
Intrauterine along the fetal cheek; normal >30%
How is the progression of labor assessed?
By the progress of cervical effacement, cervical dilation, and descent of fetal presenting part
What are the 6 cardinal movements of labor and describe each.
1) Engagement: fetal presenting part enters pelvis
2) Descent: head descends into pelvis
3) Flexion: allows smallest diameter to present
4) Internal rotation: rotation from an occiput transverse (OT) position, usually to occiput anterior (OA)
5) Extension: vertex passes beneath pubic symphysis
6) External rotation (restitution): once head is delivered
What is stage 1 labor?
Onset of labor until complete dilation of cervix
How long does nulliparous stage 1 labor last? Multiparous stage 1 labor?
(1) Nulliparous: 10-12 hrs
(2) multiparous: 6-8 hrs
What 2 aspects does stage 1 labor include?
(1) latent phase: from onset of labor to 3-4 cm
(2) active phase: from latent phase to beyond 9 cm, slope of cervical change against time inc (1 cm for nulliparous, 1.2 cm for multiparous)
What are the 3 P’s and what do they do?
- The 3 P’s affect transit time during active phase of labor
1) Powers: strength and frequency of contractions
2) Passenger: size and position of fetus (if too large for pelvis- cephalopelvic disproportion (CPD))
3) Passage or pelvis: size and shape of maternal pelvis
What is stage 2 of labor?
Complete cervical dilation to delivery of infant
When is stage 2 considered prolonged in nulliparous pts? w/epidural?
> 2 hrs; 3 hrs w/epidural
When is stage 2 considered prolonged in multiparous pts? w/epidural?
> 1 hr; 2 hrs w/epidural
What are 3 non-reassuring signs in stage 2 labor?
(1) repetitive late decels
(2) bradycardia
(3) loss of variability
What is stage 3 of labor?
From delivery of the infant until delivery of the placenta completed (5-30 mins)
What are 3 signs of placental separation?
(1) cord lengthening
(2) gush of blood
(3) uterine fundal rebound as placenta detaches
What is the modified ritgen maneuver?
Using the heel of the delivering hand to exert pressure on the perineum and fingers below the maternal anus to extend the fetal head
After the head is delivered, what do you want to check for?
Check infant neck for umbilical cord
What is an episiotomy and what are the 2 types?
Incision made in the perineum to facilitate delivery
1) Median-vertical midline incision from the posterior fourchette into the perineal body
2) Mediolateral-oblique incision from 5 or 7 o’clock on perineum cut laterally
What are 3 indications for operative vaginal deliveries?
(1) prolonged 2nd stage
(2) maternal exhaustion
(3) need to hasten delivery
What are 2 types of operative vaginal deliveries?
(1) forceps: blades placed around fetal head to aid efforts and guide fetal head through curvature of the pelvis
(2) vacuum extraction: vacuum cup placed on fetal scalp, exertion in parallel axis
What is a retained placenta and what are 3 types of deliveries when it happens?
When the placenta is not delivered w/in 30 mins after the infant; seen in:
1) preterm, previable deliveries
2) precipitous deliveries
3) placenta accreta-when placenta invades endometrial stroma
What are the 4 degrees of perineal lacerations?
- 1st degree: superficial, confined to vaginal mucosal layer
- 2nd degree: into the body of the perineum
- 3rd degree: into the anal sphincter
- 4th degree: into the rectum
