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Clin Med 3- Exam 3 > Normal Labor and Delivery > Flashcards

Normal Labor and Delivery Flashcards

1
Q

What are the 4 components of the leopold maneuvers?

A

First: fundus
Second: sides
Third: presenting part
Fourth: pubic symphysis

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2
Q

What is the premature rupture of membranes (PROM)?

A

Rupture of membranes before the onset of labor

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3
Q

What is the preterm, premature rupture of membranes (PPROM)?

A

Rupture of membranes before 37 weeks

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4
Q

What is prolonged PROM?

A

When PROM occurs > 18 hrs before labor, putting the mother and fetus at inc risk of infection

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5
Q

How do you dx rupture of membranes?

A

SSE showing pooling, nitrazine, ferning

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6
Q

What is the amnisure?

A

Rapid test that identifies placental alpha-microglobulin-1 via immunoassay

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7
Q

What is the amnio dye test and what is a finding indicating rupture?

A

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

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8
Q

What are the 5 components of a cervical exam?

A

Dilation, effacement, fetal station, cervical position, consistency of cervix

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9
Q

What bishop score is consistent w/a cervix favorable for induced labor?

A

Score >8

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10
Q

What is dilation?

A

How open the cervix is at level of internal os (0-10 cm)

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11
Q

What is effacement?

A

Subjective measurement of length of cervix (0-100%)

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12
Q

What is fetal station?

A

Relation of fetal head to ischial spines of maternal pelvis (-3 to +3)

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13
Q

Describe the vertex, breech, and transverse fetal positions.

A

Vertex: head down (cephalic)

breech: buttocks down
transverse: neither down

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14
Q

Describe the face or brow fetal position.

A

Fetus is cephalic w/an extended head

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15
Q

Describe compound presentation.

A

Vertex presentation w/a fetal extremity

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16
Q

Describe the fetal position in vertex presentation.

A

Based on relationship of fetal occiput to the maternal pelvis; position determined by palpation of sutures and fontanelles

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17
Q

Define labor.

A

Regular uterine contractions that cause cervical change in either effacement or dilation

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18
Q

Define prodromal (false) labor.

A

Irregular contractions that yield little or no cervical change

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19
Q

What are 5 possible signs of labor?

A

(1) bloody show
(2) nausea
(3) vomiting
(4) palpability of contractions
(5) pt discomfort

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20
Q

What are 4 induction agents to induce labor?

A

(1) prostaglandins
(2) oxytocin
(3) mechanical dilation of cervix
(4) artificial rupture of membranes

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21
Q

What are 5 indications to induce labor?

A

(1) post-dates
(2) preeclampsia
(3) PROM
(4) nonreassuring fetal testing
(5) IUGR-intrauterine growth restriction

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22
Q

What is pitocin?

A

Synthesized version of the octapeptide oxytocin normally released from the posterior pituitary that causes uterine contractions

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23
Q

What is the augmentation of labor?

A

Intervening to inc the already present contractions

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24
Q

What do you use to tell if a contraction is a true contraction and what does it measure?

A

Intrauterine pressure catheter (IUPC): used to directly measure changes in the pressure during contractions

25
Q

What is the baseline fetal heart rate range?

A

110-160 bpm

26
Q

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)?

A

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

27
Q

What must accelerations be at 32 weeks?

A

15x15

28
Q

Define early deceleration.

A

Symmetrical gradual dec and return of FHR associated w/uterine contraction

29
Q

Define late deceleration.

A

Deceleration w/nadir occurring after peak of contraction then slowly returning to baseline

30
Q

Define variable deceleration.

A

Abrupt dec in FHR

31
Q

Define prolonged deceleration.

A

Deceleration lasts 2+ mins

32
Q

What does the ultrasound transducer measure?

A

Fetal heart rate

33
Q

What does the tocodynamometer measure?

A

Uterine activity

34
Q

What are 4 devices used in fetal monitoring?

A

(1) fetal scalp electrode (FSE)
(2) intrauterine pressure catheter (IUPC)
(3) fetal scalp pH
(4) pulse oximetry

35
Q

What is a FSE and what are the C/I to using it?

A

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

36
Q

What is an IUPC and what units is it measured in?

A

Catheter threaded past fetal head into uterine cavity to measure pressure changes during uterine contractions; measured in Montevideo units in a 10 min period

37
Q

Describe how to obtain a fetal scalp pH and what it is used for.

A

Fetal blood is obtained from small nick in fetal scalp to directly assess fetal hypoxia and acidemia

38
Q

What is a reassuring pH value and a non-reassuring pH value?

A

Reassuring pH: >7.25

Non-reassuring pH: <7.20

39
Q

Where is a fetal pulse oximetry placed and what is a normal value?

A

Intrauterine along the fetal cheek; normal >30%

40
Q

How is the progression of labor assessed?

A

By the progress of cervical effacement, cervical dilation, and descent of fetal presenting part

41
Q

What are the 6 cardinal movements of labor and describe each.

A

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

42
Q

What is stage 1 labor?

A

Onset of labor until complete dilation of cervix

43
Q

How long does nulliparous stage 1 labor last? Multiparous stage 1 labor?

A

(1) Nulliparous: 10-12 hrs

(2) multiparous: 6-8 hrs

44
Q

What 2 aspects does stage 1 labor include?

A

(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)

45
Q

What are the 3 P’s and what do they do?

A
  • 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
46
Q

What is stage 2 of labor?

A

Complete cervical dilation to delivery of infant

47
Q

When is stage 2 considered prolonged in nulliparous pts? w/epidural?

A

> 2 hrs; 3 hrs w/epidural

48
Q

When is stage 2 considered prolonged in multiparous pts? w/epidural?

A

> 1 hr; 2 hrs w/epidural

49
Q

What are 3 non-reassuring signs in stage 2 labor?

A

(1) repetitive late decels
(2) bradycardia
(3) loss of variability

50
Q

What is stage 3 of labor?

A

From delivery of the infant until delivery of the placenta completed (5-30 mins)

51
Q

What are 3 signs of placental separation?

A

(1) cord lengthening
(2) gush of blood
(3) uterine fundal rebound as placenta detaches

52
Q

What is the modified ritgen maneuver?

A

Using the heel of the delivering hand to exert pressure on the perineum and fingers below the maternal anus to extend the fetal head

53
Q

After the head is delivered, what do you want to check for?

A

Check infant neck for umbilical cord

54
Q

What is an episiotomy and what are the 2 types?

A

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

55
Q

What are 3 indications for operative vaginal deliveries?

A

(1) prolonged 2nd stage
(2) maternal exhaustion
(3) need to hasten delivery

56
Q

What are 2 types of operative vaginal deliveries?

A

(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

57
Q

What is a retained placenta and what are 3 types of deliveries when it happens?

A

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

58
Q

What are the 4 degrees of perineal lacerations?

A
  • 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

Clin Med 3- Exam 3 (4 decks)

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