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R2F > Normal Labor and Delivery > Flashcards

Normal Labor and Delivery Flashcards

1
Q

labor

A

-progressive cervical dilation resulting from uterine contractions that occur every 5 min and last 30-60 seconds

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2
Q

false labor

A

irregular contractions w/o cervical change

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3
Q

pelvic shapes

A
  • gynecoid
  • android
  • anthropoid
  • platypelloid
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4
Q

gynecoid

A

classic female type of pelvis (50%)

  • round at inlet
  • wide transverse diameter only slightly greater than AP diameter
  • wide suprapubic arch (>90 degrees)
  • good prognosis of delivery- head rotates in OA position
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5
Q

android

A

classic male type of pelvic (30% of females)

  • widest transverse diameter closer to sacrum
  • prominent ischial spines
  • narrow pubic arch
  • head forced to be in OP position- poor prognosis
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6
Q

anthropoid

A

ape pelvic (20% of females)

  • much larger AP then transverse diameter
  • long narrow oval shape
  • narrow pubic arch
  • head in OP position- good prognosis
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7
Q

platypelloid

A

flattened gynecoid pelvic (3%)

  • short AP, wide transverse diameter
  • wide bispinous diameter
  • wise suprapubic arch
  • poor prognosis
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8
Q

obstetric exam

A
  • fetal lie (longitudinal, transverse, oblique)
  • fetal presentation (vertex, breech, transverse, or compound)
  • cervical exam
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9
Q

leopold maneuvers

A
  • palpate fundus (fetal head vs buttocks vs transverse position)
  • palpate for spine and fetal small parts
  • palpate what is presenting in the pelvis with suprapubic palpation
  • palpate for cephalic prominence
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10
Q

cervical exam

A
  • dilation (level of internal os)
  • effacement (thinning of cervix, % of change in length)
  • station (-5 cm to +5 cm- ischial spines is 0)
  • consistency and position
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11
Q

labor stages

A
  • 1- onset of true labor to complete cervical dilation- latent and active phase
  • 2- complete cervical dilation to delivery of infant
  • 3- delivery of infant to delivery of placenta
  • 4- delivery of placenta to stabilization of pt
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12
Q

labor- 1st stage

A
  • latent (early labor)- slow cervical dilation

- active- faster rate of dilation (when cervix is dilated to 4 cm)

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13
Q

labor- 1st stage- duration, cervical dilation rate

A
  • duration- primiparas- 6-18 hrs; multiparas 2-10 hrs

- cervical dilation- primiparas 1.2 cm/hr; multiparas 1.5 cm/hr

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14
Q

1st stage- management

A
  • maternal position
  • fluids- IV
  • labs- CBC and T&S
  • maternal monitoring- vitals q1-2 h while in labor
  • analgesia
  • fetal monitoring
  • uterine activity
  • vaginal examinations
  • amniotomy
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15
Q

1st stage- fetal monitoring

A

-external- continuous, q30 min in active phase in 1st phase, q15 min in 2nd stage

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16
Q

second stage- duration

A

desc of presenting part and delivery!

  • primara w/o epidural- 2 h
  • primarapara w/ epidural- 3 h
  • multipara w/o epidural- 1 h
  • multipara w epidural- 2 h
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17
Q

cardinal movements of labor- engagement

A

-presenting part at 0 station

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18
Q

cardinal movements of labor- flexion

A

-OA- baby’s chin to chest thus changing the presenting part from occipitofrontal to the smaller suboccipitobregmatic

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19
Q

cardinal movements of labor- internal rotation

A
  • usually occurs at ischial spines
  • fetal head enters pelvic in transverse diameter, rotates so the occiput turns anteriorly or posteriorly twd pubic symphysis
20
Q

cardinal movements of labor- extension

A
  • crowning occurs when the largest diameter of fetal head is encircled by vaginal introitus
  • station is +5
  • head is born by rapid extension
21
Q

cardinal movements of labor- external rotation

A

-delivered head returns to its original position to align itself with fetal back and shoulers

22
Q

cardinal movements of labor- expulsion

A

-ant shoulder delivers under the pubic symphysis followed by posterior shoulder and rest of body

23
Q

second stage- management

A
  • maternal position- avoid supine position
  • bearing down
  • fetal monitoring- continuous- q15 or 5 with risk factors
  • vaginal exam
  • delivery of fetus
24
Q

episiotomy- indiations

A
  • likelihood of spontaneous lacerations seems high; expedite delivery
  • midline- most common
  • mediolateral
25
Q

modified ritgen maneuver

A

-fingers of right head are used to extend the head while counterpressure is applied to the occiput by the left hand to allow for more controlled delivery

26
Q

perineal lacerations

A
  • 1st degree- superficial- vaginal mucosa and/or perineal skin
  • 2nd- m’s of perineal body
  • 3rd- thru anal sphincter
  • 4th- rectal mucosa
27
Q

third stage

A

interval b/w delivery of infant to delivery of placenta (2-10 min)

  • retained placenta if not delivered > 30 min
  • apply counter pressure b/w symphysis and fundus
  • do NOT pull on cord until classic signs are noted
28
Q

placental separation- classic signs

A
  • gush of blood from vagina
  • lengthening of umbilical cord
  • fundus of uterus rises up
  • change in shape of uterine fundus from discoid to globular
29
Q

third stage- management

A
  • look for lacerations of cervix, vagina, perineum
  • monitor uterine bleeding
  • repair episiotomy or spontaneous lacerations
  • inspect placenta for completeness
30
Q

4th stage- management

A
  • monitor pt closely
  • vitals
  • uterine fundal checks, assess for vaginal bleeding
  • postpartum hemorrhage commonly occurs at this time- uterine atony, retained placenta, unrepaired vaginal laceration
31
Q

induction and augmentation of labor

A
  • cervical ripening
  • induction of labor
  • augmentation
32
Q

indications for induction

A
  • abruptio placentae
  • chorioamnionitis
  • fetal demise
  • preeclampsia, eclampsia
  • gestational HTN
  • PROM
  • postterm pregnancy
  • maternal medical conditions
  • fetal compromise
33
Q

contraindications to induction

A
  • unstable fetal presentation
  • acute fetal distress
  • placental previa or vasa previa
  • prev classical c-section
  • contraindications to vaginal delivery
34
Q

bishop score

A

<6- unfavorable

>8- probability of vaginal delivery after labor induction is similar to that of spontaneous labor

35
Q

cervical ripening agents

A

-cervidil (dinoprostone)- PGE2- vaginal insert
(contraindicated in pts w/ prev c-section)
-cytotec (misoprostol)- PGE1
-mechanical dilators- foley bulb catheter, laminara jopincum

36
Q

pitocin insufion

A
  • synthetic oxytocin- stim myometrial contractions

- IV

37
Q

Pitocin complications

A
  • uterine tachysystole- > 5 contractions in 10 min- most common SE
  • antidiuretic effect
  • uterine m fatigue (unresponsiveness)- inc risk of postpartum hemorrhage secondary to uterine atony
38
Q

obstetric anesthesia

A
  • adequate hydration prior to regional anesthesia (mitigate risk for hypotension)
  • regional anesthesia- partial/complete loss of pain sensation below T10!!
39
Q

pain pathways

A
  • uterine contractions and cervical dilation- visceral pain- T10-12 thru L1
  • descent of fetal head- somatic pain- pudendal n- S2-4
40
Q

anesthesia options

A
  • nonpharmacologic
  • parenteral
  • regional- epidural, spinal
  • local- local infiltration of perineum, pudendal block
  • general
41
Q

anesthesia options- nonpharmacologic

A
  • lamaze
  • emotional support
  • back massage
  • hydrotherapy
  • acupuncture
42
Q

anesthesia options- parenteral

A
  • more effective in early 1st stage of labor when pain is more visceral and less intense
  • little efficacy for relief of labor pain- primary moa is heavy sedation
  • opioids cross placental barrier- neonatal resp depression (Naloxone- opioid antagonist)
43
Q

anesthesia options- regional

A
  • loss of pain sensation below T8-10
  • local anesthesia (bupivacaine/lidocaine) + narcotic (fentanyl)
  • epidural- most effective form- needle b/w L2-3- catheter placed over needle
  • spinal- single-shot analgesia
44
Q

regional anesthesia- benefits, SE’s

A
  • highly effective, mother remains alert/awake, will remember experience, rarely requires local anesthesia for perineal lacerations
  • hypotension (10%)
  • spinal headaches (1%)
  • fever, spinal hematomas and abscess
45
Q

regional anesthesia- contraindication

A
  • maternal coagulopathy
  • heparin use within 12 hrs
  • untreated maternal bacteremia
  • inc ICP caused by mass lesion
  • skin infection over site of needle placement
46
Q

anesthesia options- ocal

A
  • local infiltration of perineum- 1-2% lidocaine provides anesthesia for 20-40 min- b/f episiotomy or with laceration repairs
  • pudendal block
47
Q

anesthesia options- general

A
  • propofol!!
  • loss of maternal consciousness, airway management
  • 16x risk of maternal mortality compared to regional anesthesia
  • inhaled anesthetics cross placenta- neonatal resp depression

R2F (18 decks)

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