Normal Labor and Delivery Flashcards
Leopold maneuvers check what
fetal movement
Order than the leopold maneuvers are done
- fundus
- sides
- presenting part
- pubic symphysis
Concern with prolonged PROM
increased risk of infection
How do you diagnose PROM
- sterile speculum exam showing pooling
- +nitrizine
- ferning
What is amnisure
rapid test that identifies placental alpha-microglobulin-1 via immunoassay
What is an amnio dye test
amniocentesis used to inject dilute indigo carmine into the amniotic sac to look for leakage from cervix onto a tampon
5 components of cervical exam
-dilation
-effacement
-fetal station
cervical position
-consistency of cervix
Bishop score greater than 8 is consistent with
a cervix favorable for induced labor
Fetal station is what
the relation of fetal head to ischial spines of maternal pelvis
Vertex presentation
head down
Breech presentation
butt down
Transverse presentation
neither part is down
Face or brow presentation
fetus is cephalic with an extended head
Compound presentation
vertex presentation with a fetal extremity
What is the fetal position in vertex presentation based on
the relationship of fetal occiput to the maternal pelvis
What is labor
regular uterine contractions that cause cervical change in either effacement or dilation
What is prodromal labor
irregular contraction that yield little or no cervical change
Signs of labor
- bloody show
- nausea or vomiting
- papability of contractions
- patient discomfort
Induction agents
- prostaglandins
- oxytocin
- mechanical dilation of cervix
- artificial rupture of membrantes
Common indications for induction of labor
- post dates
- preeclampsia
- PROM
- nonreassuring fetal testing
- IUGR
Bishop score less than ___ can lead to failed induction. What do you do?
less than 5
cervical ripening with PGE2 gel, cervidil or misoprostol
What is pitocin
synthesized version of the actapeptide oxytocin normally released from the posterior pituitary that causes uterine contractions
Two ways to augment labor
- pitocin
- amniotomy
What is augmentation of labor
intervening to increase the already present contractions
Indications of augmentation of labor
- similar to IOL
- inadequate contractions
- prolonged phase of labor
Baseline fetal heart rate
110-160
Absent variability. minimal. Moderate. Marked.
absent: undetectable amplitude range
minimal: amplitude range 5bpm or less
moderate: amplitude range between 6-25 bpm
marked: amplitude greater than 25 bpm
What do you want accelerations to be at 32 weeks
15x15
What are early decelerations
symmetrical gradual decrease and return of FHR associated with uterine contraction
What are late decelerations
deceleration with nadir occurring after peak of contraction then slowly returning to baseline
What are variable decelerations
abrupt decreases in FHR
When are decelerations considered prolonged
when they last 2 minutes or more
What is a fetal scalp electrode
type of fetal monitoring
small electrode is attached directly to the fetal scalp and senses potential differences created by depolarization of the fetal heart
What are contraindications to fetal scalp monitoring
- maternal hepatitis or HIV
- fetal thrombocytopenia
How is an intrauterine pressure catheter used
catheter threaded past the fetal head into the uterine cavity to measure pressure changes during uterine contractions
How is pressure measured using an IUCP
in montevideo unitys in a 10 minute period
Fetal scalp pH
fetal blood is obtained from small nick in fetal scalp to directly assess fetal hypoxia and acidemia
Reassuring fetal scalp pH. Nonreassuring fetal scalp pH
reassuring: >7.25
non-reassuring: <7.2
Normal fetal pulse oximetry
> 30%
What are the cardinal movements of labor
- engagement
- descent
- flexion
- internal rotation
- extension
- external rotation
What is stage 1 of labor? How long does it typically last?
onset of labor until complete dilation of cervix
- 10 to 12 hours in nulliparous woman
- 6 to 8 hours in a multiparous woman
Latent phase of stage 1 of labor is from ___ to ___
from the onset of labor to 3 or 4 cm
Active phase of stage 1 of labor is from ___ to __
from latent phase to beyond 9 cm
How fast to women dilate
1cm/hr for nulliparous
1.2cm/hr for multiparous
What is stage 2 of labor
complete cervical dilation to delivery of infant (pushing)
When is phase 2 of labor considered prolonged?
nulliparous: >2hr or >3hrs with epidural
multiparous: >1hr or >2hrs with epidural
What is stage 3 of labor
from delivery of the infant until delivery of the placenta
What are the 3 signs of placental separation
- cord lengthening
- gush of blood
- uterine fundal rebound as placenta detaches
What is an episiotomy? What are the two common types?
-an incision made in the perineum to facilitate delivery
two types:
median
mediolateral
What conditions are necessary in order to use forceps/vacuum to deliver the baby
- full dilation
- ruptured membranes
- at least 2+ station
- knowledge of fetal position
- no evidence of CPD
- adequate anesthesia
- empty bladder
Complications of using forceps to deliver
- bruising on face and head
- laceration of fetal head, cervix, vagina and perineum
- facial nerve palsy
- rarely skull fracture or intracranial damage
Complications of vacuum extraction
- scalp laceration
- cephalohematoma
What is a retained placenta?
a placenta that is not delivered withing 30 minutes after baby is delivered
What conditions put mother for a higher risk of retained placenta
- preterm, previable delivery
- precipitous delivery
- placenta accreta
How do you fix a retained placenta?
-manual removal
OR
-curettage if manual excision failed
Classification of perineal lacerations
1st degree- superficial, confined to vaginal mucosa
2nd degree- into the body of the perineum
3rd degree- into the anal sphincter
4th degree- into the rectum
