Normal Labor and Delivery

Question 1

Leopold maneuvers check what

Answer 1

fetal movement

Question 2

Order than the leopold maneuvers are done

Answer 2

1. fundus
2. sides
3. presenting part
4. pubic symphysis

Question 3

Concern with prolonged PROM

Answer 3

increased risk of infection

Question 4

How do you diagnose PROM

Answer 4

• sterile speculum exam showing pooling
• +nitrizine
• ferning

Question 5

What is amnisure

Answer 5

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

Question 6

What is an amnio dye test

Answer 6

amniocentesis used to inject dilute indigo carmine into the amniotic sac to look for leakage from cervix onto a tampon

Question 7

5 components of cervical exam

Answer 7

-dilation
-effacement
-fetal station
cervical position
-consistency of cervix

Question 8

Bishop score greater than 8 is consistent with

Answer 8

a cervix favorable for induced labor

Question 9

Fetal station is what

Answer 9

the relation of fetal head to ischial spines of maternal pelvis

Question 10

Vertex presentation

Answer 10

head down

Question 11

Breech presentation

Answer 11

butt down

Question 12

Transverse presentation

Answer 12

neither part is down

Question 13

Face or brow presentation

Answer 13

fetus is cephalic with an extended head

Question 14

Compound presentation

Answer 14

vertex presentation with a fetal extremity

Question 15

What is the fetal position in vertex presentation based on

Answer 15

the relationship of fetal occiput to the maternal pelvis

Question 16

What is labor

Answer 16

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

Question 17

What is prodromal labor

Answer 17

irregular contraction that yield little or no cervical change

Question 18

Signs of labor

Answer 18

• bloody show
• nausea or vomiting
• papability of contractions
• patient discomfort

Question 19

Induction agents

Answer 19

• prostaglandins
• oxytocin
• mechanical dilation of cervix
• artificial rupture of membrantes

Question 20

Common indications for induction of labor

Answer 20

• post dates
• preeclampsia
• PROM
• nonreassuring fetal testing
• IUGR

Question 21

Bishop score less than ___ can lead to failed induction. What do you do?

Answer 21

less than 5

cervical ripening with PGE2 gel, cervidil or misoprostol

Question 22

What is pitocin

Answer 22

synthesized version of the actapeptide oxytocin normally released from the posterior pituitary that causes uterine contractions

Question 23

Two ways to augment labor

Answer 23

• pitocin

- amniotomy

Question 24

What is augmentation of labor

Answer 24

intervening to increase the already present contractions

Question 25

Indications of augmentation of labor

Answer 25

- similar to IOL - inadequate contractions - prolonged phase of labor

Question 26

Baseline fetal heart rate

Answer 26

110-160

Question 27

Absent variability. minimal. Moderate. Marked.

Answer 27

absent: undetectable amplitude range minimal: amplitude range 5bpm or less moderate: amplitude range between 6-25 bpm marked: amplitude greater than 25 bpm

Question 28

What do you want accelerations to be at 32 weeks

Answer 28

15x15

Question 29

What are early decelerations

Answer 29

symmetrical gradual decrease and return of FHR associated with uterine contraction

Question 30

What are late decelerations

Answer 30

deceleration with nadir occurring after peak of contraction then slowly returning to baseline

Question 31

What are variable decelerations

Answer 31

abrupt decreases in FHR

Question 32

When are decelerations considered prolonged

Answer 32

when they last 2 minutes or more

Question 33

What is a fetal scalp electrode

Answer 33

type of fetal monitoring small electrode is attached directly to the fetal scalp and senses potential differences created by depolarization of the fetal heart

Question 34

What are contraindications to fetal scalp monitoring

Answer 34

- maternal hepatitis or HIV | - fetal thrombocytopenia

Question 35

How is an intrauterine pressure catheter used

Answer 35

catheter threaded past the fetal head into the uterine cavity to measure pressure changes during uterine contractions

Question 36

How is pressure measured using an IUCP

Answer 36

in montevideo unitys in a 10 minute period

Question 37

Fetal scalp pH

Answer 37

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

Question 38

Reassuring fetal scalp pH. Nonreassuring fetal scalp pH

Answer 38

reassuring: >7.25 non-reassuring: <7.2

Question 39

Normal fetal pulse oximetry

Answer 39

>30%

Question 40

What are the cardinal movements of labor

Answer 40

- engagement - descent - flexion - internal rotation - extension - external rotation

Question 41

What is stage 1 of labor? How long does it typically last?

Answer 41

onset of labor until complete dilation of cervix - 10 to 12 hours in nulliparous woman - 6 to 8 hours in a multiparous woman

Question 42

Latent phase of stage 1 of labor is from ___ to ___

Answer 42

from the onset of labor to 3 or 4 cm

Question 43

Active phase of stage 1 of labor is from ___ to __

Answer 43

from latent phase to beyond 9 cm

Question 44

How fast to women dilate

Answer 44

1cm/hr for nulliparous 1.2cm/hr for multiparous

Question 45

What is stage 2 of labor

Answer 45

complete cervical dilation to delivery of infant (pushing)

Question 46

When is phase 2 of labor considered prolonged?

Answer 46

nulliparous: >2hr or >3hrs with epidural multiparous: >1hr or >2hrs with epidural

Question 47

What is stage 3 of labor

Answer 47

from delivery of the infant until delivery of the placenta

Question 48

What are the 3 signs of placental separation

Answer 48

- cord lengthening - gush of blood - uterine fundal rebound as placenta detaches

Question 49

What is an episiotomy? What are the two common types?

Answer 49

-an incision made in the perineum to facilitate delivery two types: median mediolateral

Question 50

What conditions are necessary in order to use forceps/vacuum to deliver the baby

Answer 50

- full dilation - ruptured membranes - at least 2+ station - knowledge of fetal position - no evidence of CPD - adequate anesthesia - empty bladder

Question 51

Complications of using forceps to deliver

Answer 51

- bruising on face and head - laceration of fetal head, cervix, vagina and perineum - facial nerve palsy - rarely skull fracture or intracranial damage

Question 52

Complications of vacuum extraction

Answer 52

- scalp laceration | - cephalohematoma

Question 53

What is a retained placenta?

Answer 53

a placenta that is not delivered withing 30 minutes after baby is delivered

Question 54

What conditions put mother for a higher risk of retained placenta

Answer 54

- preterm, previable delivery - precipitous delivery - placenta accreta

Question 55

How do you fix a retained placenta?

Answer 55

-manual removal OR -curettage if manual excision failed

Question 56

Classification of perineal lacerations

Answer 56

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