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Clin Med III exam III > Normal Labor and Delivery > Flashcards

Normal Labor and Delivery Flashcards

1
Q

Leopold maneuvers check what

A

fetal movement

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2
Q

Order than the leopold maneuvers are done

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

Concern with prolonged PROM

A

increased risk of infection

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4
Q

How do you diagnose PROM

A
  • sterile speculum exam showing pooling
  • +nitrizine
  • ferning
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5
Q

What is amnisure

A

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

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6
Q

What is an amnio dye test

A

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

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7
Q

5 components of cervical exam

A

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

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8
Q

Bishop score greater than 8 is consistent with

A

a cervix favorable for induced labor

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9
Q

Fetal station is what

A

the relation of fetal head to ischial spines of maternal pelvis

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10
Q

Vertex presentation

A

head down

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11
Q

Breech presentation

A

butt down

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12
Q

Transverse presentation

A

neither part is down

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13
Q

Face or brow presentation

A

fetus is cephalic with an extended head

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14
Q

Compound presentation

A

vertex presentation with a fetal extremity

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15
Q

What is the fetal position in vertex presentation based on

A

the relationship of fetal occiput to the maternal pelvis

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16
Q

What is labor

A

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

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17
Q

What is prodromal labor

A

irregular contraction that yield little or no cervical change

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18
Q

Signs of labor

A
  • bloody show
  • nausea or vomiting
  • papability of contractions
  • patient discomfort
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19
Q

Induction agents

A
  • prostaglandins
  • oxytocin
  • mechanical dilation of cervix
  • artificial rupture of membrantes
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20
Q

Common indications for induction of labor

A
  • post dates
  • preeclampsia
  • PROM
  • nonreassuring fetal testing
  • IUGR
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21
Q

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

A

less than 5

cervical ripening with PGE2 gel, cervidil or misoprostol

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22
Q

What is pitocin

A

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

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23
Q

Two ways to augment labor

A
  • pitocin

- amniotomy

24
Q

What is augmentation of labor

A

intervening to increase the already present contractions

25
Q

Indications of augmentation of labor

A
  • similar to IOL
  • inadequate contractions
  • prolonged phase of labor
26
Q

Baseline fetal heart rate

A

110-160

27
Q

Absent variability. minimal. Moderate. Marked.

A

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

28
Q

What do you want accelerations to be at 32 weeks

A

15x15

29
Q

What are early decelerations

A

symmetrical gradual decrease and return of FHR associated with uterine contraction

30
Q

What are late decelerations

A

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

31
Q

What are variable decelerations

A

abrupt decreases in FHR

32
Q

When are decelerations considered prolonged

A

when they last 2 minutes or more

33
Q

What is a fetal scalp electrode

A

type of fetal monitoring

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

34
Q

What are contraindications to fetal scalp monitoring

A
  • maternal hepatitis or HIV

- fetal thrombocytopenia

35
Q

How is an intrauterine pressure catheter used

A

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

36
Q

How is pressure measured using an IUCP

A

in montevideo unitys in a 10 minute period

37
Q

Fetal scalp pH

A

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

38
Q

Reassuring fetal scalp pH. Nonreassuring fetal scalp pH

A

reassuring: >7.25

non-reassuring: <7.2

39
Q

Normal fetal pulse oximetry

A

> 30%

40
Q

What are the cardinal movements of labor

A
  • engagement
  • descent
  • flexion
  • internal rotation
  • extension
  • external rotation
41
Q

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

A

onset of labor until complete dilation of cervix

  • 10 to 12 hours in nulliparous woman
  • 6 to 8 hours in a multiparous woman
42
Q

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

A

from the onset of labor to 3 or 4 cm

43
Q

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

A

from latent phase to beyond 9 cm

44
Q

How fast to women dilate

A

1cm/hr for nulliparous

1.2cm/hr for multiparous

45
Q

What is stage 2 of labor

A

complete cervical dilation to delivery of infant (pushing)

46
Q

When is phase 2 of labor considered prolonged?

A

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

47
Q

What is stage 3 of labor

A

from delivery of the infant until delivery of the placenta

48
Q

What are the 3 signs of placental separation

A
  • cord lengthening
  • gush of blood
  • uterine fundal rebound as placenta detaches
49
Q

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

A

-an incision made in the perineum to facilitate delivery

two types:
median
mediolateral

50
Q

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

A
  • full dilation
  • ruptured membranes
  • at least 2+ station
  • knowledge of fetal position
  • no evidence of CPD
  • adequate anesthesia
  • empty bladder
51
Q

Complications of using forceps to deliver

A
  • bruising on face and head
  • laceration of fetal head, cervix, vagina and perineum
  • facial nerve palsy
  • rarely skull fracture or intracranial damage
52
Q

Complications of vacuum extraction

A
  • scalp laceration

- cephalohematoma

53
Q

What is a retained placenta?

A

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

54
Q

What conditions put mother for a higher risk of retained placenta

A
  • preterm, previable delivery
  • precipitous delivery
  • placenta accreta
55
Q

How do you fix a retained placenta?

A

-manual removal
OR
-curettage if manual excision failed

56
Q

Classification of perineal lacerations

A

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

Clin Med III exam III (10 decks)

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