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Clin Med 3 - Exam 3 (Women's Health) > Normal Labor and Delivery > Flashcards

Normal Labor and Delivery Flashcards

1
Q

what maneuvers are done on initial exam for pregnancy? what do they assess for?

A

Leopold maneuvers - assess fetal position externally

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2
Q

what is better than the Leopold maneuvers for assessing fetal position?

A

beside US

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3
Q

when do you do a sterile speculum exam for initial exam for pregnancy?

A

if ruptured membranes suspected

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4
Q

4 steps of Leopold Maneuvers?

A

First - fundus

Second - sides

Third - presenting part (head, butt?)

Fourth - pubic symphysis

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5
Q

rupture of membranes dx

A

SSE showing pooling -> sterile speculum exam

+ nitrizine, Ferning, Amnisure, Amniodye test

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6
Q

what is the Amniodye test for dx of rupture of membranes? what is a positive test?

A

inject blue dye into amniotic sac to look for leakage from cervix onto tampon

if don’t see it right away, but still suspect, have pt lay down for 1hr and then stand up

if tampon turns blue -> positive test

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7
Q

what is labor defined by?

A

cervical changes

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8
Q

what are 5 components of cervical examination for determining labor?

A
  • Dilation
  • Effacement
  • Fetal station
  • Cervical position
  • Consistency of cervix
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9
Q

what is the Bishop score for cervical exam for determining labor?

A

Score greater than 8 is consistent with a cervix favorable for induced labor

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10
Q

dilation of cervix for determining labor is what?

A

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

0 cm = long cervix - not dilated

10 cm = paper thin cervix - fully dilated

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11
Q

what is effacement?

A

subjective measure 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)

0 is level of ischial spine

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13
Q

vertex position of fetus?

A

head down (cephalic)

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14
Q

breech position of fetus?

A

buttocks down

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15
Q

transverse position of fetus?

A

neither head or butt down

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16
Q

face or brow position of fetus?

A

fetus is cephalic with an extended head

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17
Q

compound presentation of fetus?

A

vertex presentation with a fetal extremity

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18
Q

position of fetus determined by?

A

palpation of sutures and fontanelles

-based on relationship of fetal occiput to the maternal pelvis

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19
Q

when do you deliver the shoulders of the baby?

A

when head is completely rotated

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20
Q

what are the induction agents?

A

Prostaglandins, oxytocin, mechanical dilation of cervix, artificial rupture of membranes

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21
Q

what are the indications for IOL?

A

Post-dates, preeclampsia, PROM, nonreassuring fetal testing, IUGR (intrauterine growth restriction)

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22
Q

what bishop score may lead to failed induction 50% of the time?

A

5 or less

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23
Q

how do you do cervical ripening?

A

with PGE2 gel, cervidil, or misoprostol

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24
Q

what is cervical ripening?

A

trying to make cervix more ready for labor

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25
Q

if vaginal birth after C-section delivery, what do you NOT give?

A

DON’T give misoprostol -> won’t be able to stop labor if you need to -> increased risk of uterine rupture

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26
Q

what is Pitocin?

A

synthesized version of the octane-tide oxytocin normally released from the posterior pituitary that causes uterine contractions

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27
Q

what is augmentation of labor? what do you give?

A

Intervening to increase the already present contractions

If get to 6 cm dilated, but contractions fizzle out, may give Pitocin (or do amniotomy)

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28
Q

indications for augmentation of labor?

A

Indications similar to those for IOL, plus inadequate contractions or a prolonged phase of labor

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29
Q

what is intrauterine pressure catheter?

A

directly measures change in pressure during uterine contractions

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30
Q

what is the standard of care for fetal monitoring in labor?

A

electronic fetal monitoring

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31
Q

what is baseline fetal HR? bradycardia? tachycardia?

A

baseline is 110-160bpm

Brady = <110 bpm
Tachy = >160 bpm
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32
Q

what is absent fetal heart rate mean on monitoring?

A

amplitude range undetectable -> flat line

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33
Q

what is minimal fetal HR mean on monitoring?

A

amplitude range 5 bpm or less

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34
Q

what is moderate fetal HR mean on monitoring?

A

amplitude range between 6-25 bpm

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35
Q

what is marked fetal HR mean on monitoring?

A

amplitude range greater than 25 bpm

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36
Q

what are acceleration in fetal HR defined as?

A

onset to peak < 30sec

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37
Q

at 32 weeks, what much fetal HR acceleration be?

A

15bpm x 15 sec

38
Q

what is early deceleration of FHR?

A

Symmetrical gradual decrease and return of FHR associated with uterine contraction
(contraction and dip in FHR happening simultaneously)

39
Q

what is later deceleration of FHR?

A

Deceleration with nadir occurring after peak of contraction then slowly return to baseline

40
Q

what is variable deceleration of FHR?

A

Abrupt decrease in FHR

41
Q

what is prolonged deceleration of FHR?

A

last 2 mins or more

42
Q

what is fetal scalp electrode (FSE)? C/I’s?

A

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

Contraindications: maternal Hepatitis or HIV, fetal thrombocytopenia

43
Q

what is the only way you can truly know the strength and duration of contraction?

A

intrauterine pressure catheter (IUPC)

44
Q

what is IUPC measured in?

A

Montevideo units in a 10-min period

45
Q

what is fetal scalp pH? reassuring pH vs non-reassuring pH?

A
  • Fetal blood is obtained from small nick in fetal scalp to directly assess fetal hypoxia and acidemia
  • Reassuring >7.25, Non-reassuring <7.20
  • Not commonly done -> if truly worried about hypoxia, then SHOULD BE DELIVERING
46
Q

fetal pulse oximeter? normal O2 sat for fetus?

A

placed intrauterine along the fetal cheek to measure oxygen sat

normal >30%

47
Q

how is labor progression assessed?

A

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

48
Q

what are the cardinal movements of labor?

A

(1) Engagement
(2) Descent
(3) Flexion
(4) Internal rotation
(5) Extension
(6) External rotation (restitution)

49
Q

what is engagement?

A

fetal presenting part enters pelvis

50
Q

what is descent?

A

head descends into pelvis

51
Q

what is flexion?

A

allows smallest diameter to present

52
Q

what is internal rotation?

A

rotation of baby from an OT position, usually to OA

53
Q

what is extension?

A

vertex passes beneath pubic symphysis

54
Q

what is external rotation (restitution)?

A

once head is delivered

55
Q

how many stages of labor?

A

3

56
Q

what is stage 1 of labor?

A

onset of labor until complete dilation of cervix

57
Q

how long does stage 1 of labor take?

A

Nulliparous - 10 to 12 hrs (first baby)

Multiparous - 6 to 8 hrs

58
Q

what is latent phase vs active phase of stage 1 labor?

A

latent phase - from onset of labor to 3 or 4cm dilated
-SLOW PHASE

active phase - from latent phase to beyond 9cm
-FAST PHASE

59
Q

what is stage 2 of labor?

A

complete cervical dilation to delivery of infant

60
Q

stage 2 of labor is prolonged if?

A

> 2 hours in nulliparous patient or >3 hours with epidural

> 1 hour in multiparous patient or >2 hours with epidural

61
Q

what is common in stage 2 of labor? when does early deceleration occur? when does variable deceleration occur?

A

Repetitive early and variable decels are common

  • Head is being compressed during contraction -> early decel
  • Cord is being compressed during contraction -> variable decel
62
Q

what is NON-REASSURING in stage 2 of labor?

A

Repetitive late decels, bradycardia, or loss of variability are NON-REASSURING

63
Q

what is stage 3 of labor?

A

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

64
Q

what are the 3 signs of placental separation?

A
  • Cord lengthening
  • Gush of blood
  • Uterine fundal rebound as placenta detaches (uterus globes up, goes down and then gets firm)
65
Q

what is considered a RETAINED PLACENTA?

A

Once get to 30 mins in stage 3 of labor and still no placenta delivered

66
Q

what are the 3 P’s?

A

Power (strength and frequency of uterine contraction)

Passenger (size and position of fetus)

Passage/pelvis (size and shape of maternal pelvis)

67
Q

what is it called when baby is too large for pelvis?

A

cephalopelvic disproportion (CPD)

68
Q

what do all of the 3 P’s affect?

A

transit time during active phase of labor

69
Q

what is the Modified rigged maneuver?

A

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

70
Q

what are the 2 most common types of episiotomy?

A

median (midline) - from posterior fourchettqe into the perineal body

mediolateral - oblique incision from perineum cut laterally

NOT ROUTINELY DONE

71
Q

when do you do an episiotomy during labor?

A

fetal distress and mom has tight perineum or if you need to get hands in there for a shoulder

72
Q

when do operative vaginal delivery?

A

Prolonged second stage, maternal exhaustion, or the need to hasten delivery

73
Q

what is used to do operative vaginal delivery?

A

forceps (NOT DONE ANYMORE) or vacuum extraction - both guide fetal head out

74
Q

necessary conditions for use of forceps and vacuum extraction for operative vaginal delivery?

A

Full dilation, ruptured membranes, engaged head, at least 2 stations, knowledge of fetal position, no evidence of CPD, adequate anesthesia, empty bladder

75
Q

complications of forceps for operative vaginal delivery?

A

Bruising on face and head, laceration of fetal head, cervix, vagina, and perineum, facial nerve palsy, and rarely skull fx or intracranial damage

76
Q

what are the complications of vacuum extraction for operative vaginal delivery?

A

scalp laceration and cephalohematoma

-Hematoma is on the outside -> no damage intracranially

77
Q

when does retained placenta occur?

A

Preterm, pre-viable deliveries

Precipitous delivery (very fast delivery)

Placenta accreta (placenta invaded endometrial stroma)

Can also see in VBAC - placenta can adhere to scar from previous c-section

78
Q

how do you remove a retained placenta?

A

Manual removal - hand placed intrauterine, fingers used to shear placenta from surface of uterus

Curettage if manual extraction fails

79
Q

once whole placenta is out, what happens to uterus?

A

Uterus will contract down and feel smooth

80
Q

how many degrees of perineal lacerations?

A

4 degrees

81
Q

what is 1st degree perineal laceration?

A

superficial, confined to vaginal mucosal layer

82
Q

what is 2nd degree perineal laceration?

A

into the body of the perineum

put body of perineum back together first, then vaginal mucosa, then skin

83
Q

what is 3rd degree perineal laceration?

A

into the anal sphincter

84
Q

what is 4th degree perineal laceration? risk of this one?

A

into the rectum

  • HUGE risk for feceal incontinence
  • Make sure they are stitched up well
  • Put on stool softeners -> 100% want to avoid straining
85
Q

for 3rd and 4th degree perineal lacerations, when do you follow-up to see incision?

A

in a week

86
Q

for any delivery, what do you check to make sure are intact?

A

cervix, vagina, and rectum

87
Q

what is labor?

A

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

88
Q

what is prodromal labor?

A

false labor

irregular contractions that yield little or no cervical change

89
Q

signs of labor?

A

bloody show, N/V, palpability of contractions, patient discomfort

90
Q

what is bloody show?

A

sign of labor

a little bit of blood mucus that can be signs of labor

Clin Med 3 - Exam 3 (Women's Health) (9 decks)

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