Normal Labor And Delivery

Question 1

How do we define labor?

Answer 1

Progressive cervical dilation from uterine contractions that occur every 5 minutes and last 30-60 seconds

Question 2

Which two pelvis shapes have good prognosis for delivery and which two pelvis shapes have bad prognosis for delivery?

Answer 2

Gynecoid and anthropoid

Android and platypelloid

Question 3

What is adequate for the diagonal conjugate for delivery?
What is considered adequate of the transverse diameter for delivery?
What is considered adequate for infra pubic angle for delivery?

Answer 3

Greater than 11.5 cm
8.5 cm
Greater than 90 degrees

Question 4

Where do we check cervical dilation and what is the range?

Answer 4

Internal os, closed to 10cm

Question 5

What is effacement and how do we report it?

Answer 5

Thinning of the cervix and we report it as a percentage of change from normal thickness.

Question 6

What is considered station zero of the baby and what is the range of station?

Answer 6

Degree of descent of baby.

Zero station is when head reaches the level of the ischial spines of mom

Question 7

How many stages of labor are there?

Answer 7

4

Question 8

What are the two phases of the fist stage of labor and how do we define them?

Answer 8

Latent phase which is onset of labor to about 4 cm of dilation. Slower dilation.
Active phase is 4 cm of dilation moving forward and faster rate of dilation. Admit at this stage.

Question 9

5 things to monitor for mom during first stage of labor?

Answer 9

Her position
IV fluids to stay hydrated
Labs
Vitals every 1-2 hours 
Pain meds

Question 10

How often are we monitoring baby vitals during first and second stage of uncomplicated and complicated pregnancies?

Answer 10

Every 30 minutes first stage and every 15 minutes second stage for uncomplicated
Every 15 and 5 for first and second stage of complicated pregnancies

Question 11

What should the doc be examining during active phase of stage 1?

Answer 11

Check cervix every 2 hours

Check for dilation, effacement, and station.

Question 12

What is amniotomy?

Answer 12

Basically, breaking the membranes which can help induce labor. Move things along.

Question 13

How do we define the second stage of labor?

Answer 13

Baby comes through maternal pelvis and ends with delivery of baby.

Question 14

What are the 7 cardinal movements of labor?

Answer 14

Engagement, descent, flexion, IR, extension, ER, expulsion

Question 15

What should mom be doing for easier delivery of baby during delivery?

Answer 15

Lay on back, legs up and spread, and hold breath and bear down.

Question 16

Two things doc can do when baby’s head comes out?

Answer 16

Bulb suction mouth then nose to clear blood and fluid from airway
Check for nuchal cord

Question 17

Technique to delivery baby?

Answer 17

Once head is out, gently push down on head to get anterior shoulder out, then pull up on head to get posterior shoulder out. Support body as baby is delivered.

Question 18

What is an episiotomy and which type is most common?

Answer 18

Cut the vaginal canal to be bigger if you think there is a high chance it will tear.
Midline is best technique.

Question 19

What is the modified ritgen maneuver for and how is it performed?

Answer 19

To deliver the head.

Use right hand to extend baby and left hand to apply counter pressure on top of head.

Question 20

What is torn in a first degree, second degree, third degree and fourth degree laceration?

Answer 20

Vaginal mucosa and or perineal skin
Extends into perineal body but not anal sphincter
Extends into or through anal sphincter but not rectal mucosa
Involves rectal mucosa

Question 21

What is going on during stage 3?

Answer 21

Deliver that placenta

Question 22

When can we diagnose retained placenta and what do we not do while waiting for delivery of the placenta?

Answer 22

If placenta has not been delivered within 30 minutes

Don’t pull on the cord until classic signs of delivery are seen.

Question 23

What is a good maneuver to do to encourage the placenta to be delivered?

Answer 23

Apply counter pressure between symphysis and fundus

Question 24

3 things to complete for management of stage 3?

Answer 24

Repair any lacerations
Monitor uterine bleeding
Check placenta for completeness that everything came out

Question 25

What is the big deal during stage 4?

Answer 25

Monitoring the patient

Uterine fundal checks and checking vaginal bleeding

Question 26

What is the goal of cervical ripening?

Answer 26

Stimulate softening, thinning and dilation of cervix

Question 27

Difference between inducing Labor and augmenting it?

Answer 27

Induction is starting it

Augmenting is stimulating labor that has already started

Question 28

5 contraindications to induction?

Answer 28

Unstable baby
Acute fetal distress
Placental previa
Previous c section
Any contraindications to vaginal delivery

Question 29

What does the bishop score tell us?

Answer 29

If the cervix is favorable for delivery