Normal Labor and Delivery - Moulton

Question 1

Labor vs False Labor

Answer 1

Labor - regular uterine contractions that cause progressive cervical dilation

False labor - Irregular contractions, no cervical dilation

Question 2

***Fetal head should be in what position at birth?

***What “axis” is the shortest and associated w/ this?

Answer 2

Well flexed

Suboccipitobregmatic

Question 3

***Most common pelvis shape

Baby position?

Answer 3

Gynecoid (50%) - round inlet, wide transverse in middle, wide suprapubic arch

OA (occiput anterior)

Question 4

Woman, delivering well, baby is occiput posterior. Most likely pelvis shape?

Answer 4

Anthropoid (20%) - large A-P axis, long narrow oval shape

Question 5

2 pelvis shapes w/ poor prognosis for delivery

Answer 5

Platypelloid (transverse)

Android (OP)

Question 6

Diagonal conjugate

Good value?

Answer 6

Inferior of pubic symphysis to sacral promentory = close to size of pelvic inlet

11.5 cm

Question 7

Measuring pelvic inlet

Answer 7

• Distance between ischial tuberosities (> 8.5)

- Infrapubic arch (> 90)

Question 8

**Fetal lie vs. Fetal presentation

Answer 8

Lie = longitudinal, transverse, or oblique

Presentation = vertex, breech, transverse

Question 9

Fully dilated = ___ cm

Answer 9

10

Question 10

Effacement = what?

Answer 10

Thinning of cervix, reported as % of change in length

Question 11

Station = what?

- Values?

Answer 11

Degree of descent of baby

• Zero = at ischial spines
• (-1) to (-5) = above that
• +1 to +5 = below that

Question 12

• **Duration of first stage of labor…
  
  • 1st pregnancy
  • 2nd + pregnancy

Answer 12

6-18 hours

2-10 hours

Question 13

• **Rate of cervical dilation…
  
  • 1st pregnancy
  • 2nd + pregnancy

Answer 13

1. 2 cm per hour

1. 5 cm per hour

Question 14

***2 types of fetal monitoring

***Uncomplicated vs. complicated?

Answer 14

• Continuous
• Intermittent
  
  • Uncomp. = q30 min 1st stage, q15 min 2nd stage
  • Comp. = q15 min 1st stage, q5 min 2nd stage

Question 15

• **Durations of 2nd stage…
  
  • 1st vs. 2nd +
  • Epidural?

Answer 15

1st = 2 hours
2nd = 1 hour
Epidural = ADD 1 HOUR

Question 16

***7 cardinal movements of labor

How to remember?

Answer 16

• Engagement (station = 0)
• Descent
• Flexion (to get SOB diameter)
• Internal rotation (to OA/OP)
• Extension (crowining = +5, then rapid extension to birth)
• External rotation (back to TV)
• Expulsion (shoulders)

“Every decent family in England eats eggs”

Question 17

If placenta doesn’t come out after 30 minutes…

Answer 17

“Retained placenta” - must go get it

Question 18

***Signs of placental separation

Answer 18

• Gush of blood
• Lengthening of cord
• Fundus rises up
• Fundus becomes globular

Question 19

3 most common causes of postpartum hemorrhage

MOST common one?

Answer 19

• Uterine atony
• Retained placenta
• Unrepaired laceration

ATONY

Question 20

***3 ways to ripen a cervix

Answer 20

• Dinoprostone (PGE2 insert)
• Misoprostol (PGE1)
• Foley bulb catheter (mechanical dilation)

Question 21

**When can you NOT use Cervidil (Dino) or Cytotec (Miso)?

Answer 21

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