normal labor and delivery- Moulton Flashcards
define labor
progressive cerival dilation resulting from regular uterine contractions that occur at least every 5 min and last 30-60 seconds
what is false labor?
” braxton- hicks contractions” irregular contractions, WITHOUT cervical change
what aer teh different diameters of the fetal head?
suboccipitobregmatic (9.5cm)- head well flex
supraoccipitomental- 13.5-brow presentation
occipitofrontal- 11
submentobregmatic- 9.5 - face presentation
what are the types of pelvises a woman can have?
gynecoid, android, anthroploid, platypelloid
what are the definitions of gynecoid?
most common
best type for vaginal birth
wide transverse diameter, slightly greater than anterior/posterior diameter
fetus head comes out occiput anterior ( looking down)
what is android pelvis?
baby comes out looking at ceiling, prominent ischial spines, narrow pubic arch, male type of pelvis, POOR PROGNOSIS FOR DELIVERY
what si anthropoid?
ape pelvis
larger anteroposterior diameter than transverse
narrow pubic arch
fetal head comes out looking up ( anterioposterior diameter)
what is platyploid pelvis?
short AP and wide transverse diameter
fetal head in transverse diameter
poor prognosis for delivery
how do you measiure the diagonal conjugate?
from the inferior portion of the pubic symphasys to the sacral promentory
what si the number for the diagonal conjugate that shows the pelvic inlet is adequate for delivery?
> 11.5 cm
what is the obstetric conjugate?
subtract two from the diagonal conjugate
what is fetal lie? what is fetal presentation?
fetal lie- determines if the infant is longitudinal, transverse or oblique
fetal presentation- the presenting part to the pelvis
what are teh things you want to know about the cervix when pregnant?
dilation, effacement, station, position, consistency
what are teh 4 steps of the leopold maneuvers?
- palpate the funds ( for head, buttocks, or transverse position)
- palpate for the spine
- palpate what is presenting in the pelvis
- palpate for cephalic prominence
what is the value for complete cervical dilation?
10cm
what is effacement? what are the ranges used?
thinning of the cervix, reported as % of change in length, normal is 3-5 cm, the range is thick–> 100% effaced
what is the “station” reffering to in the birthing process?
the degree of descent of the presenting part of the fetus. measured in cm from the presetning part to the ischial spines
range= -5 to 5
0= bony part of head is at the level of the ischial spine
if the baby is above the ischial spine= negative numbers
what si the value that is used for “crowning”
3 or 5
what happens in the first stage of labor?
onset of true labor to complete cervical dilation, there is a latent and active phase
what hapens in the second stage of labor?
comlete cervical dilation to delivery of infant
what happens in the third stage of delivery?
delivery of infant to delivery of placenta
what is teh fourth stage of labor?
placental delivery to stabilization of pateint
what is teh difference in the active and latent phases in the first phase of labor?
latent- slower cervical dilation
active- faster dilation of cervix ( admit for labor here)
what are teh rates of cervical dilation after the initial 4 cm?
primiparas- 1.2 cm/hour ( minimum)
multiparas - 1.5 cm/hour ( minimum)
how do you manage the frist stage of labor?
make sure to lay in the left lateral recumbant position when in bed
what are the options for fetal monitoring?
external- continuous or intermittent
or internal- ( the most accurate)
what are the guidelines for intermittent monitoring in uncomplicated preggo?
every 30 min in active stage of first stage
every 15 min in second stage of labor
what is the guidelines for intermittent monitoring for a complicated preggo ( diabetes, HTN, pre eclampsia)
ebery 15 min in active phase ( follow a contraction)
every 5 min in second stage
how do you record the dilation, effacement, and station of the labor?
4/50/-2= 4 cm dilated, 50% effaced, -2 cm station
who typically takes longer in the first stage of labor, first time moms or veterans ?
first timers ( 6-18 hours)
how long does the second stage last?
primiparas- 2 hours, 3 with epidural
multipara- 1 hour, 2 with epidural
what is the order of the cardinal movemnts?
engagement, descent, flexion, internal rotation, extension, external rotation, expulsion
“ every decent family in england eats eggs”
where does the internal rotation normally occur
ischial spines, the fetal head enters pelvis in transverse diameter, rotates so the occiput is anterior ( facing downward)
what is the station during the “extension” cardinal movement? which shoulder is birthed first?
+5, this is crowning, the anterior shoulder is birthed first under the pubic symphasis
what position should the mom avoid in the second phase of preggo?
supine, normally they are in the lithotomy position
what is the maneuver used to deliver the fetal head?
ritgen maneuver
what are indications for an episiotomy? what is the most common type of episiotomy?
when the likelyhood of spontaneous laceration seems likely, or to expediate delivery
midline is the most common
what are the degrees of lacerations in teh perineum?
1st- superficial, vaginal mucosa
2nd- extending into muscle of perineal body
3rd- includes the anal sphincter
4th- involves rectal mucosa
what is needed for the diagnosis of retained placenta?
if the placenta is not delivered in 30 min
what are the classic signs of placental separation, which means that it is now ok to remove?
gish of blood from the vagina, lengthening umbilical cord, fundus of uterus rises up, DO NOT PULL ON THE CORD UNTIL THESE SIGNS PRESENT
what stage is most common for post partum hemorrhage? what si the most common cause?
4th stage, the most common casue is uterine atony
when do you use cervical ripening technique?
induction is indicated, and cervix is unfavorabel
what are some indications for induction of delivery?
abruptio placenta, fetal demise, eclampsia, and pre eclampsia, gestational HTN
what is thebishop score, and what does is mean, whats a good score?
this is to look at weatehr or not an induced vaginal birth is indicated, a score of 8 or greater is good, means that induction is just like spontaneous labor
<6 is unfavorable
what is the action of pitocin?
synthetic oxytocin, stimulates myometrial contractions,
what is uterine tachysystole?
more than 5 contractions in a 10 min period, this is the most common side effect of pitocin
what si the goal of obstetric anesthesia?
provide effective pain relief for mother during labor, and delivery that is safe for her and baby
what is teh uterine blood flow at term gestation?
700-900 ml/min
what is regional anesthesia?
partial or complete loss of pain sensations below T10 level
what is teh side effect of opiod use in maternal anesthesia?
crosses placenta, can lead to respiratory depression of neonate
what is the most effective form of pain relief and used the msot in the USA?
epidural- a catheter is placed in the epidural space, allows for continuous infusion
when do you use spinal anesthesia?
with C section, this is a one time shot, limited time frame
what is the number 1 side effect of anesthesia?
hypotension
should you use inhaled anesthetics?
no, they all cross the placenta, and have been associated with neonatal respiratory depression
is general anesthesia a good idea?
no, it has a 16 fold increase in maternal mortality
