normal labor and delivery- Moulton

Question 1

define labor

Answer 1

progressive cerival dilation resulting from regular uterine contractions that occur at least every 5 min and last 30-60 seconds

Question 2

what is false labor?

Answer 2

” braxton- hicks contractions” irregular contractions, WITHOUT cervical change

Question 3

what aer teh different diameters of the fetal head?

Answer 3

suboccipitobregmatic (9.5cm)- head well flex
supraoccipitomental- 13.5-brow presentation
occipitofrontal- 11
submentobregmatic- 9.5 - face presentation

Question 4

what are the types of pelvises a woman can have?

Answer 4

gynecoid, android, anthroploid, platypelloid

Question 5

what are the definitions of gynecoid?

Answer 5

most common
best type for vaginal birth
wide transverse diameter, slightly greater than anterior/posterior diameter
fetus head comes out occiput anterior ( looking down)

Question 6

what is android pelvis?

Answer 6

baby comes out looking at ceiling, prominent ischial spines, narrow pubic arch, male type of pelvis, POOR PROGNOSIS FOR DELIVERY

Question 7

what si anthropoid?

Answer 7

ape pelvis
larger anteroposterior diameter than transverse
narrow pubic arch
fetal head comes out looking up ( anterioposterior diameter)

Question 8

what is platyploid pelvis?

Answer 8

short AP and wide transverse diameter
fetal head in transverse diameter
poor prognosis for delivery

Question 9

how do you measiure the diagonal conjugate?

Answer 9

from the inferior portion of the pubic symphasys to the sacral promentory

Question 10

what si the number for the diagonal conjugate that shows the pelvic inlet is adequate for delivery?

Answer 10

> 11.5 cm

Question 11

what is the obstetric conjugate?

Answer 11

subtract two from the diagonal conjugate

Question 12

what is fetal lie? what is fetal presentation?

Answer 12

fetal lie- determines if the infant is longitudinal, transverse or oblique
fetal presentation- the presenting part to the pelvis

Question 13

what are teh things you want to know about the cervix when pregnant?

Answer 13

dilation, effacement, station, position, consistency

Question 14

what are teh 4 steps of the leopold maneuvers?

Answer 14

1. palpate the funds ( for head, buttocks, or transverse position)
2. palpate for the spine
3. palpate what is presenting in the pelvis
4. palpate for cephalic prominence

Question 15

what is the value for complete cervical dilation?

Answer 15

10cm

Question 16

what is effacement? what are the ranges used?

Answer 16

thinning of the cervix, reported as % of change in length, normal is 3-5 cm, the range is thick–> 100% effaced

Question 17

what is the “station” reffering to in the birthing process?

Answer 17

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

Question 18

what si the value that is used for “crowning”

Answer 18

3 or 5

Question 19

what happens in the first stage of labor?

Answer 19

onset of true labor to complete cervical dilation, there is a latent and active phase

Question 20

what hapens in the second stage of labor?

Answer 20

comlete cervical dilation to delivery of infant

Question 21

what happens in the third stage of delivery?

Answer 21

delivery of infant to delivery of placenta

Question 22

what is teh fourth stage of labor?

Answer 22

placental delivery to stabilization of pateint

Question 23

what is teh difference in the active and latent phases in the first phase of labor?

Answer 23

latent- slower cervical dilation

active- faster dilation of cervix ( admit for labor here)

Question 24

what are teh rates of cervical dilation after the initial 4 cm?

Answer 24

primiparas- 1.2 cm/hour ( minimum)

multiparas - 1.5 cm/hour ( minimum)

Question 25

how do you manage the frist stage of labor?

Answer 25

make sure to lay in the left lateral recumbant position when in bed

Question 26

what are the options for fetal monitoring?

Answer 26

external- continuous or intermittent | or internal- ( the most accurate)

Question 27

what are the guidelines for intermittent monitoring in uncomplicated preggo?

Answer 27

every 30 min in active stage of first stage | every 15 min in second stage of labor

Question 28

what is the guidelines for intermittent monitoring for a complicated preggo ( diabetes, HTN, pre eclampsia)

Answer 28

ebery 15 min in active phase ( follow a contraction) | every 5 min in second stage

Question 29

how do you record the dilation, effacement, and station of the labor?

Answer 29

4/50/-2= 4 cm dilated, 50% effaced, -2 cm station

Question 30

who typically takes longer in the first stage of labor, first time moms or veterans ?

Answer 30

first timers ( 6-18 hours)

Question 31

how long does the second stage last?

Answer 31

primiparas- 2 hours, 3 with epidural | multipara- 1 hour, 2 with epidural

Question 32

what is the order of the cardinal movemnts?

Answer 32

engagement, descent, flexion, internal rotation, extension, external rotation, expulsion " every decent family in england eats eggs"

Question 33

where does the internal rotation normally occur

Answer 33

ischial spines, the fetal head enters pelvis in transverse diameter, rotates so the occiput is anterior ( facing downward)

Question 34

what is the station during the "extension" cardinal movement? which shoulder is birthed first?

Answer 34

+5, this is crowning, the anterior shoulder is birthed first under the pubic symphasis

Question 35

what position should the mom avoid in the second phase of preggo?

Answer 35

supine, normally they are in the lithotomy position

Question 36

what is the maneuver used to deliver the fetal head?

Answer 36

ritgen maneuver

Question 37

what are indications for an episiotomy? what is the most common type of episiotomy?

Answer 37

when the likelyhood of spontaneous laceration seems likely, or to expediate delivery midline is the most common

Question 38

what are the degrees of lacerations in teh perineum?

Answer 38

1st- superficial, vaginal mucosa 2nd- extending into muscle of perineal body 3rd- includes the anal sphincter 4th- involves rectal mucosa

Question 39

what is needed for the diagnosis of retained placenta?

Answer 39

if the placenta is not delivered in 30 min

Question 40

what are the classic signs of placental separation, which means that it is now ok to remove?

Answer 40

gish of blood from the vagina, lengthening umbilical cord, fundus of uterus rises up, DO NOT PULL ON THE CORD UNTIL THESE SIGNS PRESENT

Question 41

what stage is most common for post partum hemorrhage? what si the most common cause?

Answer 41

4th stage, the most common casue is uterine atony

Question 42

when do you use cervical ripening technique?

Answer 42

induction is indicated, and cervix is unfavorabel

Question 43

what are some indications for induction of delivery?

Answer 43

abruptio placenta, fetal demise, eclampsia, and pre eclampsia, gestational HTN

Question 44

what is thebishop score, and what does is mean, whats a good score?

Answer 44

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

Question 45

what is the action of pitocin?

Answer 45

synthetic oxytocin, stimulates myometrial contractions,

Question 46

what is uterine tachysystole?

Answer 46

more than 5 contractions in a 10 min period, this is the most common side effect of pitocin

Question 47

what si the goal of obstetric anesthesia?

Answer 47

provide effective pain relief for mother during labor, and delivery that is safe for her and baby

Question 48

what is teh uterine blood flow at term gestation?

Answer 48

700-900 ml/min

Question 49

what is regional anesthesia?

Answer 49

partial or complete loss of pain sensations below T10 level

Question 50

what is teh side effect of opiod use in maternal anesthesia?

Answer 50

crosses placenta, can lead to respiratory depression of neonate

Question 51

what is the most effective form of pain relief and used the msot in the USA?

Answer 51

epidural- a catheter is placed in the epidural space, allows for continuous infusion

Question 52

when do you use spinal anesthesia?

Answer 52

with C section, this is a one time shot, limited time frame

Question 53

what is the number 1 side effect of anesthesia?

Answer 53

hypotension

Question 54

should you use inhaled anesthetics?

Answer 54

no, they all cross the placenta, and have been associated with neonatal respiratory depression

Question 55

is general anesthesia a good idea?

Answer 55

no, it has a 16 fold increase in maternal mortality