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Repro weeks 3-4 Jake > normal labor and delivery- Moulton > Flashcards

normal labor and delivery- Moulton Flashcards

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1
Q

define labor

A

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

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2
Q

what is false labor?

A

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

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3
Q

what aer teh different diameters of the fetal head?

A

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

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4
Q

what are the types of pelvises a woman can have?

A

gynecoid, android, anthroploid, platypelloid

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5
Q

what are the definitions of gynecoid?

A

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

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6
Q

what is android pelvis?

A

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

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7
Q

what si anthropoid?

A

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

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8
Q

what is platyploid pelvis?

A

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

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9
Q

how do you measiure the diagonal conjugate?

A

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

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10
Q

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

A

> 11.5 cm

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11
Q

what is the obstetric conjugate?

A

subtract two from the diagonal conjugate

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12
Q

what is fetal lie? what is fetal presentation?

A

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

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13
Q

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

A

dilation, effacement, station, position, consistency

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14
Q

what are teh 4 steps of the leopold maneuvers?

A
  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
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15
Q

what is the value for complete cervical dilation?

A

10cm

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16
Q

what is effacement? what are the ranges used?

A

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

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17
Q

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

A

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

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18
Q

what si the value that is used for “crowning”

A

3 or 5

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19
Q

what happens in the first stage of labor?

A

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

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20
Q

what hapens in the second stage of labor?

A

comlete cervical dilation to delivery of infant

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21
Q

what happens in the third stage of delivery?

A

delivery of infant to delivery of placenta

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22
Q

what is teh fourth stage of labor?

A

placental delivery to stabilization of pateint

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23
Q

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

A

latent- slower cervical dilation

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

24
Q

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

A

primiparas- 1.2 cm/hour ( minimum)

multiparas - 1.5 cm/hour ( minimum)

25
Q

how do you manage the frist stage of labor?

A

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

26
Q

what are the options for fetal monitoring?

A

external- continuous or intermittent

or internal- ( the most accurate)

27
Q

what are the guidelines for intermittent monitoring in uncomplicated preggo?

A

every 30 min in active stage of first stage

every 15 min in second stage of labor

28
Q

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

A

ebery 15 min in active phase ( follow a contraction)

every 5 min in second stage

29
Q

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

A

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

30
Q

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

A

first timers ( 6-18 hours)

31
Q

how long does the second stage last?

A

primiparas- 2 hours, 3 with epidural

multipara- 1 hour, 2 with epidural

32
Q

what is the order of the cardinal movemnts?

A

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

33
Q

where does the internal rotation normally occur

A

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

34
Q

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

A

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

35
Q

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

A

supine, normally they are in the lithotomy position

36
Q

what is the maneuver used to deliver the fetal head?

A

ritgen maneuver

37
Q

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

A

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

38
Q

what are the degrees of lacerations in teh perineum?

A

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

39
Q

what is needed for the diagnosis of retained placenta?

A

if the placenta is not delivered in 30 min

40
Q

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

A

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

41
Q

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

A

4th stage, the most common casue is uterine atony

42
Q

when do you use cervical ripening technique?

A

induction is indicated, and cervix is unfavorabel

43
Q

what are some indications for induction of delivery?

A

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

44
Q

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

A

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

45
Q

what is the action of pitocin?

A

synthetic oxytocin, stimulates myometrial contractions,

46
Q

what is uterine tachysystole?

A

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

47
Q

what si the goal of obstetric anesthesia?

A

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

48
Q

what is teh uterine blood flow at term gestation?

A

700-900 ml/min

49
Q

what is regional anesthesia?

A

partial or complete loss of pain sensations below T10 level

50
Q

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

A

crosses placenta, can lead to respiratory depression of neonate

51
Q

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

A

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

52
Q

when do you use spinal anesthesia?

A

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

53
Q

what is the number 1 side effect of anesthesia?

A

hypotension

54
Q

should you use inhaled anesthetics?

A

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

55
Q

is general anesthesia a good idea?

A

no, it has a 16 fold increase in maternal mortality

Repro weeks 3-4 Jake (9 decks)

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