Normal Labor and Delivery (Moulton) Flashcards
Labor is a progressive cervical dilation from regular uterine contractions that occur how often and last how long?
1) every 5 minutes
2) 30-60 seconds
False Labor (Braxton-Hicks contractions) is defined as?
Irregular contractions without cervical change
What is Anterior Fontanelle shape
What is Posterior Fontanelle Shape
1) Diamond
2) Y/Triangle
What is the longest anterior posterior diameter of the head?
Supraoccipitomental
What are the 4 pelvic shapes?
What are the Prognosis of each
What position do they come in?
Gynecoid-Good- Occiput Anterior
Anthropoid -Good- Occiput Posterior
Android (male)- Poor- Occiput Posterior
Platypelloid- Poor- Transverse
Which pelvis shape is characterized by a much larger anteroposterior than transverse diameter, creates a long narrow oval shape, and has a narrow pubic arch?
Which pelvis shape is characterized by the widest transverse diameter closer to the sacrum, prominent ischial spines, and a narrow pubic arch?
Which pelvis shape is characterized by a short AP and wide transverse diameter, wide bispinous diameter, and a wide suprapubic arch?
Which pelvis shape is characterized by round at the inlet, wide transverse diameter only slightly greater then the anteroposterior diameter, and a wide suprapubic arch (>90 degrees)?
1) Anthropoid
2) Android
3) Platypelloid
4) Gynecoid
The diagonal conjugate is approximated by measuring from the inferior portion of what to what?
If the diagonal conjugate is greater than 11.5 cm, then what is adequate?
1) Pubic symphysis to the sacral promontory
2) >11.5 cm, then AP diameter of pelvic inlet is adequate
What is the obstetric conjugate?
It is measured by?
1) The narrowest distance the fetal head must pass through during a vaginal delivery
2) Subtracting 2.0 cm from the diagonal conjugate
1) Pelvic outlet is assessed by measuring what?
2) What distance between ischial tuberosities is good for transverse diameter?
1) Measuring Ischial tuberosities and Pubic Arch
2) 8.5 cm
When assessing the infrapubic angle you want to place thumb next to each inferior pubic ramus and estimate the angle at which they meet, greater than ____ degrees is good.
90
1) What is the reference for fetal lie?
2) It determines if the infant is what?
1) Maternal spine to fetus spine
2) Longitudinal, transverse, or oblique
The Leopold maneuvers are a series of 4 maneuvers:
Palpate
1) Fundus
2) Spine
3) Suprapubic
4) Cephalic prominence (chin)
FSSC
How is Cervical Exam done?
What are the ranges?
1) Dilation (at internal os)
2) Cervical effacement (Thinning of the cervix)
3) Station- Degree of descent (-5 to 5 cm)
4) Consistency and position- to calculate Bishop Score
*DCSC
What is the first stage of labor
What is the second stage of labor is from
What is the third stage of labor
What is the fourth stage of labor
1) Onset of true labor to complete cervical dilation
2) Complete cervical dilation to delivery of infant
3) Delivery of infant to delivery of placenta
4) Delivery of placenta to stabilization of patient
1) How is Latent phase characterized as?
2) How is Active phase characterized as?
3) When does active phase begin?
4) What stage of labor?
1) Slow cervical dilation
2) Faster dilation
3) when cervix is 6 cm dilated
4) First stage of labor
1) The duration of the first stage is typically 6-18 hours and the rate of cervical dilation is 1.2 cm per hour for which types of mothers?
2) The duration is typically 2-10 hours and the rate of cervical dilation is 1.5 cm per hour for which type of mothers?
3) With maternal position in the first stage is recommended if they are lying in bed?
1) Primiparas
2) Multiparas
3) Left Lateral Recumbant
If uncomplicated, fetal monitoring every
1) active phase?
2) second stage of labor?
Complicated, Fetal Monitoring every
3) Active Phase?
4) Second Stage?
1) 30 minutes
2) 15 minutes
3) 15 minutes
4) 5 minutes
What can be used to monitor uterine activity by allowing you to assess the strength of the contractions?
Internal pressure catheter
1) With Vaginal Examinations what do you do during active phase and for how often?
2) What do you record?
3) 4/50/-2 is recorded, what does this mean?
1) Cervical check every 2 hour
2) Dilation, effacement, station
2) 4 cm dilated/ 50% effaced/ -2 cm station
SECOND STAGE DURATION
1) The duration of the second stage of labor is about 2 hours for?
2) The duration is about 3 hours for?
3) The duration is about 1 hour for?
4) The duration is also about 2 hours for?
1) Primipara without epidural
2) Primipara with epidural
3) Multipara without epidural
4) Multipara with epidural
Cardinal Movements
* What are the steps
__1__ is presenting part at “zero” station.
__2__ is brought about by the force of uterine contractions and maternal valsalva efforts.
__3__ is baby’s chin moves to its chest thus changing the presenting part from occipitofrontal to the smaller suboccipitobregmatic.
__4__ occurs usually at the ischial spines and the fetal head enters pelvis in transverse diameter, rotates so the occiput turns anteriorly or posteriorly toward the pubic symphysis.
__5__ occurs when largest diameter of the fetal head is encircled by the vaginal introitus and station is +5.
__6__ the delivered head now returns to its original position at the time of engagement to align itself with the fetal back and shoulders.
__7__the anterior shoulder then delivers under the pubic symphysis, followed by the posterior shoulder and the remainder of the body.
1) Engagement
2) Descent
3) Flexion
4) Internal rotation
5) Extension
6) External rotation
7) Expulsion
*Every Darn Fool In Egypt Eats Raw Eggs
Second Stage management
1) Avoid what position
2) What should mother do with each contraction
1) Supine
2) hold breath and bear down
During delivery of the fetus as the perineum becomes flattened by the crowning head a ____ may be warranted (Routinely it is not recommended).
Episiotomy (cut perineum)
1) What is modified Ritgen Maneuver used for?
2) How is it done?
1) Delivery of Fetal head
2) Fingers of right hand used to extend head while counterpressure to occiput by left hand
1) Once head is delivered, What do you do first?
2) Then what?
3) Why?
1) Suction oral cavity
2) Nares after
3) Clear airway of blood and amniotic fluid
During delivery of the fetus, use an index finger to assess for a __1__.
If it is __2__, you can manually reduce over the infant’s head.
If it is __3__, you need to clamp x 2 and cut.
1) Nuchal cord
2) Loose
3) Tight
1) During delivery of the fetus, How do you deliver anterior shoulder?
2) How is posterior shoulder delivered?
1) Gentle downward traction on head
2) Elevating Head
Episiotomy Indications?
1) Likelihood of laceration
2) Expedite delivery (by enlarging hole)
What location of episiotomy is the most commonly performed, causes less postpartum pain, but has a greater risk of extension into third or fourth degree?
What location of episiotomy causes greater blood loss, more difficult to repair, has more postpartum pain, and an increased risk of dyspareunia?
1) Midline episiotomy
2) Mediolateral episiotomy
1) First degree perineal laceration?
2) Secondary Degree?
3) Third Degree ?
4) Fourth Degree?
1) Vaginal mucosa and/or perineal skin
2) Extends to muscle
3) Extend to Anal sphincter
4) Extend Rectal mucosa
1) What stage of labor does interval between delivery of infant and delivery of placenta occur?
2) What is retained Placenta
1) Third stage
2) Placenta Does not deliver within 30 minutes
1) Gush of blood from the vagina
Lengthening of the umbilical cord
Fundus of the uterus rises up
Change in shape of the uterine fundus from discoid to globular are classic signs of?
2) What do you NOT want to do until these classic signs are noted?
3) What happens if you do?
1) Placental separation
2) Pull on cord
3) Uterine inversion
1) What stage does Postpartum hemorrhage occur in?
2) What are the causes?
1) Fourth Stage
2) Uterine Atony, Retained Placenta, Unrepaired laceration
Goal of ____ is to facilitate the process of cervical softening, thinning and dilating in hopes to reduce the rate of failed inductions.
Cervical Ripening
1) What is the process by which labor is brought about by artificial means.
2) What is the artificial stimulation of labor which has already begun
1) Induction of labor
2) Augmentation
Abruptio placentae, Chorioamnionitis, Fetal demise, Preeclampsia, eclampsia, Gestational hypertension, and Premature rupture of membranes are all indicated for?
Induction
What is contraindicated for the following?
- Unstable fetal presentation
- Acute fetal distress
- Placental previa or vasa previa
- Previous classical cesarean section
- Transfundal uterine surgery
Induction
1) What is unfavorable Bishop score?
2) With a Bishop score of what does the probability of vaginal delivery after labor induction is similar to that of spontaneous labor.
1) < 6
2) > 8
1) What type of drug is Cervidil (Dinoprostone)?
2) How is it inserted?
3) It is contraindicated in patients with?
1) Prostaglandin E2
2) Vaginally
2) Previous c-sections
What type of drug is Cytotec (Misoprostol) which is vaginally or orally inserted?
What downside does this medication have?
It is contraindicated in patients with?
1) Prostaglandin E1
2) Cannot be readily removed if concerns arise
3) Previous c-sections
What are the 2 types of mechanical dilators?
Foley Bulb catheter
Laminara Japonicum
1) Pitocin is used for what?
2) What is it a version of?
3) What does it cause?
4) What are the side effects?
5) What can it also lead to from it being similar to ADH
6) What is prolonged usage a risk for?
1) Induction and Augmentation
2) Synthetic Oxytocin
3) Myometrial contractions
4) Uterine Tachysystole (high contractions)
5) Water reabsorption
6) Postpartum hemorrhage secondary to Uterine Atony
1) What can Regional anesthesia lead to if hypotension occurs?
2) What can stop hypotension if given 30-60 min before anesthesia given?
1) Decreased Uterine Blood flow
2) Hydration (IV bolus of 1000cc LR)
1) What levels do Uterine contraction and cervical dilation affect? (Visceral Pain)
2) What does Pudendal Nerve (S2-S4) affect? (somatic pain)
3) Regional Anesthesia is partial to complete loss of pain below what level?
1) T10-T12 through L-1
2) Descent of fetal head
Pressure from pelvic floor, vagina, perineum
3) T8-T10
1) Morphine, Fentanyl, Meperidine, and Nalbuphine are more effective in the early first stage of labor as they all have very little efficacy for relief of labor pain because their primary mechanisms of action is?
2) These opioids readily cross the placental barrier which can lead to?
3) What is given if this occurs?
4) What is the most effective form of pain relief and is used by most women in the U.S.
1) Heavy sedation
2) Neonatal respiratory depression
3) Naloxone (opioid antagonist)
4) Epidural
What interspace levels are Large bore needle used to locate epidural space between?
*Catheter is then placed over the needle.
1) L2-3
2) L3-4
3) L4-5
1) What is contraindicated 12 hours within an epidural?
2) What can help in vaginal delivery for those not using regional anesthesia?
3) What is the most common induction anesthetic agent used?
4) What does it cause?
5) What must it be accompanied by?
1) Heparin
2) Pudendal Block
3) Propofol
4) Loss of maternal consciousness
5) Airway management
