Normal Labor and Delivery (Moulton) Flashcards
Labor is defined as progressive cervical dilation resulting from regular uterine contractions that occur at least every __1__ minutes and last __2__ seconds.
1) 5
2) 30-60
False Labor (Braxton-Hicks contractions) is defined as?
Irregular contractions without cervical change
The cranial bones of the fetal head consists of?
1) Occipital bone
2) 2 parietal bones
3) 2 frontal bones
Which fontanelle is diamond shaped and measures at about 2 x 3 cm?
Which fontanelle is “Y” or triangular in shape?
1) Anterior
2) Posterior
What is the longest anterior posterior diameter of the head?
Supraoccipitomental
Gynecoid, Android, Anthropoid, and Platypelloid describe?
Pelvic shapes
What is the classic female type of pelvis (50% of females) and has a good prognosis for delivery?
Gynecoid
The fetal head generally rotates into the occiput ___ position with gynecoid shaped pelvis.
Anterior
Android shaped pelvis are the classic male type of pelvis (30% of females) and the fetal head is force to be in the occiput __1__ position.
It has a __2__ prognosis for delivery.
1) Posterior
2) Poor
Anthropoid shaped pelvis resembles an ape pelvis (20% of females) and the fetal head engages only in the anterior posterior diameter usually in the occiput __1__ position.
It has a __2__ prognosis for delivery.
1) Posterior
2) Good
Platypelloid shaped pelvis is described as a flattened gynecoid pelvis (3% of females) and the fetal head has to engage in the __1__ diameter.
It has a __2__ prognosis for delivery.
1) Transverse
2) Poor
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 the __1__ to the __1__.
If > 11.5 cm the __2__ diameter of pelvic inlet is adequate.
1) Pubic symphysis to the sacral promontory
2) Anteroposterior
What is the obstetric conjugate?
It is measured by?
1) The narrowest fixed distance through which the fetal head must pass through during a vaginal delivery
2) Subtracting 2.0 cm from the diagonal conjugate
The pelvic outlet is assessed by measuring the __1__ and __2__.
If the measure between the __1__ is 8.5 cm in distance, this is considered an adequate __3__ diameter.
1) Ischial tuberosities
2) Pubic arch
3) Transverse
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
The reference to fetal lie is __1__ to __1__.
It determines if the infant is __2__, __2__, or __2__.
1) Maternal spine to fetus spine
2) Longitudinal, transverse, or oblique
The Leopold maneuvers are a series of 4 maneuvers:
First you want to palpate the __1__ to determine fetal head vs buttocks vs transverse position.
Next you want to palpate for __2__ and fetal small parts.
Then you want to palpate what is presenting in the pelvis with __3__ palpation.
Lastly you want to palpate for __4__
1) Fundus
2) Spine
3) Suprapubic
4) Cephalic prominence
With a cervical exam you want to check dilation at the level of __1__, which is ranged from closed to completely dilated at 10 cm.
2) Then you want to check for cervical effacement which is reported as a % of change in length, what does this mean?
Station, which is the degree of __3__ of the presenting part of the fetus is measured in cm from presenting part to ischial spines. When the bony portion of the head reaches the level of the ischial spines the station is __4__.
__5__ and __5__ are commonly used to calculate Bishop score.
1) Internal os
2) Thinning of the cervix
3) Descent
4) Zero
5) Consistency and Position
The first stage of labor is from the __1__ to __1__.
The second stage of labor is from __2__ to __2__.
The third stage of labor is from __3__ to __3__.
The fourth stage of labor is from __4__ to __4__.
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
What phase of the first stage of labor is the period between onset of labor and is characterized by slow cervical dilation?
What phase is associated with a faster rate of dilation and usually begins when cervix is dilated to 6 cm?
1) Latent
2) Active
The duration of the first stage is typically 6-18 hours and the rate of cervical dilation is 1.2 cm per hour for __1__?
The duration is typically 2-10 hours and the rate of cervical dilation is 1.5 cm per hour for __2__?
1) Primiparas
2) Multiparas
With maternal position in the first stage is recommended if they are lying in bed?
Left lateral recumbent position
Fetal monitoring if the pregnancy is uncomplicated should be done every 30 minutes in the __1__ of labor.
Monitor every 15 minutes in the __2__ of labor.
Fetal monitoring if the pregnancy is complicated should be done every __3__ minutes in the __1__ of labor.
Monitor every __4__ minutes during the __2__ of labor.
1) Active phase of first stage of labor
2) Second stage of labor
3) 15
4) 5
What can be used to monitor uterine activity by allowing you to assess the strength of the contractions?
Internal pressure catheter
During active phase, should perform cervical check q 2 hr. You want to record __1__, __1__, and __1__.
4/50/-2 is recorded, what does this mean?
1) Dilation, effacement, station
2) 4 cm dilated/ 50% effaced/ -2 cm station
The duration of the second stage of labor is about 2 hours for?
The duration is about 3 hours for?
The duration is about 1 hour for?
The duration is also about 2 hours for?
1) Primipara without epidural
2) Primipara with epidural
3) Multipara without epidural
4) Multipara with epidural
__1__ is a cardinal movement of labor that is defined as presenting part at “zero” station.
__2__ is a cardinal movement of labor that is brought about by the force of uterine contractions and maternal valsalva efforts.
__3__ is a cardinal movement of labor where the baby’s chin moves to its chest thus changing the presenting part from occipitofrontal to the smaller suboccipitobregmatic.
__4__ is a cardinal movement of labor that 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__ is a cardinal movement of labor occurs when largest diameter of the fetal head is encircled by the vaginal introitus and station is +5.
__6__ is a cardinal movement of labor where the delivered head now returns to its original position at the time of engagement to align itself with the fetal back and shoulders.
__7__ is a cardinal movement of labor where 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
In the second stage of labor in regards to maternal positioning you want to avoid the ____ position.
Supine
In the second stage of labor with each contraction, the mother should ____ and bear down with expulsive efforts.
Hold her breath
During delivery of the fetus as the perineum becomes flattened by the crowning head a ____ may be warranted (Routinely it is not recommended).
Episiotomy
To facilitate the delivery of the ____ a modified Ritgen maneuver is often performed.
Fetal head
Once head is delivered, you can bulb suction oral cavity first then nares to clear the airway of ___ and ___.
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
During delivery of the fetus, you want to deliver the __1__ with gentle downward traction on fetal head.
The __2__ is then delivered by elevating the head.
1) Anterior shoulder
2) Posterior shoulder
An episiotomy is indicated if the likelihood of __1__ seems high.
Also is indicated to __2__ delivery by enlarging the vaginal outlet.
1) Spontaneous laceration
2) Expedite
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
What maneuver is characterized by the fingers of the right hand are used to extend the head while counter pressure is applied to the occiput by the left hand to allow for a more controlled delivery?
Modified Ritgen Maneuver
A first degree perineal laceration is described as a superficial laceration involving the __1__ and/or __1__.
A second degree perineal laceration extends into the __2__ of the perineal body but does not involve the __2__.
A third degree perineal laceration extends into or completely through the __3__ but not the __3__.
A third degree perineal laceration involves the __4__.
1) Vaginal mucosa and/or the perineal skin
2) Muscles; Anal sphincter
3) Anal sphincter; Rectal mucosa
4) Rectal mucosa
The interval between delivery of the inant and delivery of the placenta is what stage of labor?
Third
What is diagnosed if placenta has not delivered within 30 minutes?
Retained placenta
Gush of blood from the vagina, lengthening of the umbilical cord, fundus of the uterus rises up, and a change in shape of the uterine fundus from discoid to globular are classic signs of?
What do you NOT want to do until these classic signs are noted?
This may result in?
1) Placental separation
2) Pull on cord
3) Uterine inversion
___ commonly occurs during the fourth stage due to uterine atony, retained placenta, or unrepaired vaginal or cervical laceration.
Postpartum hemorrhage
Goal of cervical ____ is to facilitate the process of cervical softening, thinning and dilating in hopes to reduce the rate of failed inductions.
Ripening
__1__ is the process by which labor is brought about by artificial means.
__2__ 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
Unstable fetal presentation, Acute fetal distress, Placental previa or vasa previa, Previous classical cesarean section or transfundal uterine surgery are all contraindicated for?
Induction
Bishop score __1__ is considered unfavorable.
With a Bishop score__2__ probability of vaginal delivery after labor induction is similar to that of spontaneous labor.
1) < 6
2) > 8
What type of drug is Cervidil (Dinoprostone) which is vaginally inserted?
It is contraindicated in patients with?
1) Prostaglandin E2
2) Previous cesarean 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 cesarean sections
Foley bulb catheter and Laminara Japonicum are both ____.
Mechanical dilators
Pitocin which is the only FDA approved drug for induction and augmentation is an IV synthetic ____ which stimulates myometrial contractions.
Oxytocin
What is the most common side effect of pitocin?
Uterine Tachysystole
Pitocin has similar structure to ____ which can lead to increase water reabsorption.
ADH
Prolonged use of pitocin can lead to increase risk of postpartum hemorrhage secondary to?
Uterine atony
Regional anesthesia may decrease uterine __1__ if hypotension occurs and is not promptly treated.
Adequate __2__ 30 to 60 min prior to regional anesthesia may mitigate the risk for hypotension.
1) Blood flow
2) Hydration (IV bolus of 1000cc LR)
Uterine contractions and cervical dilation result in
visceral pain which is due to ____ through ____ being affected.
T10-T12 through L-1
Descent of fetal head and pressure from the pelvic floor, vagina and perineum generate somatic pain via
the __1__ nerve which originates from __2__.
1) Pudendal
2) S2-S4
Regional anesthesia refers to partial or complete loss of pain sensation below ____ level.
T8-T10
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?
These opioids readily cross the placental barrier which can lead to?
What is given if this occurs?
1) Heavy sedation
2) Neonatal respiratory depression
3) Naloxone (opioid antagonist)
____ is the most effective form of pain relief and is used by most women in the U.S.
Epidural
Large bore needle is used to locate epidural space between the __1__, __2__, or __3__ interspace and the catheter is then placed over the needle.
1) L2-3
2) L3-4
3) L4-5
____ use within 12 hrs is a contraindication of epidural.
Heparin
A ____ block can aid operative vaginal delivery in women who do not have regional anesthesia.
Pudendal
____ is the most common induction anesthetic agent used and results in loss of maternal consciousness and it must be accompanied by airway management.
Propofol
