Normal Labor, Delivery And The Puerperium (Lauren 🌭) Flashcards
What are the 3 types of decelerations?
Early- deceleration at exact same time as the contraction. Normal
Variable- no relation to the contraction
Late- deceleration happens after the contraction
True or False Labor:
Giving pain medication does not stop it
True
Why do we do antepartum testing?
To evaluate a fetus who is at a higher than normal risk for intrauterine complications that could cause placental insufficiency and fetal acidosis
So youre telling me that they’re gonna stick one thing in my vag to monitor contractions and another thing in my vag and stick it to my baby’s head to monitor him?
Yes if you do internal tocodynomometry and internal fetal monitoring, you will have two wires coming out of your vagine
What are the different kinds of presentations of the Passenger?
Cephalic (Vertex)- 👍 head first, rapid
Breech- Frank, complete, or footling
Brow, Face Compound, etc- face first
What anatomical changes happen to a woman during the puerperium period (delivery to 6 weeks post partum)
Uterus involutes (becomes about 10x smaller)
Cervix loses vascularity and glandular hypertrophy
Ovaries stay asleep for 6-12 weeks
Vagina vault decreases in size but walls remain thin, inelastic, and dry until ovulation resumes
What do we want to see in a Non-Stress Test?
2 accelerations within 30 minutes associated with movement
A young lady who is 39 wks pregnant walks into the hospital because she thinks her water broke.
Her contractions are 4-5 minutes apart
On exam, her cervix is 3-4 cm and 90% effaced.
Fern test is positive.
What stage of labor is she in?
Do we have her wait at home or do we admit her?
She is in Stage I Latent
We need to admit her because her Fern test is positive. (Even though we don’t normally admit women in Stage I Latent)
What are the the 3 diagnostic tests that can be done on vaginal fluid to see if a woman’s water has broke?
Fern test
Amniosure test
Nitrazine paper test
What are 4 degrees of obstetric lacerations?
I don’t know if this is important???
First degree- involves vaginal mucosa and perineal skin
Second degree- involves underlying subcutaneous tissue but not rectum (equivalent to an episiotomy)
Third degree- extends through rectal sphincter. Stool and flatulence incontinence inevitable.
Fourth degree- vagina and rectum are now one
At a station of +3, where is the baby’s head?
Emerging from the labia
What is done to test if a woman’s water has broken or not?
You do a STERILE speculum exam to take a look and obtain a specimen of fluid for testing.
Test options are:
Fern testing
Amniosure testing
Nitrazine paper test
What is this:
“Placement of the presenting part in the maternal pelvis in relation to the ischial spines (usually dived into thirds)
Station
How long must insurance pay for a woman to stay hospiatalized after a C-SECTION delivery
1-4 days
True or False Labor:
Increasing intensity
True
Which part of the baby’s head will come through the vagina first?
The suboccipitobregmatic diameter (the smallest diameter part)
What kind of deceleration mirrors the contraction?
Early*
Caused by head compression. NORMAL
The earlier 1 egg splits into 2 babies, the more (separate/shared) they’ll be
Separate
Ex: they’ll have separate amniotic sacs and placentas vs shared
What is the name of a baby that is too small
Preterm or Growth Restricted
What are the 5 stages of labor?
Stage I latent- contractions and cervical effacement and dilation up to 5cm
Stage I Active- cervical dilation from 5-10cm
Stage II- pushing the baby out (pushing phase)
Stage III- getting the placenta out (medical student phase)
Stage IV- 2 hours post delivery of placenta
True or False Labor:
Regular intervals, gradually increasing in frequency
True
What are the 3 P’s of the Progress of Labor?
Power- maternal effort, uterine contractions💪🏼🏋️♀️
Passenger- size and position of fetus🚗✈️🚂
Passage- size and shape of maternal pelvis🛣🛤
A station of 0 means the baby’s head is where?
In line with the ischial spines
Which pelvis type is the most common and best suited for childbirth?
Gynecoid
What are the risks of carrying twins?
Preterm labor
Intrauterine growth restriction
Increased risk of fetal anomalies
Increased risk of cesarean delivery
What are some of the ways we can induce labor?
Prostaglandin gel
Misoprostol 👍
Pitocin
Stripping membranes- separate amniotic sac from cervix. Causes prostaglandin production
Amniotomy- artificial rupture of membranes
What are the 6 cardinal movements of the baby through the vaginal canal (although she said its more like a continuous dance and not individual movements)
- Engagement- enters pelvis 💍
- Flexion- baby flexes chin to chest 🤸🏻♀️
- Descent⛷
- Internal rotation🦈
- Extension- head extends under pubic bone (baby’s head is delivered)🦒
- External rotation- head rotates to line up with shoulders and the doctor pulls the rest of the baby out🐋
Are episiotomies a good thing to do?
No. Hardly ever done anymore don’t freakin do it
Monozygotic or Dizygotic Twins:
Two separate zygotes
Dizygotic lol
The inside of the amniotic sac is (sterile/non sterile)
Sterile
What are “Periodic Changes” in fetal monitoring?
Accelerations or decelerations for about 15seconds at a time
What causes Variable Decelerations?
Cord compressoin***
What is a “true knot”
When the baby is small and floats around it can tie a knot in its own umbilical cord. May cause cord compression.
True or False Labor:
No cervical change over reasonable time
False
What is this:
“Uterine activity (contractions) that results in progressive dilation and effacement of the cervix”
Labor
What is the least common type of female pelvis?
Platypelloid
What causes late decelerations?
Fetal hypoxia caused by placental insufficiency, maternal hypotension or hypoxia.
The contraction squeezes blood out of the placenta and the baby is really starved for O2 after a contraction.
BAD. Baby needs to come out NOW
What is an Amniosure test?
It is a very sensitive and specific test to see if the membranes have ruptured.
Allows you to use a very small sample.
EXPENSIVE
(This slide was missing from our powerpoints but she had one on it)
Spontaneous separation of the placenta should occur within what time frame after a vaginal delivery?
30 min
How is a Fern Test done?
Let a sample of fluid air dry on a slide and look at it under a microscope.
If you see crystals in a “Fern” pattern, it is amniotic fluid, and the woman’s membranes have ruptured.
How long must insurance pay for a woman to stay hospitalized after having a baby VAGINALLY
1-2 days
What is Nitrazine Paper Testing?
It’s basically a pH test to see if the fluid in your vagina is alkaline
(Amniotic fluid is baby pee=alkaline)
What are the options for anesthesia during delivery?
Psychoprophylaxis- relaxation, Lamaze and HYPNO-birthing lol
IV-narcotics/tranquilizers
Epidural- anesthesia continuously delivered though catheter in epidural space
Spinal- anesthesia delivered though a one-time injection into the spinal canal (usually used for Cesaerean)
Inhaled- Nitrous Oxide
General- if complications arise and you need to do a crash C section
What factors affect maternal expulsion efforts?
Maternal strength
Consciousness or sedation
Pain
Regional anesthesia (epidural or spinal)
Which is faster and more predictable:
Stage I Latent or Stage I Active
Stage I Active
What is a contraction stress test?
Stimulate mom’s nipples to cause contractions and then look for decelerations.
Not kidding I looked it up on Wikipedia
Monozygotic or Dizygotic Twins:
“Identical twins”
Monozygotic
What are the 4 components of antepartum testing?
Fetal kick counts
Non-Stress Testing
Contraction Stress Testing
Biophysical Profile
What is “Variability” in fetal monitoring?
Change in HR over time
GOOD! We WANT to see a certain amount
If a lady ruptures her membranes (water breaks) does it mean she is going to have a baby right now?
Not necessarily, but it does mean she needs to be hospitalized right away
