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
What are the 4 types of female pelvis?
Gynecoid👩🏻
Anthropoid🦗
Android🤖
Platypelloid🐦
Which one aids the descent and expulsion of the fetus:
Uterine Contractions or Maternal Efforts
Both
Which type of presentation is most common in an anthropoid pelvic?
Occiput Posterior (prolongs labor)
Will parity have an effect on how long Stage II takes?
Yes
What is the major complication of stage III of labor?
Hemorrhage
WHen can a woman have sex after having a baby
After 6 week checkup and she gets the OK. Have a lot of lube ready.
(She said this in class but it wasn’t on the slides)
How is the Position of the baby described?
The relation of the presenting part of the fetus in relation to the right/left side of the maternal pelvis
Ex: Right occipital posterior (ROP)
Which is more specific:
Nitrazine Paper testing or Fern testing
Fern testing 🌿
When does the woman get a “blood transfusion” from her own uterus
Stage IV
What are the two ways contractions are measured and monitored?
External tocodynanometer
Internal tocodynanometer
What does puerperium mean?
Post partum period up to 6 wks after delivery
What is the most common presenting position?
Left Occiput Anterior
Don’t know if this is important
Which pelvic shape is best suited for successful vaginal delivery?
Gynecoid
How long does Stage III of labor last?
30 minutes, but can be sped up by the doctor
Which placenta/amniotic sac arrangement put the twins at risk of cord entanglement?
Mono/mono
Monozygotic or Dizygotic Twins:
“Fraternal twins”
Dizygotic
How can you make Stage III of labor go faster?
You can assist the removal of the placenta by keeping tension on the umbilical cord and massaging the uterus so the placenta comes out faster
What are the risks of inducing labor?
Uterine tachysystole can cause decreased O2 and fetal hypoxia/acidosis
Risk of Cesarean especailly with an Unfavorable cervix (not all the way dilated)
Umbilical cord prolapse with amniotomy
Intra-amniotic infection becasue of multiple exams and prolonged labor time
Absent variability or a variability change of less than 3bpm of the heart rate means:
Hypoxia
What is the problem with nitrazine paper testing?
There are a lot of false positives, since several things can cause your vagina to be alkaline, including urine, blood, semen, BV, and trichomoniasis.
What is this:
“Opening of the cervical os in centimeters (an estimate)”
Dilation
True or False Labor:
Cervical dilation occurs
True
True or False Labor:
Braxton Hicks Contractions
False
Monozygotic or Dizygotic Twins:
Does not “run in families”
Monozygotic
What does antepartum mean?
Before delivery
Monozygotic or Dizygotic Twins:
Increased likelihood with fertility meds
Dizygotic
Which type of deceleration is OMINOUS and VERY VERY BAD
☠️☠️☠️☠️☠️LATE☠️☠️☠️☠️
What is the scoring system sued to determine how well things will go if you induce labor?
Bishop score
Monozygotic or Dizygotic Twins:
Result of two separate eggs fertilized by two separate sperm (essentially siblings)
Dizygotic
During labor, what is the “presentation”
Which part of the baby is coming through first.
Ex: Cephalic (90% of the time)👶🏻
Breech 🦵🏼🍑
A baby over _______ grams is considered a Macrosomic Infant
4500 g
*******
What are the 3 outcomes of a Contraction Stress test?
Negative (reassuring)- 3 contractions in 10 minutes with no late decelerations
Positive (scary)- late decelerations or variable decelerations with more than 50% of the contractions in 10 min
Equivocal- late decelerations with less than 50% of the contractions in 10 minutes
Monozygotic or Dizygotic Twins:
Can be same or opposite sex
Dizygotic
Which type of placenta/amniotic sac arrangement puts monozygotic twins at risk of twin-to-twin transfusion syndrome?
Monochorionic/Diamniotic
Which pelvis type is the most unfavorable for delivery?
Android
Which one will have an effect on the length of Stage I:
Race
Parity
Parity
First delivery vs subsequent delivery
How do monozygotic twins happen?
1 egg is fertilized and then splits within 12 days.
What are the possible combinations of placenta/amniotic sacs in monozygotic twins?
Monoamniotic/Monochorionic
Monoamniotic/Dichorionic
Diamniotic/Dichorionic
What is a Category III fetal monitoring strip?
One of two things:
- Sinusoidal
- No baseline variability with late decelerations
Baby needs to come out NOW
Does race have an effect on how long Stage II take?
Yes
Black women are the fastest
White are the slowest
At what stage do women get the urge to push?
Stage II
What causes uterine contractions to increase in frequency and intensity?
Prostaglandins and Oxytocin
True or False Labor:
Back and abdominal discomfort
Both
What happens if a single fertilized egg splits after 12 days?
You get conjoined twins
Monozygotic or Dizygotic Twins:
ONLY diamniotic
Dizygotic
How long after having a baby should a woman have a postpartum exam?
4-6 weeks
What is Leopold’s Maneuver?
Palpating the abdomen to determine fetal presentation and position
How do we do a biophysical profile?
Use an ultrasound to look at:
Amniotic fluid assessment Deepest Vertical Pocket of 2cm (? Idk what this means but she bolded the vertical pocket thing)
Gross fetal movement
Tone (flexing arms and legs)
Fetal “breathing” activity sustained for 30 seconds
During what stage of labor do major hemodynamics changes happen to the maternal cardiovascular system?
Stage IV
What is a normal fetal heart rate
110-160
Monozygotic or Dizygotic Twins:
No genetic predisposition*****
Monozygotic
What is considered “Adequate Labor”?
**
3-5 contractions in 10 minutes averaged over 30 minutes***
(Or if you are in a teaching hospital, adequate labor is quantified as 200MVu (???))
What kind of deceleration is V shaped?
Variable
**
True or False Labor:
Varying intensity
False
How long is a normal cervix
4cm
How does internal tocodynanometry work?!?
An IUPC (Intrauterine pressure catheter) is inserted into the amniotic sac
During labor, what is the “Lie”
Position of the long axis of the fetus with respect to the long axis of the mother’s body
Transverse Lie= baby is perpendicular to mom. Aka sideways
What stage of labor is a critical time for women with heart/lung disease
Stage IV
A high Bishop score (9-13) has the highest likelihood of a (successful/failed) induction
Successful
True or False Labor:
Giving sedation, hydration, or pain meds stops it
False
During labor, what is “Station”
The degree of descent of the baby down the birth canal in relationship to the ischial spines. Usually divided into thirds.
What amount of variability in fetal HR is good
6-25 bpm
Monozygotic or Dizygotic Twins:
Genetic predisposition*****
Dizygotic
When does the uterus significantly decrease in size (involution)?
Immediately after delivery
Monozygotic or Dizygotic Twins:
Single zygote separates
Monozygotic
What is the difference between an external and internal dynamometer?
External- measures frequency and duration of contractions
Internal- measures frequency, duration, and INTENSITY of contractions***
What are the 2 ways to do Fetal monitoring?
Intermittent auscultation (Doppler sound through mom’s abdomen)
Continuous Electronic Fetal Monitoring (can be external or internal with a little electrode on the baby’s scalp)
What is Twin to TWin Transfuison Syndrome?
In a Monochorionic/diamniotic pregnancy, there is an unbalanced transfusion from one twin to the other. One becomes anemia and the other becomes polycythemic.
One twin gets extra amniotic fluid (polyhydramnios) and one gets low fluid (oligohydramnios)
Why do we need to hospitalize a woman once her water breaks?
There’s a huge risk of infection to the baby since the vagina is right next to the butthole
What is this:
“Thinning of the cervix described as a percentage of a normal 4cm long cervix”
Effacement
Which kind of deceleration is normal and physiologic?
Early
What are the signs of separation of the placenta after birth? (And it means its ok to pull it out)
Uterus rises in abdomen
Globular configuration (?)
Gush of blood
Lengthening of how much umbilical cord is sticking out the the vagina
Monozygotic or Dizygotic Twins:
Has a consistent rate and is not influenced by heredity, race, or mothers age
Monozygotic
True or False Labor:
Irregular intervals and duration
False
Which type of decelerations on an electronic fetal monitor are physiologic (not concerning)?
Early
What test can be done to support your diagnosis of a ruptured membrane, but is not directly diagnostic?
Amniotic Fluid Index by ultrasound
Ultrasound to look for low fluid
