OB 1.1 Flashcards
1
Q
Persistent vomiting aggravated by inability to take in food leading to severe dehydration and ketonuria
A
Hyperemesis gravidarum
2
Q
Disturbances in urination is most prominent during
A
2nd and 3rd months
3
Q
Easy fatigability in normal pregnancy is due to
A
Increased BMR
4
Q
First perception by mother of fetal movement
A
Quickening
5
Q
Quickening: Primigravida
A
18-20 weeks
6
Q
Quickening: Multigravida
A
16-18 weeks
7
Q
T/F Quickening increases in intensity and frequency as pregnancy progresses
A
T
8
Q
Hormone: Stimulate mammary DUCT system
A
Estrogen
9
Q
Hormone: Stimulate ALVEOLAR components of breast
A
Progesterone
10
Q
Earliest sign of pregnancy
A
Cessation of menstruation
11
Q
Highly suspect pregnancy if ___ days have elapsed after expected onset of menses
A
10 or more
12
Q
Expression of colostrum is appreciated at ___ week
A
16th
13
Q
T/F There is no relation between pre-pregnant breast size and volume of milk production during lactation
A
T
14
Q
Hormone: Thermal changes in pregnancy
A
Progesterone
15
Q
Luteal vs follicular phase: Greater basal body temp
A
Luteal
16
Q
Temp in luteal phase is ___ degrees higher than in follicular phase
A
0.3-0.5C
17
Q
Hormone: Skin pigmentation changes
A
Estrogen and progesterone
18
Q
T/F Skin pigmentation is more prominent in dark-skinned individuals
A
T
19
Q
T/F Skin pigmentation in pregnancy is intensified by exposure to sunlight
A
T
20
Q
Reddish, slightly depressed streaks commonly found in abdominal skin that may turn silvery white after delivery
A
Striae gravidarum
21
Q
Striae gravidarum is due to
A
Separation of underlying collagen tissue
22
Q
Hormone: Decreased peripheral vascular resistance
A
Estrogen
23
Q
More rapid growth as uterus rises out of pelvis: Weeks
A
16-22 weeks
24
Q
Time during which fundic height is equal to gestational age, i.e. x cm = x weeks AOG
A
16-32 weeks
25
T/F Abdominal enlargement is more pronounced in
| multigravida than primigravida
T
26
T/F Uterine growth is limited to anteroposterior
| diameter
T
27
Average diameter of uterus at 12 weeks AOG
8 cm
28
Hegar sign is appreciated at ___ weeks
6-8
29
T/F At about 4 weeks AOG external cervical os and cervical canal become patulous (open/distended) to allow insertion of fingertip
T
30
Hormone: Ferning of cervical mucus
Estrogen
31
In non-pregnant women, ferning of cervical mucus is appreciated at days ___ of cycle
7-18
32
In non-pregnant women, beading of cervical mucus is appreciated at day ___ of cycle
21
33
Predominant hormone in pregnancy
Progesterone
34
False labor pain
Braxton-Hicks contraction
35
Intensity of Braxton-Hicks contractions
5-25 mmHg
36
When are Braxton Hicks contractions felt most
28 weeks AOG
37
HCG in pregnancy is produced by
Fetal trophoblasts
38
Function of HCG in pregnancy
Maintains the corpus luteum which is the main site of progesterone production in early pregnancy
39
HCG: Doubling time
1.4-2 days
40
α subunit of HCG is similar to that of (3)
1) LH
2) FSH
3) TSH
41
False positive sandwich type immunoassay pregnancy test is due to
Heterophile antibodies
42
Detection limit of home pregnancy tests
12.5 mIU/mL
43
Normal FHT
110-160 bpm
44
Most accurate method of determining FHT
UTZ
45
Soft, blowing sound synchronous with maternal pulse
Uterine souffle
46
Sharp, whistling sound that is synchronous with fetal pulse
Funic souffle or umbilical cord souffle
47
Uterine souffle: Passage of blood through
Uterine vessels
48
Funic souffle or umbilical cord souffle: Passage of blood through
Umbilical arteries
49
Fetal movement can be perceived by the examiner at what week
20th
50
Week: Gestational sac
5
51
Week: Fetus w/in gestational sac & fetal heart beat detected
6
52
Week: CRL measurement is predictive of
| gestational age
6-12
53
Imaginary or spurious pregnancy
Pseudocyesis
54
Pseudocyesis is usually seen in what population
Women nearing menopause or with strong desire to become pregnant
55
Most convincing method for women who have pesudocyesis
Ultrasound
56
T/F Pregnancy test kits are reliable means of identifying fetal death
F, trophoblasts continue to produce hcg for several days or weeks after fetal demise
57
Nonviability of a pregnancy is best confirmed by
Ultrasound
58
Usually the most noticeable symptom in fetal demise
Cessation of fetal movement
59
Overlapping of the fetal skull bones due to liquefaction of the brain
Spalding sign
60
Gas bubbles in the fetus
Robert sign
61
Phases of parturition
1) Quiescence
2) Preparation for labor
3) Process of stimulation or labor
4) Parturient recovery
62
Hormone: Dominant in phase 0 of parturition
Progesterone
63
Gap junction for interaction between uterine smooth muscle cells that is inhibited by progesterone
Connexin 43
64
Hormone: Promotes formation of connexin 43
Estrogen
65
Promoters of myometrial relaxation (7)
1) Beta adrenoreceptors
2) LH and HCG
3) Relaxin
4) CRH
5) PTH-rp
6) PGD2, E2, I2
7) ANP and BNP
66
Hormone: Cevical ripening
Relaxin
67
Hormone: Can induce both uterine relaxation and contraction
CRH
68
Phase 2 of parturition commences at
37 weeks AOG
69
Phase of parturition: Development of uterine sensitivity
Phase 2
70
Phase of parturition: T/F Phase 2 is the phase where most uterotonins are active
T
71
Phase of parturition: Progesterone withdrawal
Phase 2
72
Hormone: Upregulation of oxytocin receptors
Estrogen
73
Sensation that a pregnant woman feels that the baby has descended
Lightening
74
Important events at 37 weeks AOG (3)
1) Formation of LUS
2) Cervical softening
3) Lightening
75
Cervical softening in phase 2 of parturition is due to
Breakdown of collagen fibers
76
Placental source of CRH
Cytotrophoblast
77
Hormone: Goes to pituitary of fetus stimulating release of steroids that will act on lungs to promote pulmonary maturity
CRH
78
Major substrate for estrogen production
C19 steroids
79
Production of CRH from placenta stops when
After release of fetus
80
Hormone: Stimulates membranes to increase prostaglandin
| synthesis, which is a potent uterotonin
CRH
81
Hormone: Stimulate fetal adrenals to produce C19 steroids
| leading to increased substrate for placental aromatization
CRH
82
Fetal anomalies that may cause delayed parturition
1) Hypoestrogenism
2) Anencephaly
3) Adrenal hypoplasia
4) Placental sulfatase deficiency --> decreased CRH
83
Phase of parturition: Time when most events in labor and delivery happen
Phase 3
84
Most potent uterotonin
Oxytocin
85
3 important points at which oxytocin is increased
1) 2nd stage of labor
2) Early postpartum
3) Breastfeeding
86
Treatment of pregnant women with this agent in any gestation causes labor or abortion
PG
87
Substances that promote uterine contraction (4)
1) Platelet-activating factor
2) Endothelin-1
3) AT II
4) CRH, hCG, PTH-rp
88
Substance released with stripping of membranes
PGF-2α
89
Intrauterine tissue that provides tensile strength and resistance to tearing and rupture
Amnion
90
Intrauterine tissue that provides for immunological acceptance and is enriched with enzymes that inactivate uterotonins
Chorion laeve
91
Intrauterine tissue responsible for generation of uterotonins (paracrine) and responds to inflammatory reaction provoked by vaginal fluids
Decidua parietalis
92
Strict definition of labor
Uterine contractions that bring about demonstrable effacement and dilatation of the cervix
93
3 functional divisions of labor
1) Preparatory
2) Dilatational
3) Pelvic
94
Phase of labor: Latent phase
From perception of regular contractions to 3 cm dilation
95
Prolonged latent phase: Nullipara
> or = to 20 hours
96
Prolonged latent phase: Multipara
> or = 14 hours
97
Phase of labor: Affected by sedation or epidural analgesia
Latent phase
98
Phase of labor: Active phase
3 cm dilation to 10 cm dilation
99
Stages of labor
Stage I: Latent phase and active phase
Stage II
Stage III
100
Stage of labor: Stage II
10 cm dilation to delivery of neonate
101
Stage of labor: Stage III
Delivery of neonate to delivery of placenta
102
Normal duration: Active phase, multipara
Less than 4 hours
103
Normal duration: Active phase,nullipara
Less than 5 hours
104
Normal rate of cervical dilation during active phase: Multipara
> or = 1.5cm/hour
105
Normal rate of cervical dilation during active phase: Nullipara
> or = 1.2 cm/hour
106
Normal duration: Stage II, multipara
Less than 30 minutes
107
Normal duration: Stage II, nullipara
Less than 1 hour
108
Normal duration: Stage III (multipara and nullipara)
Less than 30 minutes
109
cm dilation wherein descent starts in nullipara
7-8 cm
110
True vs false labor: Contractions, regular
True
111
True vs false labor: Contractions, irregular
False
112
True vs false labor: Contractions, gradually shorten in duration
True
113
True vs false labor: Contractions gradually increase in intensity
True
114
True vs false labor: Pain/discomfort confined to lower abdomen
False
115
True vs false labor: Pain/discomfort at the abdomen and back
True
116
True vs false labor: Relieved by sedation
False
117
True vs false labor: Unaffected by sedation
True
118
Definition of "interval" between contraction
START of 1 contraction to the START of the next
119
Area of the abdomen where contraction starts
Fundus (not hypogastric)
120
Recpetors of oxytocin are more concentrated at which area of the uterus
Uterotubal junction
121
T/F Rest is ineffective in relieving true labor
T
122
Early vs late sign: Extrusion of mucus plug from the cervix, resulting in a bloody show
Early
123
Cervical effacement is expressed in terms of
Length of cervical canal compared to cervical canal of uneffaced cervix
124
Length of uneffaced cervix
2.5 to 3 cm
125
Cervical length is measured from
Lateral fornix to ectocervix
126
Normal biparietal diameter
9.5 cm, hence cervix should dilate 10 cm
127
Normal interspinous diameter
10 cm
128
Signals that the mother should START to push. (Do not ask to push before this happens)
1) Dilation at 10 cm 2) 2nd stage of labor 3) During contraction
129
Gestational age is ___ weeks before/after ovulation and fertilization
2 weeks before
130
Gestational age is ___ weeks before/after implantation
3 weeks before
131
Gestational age is aka
Menstrual age
132
Delivery may be more or less ___ weeks from EDD
+/- 2 weeks
133
Weeks from EDD at which pregnancy is considered postterm
> 2 weeks
134
Includes events in development from the time of ovulation (2 weeks after LMP)
Ovulation age or postconception age
135
Trimester: Spontaneous abortions
First
136
Trimester: BP is lower
Second
137
Period of organogenesis
Embryonic period
138
Emryonic period (week)
3rd week after ovulation
139
Event-week: Fetal blood vessels in chorionic villi appear
3
140
Event-week: Chorionic sac is 1 cm in diameter
3
141
Event-week: Chorionic sac is 2-3 cm in diameter
4
142
Event-week: Embryonic disc is formed
3
143
Event-week: Embryo is 4-5 mm in length
4
144
Event-week: Primitive heart
4-5
145
Event-week: Arm and leg buds
4-5
146
Event-week: Fingers and toes
6-8
147
Event-week: Arms bend at elbows
6-8
148
Event-week: Upper lip and external ears visible
6-8
149
Fetal period: AOG
10
150
T/F Fetal length is a more accurate criterion of gestational age than weight
T
151
Fetal weight increases linearly until ___ weeks
37
152
Weight gain of fetus in 3rd trimester
30g/day
153
Event-week: Centers of ossification appear
12 [CDB: 16]
154
Event-week: Gender can be determined by inspection of genitalia
14
155
Event-week: External genitalia – start to show evidence of gender
12
156
Event-week: Spontaneous fetal movements; responds to stimuli
12
157
Event-week: Downy lanugo hair surround skin
20
158
Event-week: Fetal breathing movements become regular
20
159
Event-week: Fat deposition begins
24
160
Event-week: Canalicular period of the lungs
24
161
Event-week: Fetal lung pneumocytes begin production of surfactant
24
162
Fetuses born at this time may survive w/ intensive neonatal care
24 weeks AOG
163
Event-week: Vernix caseosa
28
164
Event-week: Eyes partially open
28
165
Birth at this age: 90% survival w/ no physical or neuro impairment
28
166
Event-week: Testes start to descend
32
167
Sutures that can be palpated in vertex presentation
All except temporal
168
Junction of the lambdoid and temporal structures
Temporal/Caesarian fontanel
169
Occipitofrontal diameter
Most prominent part of occipital bone to root of nose
170
Widest transverse diameter of the fetal head
Biparietal diameter
171
Bitemporal diameter
Greatest distance between 2 temporal bones
172
Occipitomental diameter
Chin to most prominent portion of occiput
173
Suboccipitobregmatic diameter
Middle of anterior fontanel to undersurface of bone where it joins the neck
174
Shortest AP diameter that can pass through during normal cephalic delivery
Suboccipitobregmatic
175
Trachelobregmatic diameter
Bregma to undersurface of fetal mentum/mandible
176
Normal occipitofrontal diameter
11.5 cm
177
Normal bitemporal diameter
8 cm
178
Normal occipitomental diameter
12.5 cm
179
Normal suboccipitobregmatic diameter
9.5 cm
180
Normal trachelobregmatic diameter
9.5 cm
181
Greatest circumference of the head
Plane of the occipitofrontal diameter
182
Smallest circumference of the head
Plane of the suboccipitobregmatic diameter
183
Myelination of ventral roots of the cerebrospinal nerves and brainstem begins at
6th month
184
Major portion of myelination occurs
After birth
185
Fetal circulation
IMAGE
186
Medial vs lateral part of IVC: Well oxygenated blood
Medial
187
Medial vs lateral part of IVC: Less oxygenated blood
Lateral
188
Umbilical veins undergo atrophy and obliteration within ___ days
3-4
189
Ductus venosus constricts by
10-96 hours after birth
190
Ductus venosus anatomically closes at
2-3 weeks to become ligamentum venosum
191
Sites of EPO production in the fetus
Liver and kidneys
192
Hgb from yolk sac
Portland, Gower 1, Gower 2
193
Hgb from fetal liver
Hgb F
194
Accounts for higher O2 binding by fetal Hgb
Decreased 2,3-DPG binding
195
Hgb that persists in newborns of diabetic mothers
Hgb F
196
Transplacental transport of IgG starts at
16 weeks
197
Bulk of IgG is acquired by the fetus during
Last 4 weeks
198
Adult values of IgG is achieved
3 y/o
199
IgM levels are increased in
Newborns with congenital infections
200
Ig helpful in preventing newborn diarrhea
IgA from colostrum
201
GI peristalsis and glucose transport starts at
11 weeks
202
Swallowing starts at
16 weeks
203
T/F Swallowed amniotic fluid has little effect on amniotic fluid volume
T
204
T/F If baby does not swallow, polyhydramnios may occur
T
205
Stimulates pituitary gland to produce arginine vasopressin -> stimulate contraction of the smooth muscles of the colon = meconium passage / intraamniotic defecation
Hypoxia
206
T/F Kidneys are not essential for survival in utero
T
207
Urine production begins
12 weeks
208
Amount of urine produced at term
650 mL/day
209
Source of amniotic fluid: Early pregnancy
Amniotic membrane
210
Source of amniotic fluid: Midpregnancy
Fetal urine
211
Amniotic fluid: Peak volume
1L
212
Amniotic fluid: Peak volume is attained at
36-38 weeks
213
Amniotic fluid index measurement
Uterus is divided into 4 equal quadrants -> AF measured vertically in single deepest pocket of each quadrant -> add 4 values to get AFI
214
AFI in oligohydramnios
Less than or equal to 5cm
215
AFI in polyhydramnios
>24cm
216
3 essential stages of lung development
1) Pesudoglandular
2) Canalicular
3) Terminal sac
217
Weeks: Pseudoglandular stage
5-17 weeks
218
Weeks: Canalicular stage
16-25 weeks
219
Weeks: Terminal sac stage
Beyond 25 weeks
220
Stage of lung development: Production of surfactant begins
Terminal sac stage
221
Stage of lung development: Bronchial cartilage extends peripherally (terminal bronchioles -> respiratory bronchioles -> saccular ducts)
Canalicular stage
222
Stage of lung development: Growth of intrasegmental bronchial tree
Pseudoglandular stage
223
Pulmonary hypoplasia results from insult before stage ___ of lung development
3
224
Lung continues to grow with more alveoli up to ___ years
8
225
Natural stimulus for lung maturation and augmented surfactant synthesis
Cortisol
226
L/S ratio is 1:1 at
34 weeks
227
L/S ratio is 2:1 at
36 weeks
228
Test that indirectly measures phosphatidylglycerol
Foam shake test
229
Counter used for lamellar body count
Coulter counter
230
Lamellar body count that indicates fetal lung maturity
>20,000
231
Major component of surfactant
Lipid (90%)
232
Major lipid component of surfactant
Phosphatidylcholines (lecithins) (80%)
233
Principal active component of surfactant
DPPC
234
Detection of respiratory movements
4th month
235
Weight of uterus at term
1100g
236
Mechanism by which the biparietal diameter passes through the inlet
Engagement
237
At engagement, the lowermost portion of the head is at the level of
Ischial spines
238
What station is the level of ischial spines
0
239
When does engagement usually occur in nullipara
~2 weeks before EDC (Naegele's rule)
240
When does engagement usually occur in multipara
Onset of labor or with amniotomy
241
What does engagement tell about the pelvic inlet
Pelvic inlet is adequate
242
Deflection of the sagittal suture anteriorly towards the symphysis pubis or posteriorly toward the promontory
Asynclitism
243
Anterior or posterior asynclitism is determined based on
The side of the parietal bone that presents to the examining finger (anterior parietal bone presents > anterior asynclitism; posterior parietal bone presents > posterior asynclitism)
244
Significance of asynclitism
If severe, it is a common reason for CPD even with a normal-sized pelvis
245
First requisite for the birth of the newborn
Descent
246
At which stage of labor does descent occur
Stage II
247
Descent is brought about by what forces
1) Hydrostatic pressure of amniotic fluid 2) Direct pressure of funds upon the breech with contractions 3) Bearing-down of maternal abdominal muscles 4) Straightening of the fetal back
248
MC position
LOT, with fetal back at the left
249
What is determined by LM 3
Presentation
250
What is determined by LM 4
If engagement has already taken place
251
What is LM 4 if engagement has already taken place
Negative (you cannot feel for the cephalic prominence anymore)
252
Presenting landmark/reference point in cephalic/vertex position
Posterior fontanel
253
Ideal attitude of the fetal head
Flexed
254
Cardinal movement that results from resistance meeting the fetal head from the cervix and pelvic walls or floor
Flexion
255
In LOT, what is the presenting diameter
Occipitofrontal
256
How many cm is the occipitofrontal diameter
11.5
257
In Flexion, what diameter replaces the occipitofrontal diameter so that the head can pass through the interspinous diameter (10 cm)
SOB diameter (9.5 cm)
258
Turning of the head in such a way that the occiput gradually moves towards the symphysis pubis anteriorly from its original position or posteriorly (less common) toward hollow of the sacrum
Internal rotation (LOT > LOA)
259
Cardinal movement that is essential for completion of labor
Internal rotation
260
Cardinal movement wherein the sharply flexed head reaches vulva and follows the J-shaped contour of the vaginal canal in dorsal lithotomy
Extension
261
Cardinal movement, the goal of which is to deliver the head out into the vulva
Extension
262
2 forces that bring about extension
1) Uterus 2) Pelvic floor and symphysis pubis
263
Swelling of baby’s head that can cross suture lines
Caput succedaneum
264
Swelling of baby’s head that is confined to suture lines
Cephalhematoma
265
How many cm of moulding is allowable
1 cm
266
Cardinal movement that brings the base of the occiput into direct contact with the inferior margin of the symphysis pubis
Extension
267
Cardinal movement that corresponds to the rotation of the fetal body
External rotation
268
Phases of cervical dilation (active phase)
1) Acceleration phase (increasing rate) 2) Phase of maximum slope (greatest rate) 3) Deceleration phase (slowing down)
269
The gold standard for documentation of rates of cervical dilation and fetal descent during active labor
Friedman curve
270
A composite graphical record of key data (maternal and fetal) during labor entered against time that helps in decision-making during labor
Partograph
271
The latent phase of labor (regular uterine contractions to 3 cm) should not be longer than
8 hours
272
During the active phase, the rate of cervical dilatation should not be slower than
1 cm/hour
273
Phase of cervical dilation that is not always present
Acceleration phase
274
Functional divisions of labor
1) Preparatory (latent phase) 2) Dilatational (active) 3) Pelvic (deceleration phase of cervical dilation/cardinal movements of labor)
275
Protracted active phase is defined as
Less than 1.2 cm/hour in nulli; less than 1.5 cm/hour in multis
276
Prolonged deceleration (stage II) in nullipara
3 hours or more if with anesthesia; 2 hours or more if without anesthesia
277
Prolonged deceleration (stage II) in multipara
2 hours or more if with anesthesia; 1 hour or more without anesthesia
278
Station: Pelvic inlet
-3, -5
279
Station: Ischial spines
0
280
Station: Perineum (crowning)
+3, +5
281
Arrest in descent, nulli
No change in dilatation in an hour
282
Arrest in descent, multi
No change in dilatation in 30 minutes
283
Prolonged latent phase, nulli
> 20 hours
284
Prolonged latent phase, multi
> 14 hours
285
Arrest of dilation
No progress for 2 hours
286
Protracted descent, nulli
Less than 1 cm/hour
287
Protracted descent, multi
Less than 2 cm/hour
288
Shoulder dystocia is disproportion between fetal bisacromial diameter and ___
AP diameter of pelvic inlet
289
Indicator of shoulder dystocia described as retraction of feral head against maternal perineum
Turtle sign
290
Turtle sign is due to failure of what cardinal movement
Internal rotation of bisacromial diameter at midpelvis > impaction of shoulder at sacral promontory
291
MC fractured bone in shoulder dystocia
Clavicular fracture (2nd: Humeral fracture)
292
Planned CS may be reasonable for a diabetic woman with EFW ___
>4200-4500g
293
ACOG guideline for application of fundal pressure
Don't apply directly downward; lateral application from either sides of maternal abdomen at an angle towards the feral chest
294
A maneuver that flattens the maternal sacrum hence increases the size of the posterior outlet and may unlock posterior shoulder; increases intraabdominal pressure
Mc Robert
295
Progressive rotations of shoulder girdle in a corkscrew fashion by continuous pressure on anterior surface of the posterior shoulder together with downward thrust of the left hand on the buttocks of the baby
Woods maneuver
296
Posterior arm delivery; pressure applied on the antecubital fossa in order to flex the fetal forearm and then pull across the chest and face until it is outside the vagina
Barum maneuver
297
Pressure is applied to the posterior surface of the most accessible part of fetal shoulder (scapula; either the anterior or posterior shoulder) to effect shoulder abduction
Rubin maneuver (opposite Wood's)
298
Replacement of the head up to station 0 for subsequent abdominal rescue
Zavanelli maneuver
299
Placing the patient on all fours
Gaskin maneuver
300
During the active phase, the rate of cervical dilatation should not be slower than
1 cm/hour
301
Phase of cervical dilation that is not always present
Acceleration phase
302
Functional divisions of labor
1) Preparatory (latent phase) 2) Dilatational (active) 3) Pelvic (deceleration phase of cervical dilation/cardinal movements of labor)
303
Protracted active phase is defined as
Less than 1.2 cm/hour in nulli; less than 1.5 cm/hour in multis
304
Prolonged deceleration (stage II) in nullipara
3 hours or more
305
Prolonged deceleration (stage II) in multipara
1 hour or more
306
Station: Pelvic inlet
-3, -5
307
Station: Ischial spines
0
308
Station: Perineum (crowning)
+3, +5
309
Arrest in descent, nulli
No change in dilatation in an hour
310
Arrest in descent, multi
No change in dilatation in 30 minutes
311
Prolonged latent phase, nulli
> 20 hours
312
Prolonged latent phase, multi
> 14 hours
313
Arrest of dilation
No progress for 2 hours
314
Protracted descent, nulli
Less than 1 cm/hour
315
Protracted descent, multi
Less than 2 cm/hour
316
Shoulder dystocia is disproportion between fetal bisacromial diameter and ___
AP diameter of pelvic inlet
317
Indicator of shoulder dystocia described as retraction of feral head against maternal perineum
Turtle sign
318
Turtle sign is due to failure of what cardinal movement
Internal rotation of bisacromial diameter at midpelvis > impaction of shoulder at sacral promontory
319
MC fractured bone in shoulder dystocia
Clavicular fracture (2nd: Humeral fracture)
320
Planned CS may be reasonable for a diabetic woman with EFW ___
>4200-4500g
321
ACOG guideline for application of fundal pressure
Don't apply directly downward; lateral application from either sides of maternal abdomen at an angle towards the feral chest
322
A maneuver that flattens the maternal sacrum hence increases the size of the posterior outlet and may unlock posterior shoulder; increases intraabdominal pressure
Mc Robert
323
Progressive rotations of shoulder girdle in a corkscrew fashion by continuous pressure on anterior surface of the posterior shoulder together with downward thrust of the left hand on the buttocks of the baby
Woods maneuver
324
Posterior arm delivery; pressure applied on the antecubital fossa in order to flex the fetal forearm and then pull across the chest and face until it is outside the vagina
Barum maneuver
325
The pressure is applied to the posterior surface of the most accessible part of fetal shoulder (either the anterior or posterior shoulder) to effect shoulder abduction
Rubin maneuver (opposite Wood's)
326
Replacement of the head up to station 0 for subsequent abdominal rescue
Zavanelli maneuver
327
Placing the patient on all fours
Gaskin maneuver
328
At station -2, the presenting part is at the level of
2 cm above ischial spine
329
First degree laceration
Fourchette, perineal skin, vaginal mucosa; PERIURETHRAL
330
At full effacement, cervix is described to be
"Paper thin"
331
Absolute indication for CS
Contracted pelvis
332
Cutting the cervix to make the opening bigger
Duhrseen
333
Shoulder horn instrument w/ concave blade w/ long handle, is slipped b/w symphsis pubis and
impacted anterior shoulder
Chavis
334
Pressure applied at infant’s jaw and neck in the
| direction of the mom’s rectum, w/ strong fundal pressure applied by an assistant as the anterior shoulder is freed
Hibbard
335
Best anaesthesia to alleviate pain during childbirth
Epidural anesthesia
336
Incompetent cervix is defined as
Cervical dilatation in the absence of uterine contractions
337
Interval and duration of contractions true labor
2-3 minutes, 40-60 seconds
338
How often should pelvic exams be done
Every 4 hours in latent phase; every 2-3 hours during the active phase
339
Test used to confirm whether bag of water has ruptured
Litmus paper test
340
Patient in labor should be placed on NPO for
8 hours
341
When to give analgesia in labor
Active phase
342
Position and movement during labor
Position the patient is most comfortable in EXCEPT in ROM and sedated patients; IDEALLY, dorsal lithotomy (increases diameter of outlet
343
Position if membranes have ruptured and patient is sedated
Left lateral decubitus (increases blood flow to fetus)
344
Normal fetal response to movement and contractions
HR accelerates
345
Most accurate measure of labor progress
Cervical dilation
346
Sign that episiotomy may be done
Crowning, 3-4 cm of the head is visible
347
Purpose of episiotomy
Prevent tears of perineal muscle
348
What is the ONLY disadvantage of midline episiotomy compared to mediolateral episiotomy
Transection of rectum
349
When is mediolateral episiotomy indicated
1) Very short perineum 2) Anticipated large baby
350
Heel of clinician’s hand that is draped with a sterile towel is placed over posterior perineum overlying fetal chin
Modified Ritgen maneuver
351
When to start Modified Ritgen maneuver
Vulvar ring is at 5 cm
352
Purpose of Modified Ritgen maneuver
Allows control of delivery of fetal head so that the smallest diameter passes through introitus
353
Where to place clamp during cord clamping
2-5 cm from baby's umbilicus
354
Earliest sign of placental separation
Change in uterine shape from discoid to globular (CALKIN SIGN)
355
Signs of placental separation
1) Calkin sign 2) Gush of blood from vagina 3) Lengthening of the cord 4) Rise of uterus in abdomen as placenta descends to LUS or vagina
356
A pathologic constriction located at the junction of the thinned lower uterine segment and the thick retracted upper uterine segment that is associated with absence of progress in labor with very good uterine contractions
Pathologic ring of Bandl
357
First degree laceration
Fourchette, perineal skin, vaginal mucosa (sparing underlying fascia and muscle)
358
Second degree laceration
Up to fascia and muscles of perineal body
359
Third degree laceration
Up to anal sphincter
360
Fourth degree laceration
Up to rectal mucosa
361
If you are dealing with 4th degree lacerations, which mucosa should you repair first
Rectal mucosa FIRST before the vaginal mucosa
362
CI from giving ergot alkaloids (methylergonovine malate)
Hypertension
363
The Nitabuch’s layer separates the cotyledons from the
Decidua basalis
364
Mean blood loss with vaginal delivery
500 mL
365
Mean blood loss with CS
1000 mL
366
Total blood loss in vaginal delivery that is considered hemorrhage
1000 mL
367
Total blood loss in CS that is considered hemorrhage
1500 mL
368
% blood loss in class 1 hemorrhage
15
369
% blood loss in class 2 hemorrhage
20-25
370
% blood loss in class 3 hemorrhage
30-35
371
% blood loss in class 4 hemorrhage
40
372
Prenatal risk factors for hemorrhage
1) Pre-eclampsia 2) Previous PPH 3) Multiple gestation 4) Previous CS 5) Multiparity
373
Intrapartum risk factors for hemorrhage
1) Prolonged 3rd stage 2) Episiotomy, midline or mediolateral 3) Arrest of descent 4) Lacerations 5) Augmented labor 6) Forceps delivery
374
4 T's of postpartum hemorrhage
1) Tone 2) Tissue 3) Trauma 4) Thrombin
375
PPH: Frank bleeding, blood loss proportionate with maternal VS, contracted uterus
Birth canal injuries
376
MC risk factor for birth canal injuries
History of delivery of big babies
377
Management for birth canal injuries
1) Suture if >2 cm laceration, 1st stitch 1 cm above apex of tear 2) Antimicrobials 3) Crystalloids while waiting for BT
378
In complete uterine rupture, which layers of the uterine wall are separated
All
379
In incomplete uterine rupture, which layers of the uterine wall are separated
Uterine muscle separated; visceral peritoneum intact (uterine dehiscence)
380
MCC of uterine rupture
Previous classical CS scar (located at active segment)
381
By ___, you expect most organs have returned to their normal non-pregnant condition
6 weeks
382
MC location of myoma
Body of uterus
383
Cerclage in women with weak cervix has to be removed at ___ weeks AOG to prevent the risk of uterine rupture during childbirth
36 weeks
384
A pathologic constriction located at the junction of the thinned lower uterine segment and the thick retracted upper uterine segment that is associated with obstructed labor
Pathologic ring of Bandl
385
Postpartum bleeding presenting as amount of bleeding disproportionate to maternal vital signs
Uterine rupture
386
Management for uterine rupture
Laparotomy
387
Management of choice for uncontrolled uterine bleeding from rupture
Hysterectomy
388
Placental separation wherein blood escapes into the vagina due to separation from the periphery
Duncan
389
Placental separation wherein blood is concealed behind the placenta due to separation from the center
Schultze
390
In placenta accreta, abnormal attachment of the villi (trophoblasts) to the myometrium is due to the absence of
Nitabuch’s layer
391
The Nitabuch’s layer separates the cotyledons from the
Decidua basalis
392
MC risk factor for placenta accreta
Previous CS
393
Preferred diagnostic modality for placenta accreta
Ultrasound with Doppler
394
UTZ criteria that is diagnostic for placenta accreta
Intraplacental lacunae
395
Management for placenta accreta
Cut umbilical cord, leave placenta to necrose, MTX + folinic acid
396
MCC of postpartum hemorrhage
Hematomas secondary to inadequate repair of an episiotomy or vaginal laceration
397
1st manifestation of bleeding in hematomas secondary to inadequate repair of an episiotomy or vaginal laceration
Pallor
398
Complete uterine inversion
Uterus extends beyond cervix
399
Incomplete uterine inversion
Does not extend beyond cervix
400
Prolapsed uterus
Corpus is out of introitus
401
Uterine atony is failure of the uterus to contract within ___ after delivery
1 hour
402
Uterine atony can take place within ___ after placental delivery
6 weeks
403
MCC of obstetrical haemorrhage and bleeding in the 4th stage
Uterine atony
404
4th stage of labor
1-2 hours after placental delivery
405
MCC of late obstetrical hemorrhage
Retained placental fragments
406
Conservative management of uterine atony
1) Bimanual compression 2) Oxytocin 3) Ergot alakloids 4) PGF2
407
Surgical management of uterine atony
1) Uterine artery ligation (90% of uterine blood flow) 2) Hypogastric/Internal iliac artery ligation (external iliac pulsation must be present after ligation) 3) B-lynch compression sutures (previous CS and LTCS) 4) TAH
408
Puerperium
Delivery of placenta until 6 weeks postpartum
409
Non-pregnant weight is normally attained at
6 months postpartum
410
Time when most physiologic changes during pregnancy return to prepregnancy state
Puerperium
411
Mechanism of uterine involution
Atrophy
412
T/F Oxytoxic agents hasten uterine involution
F
413
T/F Uterine involusion is faster in nulliparas than multiparas
T
414
At ___ uterus is in pelvic cavity
10th – 12th postpartum day
415
Weight of uterus after delivery
1000g
416
Weight of uterus 1 week postpartum
500g
417
Weight of uterus 2 weeks postpartum
300g
418
Weight of uterus at the end of puerperium
70g
419
Weight of non pregnant uterus
100g or less
420
Prolonged lochial discharge is a sign of
Uterine subinvolution
421
Placental site at the end of 2nd week postpartum
3-4 cm diameter
422
Regeneration of the stroma and endometrial glands over the placental site
7th day postpartum
423
Regeneration of the stroma and endometrial glands over the placental site begins at what area
Desidua basalis/periphery
424
Restoration of entire endometrium postpartum completes at
3rd week
425
T/F Inflammatory changes within 6 weeks postpartum reflect infection
F, histological endometritis and acute salpingitis are part of the normal reparative process
426
Vascularity of cervix are located at
12, 3, 6, and 9
427
Small elevations of the mucous membrane encircling the vaginal orifice after vaginal delivery
Myrtiform caruncles
428
At which week are fully healed lacerations and episiotomy and return of fallopian tubes and ovaries to the pelvis expected
1-2 weeks
429
Collecting duct system which is dilated during pregnancy returns to prepregnant measurement at ___ week postpartum
6th
430
Lochia rubra lasts for
3-4 days postpartum
431
Lochia serosa lasts for
6-9 days postaprtum
432
Lochia alba is seen during
After 10 days postpartum
433
Refers to intermittent, crampy lower abdominal pain that is experienced by some after delivery
After pain
434
Duration and intensity of after pain are increased with
1) Parity 2) Breastfeeding
435
Return of non-pregnant blood volume
1 week postpartum
436
CO returns to normal at
2 weeks postapartum
437
Non-pregnant weight is normally attained at
6 months postpartum
438
Return of menses postpartum is delayed with lactation because
Prolactin inhibits GnRH
439
Return of menstruation in non-lactating
7-8 weeks
440
Puerperal infection is defined as
38C or higher, 2nd-10th day postpartum (exclusive of the first 24 hours)
441
MCC of puerperal fever
Endometritis
442
Early-onset postpartum infection occurs within
48 hours
443
Late-onset postpartum infection occurs
After 48 hours up to 6 weeks postpartum
444
Single most significant risk factor for the development of uterine infection
Route of delivery
445
Most important criterion for diagnosis of postpartum metritis
Fever
446
Chills in puerperal infection suggests
Bacteremia
447
When to do antepartum fetal surveillance
28-32 weeks until 42 weeks
448
Fetal viability begins at
28 weeks
449
What patients will benefit from antepartum fetal surveillance
Those at risk for perinatal morbidity and/or mortality
450
T/F Do antepartum fetal surveillance in the presence of fetal abnormalities that are incompatible with life
F
451
Usual frequency of antepartum fetal surveillance
Once to 2x a week
452
Antepartum fetal surveillance techniques
1) Fetal movement counting 2) Non-stress test 3) Contraction stress test 4) Biophysical profile 5) Fetal umbilical artery velocimetry
453
Simplest and least expensive antepartum fetal surveillance
Fetal movement counting
454
When to do fetal movement counting
2nd half of pregnancy
455
Maximum period of awake stage when the baby makes a lot of movement
11pm-4am
456
Number of fetal movements that indicate a well baby in utero
10/hour
457
Maximal fetal activity when amniotic fluid volume is greater than the fetus
28-32 weeks
458
T/F Sleep cycle of a fetus becomes longer as the baby matures
T
459
Normal response of fetus to hypoxia
Reduction/cessation of movements to reduce O2 consumption and conserve energy
460
In stillbirth, fetal movement stops ___ hours before death
12-24
461
What is assessed in a non-stress test
FHR response to movement
462
Normal response in a non-stress test
FHR will temporarily accelerate/increase in response to the
| fetal movement
463
Parameters measured in NST
1) Baseline FHR (110-160) 2) FHR variability (6-25/min) 3) Accelerations (normal response) 4) Decelerations (sign of fetal hypoxia)
464
Causes of non-reactive NST
1) Prematurity 2) Fetal sleep cycle 3) Tramadol
465
One dark line to another in an NST strip
1 minute
466
Each small box horizontally in an NST strip corresponds to
10 seconds
467
Define an acceleration in an NST
Increase in FHR of at least 15 beats lasting for at least 15 seconds
468
Reactive NST
2 or more FHR accelerations that peak at least 15 bpm above the baseline lasting for 15 seconds within a 20-minute period
469
Non-reactive NST
Does not meet the criteria over a period of 40 minutes
470
T/F A contraction stress test may be done in a preterm baby
F, may induce preterm labor
471
Intensity of contractions: 30-40 mmHg
Mild
472
Intensity of contractions: 40-60 mmHg
Moderate
473
Intensity of contractions: 60-80 mmHg
Strong
474
Intrauterine resuscitative measures
1) Maternal O2 in left lateral recumbent position (4-5 L) 2) Change oxytocics to plain IV, preferably D5 glucose for the brain of the fetus
475
Interpretation of NST: No late or significant variable deceleration
Negative; Assured that baby is okay
476
Interpretation of NST: Late decelerations following 50% or more of contractions
Positive; Non-reassuring FHR pattern
477
Interpretation of NST: Intermittent late decelerations
Suspicious
478
Non-invasive mode of antepartum fetal surveillance that predicts the presence or absence of fetal asphyxia and predicts risk of fetal death in the antenatal period
BPS
479
Redistribution of blood in a fetus will favour which organs
1) Brain 2) Heart 3) Adrenals
480
5 parameters of BPS
[NR Ba Talaga Ako]
| NST + 4 variables observed by ultrasound 1) fetal bReathing 2) fetal Body movements 3) fetal Tone 4) AFV
481
BPS parameters of acute hypoxia
NST + RBT
482
BPS parameters of chronic hypoxia
AFV
