OB Flashcards
Nullipara
had no deliveries
nullgravida
never pregnant
Primipara
one delivery
Multipara
multiple deliveries
Grand multipara
> 5 births; more likely to have complications
TPAL
T= term (>/= 37 wks) P= preterm (
G3 P 0202
3rd pregnancy 0 term babies 2 preterm babies 0 abortions 2 living
Gravidity
current or completed pregnancies
cutpoint for abortions in TPAL
> 2
G = ?
T+P+A
What do you do with adoptions?
some ppl add them into L
Term vs preterm
37 weeks
i.e. 36 wks 6 days still preterm
G5 P2110
5 pregnancies 2 terms 1 preterm 1 abortion 0 living
Braxton-Hicks contractions
False Labor
- may be present first trimester
- irregular, nonrhythmic– cervix not changing
- Some ppl get them, some don’t
3 things to ask every pregnant woman
bleeding, contractions, leaking fluid
+ baby moving?
True Labor
Regular contractions with cervical change
2 main hormones
Prostaglandins
Oxytocin
What do prostaglandins do
make cervix soft
what does oxytocin do
from posterior pituitary and helps with uterine contractions
3 Stages of labor
Stage I: 2 phases (latent vs active) - cervix dilating
Stage II: from when 10 cm to when baby is out
Stage III: from when baby is out until placenta delivered
Latent Phase
NOW 0-6 cm but used to be 0-4
SLOW
Active Phase
Officially starts at 6 cm
FAST
What is effacement vs dilation
Dilation = enlargening cervix Effacement = thinning of cervix
In woman with first pregnancy will effacement first then dilate
Multiparous- usually dilate then efface
Laboring down
way for mom to get uterus to move baby down naturally to get ready for birth
Cardinal movements
- Engagement, descent, flexion
- Internal rotation
- Complete rotation with beginning of excision
- Complete extension (restitution)
- Deliver anterior shoulder
signs of Third stage of labor
uterus becomes firmer, gush of blood, uterus rises in abdomen as placenta passes into lower segment, lengthening of umbilical cord
- usually takes a half an hr
Lacerations classifications
1st degree: tears into vaginal mucosa/skin
2nd deg: into submucosa and can involve muscles of perineal body
3rd deg: involves anal sphincter
4th: involves rectal mucosa
3 Factors of labor
Passage (bony pelvis, soft tissue)
Power
Passenger
Caldwell-Moloy Classification
Classifies pelvic shape
- Gynecoid most common
- Anthropoid more common in African American (taller, not wider)
Assessment of Mid-pelvis
Feel for ischial spines
Big reason babies get stuck
not coming through the canal in the right way
What to consider on fetal heads
Bones in face fused but movable bones
Sutures
Fontanelle- spaces between bones
5 terms for describing baby in mom
- Fetal Lie- axis of mom to axis of baby (longitudinal vs transverse)
- Fetal Presentation **: what is presenting to cervix first
- Attitiude
Fetal Station**
Fetal position
Fetal presentation types
Cephalic/Vertex Breech Transverse Compound - 2 things coming out at a time Face Brow
Types of Breech
- Complete (crossing legs)
- incomplete (partial up/down)
- Frank (Feet up by head)
How to diagnose fetal presentation
Abdominal palpation (Leopold’s Maneuvers)
Vaginal Examination
Auscultation (where is heart beat? high = breech)
Sonography
Fetal attitude
Degree of flexion a fetus assumes during labor
- Flexed,
- sinciput/military
- brow
- face
Station
relationship of part of baby presenting to ischial spine levels
(-5 to +5); ischial spines = 0
+5 = crowning and about to deliver
Fetal Position
relation of arbirarily chosen portion of fetal presenting part to right or left side of maternal birth canal
Reference points:
- fetal occiput :babies coming head first
- Fetal chin (mentum): face first babies
- Fetal sacrum: breech babies
OP vs OA
occiput posterior vs anterior compared to mom
most of time babies face posterior = occiput anterior
- everything relative to mom
What parameters can you change in shock
- CO (heart rate—children more HR dependent;
SV- increase preload, contractility, alter afterload - CAO2- Increase oxygenation
first thing to give in shock
isotonic fliud
Saline, surgeons may be like LR
