OB Lecture 4- Keppler Flashcards
What is a bishop score?
-Combined somewhat objective scoring system for determining a patient’s likelihood of
successful induction of labor
-Considers dilation, effacement, position and consistency of the cervix plus station of the fetal
presenting part
Max score in bishop score?
13
Labor progressing at a slower pace than “normal”
Protracted labor
Either arrest of dilation after diagnosis of active labor, or failure of descent of the fetal head
during the second stage of labor
Arrested labor
Less than 3 hours from onset of labor to delivery
Precipitous labor
○ Green/brown staining of the amniotic fluid when the fetus defecates prior to delivery
○ Associated with adverse fetal outcomes including fetal intolerance of labor and respiratory
distress with aspiration
Meconium
What is a Friedman’s curve?
Friedman’s Curve is a graph that care providers have traditionally used to define a “normal” length and pace of labor–giving first-time mothers about 14 hours to go from zero to ten cm and experienced mothers eight hours (Friedman 1955). If a cervix does not dilate according to this schedule, she may be assigned a diagnosis of Failure to Progress and taken to the operating room for a Cesarean.
What are the 3 P’s you should remember in labor?
○ Pelvis
○ Passenger
○ Powers
What degree laceration?
vaginal and perineal mucosa only, no disruption of muscles
1st degree
What degree laceration?
1st degree plus superficial perineal muscles (transverse perineal and bulbocavernosus muscles)
2nd degree
What degree laceration?
2nd degree plus anal sphincter(s)
3rd degree
What degree laceration?
3rd degree plus anal mucosa
4th degree
Is an episiotomy something that is commonly done?
No! Resist the urge
_____ is the process of delivering a fetus and products of conception through coordinated uterine contractions combined with maternal expulsive efforts
Labor
What stage of active labor is this? Progressive dilation of the uterine cervix from entry to the active phase to complete (10 cm) dilation
The first stage
What stage of active labor is this?
Complete dilation and culminates with delivery of the neonate
The second stage
What stage of labor is this?
The third stage starts at delivery of the newborn and culminates with delivery of the placenta
The third stage
Why is fetal monitoring in labor important?
Fetal monitoring in labor is intended to confirm fetal wellbeing and guide interventions to decrease fetal harm in labor
What are complications in labor?
Complications in labor are many and include bleeding, cord complications, protracted or arrested labor, and infection
You are managing a patient in active labor. Her pain is controlled with an epidural and the fetal heart rate is being continuously monitored with a Category 1 tracing. Which of the following, if present, would change the fetal heart tracing to Category 2?
1. A baseline frequency of 165 beats per minute
2. Early decelerations
3. A temporary increase in the heart rate lasting 15 seconds, at least 15 beats per
minute above the baseline
4. Moderate variability
- A baseline frequency of 165 beats per minute
A 23 year old G1P0 at 39 weeks is admitted in active labor at 5 cm cervical dilation. In 3 hours her cervix is dilated to 7 cm dilation. After 6 hours, she is dilated to 8 cm. Which of the following best describes her labor progress?
- Her labor is progressing normally
- Her labor is protracted
- Her labor is arrested
- She is in the second stage of labor
- Her labor is protracted
abnormally slow cervical dilation
A 26 y/o G4P1021 at 41 0/7 weeks gestation presents for a post-dates induction of labor. You examine her cervix and note she’s 4 cm dilated, 50% effaced, at -1 station. Her cervix is soft and anterior. You calculate a Bishop score of 9. What is the significance of this finding?
1. She is guaranteed to have a vaginal delivery
2. Her induction is more likely to fail
3. Her induction is more likely to be successful using nipple stimulation
4. Her induction is as likely to result in a vaginal delivery as if she presented in
spontaneous labor
- Her induction is as likely to result in a vaginal delivery as if she presented in
spontaneous labor
A patient has arrest in the active phase of labor. You are considering what factors are contributing to her stalled labor. Which of the following is not one of the three “Ps”?
- Passenger
- Powers
- Pitocin
- Pelvis
- Pitocin
Which of the following most accurately indicates that a patient admitted with contractions is in the first stage of active labor?
- She is dilated to 5 cm
- She is having enough pain to request an epidural
- Her fetal heart rate pattern shows accelerations
- The slope of cervical change over time is increasing
- The slope of cervical change over time is increasing
The orientation of the fetal head is assessed based on the location of which feature of the fetal cranium?
- The parietal bones
- The frontal suture
- The occipital bone
- The funny bone
- The occipital bone
Which of the following characteristics of a fetal heart rate being monitored in labor is not found in a category I tracing?
- Late decelerations
- Early decelerations
- Accelerations
- Moderate variability
- Late decelerations
Which of the following is not an indication for making an episiotomy?
- Maternal exhaustion
- Category 2 or 3 fetal heart rate tracing
- Maternal history of cardiovascular disease
- To decrease extension of a laceration to a more severe grade
- To decrease extension of a laceration to a more severe grade