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OBGYN > OBN: Labor and Delivery > Flashcards

OBN: Labor and Delivery Flashcards

1
Q

___ refers to the relationship of fetal presenting part to the right or left of birth canal

A

fetal position

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2
Q

____ refers to the portion of the body that is foremost within the birth canal

A

fetal presentation

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3
Q

____ refers to the relation of the fetal long axis to that of the mother

A

fetal lie

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4
Q

cite 3 factors predisposing for face presentation:

A
  1. ) Fetal malformation (anencephaly)
    2) Cord coil
    3) High parity / lax abdomen
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5
Q

____ results in shortened suboccipitobregmatic diameter from body changes in the fetal head

A

molding

Caput succedaneum is local edema

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6
Q

Cite the 4 phases of parturition.

A

Phase 1: Quiescence
Phase 2: Activation
Phase 3: Stimulation
Phase 4: Involution

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7
Q

___ phase of parturition is when there is uterine involution, cervical repair, breastfeeding

A

Phase 4 - parturient recovery

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8
Q

___ phase of parturition is when the uterine is preparing for labor, there is cervical ripening, effacement, and loss of structural integrity

A

Phase 2 - activation/preparation for labor

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9
Q

___ phase of parturition is when there is contractile unresponsiveness, cervical softening

A

Phase 1 - Quiescence

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10
Q

____ phase where processes of labor occur, uterine contraction, cervical dilatation, and fetal and placental expulsion

A

Phase 3 - Stimulation

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11
Q

___ stage of labor when the cervix dilates to 10cm and ends with fetal delivery

A

second stage

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12
Q

Cite 4 reasons why uterine contractions are painful

A
  1. Hypoxia of the myometrium
  2. Compression of the nerve ganglia
  3. Cervical stretching during dilatation
  4. Stretching of peritoneum overlying fundus
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13
Q

___ is the most important force in fetal expulsion

A

maternal intraabdominal pressure

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14
Q

What are the 7 cardinal movement of labor?

A
  1. Engagement
  2. Descent
  3. Flexion
  4. Internal rotation
  5. Extension
  6. External rotation (restitution)
  7. Expulsion

ED FIRE ERE

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15
Q

What are the 4 forces that cause fetal descent?

A
  1. STRAIGHTening of fetal body
  2. Pressure of Fundal contractions
  3. Pressure of Amniotic fluid
  4. Maternal effort

Remember: Straight aFAM

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16
Q

___ division of labor where phase of maximum slope occurs and is unaffected by sedation?

A

Dilatational division

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17
Q

____ division of labor where the cardinal movements of labor happen

A

Pelvic Division or deceleration phase

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18
Q

Cut off time to consider prolonged latent phase for Multipara and Nullipara

A

Nullipara - >20 hours

Multipara - > 14 hours

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19
Q

Abnormal labor progression in the active phase when the cervix dilates less than ___ cm in both multipara and nullipara

A

Nullipara < 1.2cm

Multipara <1.5cm

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20
Q

____ hours in the presence of adequate uterine contraction is considered labor arrest

A

2 hours

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21
Q

What is the normal uterine contraction to say that the patient is in active labor

A
  1. One in 10 minutes

2. 4 in 20 minutes

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22
Q

What is the minimum MVU to say that the patient has adequate contraction?

A

200 MVU

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23
Q

What are the criteria for diagnosis that the patient is in labor?

A
  1. Contractions - 1 in 10mins
  2. at least 200 MVU
  3. Effacement >70-80%
  4. Dilatation >3cm
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24
Q

___ scoring system to predict labor induction outcomes

A

Bishop Score

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25
Q

A bishop score of ____ has a high likelihood for a successful induction

A

Bishop Score 9

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26
Q

What are the components of the Bishop score?

A

DESPC 2 (despacito)

Dilation: 3-4cm
Effacement: 60-70%
Station: -1
Position: anterior
Consistency: soft
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27
Q

Patient with initial bishop score of 8 but has pre-eclampsia. What is her new bishop score?

A

9

add 1 point for preeclampsia and each previous vaginal delivery

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28
Q

Patient has a bishop score of 9. However, it was found out that the fetus is 40 weeks AOG. What is her new bishop score?

A

8

Subtract 1 point for

  1. Postdate pregnancy
  2. Nulliparity
  3. PPROM
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29
Q

What are the contraindications for labor induction?

A
  1. Breech
  2. CPD
  3. Placeta previa
  4. Previous major uterine surgery
  5. Invasive cervical CA
  6. Cord presentation
  7. active genital herpes
  8. Physician’s convenience
  9. Conditions that preclude vaginal birth
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30
Q

__ is the bishop score suggests an unfavorable cervix, and indication for cervical ripening

A

Bishop 4

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31
Q

What are the indications for labor induction?

A
  1. Gestational Hypertension
  2. Preeclampsia, eclampsia
  3. PROM
  4. Maternal medical conditions
  5. > 41 1/7 weeks AOG
  6. Intraamniotic infection
  7. Fetal demise
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32
Q

Membrane stripping is an effective method of labor induction since it increases ____ and reduce pregnancy duration

A

local prostaglandins

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33
Q

What are the signs of hyperstimulation due to oxytocin as method of labor induction?

A
  1. 5 contractions in 10 minutes

2. Contraction lasting more than 120 seconds

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34
Q

Early amniotomy is defined as puncturing the amniotic fluid despite having a cervical dilatation of ___ cm

A

1-2cm

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35
Q

Late amniotomy is defined as puncturing the amniotic fluid despite having a cervical dilatation of ___ cm

A

5cm

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36
Q

What are the uses of amniotomy?

A
  1. Speed up contractions
  2. shorter length of labor
  3. Earlier detection of meconium staining
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37
Q

What are the complications of amniotomy?

A
  1. Chorioamnionitis
  2. Umbilical cord prolapse
  3. Cord compression
  4. Fetal heart rate deceleration
  5. Bleeding from fetal or placental vessels
38
Q

[Mechanisms of labor]

Refers to the relationship of the long axis of the fetus to that of the mother

A

fetal lie

39
Q

[Mechanisms of labor]

refers to the presenting part foremost in the birth canal or in closest proximity with it

A

fetal presentation

40
Q

[Fetal Presentation]

longitudinal

A

cephalic, breech

41
Q

[Fetal Presentation]

transverse

A

shoulder

42
Q

[Mechanisms of labor]

relationship of an arbitrarily chosen presenting part to the right or left side of the maternal birth canal

A

fetal position

43
Q

What is the correct order of cardinal movements

A

ED FIRE ERE

  1. Engagement
  2. Descent
  3. Flexion
  4. Internal rotation
  5. Extension
  6. External rotation
  7. Expulsion
44
Q

What are the stages of labor?

A
  1. Preparatory division
  2. Dilatational division
  3. Pelvic division
45
Q

[Stages of Labor]

sedation and conduction analgesia are capable of arresting this division

A

Preparatory division

46
Q

[Stages of Labor]

unaffected by sedation

A

Dilatational division

47
Q

[Stages of Labor]

The deceleration phase of cervical dilatation commences with this stage of labor

A

pelvic division

48
Q

Which division of labor does the cardinal fetal movements occur

A

pelvic division

49
Q

Patient is in latent phase of labor when the cervix is ____ dilated

A

3-5 cm dilated

50
Q

What are the factors affecting the latent phase duration?

A
  1. Excessive sedation or epidural anesthesis
  2. Unfavorable cervical condition
  3. False labor
51
Q

___ cm dilated marks the active phase of labor

A

3-5 com to fully

52
Q

What is the rate of cervical dilation in nullipara?

A

1.2cm/hour

53
Q

What is the rate of cervical dilation in multipara?

A

1.5cm/hr

54
Q

What are the factors affecting the active phase duration?

A
  1. Epidural anesthesia (prolongs labor curve to 1 hour)
  2. Maternal obesity - prolongs to 30 to 60 minutes
  3. Maternal fear - prolong to 45 minutes
55
Q

[Second stage of labor]

Vertex enters the pelvis with the saggital suture lying in ___ (parallel, transverse) pelvic diameter

A

transverse

56
Q

Most common fetal position entering the pelvis

A

LOT

57
Q

What is the greatest transverse diameter in an occiput presentation

A

BPD

58
Q

[Cardinal Movement]

BPD passes through the pelvic inlet

A

Engagement

59
Q

[Asynclitism]

Sagittal suture approaches the sacral promontory

A

Anterior asynclitism

anterior parietal bone is palpable

60
Q

[Asynclitism]

Sagittal suture lies close to the symphysis pubis

A

Posterior asynclitism

posterior parietal bone is palpable

61
Q

[Pelvic planes]

Linea terminalis marks what inlet

A

Pelvic inlet

62
Q

[Pelvic planes]

What is the marker of pelvic midplane?

A

ischial spine

63
Q

[Pelvic planes]

what is the marker for pelvic outlet?

A

Ischial tuberosit

64
Q

[Pelvic planes]

what are the landmarks of pelvic inlet?

A
  1. Posterior - promontory, sacral alae
  2. Lateral - linea terminalis
  3. Anterior - pubic rami, symphysis pubis
65
Q

[Diameters]

True anatomic conjugate

A

promontory to upper margin of symphysis

11cm

66
Q

[Diameters]

Obstetric conjugate

A

promontory to posterior symphysis

> 10cm

67
Q

[Diameters]

Diagonal conjugate

A

Promontory to lower margin of symphysis

> 11.5

this is measured manually

68
Q

What is the first requisite for birth of the newborn?

A

Descent

69
Q

___ cm dilatation where descent begins

A

7 to 8cm

70
Q

[Descent]

Descent is brought about by these forces

A
  1. Pressure of the amniotic fluid
  2. Direct pressure of the fundus upon the breech with contractions
  3. Bearing-down efforts of maternal abdominal muscles
  4. Extension and straightening of the fetal body
71
Q

[Cardinal Movement]

Flexion occurs as the descending head meets the following resistance

A
  1. Cervix
  2. Pelvic walls
  3. Pelvic floor

Chin in contact with fetal thorax, shorter suboccipitobreagmatic diameter

72
Q

[Cardinal Movement]

____ is essential for completion of labor

A

internal rotation

occiput moves toward the symphysis pubis

73
Q

[Cardinal Movement]

What are the forces involved during extension?

A
  1. Uterus - acts more posteriorly

2. Resistant pelvic floor and the symphysis

74
Q

[Cardinal Movement]

in extension, the base of the occiput is in direct contact with ____

A

the inferior margin o the symphysis pubis

75
Q

[Cardinal Movement]

___ this serves to bring the biacromial diameter into relation with the anteroposterior diameter of the pelvic outlet

A

External rotation

the fetal body rotates

76
Q

[Cardinal Movement]

this is when the anterior shoulder appears under the symphysis pubis;

perineum is distended by the posterior shoulder

A

Expulsion

77
Q

[Stage of Labor]

begins immediately after fetal birth, ends with placental delivery

A

3rd stage of labor

78
Q

What are the goals of third stage of labor?

A
  1. delivery of an intact placenta
  2. avoidance of uterine inversion
  3. avoidance of post-partum hemorrhage
79
Q

What are the signs of placental separation?

A
  1. sudden gush of blood
  2. Globular and firmer fundus
  3. Lengthening of the umbilical cord
  4. Rise of uterus into the abdomen
80
Q

What are the indications for episiotomy?

A
  1. Expedite 2nd stage
  2. When spontaneous laceration is less likely
  3. Breech position
  4. Assisted forceps
  5. Large baby
  6. Maternal exhaustion
81
Q

[Perineal laceration]

fourchette, perineal skin but not underlying fascia and muscle

A

1st degree

82
Q

[Perineal laceration]

skin, mucous membrane, fascia and muscles of the perineal body are involved

A

2nd degree

83
Q

[Perineal laceration]

skin, mucous membrane, anal sphincter

A

3rd degree

84
Q

[Perineal laceration]

skin, mucosa,perineal body, anal sphincter, rectal mucosa exposing lumen of rectum

A

4th degree

85
Q

[Perineal laceration]

skin, mucous membrane,
<50% external anal sphincter, intact internal anal sphincter

A

3a deree

86
Q

[Perineal laceration]

skin, mucous membrane,

> 50% external anal sphincter, intact internal anal sphincter

A

3b degree

87
Q

[Perineal laceration]

skin, mucous membrane,

external anal sphincter and internal anal sphincter are torn

A

3c degree

88
Q

What are the components of the active management of third stage of labor?

A
  1. Palpate abdomen to rule out additional baby
  2. Give oxytocin
  3. Delayed cord clamping
  4. Gentle cord traction
  5. Deliver placenta
  6. Examine placenta
  7. check uterus if contracted
  8. Inspect for genital laceration
  9. Consider uterotonics if high risk for PPH
89
Q

[Uterotonic drugs]

what is the first line uterotonic for prophylaxis?

A

oxytocin

90
Q

[Uterotonic drugs]

uterotonic avoided in phypertensive patientes

A

methyergonivne

OBGYN (33 decks)

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