Obstetric terminology Flashcards by Caitlin miller

estimated date of confinement (EDC)?

40 weeks from first day of last menstural period

add 7 days to first day of LMP, subtract 3 mos, add one year

= 280 days, 9 mos, 3 trimesters

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when do you visualize yolk sac?

5-6 weeks

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when do you visualize fetal pole and cardiac activity/mvmt?

7-8 weeks

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best time to get US measurements?

weeks 16-24 - all fetal growth is same up until here

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hear heart tones?

9-12 weeks

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mom feels mvmt?

17-19 weeks

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placenta previa?

uterus implants in lower portion of uterus - covering opening to cervix

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placenta implants too deep?

placenta accreta < increta < percenta = placenta implants too deep

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abruptio placenta

early seperation of placenta and uterus - space fills w/ hemorrhage

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fetal circulation

umbilical vein - brings maternal blood to the placenta

blood flows through the umbilical vein to the liver (some is shunted directly to IVC from liver through ductus venosus) and then to IVC and to the right atrium

flow through RA –> LA via the foramen ovale (some blood goes to RV and is pumped to lungs, but lung pressure is high, also there is the ductus arteriosus - directing blood away from lungs)

blood is pumped through LV and through aorta to the body

then blood flows through internal iliac arteries to umbilical arteries –> enters placenta and is reoxygenated

when baby breaths for first time, results in low pressure system in lungs, causing the foramen ovale to slam closed - also the increased oxygen results in increased progstaglandins –> close the ductus arteriosus

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3 vessels?

one vein (flowing away from mom to supply O2 blood),

two arteries (flowing back towards mom, carrying deoxygenated fetal blood )

surrounded by whartons jelly

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umbilicus

marks 20 weeks (halfway mark) - located at the umbilicus

growth occurs two fingers bredth every two weeks until 20 weeks

growth after 20 weeks occurs every one finger breadth every two weeks

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cervical effacement

= the gradual thinning, shortening and drawing up of the cervix

results in loosening of cervical mucus plug

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cervical dilation

the gradual opening of the cervix measured in centemeters from 1-10cm

during labor cervix opens to 6 cm - then the head begins to push through allowing it to open up to 10 cm

Latent phase: 0-3 centimeters (first stage)

Active Labor: 4-7 centimeters (second stage)

Transition: 8-10 centimeters

Complete: 10 centimeters. Delivery of the infant takes place shortly after this stage is reached

Prostaglandins help induce cervical dilation

results in loosening of mucus plug

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progression of labor

Lasts about 12-14 hours (first baby)

Lasts about 6-8 hours (subsequent babies)

Effacement (thinning)

Dilatation (opening)

Descent (progress through the birth canal)

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status of membranes?

use nitrazine paper - turns blue if alkaline amniotic fluid is present (vaginal secretions are yellow d/t acidity)

leopold’s maneuver

check fundus, then pubus, then evaluate fetal back and extremities and degre of flextion of fetal head

vertex = baby coming out head first

breech = baby coming out butt first

transferse = baby sitting with belly to come out first - or legs

monitoring of fetal heart rate

During early labor, for low risk patients, note the fetal heart rate every 1-2 hours.

During active labor, evaluate the fetal heart every 30 minutes

Normal FHR is 120-160 BPM

Persistent tachycardia
(>160) or bradycardia (<100) is of concern

vertex

smallest diameter of fetus, followed by sinciput, then mental

midplane barrier

Fetal head descends through the birth canal

Defined relative to the ischial spines

0 station = top of head at the spines (fully engaged)

+2 station = 2 cm past (below) the ischial spines

braxton hicks contractions

practice contractions = tightening of unterine mm.

sporadic uterine contractions that sometimes start around six weeks into a pregnancy. However, they are not usually felt until the second trimester or third trimester of pregnancy.

latent phase of labor

<4 cm dilated

Contractions may or may not be painful

Dilate very slowly

Can talk or laugh through contractions

May last days or longer

May be treated with sedation, hydration, ambulation, rest, or pitocin

active phase of labor

At least 4 cm dilated

Regular, frequent, usually painful contractions

Dilate at least 1.2-1.5 cm/hr

Are not comfortable with talking or laughing during their contractions

normal FHR patterns

Short term variability (3-5 BPM)

Long term variability (15 BPM above baseline, lasting 10-20 seconds or longer)

Contractions every 2-3 minutes, lasting about 60 seconds

tachycardia via FHR

>160 BPM Most are not suggestive of fetal jeopardy ``` Associated with: Fever, Chorioamnionitis Maternal hypothyroidism Drugs (tocolytics, etc.) Fetal hypoxia Fetal anemia Fetal arrhythmia ```

early decelerations

Periodic slowing of the FHR, synchronized with contractions Rarely more than 20-30 BPM below the baseline Innocent Associated with fetal head compression

variable decelerations

Below 60 BPM for at least 60 seconds If persistent, can be threatening to fetal well-being, with progressive acidosis: think cord compression

late decelerations

* most ominous Repetitive, non-remediable slowing of the fetal heartbeat toward the end of the contraction cycle Reflect utero-placental insufficiency = hypoxia

prolonged decelerations

don't prolong delivery, get baby out right away! Last > 60 seconds Occur in isolation ``` Associated with: Maternal hypotension Epidural Paracervical block Tetanic contractions Umbilical cord prolapse ```

7 cardinal mvmts of labor?

``` ENGAGEMENT FLEXION DECENT INTERNAL ROTATION EXTENSION EXTERNAL ROTATION EXPULSION ``` INFANT ENGAGES IN OCCIPUT TRANSVERSE POSITION (FACE LOOKING AT MOM’S ILIUM LEFT OR RIGHT.) UTERINE CONTRACTIONS CAUSE INFANT TO DECEND INTO PELVIS AND TURN INFANTS FACE TO SACCRUM INFANT HAS head FLEXED ON IT’S CHEST HEAD BEGINS TO MOULD TO CLEAR PUBIS. AFTER CLEARING PUBIC BONE INFANTS HEAD EXTENDS AND ROTATES TO THE ORIGINAL TRANSVERSE POSITION IT LOCKED UP IN IN FIG.A PHYSICIAN CLEARS AIRWAY ON BABY AND GENTLY PULLS DOWN ON HEAD TILL FRONT SHOULDER SPIRALS OUT. PHYSICIAN GENTLY LIFTS BABYS HEAD TO DELIVER OTHER SHOULDER INSPECT THE DELIVERED BABY AND CLAMP AND CUT CORD

look at diagrams! which ones are correct?

do it now. slide 42 LOA and ROA are always ok CROWNING OF THE HEAD AND VAGINAL OPENING SHOWS TOP OF FETAL SCALP FETAL CHIN ON CHEST PUSHING AND CONTRACTIONS CASUSES FELXION OF FETAL NECK AND EXTENSION OF THE HEAD FETAL HEAD EMERGES WITH OCCIPUT FACING ANTERIOR AND FACE POSTERIOR. (Infant rotates head to original position) PHYSICIAN CRADELS HEAD IN HANDS AND PULLS DOWN ON HEAD TILL FRONT SHOULDER IS DELIVERED THEN PULLS UP TO DELIVER THE BACK SHOULDER

placental separation

Signs of separation: Increased bleeding Lengthening of the cord Uterus rises, becoming globular instead of discoid Uterus enlarges, approaching the umbilicus Normally separates within a few minutes after delivery