Obstetric terminology Flashcards
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
when do you visualize yolk sac?
5-6 weeks
when do you visualize fetal pole and cardiac activity/mvmt?
7-8 weeks
best time to get US measurements?
weeks 16-24 - all fetal growth is same up until here
hear heart tones?
9-12 weeks
mom feels mvmt?
17-19 weeks
placenta previa?
uterus implants in lower portion of uterus - covering opening to cervix
placenta implants too deep?
placenta accreta < increta < percenta = placenta implants too deep
abruptio placenta
early seperation of placenta and uterus - space fills w/ hemorrhage
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
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
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
cervical effacement
= the gradual thinning, shortening and drawing up of the cervix
results in loosening of cervical mucus plug
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
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)
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
