Obstetric terminology

Question 1

estimated date of confinement (EDC)?

Answer 1

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

Question 2

when do you visualize yolk sac?

Answer 2

5-6 weeks

Question 3

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

Answer 3

7-8 weeks

Question 4

best time to get US measurements?

Answer 4

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

Question 5

hear heart tones?

Answer 5

9-12 weeks

Question 6

mom feels mvmt?

Answer 6

17-19 weeks

Question 7

placenta previa?

Answer 7

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

Question 8

placenta implants too deep?

Answer 8

placenta accreta < increta < percenta = placenta implants too deep

Question 9

abruptio placenta

Answer 9

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

Question 10

fetal circulation

Answer 10

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

Question 11

3 vessels?

Answer 11

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

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

surrounded by whartons jelly

Question 12

umbilicus

Answer 12

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

Question 13

cervical effacement

Answer 13

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

results in loosening of cervical mucus plug

Question 14

cervical dilation

Answer 14

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

Question 15

progression of labor

Answer 15

Lasts about 12-14 hours (first baby)

Lasts about 6-8 hours (subsequent babies)

Effacement (thinning)

Dilatation (opening)

Descent (progress through the birth canal)

Question 16

status of membranes?

Answer 16

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

Question 17

leopold’s maneuver

Answer 17

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

Question 18

monitoring of fetal heart rate

Answer 18

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

Question 19

vertex

Answer 19

smallest diameter of fetus, followed by sinciput, then mental

Question 20

midplane barrier

Answer 20

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

Question 21

braxton hicks contractions

Answer 21

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.

Question 22

latent phase of labor

Answer 22

<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

Question 23

active phase of labor

Answer 23

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

Question 24

normal FHR patterns

Answer 24

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

Question 25

tachycardia via FHR

Answer 25

> 160 BPM

Most are not suggestive of fetal jeopardy

Associated with:
Fever, Chorioamnionitis
Maternal hypothyroidism
Drugs (tocolytics, etc.)
Fetal hypoxia
Fetal anemia
Fetal arrhythmia

Question 26

early decelerations

Answer 26

Periodic slowing of the FHR, synchronized with contractions

Rarely more than 20-30 BPM below the baseline

Innocent

Associated with fetal head compression

Question 27

variable decelerations

Answer 27

Below 60 BPM for at least 60 seconds

If persistent, can be threatening to fetal well-being, with progressive acidosis: think cord compression

Question 28

late decelerations

Answer 28

• most ominous

Repetitive, non-remediable slowing of the fetal heartbeat toward the end of the contraction cycle

Reflect utero-placental insufficiency = hypoxia

Question 29

prolonged decelerations

Answer 29

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

Question 30

7 cardinal mvmts of labor?

Answer 30

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

Question 31

look at diagrams! which ones are correct?

Answer 31

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

Question 32

placental separation

Answer 32

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