Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OB/GYN > Obstetrics - Labor & Delivery, Postpartum Care > Flashcards

Obstetrics - Labor & Delivery, Postpartum Care Flashcards

1
Q

Fetal lie

A

= infant longituidnal or tarnsverse within uterus - use

leopold manueuvers to dermine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Best test to see if will deliver preterm

A

fetal fibronectin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

PROM (premature ROM)

A

= rupture membranes prior to onset of labor

Concerned about chorioamnitis (risk for PROM)

Give abx

Immediate delivery if fetus near term with oxytocin, c/s if fetal distress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Prolonged premature ROM

A

= if > 18 hrs rupture membranes before delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

preterm premature ROM (PPROM)

A

= before 37 weeks gestation rupture membranes and no labor signs yet

Tx:
Give ampicillin +/- erythromycin

+ corticosteroids if < 34 weeks GA

Immediate delivery if fetus near term with oxytocin, c/s if fetal distress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Dx ROM with

A

pool, nitrazine and fern tests

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Pool test

A

= + if collection of fluid in the vagina in laboring woman

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Nitrazine test

A

Vaginal secretions are normally acidic, whereas amniotic fluid is alkaline.

when amniotic fluid is placed on nitrazine paper, the
paper should immediately turn blue

It is important to test the fluid from the vagina and not to test cervical mucus because of false positive ferning patterns**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Fern test

A

= The estrogens in the amniotic fluid cause crystallization
of the salts in the amniotic fluid when it dries.

Under low microscopic power, the crystals resemble the blades of a fern

Caution should be exercised to sample fluid that is not directly from the cervix because cervical mucus also ferns and may result in a false + reading

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

The five components of the cervical examination during labor

A 
dilation,
effacement, 
fetal station, 
cervical position, 
consistency of the cervix.

> 8 is consistent with a cervix favorable for both spontaneous labor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Effacement

A

The typical cervix is 3 to 5 cm in length;

thus, if the cervix feels like it is about 2 cm from external to internal os, it is 50% effaced.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Station

A

The relation of the fetal head to the ischial spines of the female pelvis

0 = most descended aspect of the presenting part is at the level of the ischial spines

Negative = presenting part is above the ischial spines

+ = presenting part is below the ischial spines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which fetal position can lead to prolonged labor and a higher rate of cesarean delivery?

A

occiput transverse (OT) or occiput posterior (OP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Labor is induced with

A

prostaglandins, oxytocic agents, mechanical dilation of the cervix, and/or artificial ROM.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Common indications for induction of labor include

A 
postterm pregnancy,
preeclampsia, 
diabetes mellitus, 
nonreassuring fetal testing, 
intrauterine growth restriction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

There are both maternal and obstetric contraindications for the use of prostaglandins.

A

Maternal reasons include asthma and glaucoma.

Obstetric reasons include having had a prior cesarean delivery and nonreassuring fetal testing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Etiology of

  • early decelerations
  • variable decelerations
  • late decelerations
A

Early decelerations

  • begin and end approximately at the same time as contractions
  • 2/2 increased vagal tone secondary to head compression during a contraction.

Variable decelerations

  • can occur at any time and tend to drop more precipitously than either early or late decelerations
  • 2/2 umbilical cord compression.

Late decelerations

  • begin at the peak of a contraction and slowly return to baseline after the contraction has finished
  • 2/2 uteroplacental insufficiency and are the most worrisome type.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

The cardinal movements of delivery

A 
engagement = fetal presenting part enters pelvis
descent = head descends into pelvis
flexion, 
internal rotation, 
extension, 
external rotation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Stages 1, 2, 3 of labor

A

Stage 1 begins with the onset of labor and lasts until dilation and effacement of the cervix are completed.

Stage 2 is from the time of full dilation until delivery of the infant.

Stage 3 begins after delivery of the infant and ends with delivery of the placenta.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Stage 1: latent vs active phase

A

latent phase

  • onset labor –> 3-4cm dilation (some say 6cm)
  • slow cervical change.

active

  • 4 - > 9cm of dilation
  • slope of cervical change against time increases.
  • nulliparous: 1 cm/hr dilation expected
  • multiparous: 1.2 cm/hr dilation expected
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

signs of nonreassuring fetal status

A

Repetitive late decelerations,
bradycardias,
loss of variability

If a prolonged deceleration is felt to be the result of uterine hypertonus (a single contraction lasting 2 minutes or longer) or tachysystole (greater than five contractions in a 10-minute period), the patient can be given a dose of terbutaline to help relax the uterus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Best occipital presentation to deliver baby

A

Vertex with occiput anterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

A Bishop score of 5 or less may lead to a failed induction as often as _____% of time

A

50% of the time

In these patients, prostaglandin E2 (PGE2) gel, PGE2 pessary (Cervidil), or PGE1M (misoprostol) is often used to “ripen” the cervix.

Oxytocin is used to induce labor with a Bishop score greater than 5.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Preterm delivery

A

< 37 weeks gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Risks for preterm labor

A 
Preterm ROM
Chorioamniotis
Multiple gestations
Uterine anomalies
Previous preterm
Maternal prepreggers wt < 50 kg
Placental abruption
Preeclampsia
Infections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Tocolytics

A

Beta mimetics

  • ritodrine
  • terbutaline

MgSO4

Nifedipine

Prostaglandin inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Ritodrine, terbutaline

A

B2-agonist

Act on uterine smooth muscle fibers (inc cAMP)

S/E:

  • HA
  • pulmonary edema
  • maternal death
  • tachy

Blackbox warning for terbutaine > 24-48 hrs - DO NOT USE!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

MgSO4

A

Decreases uterine tone and contractions

Magnesium sulfate works by competing with calcium entry into cell

Also membrane stabilizer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Way to assess for magnesium toxicity?

A

DTR exams

If Mg level too high, DTRs depressed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Prolonged deceleration

A

FHR < 100-110 for longer than 2 mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Bradycardia

A

FHR < 100-110 for longer than 10 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Prolonged FHR deceleration - initial management?

A

Put in L or R lateral decubitus to see if FHR is 2/2 IVC compression

O2 for hypoxia

Examine pt w/ 1 hand on maternal abdomen and 1 hand vaginally feeling for cervical dilation, fetal station, prolapsed umbilical cord

33
Q

Maneuvers to deliver infant w/ shoulder dystocia

A

McRoberts - sharp flexion of maternal hips to increase AP diameter

Suprapubic pressure

Rubin maneuver - pressure on either accessible shoulder toward anterior chest wall of fetus

Wood’s corkscrew maneuver - P behind posterior shoulder to rotate infant and dislodge anterior shoulder

Delivery of posterior arm/shoulder

Episiotomy

Zavanelli - put infant’s head back into pelvis and get c/s

34
Q

Kleihauer-Betke test

A

blood test used to measure the amount of fetal hemoglobin transferred from a fetus to a mother’s bloodstream

Qualitative test to help determine presence of feto-maternal hemorrhage is rosette test –> if positive, use K-B test to see amt of hemorrhage and adjust anti-D immune globulin

35
Q

Postpartum period =

A

6 weeks s/p delivery

36
Q

Pts usually experience breast milk let down…

A

24-72 hrs postpartum

37
Q

Postpartum vaccines

A

Tdap (if more than 10 years)
- mainly for pertussis

MMR
- if low antibody titers in prenatal care

Rhogam
- within 72 hrs postpartum if Rh negative

38
Q

How long pelvic rest s/p delivery usually?

A

6 weeks

39
Q

Postpartum contraception

A

Very impt to address

PPTL

Breastfeeding + want hormone contraception:

  • Progesterone only mini pill
  • Depo Provera
  • implantable progesterone agents
  • –> NOT combo OCPs because can decrease milk let down

If really want combo OCPs and breastfeed, can start at 3-6 weeks pp and then milk supply should be ok

40
Q

When does risk of VTE decrease in postpartum period to levels prior to pregnancy?

A

6 weeks

41
Q

When can you put in IUD pp?

A

6 weeks pp

Usually risk expulsion before that

42
Q

4 main causes of postpartum hemorrhage

A

4 Ts
Tone - Uterine atony

Tissue - retained placenta

Trauma from childbirth (eg cervical, vaginal lacs, uterine rupture)

Thrombin - coagulopathy

43
Q

PP hemorrhage defined as

A

> 500 cc blood loss in vag deliv

> 1000 cc blood loss in cs

44
Q

Tx uterine atony

A

Oxytocin IV

Uterine massage

If still atonic…
- methylergonovine

If still atonic…

  • PGF2a (hemabate = carboprost)
  • dinoprostone (cervidil)
  • misoprostol off label (cytotec)

If still atonic…

  • D&C
  • inflatable tamponade

If still atonic…

  • ex lap
  • possible hysterectomy
45
Q

Who can you not use hemabate (carboprost) in?

A

Asthma pts

46
Q

Endometritis / Endomyometritis

A
  • polymicrobial infection of the uterine lining that often invades the underlying muscle wall.

Endometritis in the postpartum period is most closely related to the mode of delivery. Endometritis can be found in less than 3% of vaginal births and this is contrasted by a 5-10 times higher incidence after Cesarean deliveries

Risk factors:

  • meconium,
  • chorioamnionitis,
  • prolonged rupture of membranes.

Factors related to increased rates of infection with a vaginal birth include prolonged labor, prolonged rupture of membranes, multiple vaginal examinations, internal fetal monitoring, removal of the placenta manually and low socioeconomic status.

Usually occurs 5-10 days after delivery

Use US to look for retained products of conception –> D&C if yes

Broad spectrum IV abx to treat (amp/gent)

47
Q

Tx mastitis

A

Dicloxacillin

Continue breastfeeding!

48
Q

Diaphragms and cervical caps pp need to be reevaluated at

A

6 weeks

49
Q

Surgical management of PPH ranges from

A 
D&C 
ex lap
uterine artery ligation, 
hypogastric artery ligation,
hysterectomy
50
Q

Tx umbilical cord prolapse felt in labor

A

elevate the fetal head with a hand in the patient’s vagina and call for assistance to perform a Cesarean delivery

Do this even if fetal heart tracing is ok!

51
Q

Pt delivered baby s/p MgSO4 for preeclampsia - what do you care most about on neonate?

A

The first objective after delivery is to assess respiratory effort due to use of magnesium and make sure that the neonate is being oxygenated adequately, which might require a bag mask.

52
Q

Infants born to diabetic mothers are at increased risk for developing

A

hypoglycemia, polycythemia, hyperbilirubinemia, hypocalcemia and respiratory distress.

53
Q

Postpartum care of infant born to HIV+ mom

A

AZT immediately after delivery

HIV testing begins at 24 hours

54
Q

The most common cause of postpartum fever is

A

endometritis

Bacterial isolates related to postpartum endometritis are usually polymicrobial resulting in a mix of aerobes and anaerobes in the genital tract.

The most causative agents are Staphylococcus aureus and Streptococcus.

55
Q

Post partum blues

A

Signs and symptoms of depression which last for less than two weeks are called postpartum blues

56
Q

Postpartum depression

A

is a common condition estimated to affect approximately 10-15% of women

often begins within two weeks to six months after delivery.

57
Q

The safest method to suppress lactation

A

The safest method to suppress lactation is breast binding, ice packs and analgesics.

Hormonal interventions for preventing lactation appear to predispose to thromboembolic events, as well as a significant risk of rebound engorgement.
Bromocriptine, in particular, is associated with hypertension, stroke and seizures.

58
Q

Breastfeeding is associated with

A

a decreased incidence of ovarian cancer

decrease the risk for developing coronary artery disease, cervical dysplasia and cervical cancer or colon cancer in the mother

59
Q

Milk letdown is via…

A

Delivery –> rapid dec in levels of progesterone + estrogen –> no more inhibitory influence of progesterone on the production of alpha-lactalbumin by the rough endoplasmic reticulum.

increased alpha-lactalbumin —> lactose synthase —> to increase milk lactose.

Progesterone withdrawal allows prolactin to act unopposed in its stimulation of alpha-lactalbumin production.

60
Q

Breastfeeeding + intense nipple pain….what is likely going on?

A

Candida of nipple

Mastitis not too much nipple pain

61
Q

Signs that a baby is getting sufficient milk include

A

3-4 stools in 24 hours,
six wet diapers in 24 hours,
weight gain
sounds of swallowing.

62
Q

Milk prod + milk let down done by…

A

prolactin is responsible for milk production

oxytocin is responsible for milk ejection.

63
Q

Assoc of breech presentation

A 
Prematurity, 
multiple gestation, 
genetic disorders, 
polyhydramnios, 
hydrocephaly, 
anencephaly, 
placenta previa, 
uterine anomalies 
uterine fibroids
64
Q

Normal vs abnormal labor
Stage 1
- latent
- active

Tx?

A

Prolonged latent (> 6 cm dilated)

  • > 20 hours for nulliparas
  • > 14 hours for multiparas

Tx:
- rest or augmentation of labor.

Artificial rupture of membranes is not recommended in the latent phase as it places the patient at increased risk of infection.

Arrest of labor in 1st stage if:

  • dilation >= 6cm + rupture membranes and one of the following:
  • no cervical change for > 4 hrs despite adequate ctx
  • no cervical change for > 6hrs with inadequate ctx
65
Q

Arrest of dilation in active phase of labor…what do you do?

A

If baby ok, amniotomy is often recommended in this situation.

Then augmentation with oxytocin can be attempted after careful evaluation

66
Q

FFP vs Cryoprecipitate

A

No RBCs or platelets in theses!

FFP

  • fibrinogen
  • V
  • VIII

Cryo

  • fibrinogen
  • VIII
  • vWF
67
Q

Tocolytic contraindications

  • terbutaline, ritodrine
  • MgSO4
A

Terbutaline, ritodrine
- diabetic patients

magnesium sulfate
- myasthenia gravis;

68
Q

Who can you not use methylergonovine in?

A

HTN pts

Preeclampsia/eclampsia

69
Q

Treatment with betamethasone from 24 to 34 weeks gestation has been shown to

A

increase pulmonary maturity

reduce the incidence and severity of RDS (respiratory distress syndrome) in the newborn

associated with decreased intracerebral hemorrhage and necrotizing enterocolitis in the newborn

70
Q

How does fibronectin for preterm delivery work?

A

Fibronectin is an extracellular matrix protein that is thought to act as an adhesive between the fetal membranes and underlying decidua.

It is normally found in cervical secretions in the first half of pregnancy. Its presence in the cervical mucus between 22 and 34 weeks is thought to indicate a disruption or injury to the maternal-fetal interface.

High neg predictive value in sx women, low + predictive value

71
Q

Antibiotic therapy given to patients with preterm premature rupture of the membranes has been found to

A

prolong the latency period by 5-7 days, as well as reduce the incidence of maternal amnionitis and neonatal sepsis

72
Q

In some cases of preterm rupture of the membranes, amniocentesis may be performed to detect intra-amniotic infection.

What does it look for?

A

L-6 increased **

Low glucose

Leuks have low predictive value

73
Q

17 alpha-hydroxyprogesterone has been shown to reduce the risk of

A

premature labor.

74
Q

Agents used to ripen cervix

A

prostaglandin E2 (PGE2) gel, PGE2 pessary (Cervidil), or PGE1M (misoprostol) is often used to “ripen” the cervix.

75
Q

Ways to administer meds for uterine atony

A

IM
- PGF2a (carboprost)

Into uterus
- Carboprost

IV
- Oxytocin (not IVP)

Orally
- MIsoprostol

Rectally
- Misoprostol (not IV Or IM)

NOT IV
- Carbobprost —-> bronchoconstriction

76
Q

Postpartum fever causes

A

Endometritis
Cystitis
Breast engorgement
Wound infection

77
Q

SSRIs and breastfeeding - ok?

A

YES!

78
Q

endometritis is usually

A

polymicrobial infection

tx w/ clinda and gentamicin

79
Q

Low grade fever and leukocytosis postpartum - is this ok?

A

Yes! during first 24 hrs of pp

Chills are also common

reassure

OB/GYN (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions