PRENATAL CARE Flashcards
Complications of cordocentesis
Cord vessel bleed
Fetal maternal bleed
Fetal bradycardia
Fetal loss
Amniocentesis complications
Fetal loss
Amniotic leak
Chorionic villous sampling indication
Karyotyping
Chorionic villous sampling complications
Fetal loss
Limb reduction defects
Oromandibular limb hypoplasia
Amniocentesis (15-20 wks) indications
Karyotyping
FISH
Relieves hydramnios
Fetal blood sampling (cordocentesis) indication
Fetal anemia
Tx of platelet alloimmunization
Conditions which increased hCG
Multiple pregnancy Molar pregnancy Exogenous injection Impaired renal clearance hCG secreting tumors from GI, ovary, bladder, lungs
What produced hCG
Syncytiotrophoblasts
Sonographic recognition of gestation sac begins at
4-5 weeks
Sonographic recognition of yolk sac begins at
5-6 weeks
What does the presence of fetal Yolk sac indicate?
Intrauterine location
Sonographic recognition of embryonic pole with cardiac motion begins at
6 weeks
Sonographic recognition of crown-rump length begins at
Up to 12 weeks
What does crown-rump length indicate?
AOG within 4 days
Most accurate tool for gestational age assignment
Crown-rump length
Fetal heart sounds can be heard by doppler at
10 weeks
Fetal heart sounds can be heard with stethoscope at
16 weeks
Recommended weight gain for underweight (BMI <18.5)
12.5 to 16 kgs
28 to 40 lbs
1 lb/week
Recommended weight gain for Normal (BMI 18.5 to 24.9)
11.5 to 16 kgs
25 to 35 lbs
1 lb/week (0.8-1 kg)
Recommended weight gain for Overweight (BMI 25-29.9)
7 to 11.5 kg
15 to 25 lb
0.6 lb/week
Recommended weight gain for Obese (BMI 30 and up)
5 to 9.1 kg
11 to 20 lb
0.5 lb/wk
RDA calories
100-300 kcal/day
RDA protein
5-6 g/day
RDA iron
27 mg/day (low risk)
60-100 mg/day in large women, twin, anemia
RDA iodine
220 ug/day
Cretinism is associated with which mineral deficiency?
Iodine
RDA calcium
900 mg (quart of milk) 1000 mg (ages 19-50)
RDA folate for all women
400 mcg to prevent NTD
0.4 to 0.8 mg for ALL women
RDA folate for women with previous NTD baby
4 mg
RDA vitamin C
80-85 mg
Frequency of prenatal check up
Monthly until 28 wks
Every 2 wks until 36 wks
Every wk until term
Total weight gain in Underweight (BMI <18.5)
Single - 28-40
Twins
Total weight gain in normal (BMI <18.5 to 24.9)
Single: 25 to 35 lbs
Twins: 37 to 54 lbs
Total weight gain in Overweight (BMI 25 to 29.9)
Single: 15 to 25 lbs
Twins: 31 to 50 lbs
Total weight gain in Obese (BMI 30)
Single 11 to 20
Twin: 25 to 42 lbs
Average weight gain in pregnancy
- 6 lbs
4. 8 kg
Weight loss at delivery
12 lbs
5.5 kg
Weight loss 2 to 6 wks postpartum
- 5 lbs
2. 5 kg
Weight loss 2 wks postpartum
9 lbs
4 kg
Average retained weight
3 lbs
1.4 kg
Caffeine intake
3 cups of 5 oz percolated coffee
Safe to travel until when?
36 wks AOG
Immunization schedule in pregnancy
Tdap (inactivated)
Influenza
Hep B
Vaccines contraindicated in pregnancy
Measles Mumps Rubella Varicella HPV
Safe vaccines
Rabies (killed) Hep A Pneumococcus (for asplenia, cardiac dse) Meningococcus (outbreaks) Varicella Ig (post exposure)
OGTT 75 is done at?
24 to 48 eeks
Hormon e which causes insulin resistance lipolysis, increased fatty acids
HPL
When to ask for BPP
24-28 weeks
Test of fetal health
Non stress test
Test of uteroplacental function
Contraction stress test
Negative NST
normal
Fetal heart acceleration in respons to fetal movement
Positive NST
Late decelerations following 50% or more of contractions
Negative CST
3 or more contractions
40 sec or more
10 mins
No late decelerations
What are the five components of BPP?
Nonstress test Fetal breathing Fetal movement Fetal tone Amniotic fluid volume
Which component of the BPP may be omitted if the other four are normal
Nonstress test
Which component of BPP requires further evaluation, if abnormal, regardless of the BPP composite score?
Amniotic fluid volument
If largest vertical amniotic fluid pocket is less than 2 cm (score 0)
BPP scores
0 or 2
BPP interpretation
BPP score: 10
Normal, non-asphyxiated fetus
BPP interpretation
BPP score: 8/10 (normal AFV)
Normal, non-asphyxiated fetus
BPP interpretation
BPP score: 8/8 (NST not done)
Normal, non-asphyxiated fetus
BPP interpretation
BPP score: 8/10 (decreased AFV)
Chronic fetal asphyxia — DELIVER
BPP interpretation
BPP score: 6
Possible fetal asphyxia
BPP interpretation
BPP score: 6
AFV abnormal
What is the next best step?
Deliver
Possible fetal asphyxia
BPP interpretation BPP score: 6 AFV normal >36 wks AOG with favorable cervix What is the next best step?
Deliver
BPP interpretation
BPP score: 6
REPEAT TEST 6 or Less
What is the next best step?
DELIVER
BPP interpretation
BPP score: 6
REPEAT TEST: >6
What is the next best step?
Observe and repeat
Weekly
TWICE weekly In DM and postterm
BPP score: 4
interpretation?
Intervention?
Probable fetal asphyxia
Repeat on the same day
BPP score: 4 Repeat test (same day): 6 or less
Deliver
BPP score 0-2
Almost certain asphyxia
Deliver
Hypoxia cascade in Biophysical score activity
Fetal heart reactivity *1st
Fetal breathing
Fetal movement
Fetal tone *last
Normal FHR
110-160 bpm
min of 2 minutes
Normal baseline variability
6-25 bpm (moderate)
Normal acceleration
At <32 weeks AOG
Acceleration more than 10 bpm from baseline
lasts for 10 secs
But <2 mins from onset
Normal Acceleration
At 32 weeks or more AOG
Acceleration more than 15 bpm from baseline
lasts for >15 secs
But <2 mins from onset
Prolonged acceleration
Lasts >2 minutes but <10
Baseline change
Acceleration lasts 10 mins or more
Early deceleration indicates
Fetal head compression
Late deceleration indicates
Uteroplacental insufficiency
Variable deceleration indicates
Umbilical cord occlusion
CTG tracing with onset, nadir and recovery of decelerations coincident with the beginning, peak and ending of a contraction, respectively
Early deceleration
Most common deceleration pattern
Variable
Describe a prolonged deceleration
Decrease in FHR if 15 bpm or more
Lasting 2 minutes or more
But less than 10 mins
CTG tracing with onset, nadir and recovery of decelerations varying with successive uterine contractions
Variable deceleration
CTG tracing with onset, nadir and recovery of decelerations occuring after the beginning, peak and ending of a contraction, respectively
Late deceleration
Increases ICP leading to deceleration
Fetal head compression
Stimulates chemoreceptors leading to decelerations
Decrease in uteroplacental O2 transfer
Visually apparent, smooth, sine wave like undulating pattern in FHR baseline with a cycle frequency if 3-5 bom which persists for 20 mins or more
Sinusoidal pattern
Category I CTG intervention
Routine monitoring
Normal fetal acid base status
Category II CTG intervention
Improve fetal O2 and uteroplacental blood floow
Diminish uterine activity
Relieve umbilical cord compression
Category III CTG intervention
Improve fetal O2 and uteroplacental blood floow
Diminish uterine activity
Relieve umbilical cord compression
Interventions to improve fetal oxygenation and uteroplacental blood flow involve
Lateral decubitus positioning
Maternal O2
Administer IV fluid bolus
Decrease oxytocin to reduce uterine contraction frequency
Interventions to diminish uterine activity
Discontinue oxytocin or prostaglandins
Give tocolytics
— terbutaline
— MgSO4
Interventions to relieve cord compression
Reposition mother
Amnioinfusion
If with prolapse, manually elevate the presenting part while preparing for immediate delivery
Of the four phases of parturition, phase 3 is characterized by which of the following?
A. Uterine activation, cervical ripening
B. Uterine contraction, cervical dilatation
C. Uterine quiescence, cervical softening
D. Uterine involution, cervical remodeling
B. Phase 3 Stimulation
A. 2 - activation
C. 1 - quiescence
D. 4 - parturient recovery
Which of the following cervical functions and events take place during phase 1 of parturition, EXCEPT?
A. Maintenance of cervical competence despite growing uterine weight
B. Maintenance of barrier between uterine contents and vaginal bacteria
C. Alteration in extracellular matrix to gradually increase cervical tissue compliance
D. Alteration of cervical collagen to stiffen the cervix
D. Alteration of cervical collagen to stiffen the cervix
Which stage of parturition corresponds to the clinical stages of labor
Phase 3
Lower segment thinning with concomitant upper segment thickening
Physiologic retraction ring
Bandl ring
Pathologic retraction ring
When thinning of the lower uterine segment is extreme
Bandl ring
Stage of fetal descent
10 cm to delivery
Second stage
Weakest layer of placenta
Decidua spongiosa
placental expulsion mechanism wherein blood from the placental site pours into the membrane sac and does not escape externally until extrusion of the placenta
Schultze mechanism
placental expulsion mechanism wherein placenta separates first at the periphery and blood collects between the membranes and
escapes from the vaginal. The placenta descends sideways and its maternal surface appears first.
Duncan mechanism
Signs of placental separation
- fundus becomes globular and firm (Calkins sign)
- Sudden gush of blood
- elongation of cord
- Uterus rises in the abdomen
A 39 week AOG patient with a breech presenting fetus agrees to an externwl cephalic version. Prior to performing the maneuver, 0.25 mg terbutaline subcutaneously was administered. The drugs binds to B adrenergic receptors to cause which of the following cellular reactions to cause uterine relaxation? A. Increased ecf Mg B. Increased iCa C. Increased cAMP D. Increased cGMP
C. Increased cAMP
Changes in maternal blood flow and cardiac output in pregnancy mimic which of the following disease states? A. Hypertension B. Thyrotoxicosis C. Diabetes insipidus D. Chronic renal disease
B. Thyrotoxicosis
Between which ages of gestation does the fundic height (in cm)correlate closely with gestational age?
Between 20-34 weeks
When does the uterus become abdominal?
12 weeks AOG
When is the fundus located midway between the pubis symphysis and umbilicus?
16 wks
Fundus ia at the level of the umbilicus
20 weeks
Which leopold maneuver answer the question, what fetal pole occupies the fundus?
Fundal grip - L1
Which leopold maneuver answer the question, on which side is the fetal back?
Umbilical grip - L2
Which leopold maneuver answer the question, what fetal part lies above the pelvic inlet?
Pawlicks grip - L3
Which leopold maneuver answer the question,on which side is the fetal prominence?
Pelvic Grip - L4
Fetal posture or habitus?
Fetal attitude
Predisposing factors for transverse lie
Multiparity
Placenta previa
Hydramnios
Uterine anomalies
Predisposing factors for face presentation
Fetal malformation (anencephaly) Cord coil High parity (lax abdomen)
Vertex
Occiput
Face
Mentum
Breech
Sacrum
Shoulder
Scapula
Back up, back down
Local edema
Caput succedaneum
Bony changes in fetal head which result in shortened suboccipitobregmatic diameter
Molding
both hips flexed and both knees extended and the feet close to the head.
Frank breech
Most common type of breech presentation
Frank breech
Hips flexed, knees flexed
Complete breech, canonball position
What are the cardinal fetal movements in correct order?
Engagement. Descent Flexion Internal rotation Extension External rotation Expulsion
A 20 year old G1P0 at 39 weeks aog presents complaining of strong contractions. Her cervix is dilated 1 cm. She is given sedation and 4 hours later contractions have stopped. Her cervix is still 1 cm dilated, which of the following is the most likely diagnosis? A. False labor B. Prolonged latent phase of labor C. Arrest of latent phase D. Arrest of active phase
A. False labor
Factors affecting latent phase duration
Excess sedation or epidural
Unfavorable cervix
False labor
1st stage of labor is the latent phase which encompasses
Onset of labor to 3-5 cm
In nulliparous women, when is latent phase considered prolonged?
> 20 hours
In a G3P2 (2002) woman, when is latent phase considered prolonged?
> 14 hours
Active phase of labor begins at:
3 to 5 cm up to full dilatation
What is the normal rate of cervical dilatation in a G1P0 woman?
1.2 cm/hr
What is the normal rate of cervical dilatation in a G3P2 woman?
1.5 cm/hr
Which factors increase the duration of the active phase?
Epidural anesthesia - up to 1 hour
Maternal obesity - up to 30 to 60 mins
Maternal fear - up to 45 mins
Greatest transverse diameter in occiput presentation
Biparietal diameter
Lateral deflection of the sagittal suture either posteriorly toward the promontory or anteriorly toward the symphysis
Asynclitism
Sagittal suture lies close to the symphysis, more of the posterior parietal bone will present.
Posterior asynclitism
Sagittal suture approaches the sacral promontory, more of the anterior parietal bone presents itself to the examining fingers
Anterior asynclitism
This measurement involves the promontory to the upper margin of symphysis
True/anatomic conjugate
Normal diameter for true/anatomic conjugate
11 cm
This is measured manually from promontory to lower margin of symphysis
Diagonal conjugate
Normal diagonal conjugate
> 11.5 cm
This is measured indirectly by subtracting 1.5 to 2 cm from the diagonal conjugate
Obstetric conjugate
This is a measurement of the promontory to the posterior symphysis
Obstetric conjugate
Mechanical stretching of the cervix enhances uterine activity
Ferguson reflex
Contractions are painful possible because of the following except? A. Hypoxia of the myometrium B. Compression of the nerve ganglia C. Cervical stretching during dilatation D. None of the above
D. None of the above
A. Hypoxia of the myometrium
B. Compression of the nerve ganglia
C. Cervical stretching during dilatation
And stretching of the peritoneum overlying the fundus
The most important force in fetal expulsion is produced by?
Maternal intraabdominal pressure
Describes the descent of the fetal biparietal diameter in relation to a line drawn between two maternal ischial spines
Station
This is the first requisite for the birth of a newborn A. Flexion B. Engagement C. Descent D. Extension
C. Descent
The appreciably shorter suboccipitobregmaric diameter is substituted for the longer occipitofrontal diameter
Flexion
This is essential for completion of labor A. Extension B. Flexion C. Descent D. Internal rotation
Internsl rotstion
On palpation of the fetsl head during vaginal examination, you note that the sagittal suture is transverse and close to the pubic symphysis. The posterior ear can be easily palpated. Which of the following best describes this orientation? A. Anterior asynclitism B. Posterior asynclitism C. Mento-anterior position D. Mento-posterior position
B. Posterior asynclitism
Goals of a successthird stage of labor include which of the following? A. Prevention of uterine inversion B. Prevention of shoulder dystocia C. Completion of episiotomy repair D. All of the above
A. Prevention of uterine inversion
Goals of a successthird stage of labor include all of the following, EXCEPT? A. Prevention of uterine inversion B. Prevention of postpartum hemorrhage C. Delivery of an intact placenta D. None of the above
D. None of the above
Components of Unang Yakap
Immediate and thorough drying
Early skin to skin contact
Properly timed cord clamping
Non separation for early breastfeeding
Identify the degree of perineal laceration
Extension of laceration through skin mucous membrane, perineal body, and anal sphincter
Third degree
Identify the degree of perineal laceration Laceration extends from skin and mucous membrane to the fascia and muscles of the perineal body
2nd degree
Identify the degree of perineal laceration
Fourchette, perineal skin, vaginal mucous membrane but no the underlying fascia and muscle
1st degree
Identify the degree of perineal laceration
Extension of laceration through the rectal mucosa to expose the lumen of the rectum
4th degree
The functional divisions of labor include all of the following except A. Preparatory B. Dilatational C. Acceleration D. None of the above
C. Acceleration
Functional divisions of labor include:
Preparatory
Dilatational
Pelvic
Effective first line uterotonic prophylactic drug
Oxytocin
This uterotonic is contraindicated in hypertensive patients
Mergonovine (ergot alkaloids)
The following criteria must be met prior to vaginal delivery: A. Membranes ruptured B. Cervix completely dilated C. Regional anesthesia placed D. Fetal head position determined
C. Regional anesthesia
Which of the following describes forceps that are applied to the fetal head with the scalp visible at the introitus without manual separation of the labia?
A. Low
B. Mid
C. High
D. Outlet
D. Outlet
The following are indications for operative vaginal delivery except?
A. Prolonged second stage
B. Suspicion of immediate or potential fetal compromise
C. Shortening of the 2nd stage for maternal benefit
D. None of the above
D, none of the above
Criteria for outlet forceps (5)
- scalp is visible at introitus without separating the labia
- fetal skull has reached the pelvic floor
- sagittal suture is in AP diameter or ROA/LOA or ROP/LOP
- fetal head is at or on perineum
- rotation does not exceed 45 degrees
Which of the following is applied to reduce the nuchal arm in breech delivery? A. Loveset maneuver B. Zavanelli maneuver C. McRobert maneuver D. Piper forceps maneuver
A. Loveset maneuver
The following describes the cardinal movements of breech delivery except
A. The fetal head is born by flexion
B. The back of the fetus is directed posteriorly
C. The anterior hip usually descends more rapidly than the posterior hip
D. Engagement and descent usually occur with the bitrochanteric diameter in an oblique plane
B. The back of the fetus is directed posteriorly
Which of the following best describes a breech fetus that delivers spontaneously up to the umbilicus, but whose remaining body is delivered with operator traction? A. Breech decomposition B. Total breech extraction C. Partial breech extraction D. Spontaneous breech delivery
C. Partial breech extraction
— breech spontaneously delivered up to umbilicus
— posterior hip will deliver from 6 o’clock position
— anterior hip delivers next
— external rotation to sacrum anterior
— fetal bony pelvis grasped with both hands, using cloth towel
A patient presents in preterm labor at 32 weeks gestation. Her cervix is completely dilated, and the fetus is breech. You are unable to deliver the fetal head. What procedure is applied to resolve this complication? A. Symphysiotomy B. Zavanelli maneuver C. Duhrssen incision D. Mauriceau maneuver
C. Duhrssen incision
— incision on cervix at 2 and 10 o’clock
— or additional at 6
(Symphysiotomy is done for delivery of entrapped aftercoming head. Divides symphyseal cartilage up to 2.5 cm
The following criteria must be met prior to planned vaginal breech extraction, except?
A. Oxytocin induction if with hypotonic uterine dysfunction
B. Passive 2nd stage without active pushing for 90 minutes
C. Continuous EFM
D. none of the above
A. Oxytocin induction if with hypotonic uterine dysfunction
Criteria for planned vaginal breech
A. Oxytocin AUGMENTATION if with hypotonic uterine dysfunction. INDUCTION is NOT recommended
B. Passive 2nd stage without active pushing for 90 minutes to allow breech to descend into pelvis
C. Continuous EFM
D. EFW 2.5 to 4kg
E. Skilled OB with facilities for cs
CS is recommended when active pushing commences and delivery is not imminent within 60 MINUTES
Cardinal movements in BREECH
- Extension
- Descent
- Internal Rotation (45 degree rotation of hip; anterior hip toward the pubic arch; bitrochanteric diameter in AP diameter of outlet)
- Lateral flexion (posterior hip over perineum)
- External rotation (fetal back turns anteriorly)
- Internal rotation (bisacromial diameter in ap plane)
- Expulsion (posterior neck under symphysis, head born in flexion)
Pinard maneuver
In breech decomposition, 2 fingers will push knee away from midline, after spontaneous flexion
Lateral rotation of thighs
Flex knees
In the cardinal movements of breech, the bitrochanteric diameter in oblique diameter and the anterior hip descends more rapidly. Which step is described?
Engagement and descent
After delivery of the aftercoming head, the assistant applies suprapubic pressure to favor flexion and engagement of the fetal head. Which maneuver is applied?
A. Loveset maneuver
B. Zavanelli maneuver
C. Duhrssen incision
D. Mauriceau maneuver
D. Mauriceau-Smellie-Veit
Between which ages of gestation does the fundic height (in cm)correlate closely with gestational age?
Between 20-34 weeks
When does the uterus become abdominal?
12 weeks AOG
When is the fundus located midway between the pubis symphysis and umbilicus?
16 wks
Fundus ia at the level of the umbilicus
20 weeks
Which leopold maneuver answer the question, what fetal pole occupies the fundus?
Fundal grip - L1
Which leopold maneuver answer the question, on which side is the fetal back?
Umbilical grip - L2
Which leopold maneuver answer the question, what fetal part lies above the pelvic inlet?
Pawlicks grip - L3
Which leopold maneuver answer the question,on which side is the fetal prominence?
Pelvic Grip - L4
Fetal posture or habitus?
Fetal attitude
Predisposing factors for transverse lie
Multiparity
Placenta previa
Hydramnios
Uterine anomalies
Predisposing factors for face presentation
Fetal malformation (anencephaly) Cord coil High parity (lax abdomen)
Vertex
Occiput
Face
Mentum
Breech
Sacrum
Shoulder
Scapula
Back up, back down
Local edema
Caput succedaneum
Bony changes in fetal head which result in shortened suboccipitobregmatic diameter
Molding
both hips flexed and both knees extended and the feet close to the head.
Frank breech
Most common type of breech presentation
Frank breech
Hips flexed, knees flexed
Complete breech, canonball position
What are the cardinal fetal movements in correct order?
Engagement. Descent Flexion Internal rotation Extension External rotation Expulsion
After delivery of the aftercoming head, the assistant applies suprapubic pressure to favor flexion and engagement of the fetal head. Which maneuver is applied?
A. Loveset maneuver
B. Zavanelli maneuver
C. Duhrssen incision
D. Mauriceau maneuver
D. Mauriceau-Smellie-Veit
In the cardinal movements of breech, the bitrochanteric diameter in oblique diameter and the anterior hip descends more rapidly. Which step is described?
Engagement and descent
Pinard maneuver
In breech decomposition, 2 fingers will push knee away from midline, after spontaneous flexion
Lateral rotation of thighs
Flex knees
Cardinal movements in BREECH
- Extension
- Descent
- Internal Rotation (45 degree rotation of hip; anterior hip toward the pubic arch; bitrochanteric diameter in AP diameter of outlet)
- Lateral flexion (posterior hip over perineum)
- External rotation (fetal back turns anteriorly)
- Internal rotation (bisacromial diameter in ap plane)
- Expulsion (posterior neck under symphysis, head born in flexion)
The following criteria must be met prior to planned vaginal breech extraction, except?
A. Oxytocin induction if with hypotonic uterine dysfunction
B. Passive 2nd stage without active pushing for 90 minutes
C. Continuous EFM
D. none of the above
A. Oxytocin induction if with hypotonic uterine dysfunction
Criteria for planned vaginal breech
A. Oxytocin AUGMENTATION if with hypotonic uterine dysfunction. INDUCTION is NOT recommended
B. Passive 2nd stage without active pushing for 90 minutes to allow breech to descend into pelvis
C. Continuous EFM
D. EFW 2.5 to 4kg
E. Skilled OB with facilities for cs
CS is recommended when active pushing commences and delivery is not imminent within 60 MINUTES
A patient presents in preterm labor at 32 weeks gestation. Her cervix is completely dilated, and the fetus is breech. You are unable to deliver the fetal head. What procedure is applied to resolve this complication? A. Symphysiotomy B. Zavanelli maneuver C. Duhrssen incision D. Mauriceau maneuver
C. Duhrssen incision
— incision on cervix at 2 and 10 o’clock
— or additional at 6
(Symphysiotomy is done for delivery of entrapped aftercoming head. Divides symphyseal cartilage up to 2.5 cm
Which of the following best describes a breech fetus that delivers spontaneously up to the umbilicus, but whose remaining body is delivered with operator traction? A. Breech decomposition B. Total breech extraction C. Partial breech extraction D. Spontaneous breech delivery
C. Partial breech extraction
— breech spontaneously delivered up to umbilicus
— posterior hip will deliver from 6 o’clock position
— anterior hip delivers next
— external rotation to sacrum anterior
— fetal bony pelvis grasped with both hands, using cloth towel
The following describes the cardinal movements of breech delivery except
A. The fetal head is born by flexion
B. The back of the fetus is directed posteriorly
C. The anterior hip usually descends more rapidly than the posterior hip
D. Engagement and descent usually occur with the bitrochanteric diameter in an oblique plane
B. The back of the fetus is directed posteriorly
Which of the following is applied to reduce the nuchal arm in breech delivery? A. Loveset maneuver B. Zavanelli maneuver C. McRobert maneuver D. Piper forceps maneuver
A. Loveset maneuver
Criteria for outlet forceps (5)
- scalp is visible at introitus without separating the labia
- fetal skull has reached the pelvic floor
- sagittal suture is in AP diameter or ROA/LOA or ROP/LOP
- fetal head is at or on perineum
- rotation does not exceed 45 degrees
The following are indications for operative vaginal delivery except?
A. Prolonged second stage
B. Suspicion of immediate or potential fetal compromise
C. Shortening of the 2nd stage for maternal benefit
D. None of the above
D, none of the above
Which of the following describes forceps that are applied to the fetal head with the scalp visible at the introitus without manual separation of the labia?
A. Low
B. Mid
C. High
D. Outlet
D. Outlet
The following criteria must be met prior to vaginal delivery: A. Membranes ruptured B. Cervix completely dilated C. Regional anesthesia placed D. Fetal head position determined
C. Regional anesthesia
This uterotonic is contraindicated in hypertensive patients
Mergonovine (ergot alkaloids)
Effective first line uterotonic prophylactic drug
Oxytocin
The functional divisions of labor include all of the following except A. Preparatory B. Dilatational C. Acceleration D. None of the above
C. Acceleration
Functional divisions of labor include:
Preparatory
Dilatational
Pelvic
Identify the degree of perineal laceration
Extension of laceration through the rectal mucosa to expose the lumen of the rectum
4th degree
Identify the degree of perineal laceration
Fourchette, perineal skin, vaginal mucous membrane but no the underlying fascia and muscle
1st degree
Identify the degree of perineal laceration Laceration extends from skin and mucous membrane to the fascia and muscles of the perineal body
2nd degree
Identify the degree of perineal laceration
Extension of laceration through skin mucous membrane, perineal body, and anal sphincter
Third degree
Components of Unang Yakap
Immediate and thorough drying
Early skin to skin contact
Properly timed cord clamping
Non separation for early breastfeeding
Goals of a successthird stage of labor include all of the following, EXCEPT? A. Prevention of uterine inversion B. Prevention of postpartum hemorrhage C. Delivery of an intact placenta D. None of the above
D. None of the above
Goals of a successthird stage of labor include which of the following? A. Prevention of uterine inversion B. Prevention of shoulder dystocia C. Completion of episiotomy repair D. All of the above
A. Prevention of uterine inversion
On palpation of the fetsl head during vaginal examination, you note that the sagittal suture is transverse and close to the pubic symphysis. The posterior ear can be easily palpated. Which of the following best describes this orientation? A. Anterior asynclitism B. Posterior asynclitism C. Mento-anterior position D. Mento-posterior position
B. Posterior asynclitism
This is essential for completion of labor A. Extension B. Flexion C. Descent D. Internal rotation
Internsl rotstion
The appreciably shorter suboccipitobregmaric diameter is substituted for the longer occipitofrontal diameter
Flexion
This is the first requisite for the birth of a newborn A. Flexion B. Engagement C. Descent D. Extension
C. Descent
Describes the descent of the fetal biparietal diameter in relation to a line drawn between two maternal ischial spines
Station
The most important force in fetal expulsion is produced by?
Maternal intraabdominal pressure
A 20 year old G1P0 at 39 weeks aog presents complaining of strong contractions. Her cervix is dilated 1 cm. She is given sedation and 4 hours later contractions have stopped. Her cervix is still 1 cm dilated, which of the following is the most likely diagnosis? A. False labor B. Prolonged latent phase of labor C. Arrest of latent phase D. Arrest of active phase
A. False labor
Contractions are painful possible because of the following except? A. Hypoxia of the myometrium B. Compression of the nerve ganglia C. Cervical stretching during dilatation D. None of the above
D. None of the above
A. Hypoxia of the myometrium
B. Compression of the nerve ganglia
C. Cervical stretching during dilatation
And stretching of the peritoneum overlying the fundus
Mechanical stretching of the cervix enhances uterine activity
Ferguson reflex
This is a measurement of the promontory to the posterior symphysis
Obstetric conjugate
This is measured indirectly by subtracting 1.5 to 2 cm from the diagonal conjugate
Obstetric conjugate
Normal diagonal conjugate
> 11.5 cm
This is measured manually from promontory to lower margin of symphysis
Diagonal conjugate
Normal diameter for true/anatomic conjugate
11 cm
This measurement involves the promontory to the upper margin of symphysis
True/anatomic conjugate
Sagittal suture approaches the sacral promontory, more of the anterior parietal bone presents itself to the examining fingers
Anterior asynclitism
Sagittal suture lies close to the symphysis, more of the posterior parietal bone will present.
Posterior asynclitism
Lateral deflection of the sagittal suture either posteriorly toward the promontory or anteriorly toward the symphysis
Asynclitism
Greatest transverse diameter in occiput presentation
Biparietal diameter
Which factors increase the duration of the active phase?
Epidural anesthesia - up to 1 hour
Maternal obesity - up to 30 to 60 mins
Maternal fear - up to 45 mins
What is the normal rate of cervical dilatation in a G3P2 woman?
1.5 cm/hr
What is the normal rate of cervical dilatation in a G1P0 woman?
1.2 cm/hr
Active phase of labor begins at:
3 to 5 cm up to full dilatation
In a G3P2 (2002) woman, when is latent phase considered prolonged?
> 14 hours
In nulliparous women, when is latent phase considered prolonged?
> 20 hours
1st stage of labor is the latent phase which encompasses
Onset of labor to 3-5 cm
Factors affecting latent phase duration
Excess sedation or epidural
Unfavorable cervix
False labor
