Brainscape's Knowledge GenomeTM

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


See full index

OB/GYN > Prenatal, Labor, delivery and Post-delivery care > Flashcards

Prenatal, Labor, delivery and Post-delivery care Flashcards

1
Q

Impt preconception hx to ask about?

A
  • chronic diseases**
  • meds known to be teratogens
  • reproductive hx
  • genetic conditions in the family
  • substance use
  • infectious disease and vaccinations
  • folic acid intake and nutrition
  • enviro hazards and toxins
  • mental health and social health concerns
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Goals of prenatal (antepartum) care?

A
  • ensure birth of a healthy baby w/ minimal risk to the mother
  • early, accurate estimation of gestational age
  • ID of pt at risk for complications and continuing risk assessment
  • ongoing eval of health status of both mother and fetus
  • pt education and communication
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are impt preconception interventions?

A
  • folic acid supplementation
  • glycemic control in women with diabetes
  • abstinence from alcohol and illicit and Rx drugs
  • smoking cessation
  • up to date vaccinations - live vaccines should be admin 1 month or more prior to pregnancy (MMRV)
  • wt management (BMI greater than 18 ad less than 30)
  • absence from depression
  • teratogen avoidance
  • absence of STIs
  • planned pregnancy with an early prenatal visit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does antepartum care include?

A
  • dx pregnancy and determining gestational age
  • monitoring ongoing pregnancy w/ periodic exams and appropriate screening tests
  • providing pt education that addresses all aspects of pregnancy
  • preparing pt and her family for her management during labor, delivery, and postpartum period
  • detecting medical and psychosocial complications and instituting indicated interventions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

First trimester length?

A
  • weeks 1-12
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When should prenatal care be initiated?

A
  • ideally prenatal care will be initiated in 1st trimester
  • 2011 71% of women received prenatal care in 1st trimester
  • 7% received no care or initiated care in 3rd trimester
  • with early care there is better estimation of gestational age and problems can be ID and dealt with early
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why is gestational age determined? How is this done?

A
  • necessary to determine estimated date of confinement (EDC)
  • add 7 days to LMP than subtract 3 months - Naegele’s rule
  • methods:
    hx: using date of LMP
    uterine size
    US - transvaginal - measure crown rump length, biparietal diameter, and femur length
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When can biparietal diameter and femur length be used to determine EDC?

A
  • 13-25 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What needs to be discussed at first prenatal visit?

A
  • medical hx
  • reproductive hx
  • family hx - include dad and genetic hx!! - congenital abnormalities, x’somal abnormalities, advanced maternal and paternal age, ethnicity influenced diseases
  • genetic hx
  • nutritional hx
  • psychosocial hx: critical to screen for domestic violence (20% of women are physically abused when pregnant) and sexual abuse hx
  • ob hx: date of delivery, gestational age, location, sex, birth wt, mode, anesthesia, length of labor, outcome, abortions, complications
  • prenatal menstrual hx: recent hormonal contraceptive, hx of IUD use and date removed
  • meds and allergy hx
  • ## usual substance use, exercise, diet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What factors ikelihood of having twins?

A
  • dizygotic (fraternal)/monozygotic (identical)
  • 96% of multiple births

factors that increase likelihood:

  • advancing age
  • increasing parity
  • family hx from either parent
  • obese and tall women greater chance
  • fertility drugs
  • increased calories needed for pregnant mother with multiple babies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are risks of multiple gestations?

A
  • preterm birth can lead to bed rest early in pregnancy

- intrauterine growth retardation or unequal growth

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

PE - 1st perinatal checkup?

A
  • baseline BP
  • ht and wt - baseline BMI
  • general PE
  • pay attention to oral hygiene (can lead to amniotic infection)
  • cardiac exam
  • DTRs
  • breast exam
  • pelvic exam
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What labs should be checked for 1st perinatal check up?

A
  • urine specimen for pregnancy test
  • urine is checked each visit for glucose and protein
  • 1st visit UA and urine culture are done
  • CBC: to detect anemia and screen for thalassemia
  • rubella immunity (if nonimmune counselled and immunized postpartum)
  • varicella immunity (if nonimmune varicella vaccine PP)
  • syphilis test
  • hep B ag test - HepBsAg - screening for chronic infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why is it impt to get urine cultures during pregnancy?

A
  • b/c asx bacteriuria occurs in 2-7% pregnant women
  • if untx: 30-40% will get UTI
  • assoc with increased risk of preterm birth, low birth wt, and perinatal mortality
  • 2 consecutive voided specimens w/ same bacterial strain or 1 cath specimen w/ isolated bacterial species - is considered positive and reqrs tx
  • need to repeat culture to know it is sterile after tx, osme repeat urine culture each month of pregnancy
  • some providers choose to give suppressive therapy throughout pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Tx of Asx bacteriuria?

A
  • amoxicillin
  • augmentin
  • sulfisoxazole (don’t use late in pregnancy)
  • nitrofurantoin
  • ** don’t use fluoroquinolones or tetracyclines
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How common is acute cystitis in pregnancy? Dx? Tx?

A
  • considered to be a complication - cystitis 1-2%, pyelonephritis 0.5-2%
  • UA and midstream urine culture for dx
  • tx: empiric
    augmentin
    amoxicillin
    nitrofurantoin
    cephalexin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why is a blood type and Rh determination and ab screen needed during 1st perinatal checkup?

A
  • know blood type if transfusions are needed
  • Rh status is needed if mother Rh neg then anti-D immune globulin (rhogam) is given whenever there is a risk of fetomaternal hemorrhage to prevent alloimmunization
  • if mother Rh neg another ab screen needed at 28 wks and if still negative then Rh negative mother is given rhogam at 28 wks
  • baby can develop fetalis hydrops if mother has absfrom previous pregnancies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are indications for admin. for rhogam?

A
  • at 28 wks of gestation
  • spontaneous abortion, threatened abortion, induced abortion
  • ectopic pregnancy
  • invasive procedures: genetic amniocentesis, chorionic villus sampling, multi-fetal reduction, fetal blood sampling
  • hydatidifrom mole
  • fetal death in 2nd or 3rd trimester
  • blunt trauma to abdomen
  • antepartum hemorrhage in 2nd or 3rd trimester (placenta previa or abruption)
  • external cephalic version
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When is HIV tested for?

A
  • at first prenatal visit and retesting done at 36 wks gestation in high risk pts or those who refused earlier is recommended
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What other tests should be done if indicated at first prenatal visit?

A

If indicated:

  • lipids
  • PPD
  • HGb A1C
  • thyroid testing
  • other infections: Hep C, zika
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is purpose of 1st trimester prenatal genetic screening? What can this assess? What is tested?
- What would be an indication for chorionic villous sampling?

A
  • purpose is to define risk of genetic disorders in low risk population
  • can assess for down syndrome, trisomy 18, and trisomy 13
  • combining these markers yields an 82-87% detection of down syndrome:
    hCG level
    pregnancy assoc plasma protein (PAPP-A)
    nuchal transparency (NT)
  • women found to have increased risk of aneuploidy with these tests should be offered chorionic villous sampling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is chorionic villous sampling?

A
  • a procedure to get fetal DNA for testing for down syndrome and other abnormalities
  • can be done under US guidance through the vagina or by abdominal US
  • shouldn’t be done b/f 10 wks gestation b/c of increased pregnancy loss
    (usually done at 15 weeks)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the quadruple screen? When is it done?

A
  • may be an option if woman is seen later in pregnancy
  • quadruple screen:
    AFP
    hCG
    unconjugated estrodiol
    inhibin A
  • using this combo improves the detection of down syndrome to 80%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What does integrated screening for down syndrome entail?

A
  • uses both 1st trimester and 2nd trimester markers to adjust a woman’s age related risk of having a child with down syndrome
  • can be more anxiety provoking to wait and lose the chance to do CVS
  • early amniocentesis (b/f 14 wks of gestation) has high pregnancy loss and more amniotic fluid culture failures
  • indivduals who may be carriers can undergo carrier testing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

MSAFP levels in down syndrome compared to other birth defects?

A
  • maternal serum alpha fetal protein
  • in down syndrome: low
  • in neural tube defects, anencephaly, and multiple gestation it is high
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is nuchal translucency?

A
  • the width of the translucent space at the back of the fetal neck determined by US (wider the space more likely baby has abnormality)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Indications for amniocentesis?

A
  • prenatal genetic studies (MC)
  • assessment of fetal lung maturity
  • eval of fetus for infection
  • degree of hemolytic anemia
  • eval of dx neural tube defects
  • therapeutic: removal of excess amniotic fluid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Risks with amniocentesis?

A
  • leakage of amniotic fluid
  • fetal injury (rare)
  • fetal loss: 1/300 to 1/500
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Education at 1st prenatal visit?

A
  • need visit q 4 wks until 28 wks then q 2wks until 34-36 wks then q wk
  • at each visit - maternal wt, BP, uterine growth, urine dipstick, fetal activity and fetal HR are checked
  • how to reach provider after business hours
  • warning signs: vaginal bleeding, cramping, fever, passing clots or tissue (save), dizziness, fainting, or abdominal pain
  • avoid hot tubs and saunas - exposure during 1st trimester assoc with neural tube defects
  • avoid substance abuse
  • wear seatbelt
  • infection precautions: toxo, flu
  • exercise: moderate 30 min, avoid strenous exercise and supine positions after 1st trimeseter and abdominal trauma
  • work - ok unless undue lifting and prolonged standing
  • sex: ok unless risk of STI or vaginal bleeding/positions
  • travel: increased risk of DVT, can fly up to 36 wks if not high risk
  • meds: acetaminophen ok, should check on anything else including herb preps
  • wt gain: only should be 20-25 lbs
  • breastfeeding
  • childbirth classes/hospital facilities
    diet - eat healthy, no unpasteurized dairy products or fruit/veggie juices, can get listeria from processed deli meats, fish - avoid albacore, shark, mackeral (mercury), increase calories by 340 in 2nd trimester, and 450 in 3rd trimester
  • breastfeeding: increase by another 300-500 and add 1000 mg Ca2+/d
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are common sxs of pregnancy?

A
  • HAs: common early
  • N/V: hyperemesis gravidum less than 2%
  • heartburn: general maneuvers, may use turns
  • constipation: can try stool softeners, add bulk, drink fluids
  • fatigue
  • back pain: later in preg.
  • round ligament pain: as uterus grows - sharp groin pain - reassurance
  • edema: fluid retention common but can be assoc with HTN so need to eval
  • hemorrhoids: sitz baths
  • vaginal d/c is increased: check for infection if cahnges or malodorous
  • pica: inclination for nonnutritious substances such as clay or dirt is often assoc with anemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Complications of the first trimester - vaginal bleeding - DDx?

A
  • ectopic pregnancy
  • threatened miscarriage
  • inevitable miscarriage: incomplete or complete
  • vanishing twin
  • vaginal tract bleeding
  • implantation bleeding (dx of exclusion)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How common is bleeding during the first trimester? What is a threatened abortion?

A
  • 30-40% of preg women will have some bleeding during early preg
  • about 1/3 have some degree have bleeding during 1st trimester
  • when preg is complicated by vaginal bleeding b/f 20th wk it is termed a threatened abortion
  • 35-50% of threatened abortions eventually result in loss of pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What do you need to rule out if pt bleeding during first pregnancy? What do you want to assess? What if pt is unstable?

A
  • rule out ectopic
  • assess pt to make sure she is stable - ABCs, and pay attention to CV status
  • if pt unstable - presume ruptured ectopic and start fluids and get to OR ASAP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

A pt comes in with bleeding during first trimester: H and P, and eval?

A

if pt stable - get H and P:

  • get hx of bleeding, if tissue or clots have been passed, any cramping or pain, LMP, any prenatal care, blood type and Rh
  • exam: CV,
    pelvic: pay attention to whether cervical os is open or closed, is there blood in vagina, tissue, any lesions or trauma, size of uterus consistnet with gestation? consistency of uterus? - firm or boggy?
  • eval: pelvic US when suspect ectopic to see if free fluid, may follow with transvaginal US, CBC with type and cross and Rh, serum quantitative beta hCG
  • management according to findings
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Second trimester is what weeks?

A
  • weeks 13-27
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Eval in 2nd trimester?

A
  • fundal ht: at 20 wks uterus reaches umbilicus and now the fundal ht can be measured at each visit, each wk should equal 1 cm up until 36 wks, after the baby drops down into pelvis and is lower
  • fetal movement: mother begins to feel fetus move around 18-20 wks (quickening), subsequent visits ask about fetal movement, decreased fetal movement noticed by mother is a sign to come in for eval and can indicate distress or demise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What continued eval need to be done in 2nd trimester?

A
  • maternal BP and wt
  • urine dip for glucose and protein
  • documentation of fetal cardiac activity
  • assessment of significant events:
    travel, illness, stressors, infections, abuse
38
Q

Complications in the 2nd trimester?

A
  • premature labor
  • vaginal bleeding: placenta previa or placental abruption
  • premature rupture of membranes
  • HTN in preg
  • preeclampsia (may start in 2nd trimester, usually in 3rd)
39
Q

Education in 2nd trimester?

A

moms are instructed on signs and sxs of preterm labor and PROM:

  • uterine contractions, low back pain, cramping, diarrhea
  • leakage or gush of fluid from vagina (rupture of membranes)
  • low pelvic pressure, or low back pain
  • advised on selecting a newborn care provider
  • lamaze or similar type class especially for 1st time parents
  • tobacco cessation if still smoking
  • depression counseling if appropriate
  • asked about intimate partner violence
  • postpartum family planning/tubal sterilization
  • pt to lay on Left lateral not flat on back**
40
Q

length of 3rd trimester?

A
  • 28 wks to birth
41
Q

Visits during 3rd trimester?

A
  • now q 2wks and then at 36 wks visits are weekly
  • at each visist - abdomen is examined to determine the position/presentation of fetus using maneuvers of leopold
  • usually by 36 wks - fetus is in position its going to stay in
  • sometimes if baby is breech - OB doc attempts to maneuver the fetus into cephalic position: external version
42
Q

When is pt screened for gestational diabetes? What does the test include?

A 
- 28 weeks
dx:
-  random serum glucose: over 200mg/dl
- fasting serum glucose: over 126 mg/dl
- glucose challenge test: 50 g oral glucose load given: 1 hr later serum glucose measured, abnormal is over 130, to confirm gestational diabetes - do 3 hr oral GTT
43
Q

What are the adverse outcomes assoc with gestational DM?

A
  • preeclampsia
  • polyhydramnios
  • fetal macrosomia
  • birth trauma
  • operative delivery
  • perinatal mortality
  • neonatal metabolic complications: hypoglycemia, hyperbilirubinemia, hypocalcemia, erythemia
44
Q

Initial tx for gestational diabetes?

A
  • diet and exercise

- if not effective - insulin

45
Q

What other test needs to be done at 28 wks if mother is Rh -?

A
  • Rh ab screen

- rhogam is given at this time

46
Q

Screening labs for 32-36 wks?

A
  • CBC
  • US when indicated
  • HIV when indicated
  • depression screening when indicated
47
Q

How do we screen for Group B strep?

A
  • CDC recommends universal screening for group B strep at 35-37 wks
  • swabs are done of vagina and rectume, if positive - woman tx prophylactically at time of labor and delivery
  • tx with PCN, ampicillin, erythromycin or clindamycin
  • women with GBS bacteriuria during current preg and women who have given birth to an infant w/ invasive GBS are not screened they are given intrapartum abx prophylaxis
48
Q

3rd trimester education and planning?

A
  • anesthesia/birth plans
  • labor signs
  • vaginal bleeding - sign of early labor or abruption
  • signs and sxs of preeclampsia (HA, visual sxs, edema)
  • post term counselling
  • circumcision
  • breastfeeding**
  • PPD
  • intimate partner violence
  • newborn education
  • family medical leave or disability forms
49
Q

35-37 wk labs?

A
  • group B strep

- resistance testing if PCN allergic

50
Q

What are braxton hicks contractions?

A
  • commonly occur in last 2-3 wks of pregnancy - also called false labor
  • may be regular and strong
  • Don’t result in change in cervix
  • therefore not active labor
  • encourage mother, don’t tx carelessly or brush it off
51
Q

When should your pt come in (timing of contractions, signs and sxs)?

A
  • contractions q 5 min for 1 hr or very intense contractions
  • mother getting very uncomfortable or feeling pressure in pelvis
  • sudden gush or leaking of fluid from vagina
  • significant vaginal bleeding
  • decreased fetal movement
52
Q

When is a nonstress test used?

A
  • to assess fetal well-being
  • if woman presents with decreased fetal movement and fetal heart tones are heard then well-being of fetus is eval with nonstress test (usually after 28 wks)
  • while mother reclines in L lateral position - fetal heart tones are recorded by heart monitor
  • recorded for 20-30 min
  • mother presses button when she detects fetal movement
  • if FHR accelerates after movement for at least 3 episodes and there are no concerning decreased in HR the test is reassuring and no intervention is needed at that time
53
Q

What is a reassuring good tracing nonstress test?

A
  • seeing the baby’s HR react to mom’s contractions

- has good variability and accelerations (can withstand more labor)

54
Q

Complications that can occur during 3rd trimester?

A
  • preeclampsia/eclampsia
  • HELPP syndrome
  • vaginal bleeding
  • premature labor
  • PROM
55
Q

What is included in the biphysical profile?

A
    1. nonstress test
    1. fetal breathing movements (US)
    1. fetal movement (US)
    1. fetal tone (US)
    1. amniotic fluid volume (US)
56
Q

What is included in the birth plan? Purpose?

A
  • helps woman to become actively involved in making decisions about birth of her and her partner’s child
  • it provides an opportunity for discussion b/t the woman and her partner or support team, as well as with her health care provider
    common topics:
  • mobility, massage, music
  • pain relief, medical procedures (monitoring IV fluids, AROM)
  • positioning for pushing
  • mother and baby together - breastfeeding w/in 1st hr, rooming in
57
Q

What is labor? What is helping induce this?

A
  • physiologic process by which regularly occurring, uncomfortable-to-painful uterine contractions result in progressive effacement and dilation of cervix
  • this thinning out and dilation permits passage of fetus from uterus through birth canal, resulting in delivery
  • increased synthesis of prostaglandins, which stimulate uterine contractions and which may soften the cervix independent of uterine activity
  • an increase in myometrial oxytocin receptors, which amplify biologic effect from a given amt of oxytocin
58
Q

What is included in the exam for delivery?

A
  • determine presenting part (head down preferably)
  • digital vaginal exam: cervix:
    consistency: hard or soft
    effacement: shortening of cervical canal from 2 cm to paper thin
    dilation- cervix opens from closed to 10 cm (fully dilated)
  • fetal station: position of fetal head in birth canal in relation to ischial spines
59
Q

Stages of labor?

A
  • 1st stage:
    latent phase- cervical effacement and early dilatation
    active phase- begins when cervix is 3-4 cm dilated
    onset of contractions to complete dilatation and effacement of cervix
  • 2nd stage:
    delivery of infant
  • 3rd stage:
    delivery of placenta
  • 4th stage:
    hour immediately after delivery
60
Q

What occurs during first stage of labor?

A
  • onset of uterine contractions as perceived by preg woman
  • ends with complete dilatation of cervix, which is 10 cm in diameter for full term infant

minimal dilatation during active phase:

  • primiparous women: 1cm/hr
  • multiparous women: 1.5cm/hr
  • if not progressing need to eval
61
Q

What occurs during early labor?

A
  • vary in frequency and intensity
  • typically, contractions occur q 5-10 min (beginning of contraction to beginning of next contraction)
  • last for 30-45 seconds
  • 20-30 mmHg in intensity
  • contractions then become more frequent - q 2-3 min
  • lasting 60-70 sec
  • intensity of 40-60 mmHg
  • can only measure intensity of contractions accurately with internal uterine monitor, external monitor doesn’t accurately show actual pressure of contractions
62
Q

What is the management for the 1st stage of labor?

A
  • ambulation of head engaged and intermittent fetal monitoring is done
  • if laying down - supine L lateral position (avoid supine hypotensive sydrome)
  • if membranes intact may bathe or shower
  • hydration w/ IV fluids if needed
  • NPO except for ice chips
63
Q

How is fetal monitoring of FHR done? Normal range for FHR?

A
  • continuous or intermittent monitoring of FHR either externally or with scalp electrode
  • FHR:
    range: 110-160
    good variability, accelerations
  • warning signs: late decelrations, bradycardia, decreased variability
64
Q

What does decreased variability look like of FHR?

A
  • no accelerations, no reaction to contractions
65
Q

What are variable decelerations usually assoc with?

A
  • with umbilical cord compression (heart rate plunges down with contactions because contractions are compressing cord - temporarily reduces blood supply and O2 to baby)
66
Q

What are late decelerations a sign of?

A

ominous- decreased O2 to fetus

  • not a good sign if mother in early labor and this is occurring
  • give mom O2, IV fluids, on L lateral side, if didn’t change in 30 min do C section
  • if baby crowning - can deliver
67
Q

What does a sinusoidal pattern mean?

A
  • VERY bad: means baby is acidotic

- baby needs to come out

68
Q

How is pain controlled during labor?

A
  • during first stage of labor pain results from uterine contractions and dilation of cervix
  • as fetal head descends there is also distension

methods of anesthesia/analgesia:

  • sx narcotics - early in labor
  • spinal anesthesia: single injection
  • epidural block: infusion of local anesethetics or narcotics through a catheter into the epidural space
  • local block of anesthetic into vagina or perineum
  • general anesthetic
69
Q

2nd stage management of labor?

A

begins with complete dilatation of cervix and ends with delivery of baby - mother has urge to push:
primgavida: 30 min-2 hrs
multigravida: 5-30 min
- fetal descent needs to be monitored carefully to eval progress of labor:
molding and formation of caput can create flase sense of fetal descent

70
Q

The passage of the fetus through the pelvis is called? This usually takes place in predictable sequence based on what?

A
  • called mechanism of labor
  • usually takes place in predictable sequene based on mechanics of force from above and resistance from below
  • power, passenger, passage
71
Q

components of Stage 2?

A
  • continuous
  • cardinal movements:
    engagement
    flexion
    descent
    internal rotation
    extension
    external rotation or restitution
    expulsion
72
Q

Baby’s pasage through pelvis? Bony pelvis consists of what 4 bones?

A
  • sacrum, coccyx, 2 innominate bones - each made of fused pubis, ischium and ilium
  • baby’s head must go in an inferoposterior direction and then in an inferoanterior direction
73
Q

What occurs during engagement?

A
  • biparietal diameter - widest transverse diameter of fetal head, has passed the plane of the pelvic inlet
  • presenting part is palpated below the level of ischial spines
74
Q

What occurs during flexion?

A
  • as forces cause descent of fetus through pelvis, soft tissue and bony resistance is encountered
  • allows the smaller diameters of the fetal head to present to maternal pelvis
75
Q

What occurs during descent?

A
  • successful passage of presenting part through birth canal

- greatest rate of descent occurs during latter portions of first stage of labor and during 2nd stage of labor

76
Q

What occurs during internal rotation?

A
  • facilitates optimal diameters of fetal head to bony pelvis

- most commonly from transverse to either anterior or posterior

77
Q

What occurs during extension?

A
  • after further descent, fetal head reaches the introitus

- to accomodate the upward curve of the birth canal - the flexed head now extends

78
Q

What occurs during external rotation?

A
  • occurs after delivery of the head
  • the head rotates “face forward” relative to the shoulders
  • known as “restitution” then there is rapid delivery of body: expulsion
79
Q

What should be done to baby once head is delivered?

A
  • oral cavity and nares are suctioned (uptodate doesn’t recommend this)
  • check for nuchal umbilical cord
  • deliver shoulder trunk and legs
  • clamp and cut cord w/in 15-20 seconds
  • place infant on mother’s chest, if not in distress, then to warmer
80
Q

What happens in the 3rd stage of labor?

A
  • begins with delivery of baby and ends with delivery of placenta and membranes
  • obtain cord blood while waiting
  • while waiting for placenta to deliver - check for lacerations (can take 2-30 min to deliver)
  • don’t pull on umbilical cord
  • once placenta separates you can gently put traction on cord, sometimes the mother will need to push - check cord and placenta - usually give oxytocin (pitocin) IV after delivery of placenta
81
Q

What should be closely observed during stage 4 of labor?

A 
- closely observation for PPH:
uterine relaxation: MC cause of PPH
retained placental fragments
cervical or vaginal lacerations
- monitor pulse, BP, uterine blood loss 
(RR and pulse will go up first w/ blood loss, by time BP goes down - in trouble - shock!)
82
Q

APGAR assessment?

A
  • color
  • heart rate
  • reflex activitiy
  • muscle tone
  • respirations
83
Q

Milk production after labor? Nipple care?

A
  • colostrum (first 5 days): more minerals, protein, and IgG abs, and less fat and sugar
  • milk production: adequate insulin, cortisol and thyroid hormone
  • nipple care: wash with water and expose to air for 15-20 minutes afer each feeding
  • lanolin or A&D ointment may be applied if tender

**need more calories for breastfeeding

84
Q

How can labor be induced? When is this done?

A
  • done when benefits to either the mother or fetus outweigh those of continuing the pregnancy
  • cervical ripening may need to be done:
    misoprostol and prostaglandin E2 can be admin intravaginally and intracervically
    laminaria: mechanical dilation of the cervix
    pitocin drip to stimulate uterine contractions
85
Q

What is the MC major operation performed in US?

A
  • c section
  • can have vaginal birth after cesarean (VBAC)
    called trial of labor after cesarean (TOLAC)
86
Q

Breech presentation?

A
  • bottom first
  • generally known ahead of time - do c-section
  • if faced with this most likely baby will just deliver or will need expedient OB referral
87
Q

What happens to the uterus postpartum?

A
  • postpartum: 6-8 wks following birth
  • involuation of uterus - normal size by 6 wks
  • lochia: d/c from uterus after birth as the dicidua differentiates into a superficial layer which sloughs off
    heavy at first, and rapidly decreases in amt over 1st 2-3 days, may last for several wks, in women who breastfeed - lochia resolves more rapidly
88
Q

What happens to vagina postpartum?

A
  • vulvar and vaginal tissue return to normal over first several days
  • if a woman had an episiotomy or tear that can take 3-4 wks to heal
  • general rule: nothing in the vagina for 4 wks after delivery
89
Q

What happens to ovarian fxn postpartum?

A
  • in nonlactating women - avg time to ovulation is 45 days
  • in lactating woman: 189 days
  • likelihood of ovulation increases as frequency of breastfeeding decreases
  • breastfeeding isn’t a reliable contraception
90
Q

How common is PPD?

A
  • 70-80% of women get post partum blues
  • 10-15% get PPD:
    may be more likely if have a h/o personal or family deprssion, predictor if depressed during pregnancy, screening ?s at post-partum visits
  • 0.1-0.2% get post-partum psychosis

OB/GYN (17 decks)

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