Prenatal / Normal Pregnancy Flashcards
When is APGAR measured
1 and 5 minutes
purpose of APGAR score
identify infants who require immediate medical attention
APGAR acronym
Appearance
Pulse
Grimace -response to irritable stimuli, reflex irritability
Activity - extremity movement, muscle tone
Respiration
Q 31 Apgar scoring system
memorize :)
what apgar score indicates excellent condition
7-10
what apgar score indicates moderately depressed
4-6
what apgar score indicates severely depression
0-3
What are the risk factors for low Apgar scores?
Premature birth, cesarean delivery, and perinatal complications
Dizygotic twins
refers to fertilization of two separate ova during a single ovulatory period
monozygotic twins
refers to a single fertilized ovum that separates into two fetuses
RF for dizygotic twins
fertility-enhancing treatments, increasing maternal age, increasing parity, family history of dizygotic twinning, and increased maternal weight and height are associated with an increased prevalence of dizygotic twins
RF for monozygotic twins
UNKNOWN :)
Chorionicity
Refers to the number of chorionic (outer) membranes surrounding the fetuses
amnionicity
refers to the number of amnions (inner) membranes that surround the fetuses
Complications associated with multiple gestation
increased risk of preterm birth, intrauterine growth restriction, discordant growth, and increased risk of congenital anomalies
MC complication of multiple gestations
premature birth
Discordant growth
significant difference in birth weight between the heaviest and lightest infant of a multiple birth pregnancy and is associated with an increased risk of neonatal mortality, particularly when discordance is > 30%
in what type of twins are congenital malformations MC
monozygotic twins
what type of multiple gestation pregnancies are at increased risk of discordant growth and twin-twin transfusion syndrome
Monochorionic twin pregnancies and dichorionic triplet pregnancies
because the fetuses share a common placenta
Twin-twin transfusion syndrome
occurs when vascular arteriovenous anastomoses form, leading to unbalanced blood flow between the donor twin and the recipient twin
Recipient twin in twin-twin transfusion syndrome
The recipient twin will have polyhydramnios and an enlarged umbilical cord, abdominal circumference, kidneys, and bladder. The recipient twin will also be at risk for thrombosis or hyperbilirubinemia secondary to polycythemia, cardiomegaly, tricuspid regurgitation, and hydrops fetalis
Donor twin in twin-twin transfusion syndrome
The donor twin will have oligohydramnios and is at risk for severe intrauterine growth restriction, anemia, hypovolemia, kidney insufficiency, and pulmonary hypoplasia
True or false: the volume of milk production by mothers of twins is consistently twice that of mothers of singletons
True
Twins: If the egg splits 0–3 days after fertilization
it will result in dichorionic, diamniotic twins
Twins: Splitting at 4–8 days after fertilization
monochorionic, diamniotic twins
MC type of monozygotic twins
monochorionic-diamniotic twins
Twins: Splitting at 8–12 days after fertilization
Rare
monochorionic, monoamniotic twins
T sign US twins
represents the amnion coming off the placenta at a 90° angle between the two distinct amniotic sacs, which is indicative of a monochorionic, diamniotic gestation
Lambda/Twin peak sign twins US
represents dichorionic, diamniotic gestation
ACOG recommendations for delivery of uncomplicated dichorionic, diamniotic twins
38 weeks
ACOG recommendations for delivery of uncomplicated monochorionic, diamniotic twins
between 34 and 37 weeks
ACOG recommendations for delivery of uncomplicated monochorionic, monoamniotic twins
between 32-34 weeks
when are corticosteroids administered for lung development
administered to all women who may deliver prior to 34 weeks
What type of twins occurs with division of a fertilized egg 13 days or later after fertilization?
conjoined twins
what is part of the exam in the first stage of labor
evaluation for membrane rupture; presence of uterine bleeding; cervical dilation and effacement; fetal lie, presentation, and position; fetal size and pelvic capacity; fetal and maternal well being; fetal station
what is fetal station
measured by the location of the leading bony edge of the presenting part relative to the maternal ischial spines
is fetal station measured in cm, inches, mm, what???
CM
negative numbers for fetal station
a position above the ischial spines
positive numbers fetal station
position below the ischial spines
what is the highest fetal station score
-5
what is the lowest fetal station score and what does it represent
+5 station
when the baby’s head is in the vaginal opening just before birth
when can Neuraxial techniques for treatment of pain be initiated during labor
can be initiated at any stage of labor to provide pain relief
relative contraindications to neuraxial techniques
coagulopathy, infection at the site of neuraxial analgesia puncture, and increased intracranial pressure
what does Neuraxial analgesia usually consist of
dilute local anesthetic, such as bupivacaine or ropivacaine, and an opioid, such as fentanyl or sufentanil
common ADE neuraxial analgesia
pruritus
Postdural puncture headaches
occur 6–72 hours after dural puncture and present with headaches that are worse with sitting or standing
tx postdural puncture headaches
epidural blood patch
At which vertebral level is an epidural most commonly placed in obstetrics patients?
L3-L4
MC indications for C section
failure to progress during labor, nonreassuring fetal status, and fetal malpresentation
Two common transverse incisions for C section
Pfannenstiel incision and the Joel-Cohen incision
Pfannenstiel incision
performed 2–3 cm above the symphysis pubis in a curved shape
what is the preferred incision for C section
Pfannenstiel incision
why are transverse incisions preferred in c section
reduced blood loss, shorter operating duration, shorter hospital stay, and lower rates of fever, postoperative pain, and use of analgesia
MC used technique to enter the uterus in a C section
low transverse uterine incision (Munro Kerr)
Women who desire to trial vaginal birth after cesarean section should receive
two-layer closure of the uterus
single-layer closure is effective with all other patients
Women who trial labor after cesarean section have an increased risk of
uterine rupture and abnormal placentation, such as placenta previa or accreta
how many stages is labor divided into
3
first stage of labor
characterized by the onset of uterine contraction (every 3–5 minutes for more than 1 hour) until complete cervical dilation at 10 cm
consists of the latent and active phases
latent phase of first stage of labor
characterized by gradual cervical dilation until approximately 5 cm
active phase of first stage of labor
occurs when the cervix is dilated to 5–6 cm and is characterized by rapid cervical dilation (1.2 cm/hour for nulliparous women and 1.5 cm/hour for multiparous women)
second stage of labor
occurs from cervical dilation until delivery of the fetus
third stage of labor
occurs after the delivery of the fetus and ends with the delivery of the placenta
prolonged labor
An abnormally long latent phase or second stage of labor
protraction
abnormally long active phase
labor arrest
complete cessation of progress in labor
RF for labor arrest
hypocontractile uterine activity (< 3–4 contractions/10 minutes, contraction duration < 50 seconds, or contractions < 200 Montevideo units) and cephalopelvic disproportion caused by fetal malposition or malpresentation
in what type of pelvis is transverse arrest most likely to occur
android pelvis or platypelloid pelvis
android pelvis
narrow forepelvis, convergent side walls of the pelvic midcavity, forward inclination of the sacrum, and a narrow subpubic arch of the pelvic outlet
anthropoid pelvis
characterized by a narrow transverse diameter, wide anteroposterior diameter, divergent forepelvis, narrow side walls of the pelvic midcavity, and wide inclination of the sacrum
gynecoid pelvis
characterized by a wide forepelvis, straight side walls of the pelvic midcavity, and a wide subpubic arch of the pelvic outlet
what types of pelvis are least likely to be associated with labor arrest
Anthropoid and gynecoid pelvis
MC type of pelvis in females and considered normal
gynecoid
platypelloid pelvis
characterized by a narrow anteroposterior diameter, straight forepelvis, wide side walls of the pelvic midcavity, narrow inclination of the sacrum, and a wide subpubic arch of the pelvic outlet
key facts about induction of labor
Induction of labor is thought to slow down the latent part of the first stage of labor but has no impact on the duration of the active part of the first stage of labor or the second stage
indications for induction of labor
prelabor rupture of membranes, post-term pregnancy, hypertensive disorders of pregnancy when delivery is appropriate, fetal demise, oligohydramnios, chorioamnionitis, and fetal growth restriction
C/I for induction of labor
prior uterine rupture, active genital herpes, placenta previa, vasa previa, umbilical cord prolapse, transverse fetal lie, and category III fetal tracings
when can induction of labor be done electively
39 weeks if dated well and without contraindications to labor
what med is used MC for induction of labor
oxytocin
what is frequently assessed prior to induction of labor
cervix
bc it can help predict the duration of an induced labor and the chance of vaginal delivery
what measurements help to form the bishop score
Assessment of the cervix includes considering cervical dilation, fetal station, cervical effacement, cervical softness, and cervical position
what is a bishop score
provides a quantitative measurement of how favorable a cervix is for induction
what bishop score is considered favorable
≥ 6
what bishop score is considered unfavorable
3 or less
what do you do In cases where induction is desired but the cervix is unfavorable
prostaglandins or a transcervical balloon catheter can be used to increase cervical favorability (ripening)
MC ADE of oxytocin
Tachysystole - an average of more than five contractions per 10 minutes for ≥ 30 minutes
tx tachysystole
reduction or discontinuation in the dose of oxytocin
The cardinal movements of labor
describe the position of the fetus as it enters, occupies, and exits the birth canal
how many fetal positions that make up the cardinal movements of labor
7
what are the seven fetal positions that make up the cardinal movements of labor
engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion
in this order^^^
fetal positions: engagement
This is when the largest part of the fetal head (called the biparietal diameter and measured ear to ear) is introduced into the birth canal at the level of the ischial spine
fetal positions: descent
The fetal head progresses deeper into the birth canal. This is where a large majority of the molding of the fetal head takes place
fetal positions: flexion
Once the head reaches the pelvic inlet, it flexes at the neck, pressing the fetal chin to the chest. This presents the smallest aspect of the fetal head at the birth canal
fetal positions: internal rotation
Internal rotation then occurs to allow the fetal head to follow the path of least resistance in the birth canal. At the pelvic inlet (the pelvic floor), the birth canal is widest laterally. At the pelvic outlet, the birth canal is widest from the anterior to the posterior surfaces. Internal rotation allows the fetal head to deliver without causing maternal back pain
fetal positions: extension
the fetal head passes through the pelvic arch and undergoes extension. The face and chin are born face-down as extension occurs
fetal positions: external rotation
(also called restitution) occurs spontaneously once the fetal head is delivered. The infant’s head moves from a face-down position to facing one of the maternal thighs. This rotation helps the shoulder through the pelvic arch
when is the MC time to identify shoulder dystocia
during external rotation
fetal positions: expulsion
the final cardinal movement of labor, is often completed spontaneously or with one more gentle push. It is at this stage where the shoulders are delivered, first the anterior shoulder using downward traction and then the posterior shoulder using upward traction. Gentle pressure should be used to avoid a brachial plexus injury
monitoring of mom and fetus during labor
fetal heart rate, uterine contractions, and the maternal cervix
FHR monitoring during labor
performed every 30 minutes in the first stage of labor and every 15 minutes in the second stage of labor for mothers without risk factors
how are contractions monitored during labor
external tocodynamometer
when are vaginal exams performed during labor
Vaginal exams are kept to a minimum but are typically performed on admission, prior to administering analgesia when the mother feels the urge to start pushing, at 4-hour intervals in the first stage of labor, and at 2-hour intervals in the second stage of labor
what is the technical fourth stage of labor
It consists of the uterus regaining its tone and starting to involute.
