Routine Prenatal Care: Dr Keppler- Lecture 4 Flashcards
Labor=
Sequence of uterine contractions resulting in effacement and dilation of the uterine cervix,
combined with voluntary maternal expulsive efforts resulting in delivery of a fetus
Bishop Score?
Combined somewhat objective scoring system for determining a patient’s likelihood of
successful induction of labor
○ Considers dilation, effacement, position and consistency of the cervix plus station of the fetal
presenting part
Bishop score: the max score is ________
13
T/F: bishop score does not define when _____
active labor starts
Protracted labor=
Labor progressing at a slower pace than “normal”
Arrested labor=
Either arrest of dilation after diagnosis of active labor, or failure of descent of the fetal head
during the second stage of labor
Precipitous labor=
Less than 3 hours from onset of labor to delivery
Meconium stool
-describe the significance
-Green/brown staining of the amniotic fluid when the fetus defecates prior to delivery
○ Associated with adverse fetal outcomes including fetal intolerance of labor and respiratory
distress with aspiration
SROM=
AROM=
SROM - Spontaneous rupture of membranes
AROM - “Active” rupture of membranes
VBAC=
TOLAC=
VBAC - Vaginal birth after Cesarean
TOLAC - Trial of labor after Cesarean (a
successful TOLAC becomes a VBAC)
IUPC=
FSE=
IUPC - Intrauterine pressure catheter
FSE - Fetal scalp electrode
IUFD=
IUGR=
IUFD - Intrauterine fetal demise
IUGR - Intrauterine growth restriction
Sequence of fetal maneuvers in vertex presentation: (list)
Engagement ● Flexion ● Descent ● Internal rotation ● Extension ● External rotation (restitution)
Fetal positions:
- presentation=
- Orientation=
-Presentation - What’s the “presenting” part?
○ Orientation - Which way is the presenting part “facing”? Occiput vs sacrum?
Fetal assessment in labor:
-categories (list) I-III
I - normal baseline, no pathologic decels
II - everything that is not I or III
III - bradycardia; absent variability with pathologic decels; or sinusoidal pattern
Normal HR is _____ BMP
**Normal: 110-160 BPM,
-5-25 beat to beat variability,
with / without accels
or “early” decels
Complications of Labor (list ex’s)
Labor arrest or protraction ● Lacerations ● Episiotomy ● Cord complications ● Abnormal fetal heart rate tracing ● Bleeding complications ● Shoulder dystocia ● Placenta ● Infection ● Operative delivery
Arrested or Protracted Labor:
-list the 3 P’s
-Pelvis
○ Passenger
○ Powers
Arrested or Protracted Labor:
-what are your options?
Augment (Oxytocin) ○ AROM ○ Internal pressure catheter (IUPC) ○ Rotate fetal head? ○ Wait ○ Operative delivery?
Lacerations:
-1st degree=
vaginal and perineal mucosa only, no disruption of muscles
○ Repair only needed for bleeding typically
Lacerations:
-2nd degree?
- 1st degree plus superficial perineal muscles (transverse perineal
and bulbocavernosus muscles)
Lacerations:
-3rd degree?
2nd degree plus anal sphincter(s)
Lacerations: 4th degree?
3rd degree plus anal mucosa
How often are episiotomy’s performed?
rare! Resist the urge!
● Highlights broad lack of evidence of common practices in obstetrics
Cord Complications (list 4 ex’s)
Nuchal (“cord around the neck”)
● Cord prolapse (“ride of shame”)
● Marginal cord insertion
● Vasa previa
Abnormal fetal heart tracing:
category 1
Normal baseline
○ Moderate (5-25) variability
○ +/- accels or early decels
○ No pathologic decels
Abnormal fetal heart tracing:
category 2
Anything not I or III
Abnormal fetal heart tracing:
category 3
Bradycardia
○ Absent variability with
Pathologic decels
○ Sinusoidal pattern
Bleeding complications: list 3 ex’s
“Bloody show”
● Placental abruption
● Placenta or vasa previa
● Postpartum bleeding
List an ex of an obstetric EMERGENCY where the maneuver must be committed to memory
**Shoulder Dystocia
–Rapid identification and response, and team preparedness key to reducing fetal and maternal
harm
Operative Delivery:
- tools?
- indications?
-Forceps
● Vacuum
● Cesarean
Indications:
○ Maternal exhaustion
○ Expedite delivery for fetal benefit
○ Reduce maternal risks from trial of labor (prior uterine surgery, cardiovascular disease)
Labor is divided into which phases?
-active phase is divided into _____
**latent and active phases.
The active phase is divided into 3 stages: ○ first stage involves progressive dilation of the uterine cervix from entry to the active phase to complete (10 cm) dilation
○Second stage starts at complete dilation and culminates with delivery of the neonate
○ The third stage starts at delivery of the newborn and culminates with delivery of the placenta
You are managing a patient in active labor. Her pain is controlled with an epidural
and the fetal heart rate is being continuously monitored with a Category 1 tracing.
Which of the following, if present, would change the fetal heart tracing to Category 2?
- A baseline frequency of 165 beats per minute
- Early decelerations
- A temporary increase in the heart rate lasting 15 seconds, at least 15 beats per
minute above the baseline - Moderate variability
- A baseline frequency of 165 beats per minute
A 23 year old G1P0 at 39 weeks is admitted in active labor at 5 cm cervical dilation.
In 3 hours her cervix is dilated to 7 cm dilation. After 6 hours, she is dilated to 8 cm.
Which of the following best describes her labor progress?
- Her labor is progressing normally
- Her labor is protracted
- Her labor is arrested
- She is in the second stage of labor
- Her labor is protracted
A 26 y/o G4P1021 at 41 0/7 weeks gestation presents for a post-dates induction of
labor. You examine her cervix and note she’s 4 cm dilated, 50% effaced, at -1 station.
Her cervix is soft and anterior. You calculate a Bishop score of 9. What is the
significance of this finding?
- She is guaranteed to have a vaginal delivery
- Her induction is more likely to fail
- Her induction is more likely to be successful using nipple stimulation
- Her induction is as likely to result in a vaginal delivery as if she presented in
spontaneous labor
- Her induction is as likely to result in a vaginal delivery as if she presented in
spontaneous labor
A patient has arrest in the active phase of labor. You are considering what factors
are contributing to her stalled labor. Which of the following is not one of the three
“Ps”?
1. Passenger
2. Powers
3. Pitocin
4. Pelvis
- Pitocin
Which of the following most accurately indicates that a patient admitted with
contractions is in the first stage of active labor?
1. She is dilated to 5 cm
2. She is having enough pain to request an epidural
3. Her fetal heart rate pattern shows accelerations
4. The slope of cervical change over time is increasing
- The slope of cervical change over time is increasing
The orientation of the fetal head is assessed based on the location of which feature of the fetal cranium? 1. The parietal bones 2. The frontal suture 3. The occipital bone 4. The funny bone
- occipital bone
Which of the following characteristics of a fetal heart rate being monitored in labor is NOT found in a category I tracing? 1. Late decelerations 2. Early decelerations 3. Accelerations 4. Moderate variability
- Late decelerations
Which of the following is not an indication for making an episiotomy?
- Maternal exhaustion
- Category 2 or 3 fetal heart rate tracing
- Maternal history of cardiovascular disease
- To decrease extension of a laceration to a more severe grade
- To decrease extension of a laceration to a more severe grade
