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(3) MS: Pediatric Conditions > S1_L3: Parturition and Labor > Flashcards

S1_L3: Parturition and Labor Flashcards

1
Q

Relaxin is found in the ___ and placenta in pregnant women. It softens the birth canal, allows connective tissue remodeling, for mammary growth and differentiation and inhibits uterine contraction.

A

corpus luteum

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2
Q

Relaxin allows systemic (1)___ and (2)___ blood pressure during pregnancy. It also relaxes ligaments to allow bony structures to expand.

A
  1. vasodilation
  2. decreases
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3
Q

This allows breast tissue development and milk production, so the mother is able to breastfeed

A

Prolactin hormone

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4
Q

Maternal changes in the cardiovascular system

  1. Increase in vascular resistance
  2. Decrease in cardiac output
  3. Increase heart rate

A. True
B. False

A
  1. B
  2. B
  3. A
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5
Q

Maternal changes in the cardiovascular system

  1. Increase in stroke volume
  2. Decreased ventricular wall mass, myocardial contractility, and cardiac compliance

A. True
B. False

A
  1. A
  2. B
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6
Q

Maternal changes in the hematologic system

  1. Increase in blood flow to the uterus causing optimized O2 transfer to fetus
  2. Increase demand for iron throughout pregnancy
  3. Decrease in RBC mass

A. True
B. False

A
  1. A
  2. A
  3. B
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7
Q

Maternal changes in the respiratory system

  1. Increase in Functional residual capacity (FRC)
  2. Increase in inspiratory reserve volume (IRV)
  3. Increase in Expiratory reserve volume (ERV)

A. True
B. False

A
  1. B
  2. A
  3. B
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8
Q

Maternal changes in the respiratory system

  1. No change in vital capacity (VC)
  2. Increase in tidal volume
  3. Respiratory rate remains unchanged

A. True
B. False

A
  1. A
  2. A
  3. A
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9
Q

Maternal changes in the renal system

  1. Fluid retention leads to physiologic hydronephrosis
  2. Decrease in the serum concentration of creatinine, urea, and uric acid
  3. Progesterone and relaxin acts on smooth muscles causing constriction of the urinary collecting system

A. True
B. False

A
  1. A
  2. A
  3. B, causes dilation
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10
Q

Maternal changes in the gastrointestinal tract

  1. Delayed gastric emptying
  2. Decreased small bowel transit time
  3. Compression from a gravid (pregnant) uterus predisposes to GERD

A. True
B. False

A
  1. A
  2. B
  3. A
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11
Q

Longest phase of parturition that happens in the 1st 32 weeks of pregnancy
A. Phase 1 (Uterine Quiescence)
B. Phase 2 (Preparation for labor)
C. Phase 3 (Process of labor)
D. Phase 4 (Involution)

A

A. Phase 1 (Uterine Quiescence)

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12
Q

Cervix is rigid, firm, and unyielding. The uterus changes in size and vascularity to accommodate pregnancy and prepare for uterine contraction.
A. Phase 1 (Uterine Quiescence)
B. Phase 2 (Preparation for labor)
C. Phase 3 (Process of labor)
D. Phase 4 (Involution)

A

A. Phase 1 (Uterine Quiescence)

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13
Q

Cervical ripening; the cervix softens and is more readily dilatable; uterine awakening & contraction
A. Phase 1 (Uterine Quiescence)
B. Phase 2 (Preparation for labor)
C. Phase 3 (Process of labor)
D. Phase 4 (Involution)

A

B. Phase 2 (Preparation for labor; Activation)

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14
Q

The uterus goes back to its original size and is fully contracted
A. Phase 1 (Uterine Quiescence)
B. Phase 2 (Preparation for labor)
C. Phase 3 (Process of labor)
D. Phase 4 (Involution)

A

D. Phase 4 (Involution)

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15
Q

Mother starts breastfeeding; “Parturient Recovery”
A. Phase 1 (Uterine Quiescence)
B. Phase 2 (Preparation for labor)
C. Phase 3 (Process of labor)
D. Phase 4 (Involution)

A

D. Phase 4 (Involution)

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16
Q

Uterus is already contracting
A. Phase 1 (Uterine Quiescence)
B. Phase 2 (Preparation for labor)
C. Phase 3 (Process of labor)
D. Phase 4 (Involution)

A

C. Phase 3 (Process of labor; Stimulation)

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17
Q

Cervix is slowly dilating
A. Phase 1 (Uterine Quiescence)
B. Phase 2 (Preparation for labor)
C. Phase 3 (Process of labor)
D. Phase 4 (Involution)

A

C. Phase 3 (Process of labor; Stimulation)

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18
Q

Uterus is unresponsive to any contraction; Uterine smooth muscle tranquility with maintenance of cervical structural integrity
A. Phase 1 (Uterine Quiescence)
B. Phase 2 (Preparation for labor)
C. Phase 3 (Process of labor)
D. Phase 4 (Involution)

A

A. Phase 1 (Uterine Quiescence)

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19
Q

Collagen fibril diameter of the cervix is increased and there is spacing between fibrils leading to loss of tissue integrity and increased tissue compliance (more loose and elastic)
A. Phase 1 (Uterine Quiescence)
B. Phase 2 (Preparation for labor)
C. Phase 3 (Process of labor)
D. Phase 4 (Involution)

A

B. Phase 2 (Preparation for labor)

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20
Q

Myometrial changes:
1. fundus produces effective contractions that drive fetus through cervix and birth canal
2. formation of the lower uterine segment
A. Phase 1 (Uterine Quiescence)
B. Phase 2 (Preparation for labor)
C. Phase 3 (Process of labor)
D. Phase 4 (Involution)

A

B. Phase 2 (Preparation for labor)

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21
Q

Starts when the effaced (thinned) cervix is 4 cm dilated to full cervical dilation
A. Stage 1 (Latent)
B. Stage 1 (Active)
C. Stage 1 (Transition)
D. Stage 2 (Fetal delivery)
E. Stage 3 (Placental delivery)
F. Stage 4 (Parturient recovery)

A

B. Stage 1 (Active)

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22
Q

Expulsion of mucus plug: “Bloody Show”
A. Stage 1 (Latent)
B. Stage 1 (Active)
C. Stage 1 (Transition)
D. Stage 2 (Fetal delivery)
E. Stage 3 (Placental delivery)
F. Stage 4 (Parturient recovery)

A

B. Stage 1 (Active)

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23
Q

Period from just after the fetus is expelled until just after the placenta is expelled
A. Stage 1 (Latent)
B. Stage 1 (Active)
C. Stage 1 (Transition)
D. Stage 2 (Fetal delivery)
E. Stage 3 (Placental delivery)
F. Stage 4 (Parturient recovery)

A

E. Stage 3 (Placental delivery)

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24
Q

0 – 4 cm cervical dilation, longest time in labor and least intense phase
A. Stage 1 (Latent)
B. Stage 1 (Active)
C. Stage 1 (Transition)
D. Stage 2 (Fetal delivery)
E. Stage 3 (Placental delivery)
F. Stage 4 (Parturient recovery)

A

A. Stage 1 (Latent)

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25
"Pushing stage", starts when the cervical opening reaches 10 cm and the mother starts helping with the pushing of the baby out of the birth canal A. Stage 1 (Latent) B. Stage 1 (Active) C. Stage 1 (Transition) D. Stage 2 (Fetal delivery) E. Stage 3 (Placental delivery) F. Stage 4 (Parturient recovery)
D. Stage 2 (Fetal delivery)
26
Average time from delivery of the baby until complete expulsion of the placenta is estimated to be 10-12 mins A. Stage 1 (Latent) B. Stage 1 (Active) C. Stage 1 (Transition) D. Stage 2 (Fetal delivery) E. Stage 3 (Placental delivery) F. Stage 4 (Parturient recovery)
E. Stage 3 (Placental delivery)
27
Nursing right after birth will help the uterus to contract and will decrease the amount of bleeding A. Stage 1 (Latent) B. Stage 1 (Active) C. Stage 1 (Transition) D. Stage 2 (Fetal delivery) E. Stage 3 (Placental delivery) F. Stage 4 (Parturient recovery)
F. Stage 4 (Parturient recovery)
28
Beginning at the point at which the woman perceives regular uterine contractions (usually 5-20 minutes apart) A. Stage 1 (Latent) B. Stage 1 (Active) C. Stage 1 (Transition) D. Stage 2 (Fetal delivery) E. Stage 3 (Placental delivery) F. Stage 4 (Parturient recovery)
A. Stage 1 (Latent)
29
Greater intensity of contractions, with shorter interval (3-4 minutes apart) and longer duration. It may or may not cause rupture of the amniotic fluid. A. Stage 1 (Latent) B. Stage 1 (Active) C. Stage 1 (Transition) D. Stage 2 (Fetal delivery) E. Stage 3 (Placental delivery) F. Stage 4 (Parturient recovery)
B. Stage 1 (Active)
30
Shortest phase but most intense, contractions are very strong lasting 60 to 90 seconds and occurring every few minutes A. Stage 1 (Latent) B. Stage 1 (Active) C. Stage 1 (Transition) D. Stage 2 (Fetal delivery) E. Stage 3 (Placental delivery) F. Stage 4 (Parturient recovery)
C. Stage 1 (Transition)
31
Elevated hormone (estrogen or progesterone) stimulate excess ___ production.
melanin Additional: This is associated with hyperpigmentation of the face (melasma), linea nigra, and increased pigmentation of the areolae, axillae, genitals.
32
Musculoskeletal changes during pregnancy is associated with laxity from altered hormones d/t breakdown of collagen which is replaced by a modified form that contains ___ content. This leads to joint instability, such as symphysis pubis and sacroiliac laxity.
high water
33
Gastroesophageal reflux disease (GERD) is common in pregnant patients due to increased progesterone that leads to reduced resting muscle tone of the ____.
lower esophageal sphincter (LES)
34
Progesterone and relaxin acts on smooth muscles causing dilation of the urinary collecting system occurs, which can lead to ___.
urinary stasis - d/t ineffective or weak contractions of the bladder Additional: This increases the predisposition for urinary tract infections (UTI) and pyelonephritis with asymptomatic bacteriuria in pregnancy.
35
Uterine contractions are very weak and pressure during a contraction is insufficient to dilate the cervix A. Hypotonic Uterine Dysfunction B. Hypertonic Uterine Dysfunction (Incoordinate Uterine Dysfunction)
A. Hypotonic Uterine Dysfunction
36
Due to either the basal tone is elevated appreciably or the pressure gradient is distorted A. Hypotonic Uterine Dysfunction B. Hypertonic Uterine Dysfunction (Incoordinate Uterine Dysfunction)
B. Hypertonic Uterine Dysfunction (Incoordinate Uterine Dysfunction)
37
The gradient distortion present in this condition may result from more forceful contractions of the uterine midsegment than the fundus or from the complete asynchrony of the impulses originating in each cornu or a combination of these two. A. Hypotonic Uterine Dysfunction B. Hypertonic Uterine Dysfunction (Incoordinate Uterine Dysfunction)
B. Hypertonic Uterine Dysfunction (Incoordinate Uterine Dysfunction)
38
No Basal Hypertonus and uterine contractions have a normal gradient pattern (synchronous) A. Hypotonic Uterine Dysfunction B. Hypertonic Uterine Dysfunction (Incoordinate Uterine Dysfunction)
A. Hypotonic Uterine Dysfunction
39
The mechanism of labor covers the passive movement the fetus undergoes in order to negotiate through the maternal bony pelvis. Enumerate the sequence of the fetus's cardinal directions in labor.
1. Flexion 2. Internal rotation 3. Crowning 4. Extension 5. External rotation and restitution 6. Internal rotation
40
Baby drops or moves lower into the pelvis; getting ready to position for birth A. Lightening B. Bloody show C. Contractions D. Rupture of amniotic sac
A. Lightening
41
Small amount of mucus slightly mixed with blood may expel from vagina A. Lightening B. Bloody show C. Contractions D. Rupture of amniotic sac
B. Bloody show
42
When this occurs, the mom must be rushed to the hospital and usually goes into labor within 24 hours. A. Lightening B. Bloody show C. Contractions D. Rupture of amniotic sac
D. Rupture of amniotic sac
43
Most important sign of labor that may become more frequent and severe as the labor progresses A. Lightening B. Bloody show C. Contractions D. Rupture of amniotic sac
C. Contractions Occurring at intervals of less than 10 minutes
44
When this occurs, the amniotic fluid leaks from the vagina and is prone to causing infections A. Lightening B. Bloody show C. Contractions D. Rupture of amniotic sac
D. Rupture of amniotic sac
45
Can slow labor; associated with lengthening of both first- and second-stage labor and with slowing of the rate of fetal descent A. Epidural Analgesia / Anesthesia B. Chorioamnionitis C. Maternal Position During Labor
A. Epidural Analgesia / Anesthesia Note: Given when the mom reaches the crowning stage
46
Considered to be contracted if its shortest anteroposterior (AP) diameter is < 10 cm or if its greatest transverse diameter is < 12 cm. A. Fetopelvic Disproportion B. Contracted Inlet C. Contracted Midpelvis/ Midplane D. Contracted Outlet
B. Contracted Inlet Additional: A contracted pelvic inlet is usually defined as a diagonal conjugate < 11.5 cm
47
Often gives rise to perineal tears; intertuberous / transverse diameter is 8 cm or less A. Fetopelvic Disproportion B. Contracted Inlet C. Contracted Midpelvis/ Midplane D. Contracted Outlet
D. Contracted Outlet
48
Causes transverse arrest of the fetal head, occurs when the sum of the interspinous and posterior sagittal diameters of the mid pelvis falls to 13.5 cm or less, or when the interspinous diameter < 8 cm. A. Fetopelvic Disproportion B. Contracted Inlet C. Contracted Midpelvis / Midplane D. Contracted Outlet
C. Contracted Midpelvis / Midplane Additional: More common than inlet contraction and midpelvis contraction can sometimes be inferred if: 1. The ischial spines are prominent 2. The pelvic sidewalls converge 3. Sacrosciatic notch is narrow
49
An extremity prolapses alongside the presenting part, and both present simultaneously in the pelvis. Causes are conditions that prevent complete occlusion of the pelvic inlet by the fetal head, including preterm labor. A. Face Presentation B. Transverse Lie C. Compound Presentation
C. Compound Presentation
50
Commonly caused by preterm fetus, placenta previa, abnormal uterine anatomy, hydramnios, contracted pelvis, and abdominal wall relaxation from high parity. A. Face Presentation B. Transverse Lie C. Compound Presentation
B. Transverse Lie A relaxed and pendulous abdomen allows the uterus to fall forward, deflecting the long axis of the fetus away from the axis of the birth canal -> into oblique or transverse position
51
Allows presenting part of fetus to be sub-occipito bregmatic A. Flexion B. Internal rotation C. Extension D. External rotation
A. Flexion
52
hyperpigmented line running down the center of the abdomen due to excessive melanin production
Linea nigra - "Linea alba becomes darker"
53
Preeclampsia is characterized by a sudden spike in blood pressure that commonly occurs at ___ weeks of gestation or 6 weeks after delivery
20 Additional: BP goes to about 140/100 mmHg
54
Parturition ends when ___ is restored in the mother.
fertility
55
(1)___ diameter is the widest part of the baby; (2)___ diameter is the widest part of the pelvic inlet of the mother.
1. biparietal 2. transverse
56
This is necessary for appropriate brain development and thyroid function of growing fetus. It must be at an elevated amount in pregnant women.
Thyroid hormone
57
Responsible to stimulate the corpus luteum to produce progesterone to maintain pregnancy and stimulate ovaries to produce elevated levels of estrogen and progesterone until the 1st trimester
Human Chorionic Gonadotropin hormone (HCG)
58
During pregnancy, this structure releases additional Thyroid Releasing Hormone (TRH) which further releases Thyroid Stimulating Hormone (TSH) and Prolactin hormone
Placenta
59
A decrease in vascular resistance is associated with a decrease in ____.
Blood pressure Additional: Dec in vascular resistance is also related to the mechanism of relaxin
60
In pregnancy, the CoG shifts ___. This leads to an increase in lumbar lordosis and thoracic kyphosis.
Anteriorly Additional: Also results in anterior pelvic tilting
61
Separation of the linea alba during pregnancy is due to (1)____ and results to (2)____.
1. Weak rectus abdominis muscle 2. Diastasis recti abdominis
62
A series of continuous progressive contractions that help the cervix dilate and efface to allow the fetus to move out the birth canal
Labor
63
TRUE OR FALSE: The initiation of parturition occurs after Phase 1: Quiescence.
True
64
TRUE OR FALSE: Delivery of the conceptus occurs at the end of Phase 4: Involution.
False, it occurs at Phase 3: Stimulation
65
It is childbirth, the process of delivering the baby and placenta from uterus to vagina.
Parturition Additional: From latin word "parturire": to be ready to bear young
66
When fluid retention occurs, the kidneys cannot filter all of the fluid, so these become enlarged. This enlargement is known as?
Hydronephrosis Additional: Kidney size returns to normal after the baby is born
67
The progressive shortening and thinning of the cervix during labor
Cervical effacement
68
Transverse diameter: 13 cm Antero-posterior diameter: 11 cm A. Pelvic inlet B. Mid-pelvis C. Pelvic outlet
A. Pelvic inlet As the baby passes through the pelvic inlet, the widest circumference of the fetal head descends in a transverse position since the transverse diameter is greater than the AP diameter.
69
Transverse diameter: 12 cm Antero-posterior diameter: 12 cm A. Pelvic inlet B. Mid-pelvis C. Pelvic outlet
B. Mid-pelvis
70
Transverse diameter: 11 cm Antero-posterior diameter: 13 cm A. Pelvic inlet B. Mid-pelvis C. Pelvic outlet
C. Pelvic outlet When the baby nears the pelvic outlet, the nature of the pelvic floor muscle encourages the fetal head to rotate from a transverse position to an anteroposterior position.
71
The fetal head moves towards the pelvic brim in either the left or right occipito-transverse position. This allows the widest part of the fetal head to fit through the widest part of the pelvic inlet. A. Engagement B. Descent C. Flexion D. Internal rotation
A. Engagement
72
According to the WHO guideline for all pregnant and postpartum women s contraindications: Accumulate at least (1)___ minutes of (2)___ intensity physical activity throughout the week.
1. 150 2. moderate
73
These two mechanisms of labor are caused by 1. Uterine contractions 2. Amniotic fluid pressure 3. Abdominal muscle contraction
1. Descent 2. Engagement
74
TRUE OR FALSE: Isometric exercises are part of the treatment for diastasis recti abdominis.
False Isometrics put the mom in a valsalva maneuver and she may suddenly give birth. Abdominal compressions, pelvic tilts, toe taps, heel slides, single-leg stretches, and bridges with belly scooping may be prescribed.
75
Enumerate the triad of preeclampsia
PREeclampsia: 1. Proteinuria (*cardinal sign) 2. Rising blood pressure 3. Edema
76
Severe pregnancy-related high blood pressure disorder that can induce seizures or coma
Eclampsia
77
3/6 Risk factors of preeclampsia: 1. History of ___ and ___ 2. Mothers ___ years old 3. ___ pregnancy
1. Hypertension, Diabetes 2. More than 35 3. First
78
3/6 Risk factors of preeclampsia: 1. ___ gestation 2. Weight ___ 3. ___ disease
1. Multiple 2. Gain (obesity) 3. Autoimmune
79
Urinary incontinence and vaginal prolapse or uterine prolapse are associated with pelvic floor ____.
Weakness
80
Term to describe a newborn who's much larger than the average.
Fetal macrosomia
81
Myometrial contractions that may be experienced in Phase 1 of parturition and do not cause cervical dilatation. Contractions are described as unpredictable, low intensity, short duration, irregular interval, and confined to the low abdomen or groin.
Braxton Hicks Contractions (False Labor)
82
Enumerate the 3 factors involved in successful labor
1. Pelvic anatomy (Passage) 2. Fetal characteristics (Passenger) 3. Maternal efforts and uterine contractions (Power)
83
Preeclampsia leads to development of an abnormal placenta which is described as ___.
Fibrous
84
Contraindication to rehab in pregnancy 1. Severe pre-eclampsia 2. Placenta previa after 28 weeks 3. Unexplained vaginal bleeding 4. Unrestricted intrauterine growth A. True B. False
1. A 2. A 3. A 4. B
85
Contraindication to rehab in pregnancy 1. Competent cervix 2. Higher-order multiple pregnancy 3. Controlled high blood pressure, type 1 or type 2 diabetes or thyroid disease 4. Uncontrolled or severe arrhythmia 5. Active preterm labor A. True B. False
1. B 2. A 3. B 4. A 5. A
86
Infection in the membranes surrounding the fetus and the amniotic fluid. If diagnosed late in labor, it is found to be a marker of cesarean delivery performed for dystocia. A. Epidural Analgesia / Anesthesia B. Chorioamnionitis C. Maternal Position During Labor
B. Chorioamnionitis Note: This was not a marker in women diagnosed as having chorioamnionitis early in labor
87
Arises from diminished pelvic capacity / cavity, excessive fetal size, or more often its usually both A. Fetopelvic Disproportion B. Contracted Inlet C. Contracted Midpelvis/ Midplane D. Contracted Outlet
A. Fetopelvic Disproportion Also known as cephalopelvic disproportion
88
Baby's head did not flex. It is more common when there is some degree of pelvic inlet contraction and a cesarean delivery is frequently indicated A. Face Presentation B. Transverse Lie C. Compound Presentation
A. Face Presentation
89
During pregnancy, the hypercoagulable state is due to elevation of ___, which makes the mother 5x prone to develop deep vein thrombosis.
estrogen
90
The oxyhemoglobin dissociation curve shifts to the ___ favoring dissociation and facilitating transfer of O2 to the placenta
right
91
___ traction is done to the baby to deliver the posterior shoulder
Upward
92
Re-alignment of the shoulders with the head
restitution
93
Fetus is above the ischial spines
Floating
94
When the bony fetal presenting part is aligned with the maternal ischial spines, the fetus is in what station / fetal position?
Zero
95
When the head of the fetus can be seen outside the vagina (crowning), the fetus is in what station / fetal position?
+5
96
Allows head to rotate from a left or right occipito-transverse position to an occipito-anterior position A. Flexion B. Internal rotation C. Extension D. External rotation
B. Internal rotation
97
The occiput slips beneath the suprapubic arch as the head ___ and the nape of the neck is pivoting against the suprapubic arch A. Flexion B. Internal rotation C. Extension D. External rotation
C. Extension
98
Head ____ to the left or right medial thigh of the mother A. Flexion B. Internal rotation C. Extension D. External rotation
D. External rotation
99
Shoulders are rotating from a transverse position to an ant-post position A. Flexion B. Internal rotation C. Extension D. External rotation
B. Internal rotation
100
Pelvic floor has a ___ shape, with a forward and downward shape
gutter

(3) MS: Pediatric Conditions (11 decks)

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