Sept12 A1-Labor and delivery

Question 1

labor def

Answer 1

regular painful contractions that result in progressive cervical dilation and effacement

Question 2

3 stages of labor

Answer 2

• first stage (cervical changes) (effacement and dilation to 10 cm)
• second stage (pelvic stage) (from full dilation of cervix at 10 cm until delivery)
• third stage (placental stage (separation and expulsion of the placenta)

Question 3

theoris of cause of labor

Answer 3

• progesterone withdrawal = more PGs and uterine activity
• PG release (drop in P)
• oxytocin stimulation
• fetal cortisol levels
• having sex (sperm has PGs)

Question 4

3 components of labor (3 Ps)

Answer 4

• powers (contractions)
• passenger (fetus)
• passage (pelvis)

Question 5

how contractions cause cervical dilation

Answer 5

put P on fetus head and baby head down presses on the cervix

Question 6

powers charact

Answer 6

• early labor = irregular, pain is ok, weak. charact of false labor. every 5-10 mins last 30-45 sec
• advanced labor = every 2-3 min last 50-70 seconds

Question 7

when to go to hospital

Answer 7

contractions every 4-5 minutes for 1-2 hours

Question 8

tocometry is what

Answer 8

labor monitoring of fetal HR and frequency of contractions for specific pts (high risk pregnancies)

Question 9

how much contraction is too much and why

Answer 9

• uterine hyperstimulation = more than 5 contractions per 10 minutes
• dangerous for the baby bc gets squished. get fetal distress and abnormal fetal HR

Question 10

components of the passanger (fetus)

Answer 10

• fetal lie
• presentation
• fetal attitude or posture
• fetal position
• changes in shape of the fetal hed (shape to fit the pelvis)

Question 11

normal fetal lie

Answer 11

• longitudinal (99%)

- in axis of mother midline

Question 12

uncommon fetal lie

Answer 12

transverse (horizontal)

Question 13

diff possible fetal presentations

Answer 13

• cephalic (head first)
• breech = bum first (sometimes C section if labour themselves, many babies before, baby not too big)
• transverse lie (C section bc shoulder, arm or column first is dangerous)
• compound (foot stiking out and other foot sticking up, hand over the head)
• face (see part of the face
• brow (forehead of baby)

Question 14

example of fetal attiudes or postures

Answer 14

• vertex (ovoid shaped mass, fits well in pelvis)
• sinciput (moderate flexion)
• brow (partial extension)
• face (complete extension)

Question 15

fetus position definition + examples

Answer 15

which way the head is facing (not meaning head downwards but rather A, P lateral, etc.)

• occiput anterior
• occiput posterior
• occiput transverse

Question 16

best fetal position for delivery

Answer 16

A-left, A-right, P-left or P-right. is called the occiput anterior.*** bc smallest diameter of head passes first
-transverse and posterior less ideal

Question 17

how to determine fetal position

Answer 17

feel the occipital and frontal fontanelles (widenings of the bone suture in the skull) with your fingers

• occipital fontanelle = 2 sutures
• frontal = 3 sutures

Question 18

smallest diameter of the head, skull of the baby

Answer 18

suboccipitobregmatic

Question 19

changes in the shape of the fetal head at delivery

Answer 19

• molding (cone head that resolves after 48 hours)

- caput succedaneum (bump in back of the head)

Question 20

how to tell the fetal presentation (cephalic, breech, transverse, brow, face, etc.) and position (

Answer 20

• occipitut ant
• occipitut post
• occiput transverse

Question 21

limiting point in the pelvis for fetus passage

Answer 21

pelvic outlet (ischial spines, coccyx and pubic arches)
wide pubic arch and ischial spine = lot of room for delivery

Question 22

best pelvis shape for delivery

Answer 22

gynecoid pelvis

• wide ischiopubic rami
• wide space between spines

Question 23

other pelvic shapes (passages)

Answer 23

• android (narrow and close ischial spines)
• platypelloid (flat)
• anthropoid (squashed)

Question 24

trajectory that the baby will take in the passage

Answer 24

L because the uterus is bent forward

Question 25

steps (CARDINAL MOVEMENTS) of the second stage of labor

Answer 25

- engagement - descent - flexion (fetus flexes head *IMPORTANT* for smallest diameter of head to fit through* - internal rotation to look at the back of the mom - extension (extend head) - external rotation = turn again to look laterally like before (restitution). to free shoulders and deliver them up down (AP) - expulsion

Question 26

baby position during engagement and descent

Answer 26

looking laterally (passes pelvic inlet in occiput presentations)

Question 27

key thing for labor dx

Answer 27

cervical dilatation -2-3 cm at first baby and then same thing later is false labor** + other things like frequency and strength of contractions increasing

Question 28

how to detect ruptured membranes

Answer 28

- amniotic pooling of water in vagina (test fluid pH). amniotic is basic vs vagina is acid - nitrazine dye test - ferning (amniotic fluid cristallizes on microscopy and causes ferns) **IS DIAGNOSTIC** - amniscure, actimprom (test to detect placental alpha microglobulim 1 prot in amn fluid *used if premature*

Question 29

how to examine cervical dilation

Answer 29

use two fingers and dilate two fingers and know how much they're spaced out

Question 30

first stage of labor 2 parts

Answer 30

- latent phase (contraction varies in intensity and frequency, slow dilation of cervix). primigravida (first child) = lasts over 20 hours. multigravida = lasts > 14 hours - active phase of labour (contractions progressing rapidly, same for cervical dilation (progressive)

Question 31

3 phases of dilation in active phase of stage 1 of labor

Answer 31

-acceleration -linear -maximum slope and deceleration (can plot dilation)

Question 32

plotting dilation speed helps for what

Answer 32

on sheet made for this specifically, if cross a predetermined alert line, be careful (bit slow) and if cross action line (do something: give oxytocin)

Question 33

how to help 2nd stage of labor (delivery)

Answer 33

- push head a bit bc coming out too phase = tearing - help baby turn: look at floor and then help turn again - wait 1 min after delivery and then clamp the cord to avoid anemia

Question 34

how to help for third stage of delivery

Answer 34

- active management of bleeding from placenta coming off (apply pressure on the cord for it not to break) - make sure 3 cords on placenta - make sure no mass on placenta

Question 35

when to do C section

Answer 35

- severe glaucoma and can't push - fibroid obstructing outlet - labor not progresing, baby not tolerating labor (HR dropping)

Question 36

fetal monitoring in labor

Answer 36

- intermittent if low risk - cardiotocography (fetal HR and maternal contractions frequency): 3 possible curves for fetal HR: acceleration, variable deceleration and late decel

Question 37

late deceleration meaning

Answer 37

lack of oxygen to the baby, have to act

Question 38

most important thing in pain relief for labour

Answer 38

make sure no respiratory depression (imp risk) because of the meds (opiates, etc.)

Question 39

possible methods for pain relief during labour

Answer 39

- support, ambulation (=keep moving) - hydrotherapy - hyponosis - entonox (NO, O2) - opiates - epidural

Question 40

most common method for pain relief in labour

Answer 40

- epidural - anesthesia at T10 and place needle and thread catherer down. (NOT anesthesia in CSF, just on side of spinal canal) - problem = pts immobile

Question 41

maternal changes in labour

Answer 41

- increased BP (falling prog) - increased CO - higher RR - increased fluid loss = less urine output - difficulty voiding