W11_06 Intrapartum care, abnormal labour, obstetrical emergencies Flashcards
define labour in its two components
contractions and cervical change
what’s an effaced cervix?
thinned out, ready for birth
what’s a breech presentation?
baby is facing bottom down in the uterus;
complete breech is both legs and hips flexed
what’s a Frank breech?
both hips flexed
what’s the typical “lie” in intrapartum fetuses?
longitudinal, not transverse
what’s the body part for reference in vertex presentations?
occiput (anterior, posterior)
what’s the body part for reference in breech presentations?
sacrum
what’s the body part for reference in face presentations?
chin
define “station” in ob/gyn
distance of the baby’s head wrt the mother’s ischial spine
what’s the latent first stage?
0-3cm dilation
what’s the active first stage?
3-10cm dilation; dilation goes more quickly in multiparous women
define the time of second stage
time between full dilation (10cm) to complete birth;
typically within 2 hours
what are the 7 cardinal movements of labour?
engagement
descent
flexion
internal rotation (occiput facing mom pubic symphysis)
extension then crowning
external rotation/restitution
expulsion/delivery
define the time of the third stage of labour
delivery of the fetus to the placenta;
within 30 mins
define the time of the fourth stage of labour
delivery of placenta to the stabilization of the patient’s condition (6 hours)
what causes ferning of amniotic fluid?
estrogen effect
what’s the pH of amniotic fluid?
7-7.5
what does green amniotic fluid mean?
warning - fetus might be passing meconium. Check the fetal heart rate and see what’s going on
changes in FHR may precede which type of injury?
brain injury
what are the two types of fetal heart rate monitoring?
intermittent auscultation (e.g. with doppler);
continuous electronic fetal monitoring
what’s the normal fetal heart rate?
110-160 bpm
what do we look for in electronic fetal monitoring?
uterine activity pattern;
baseline FHR;
variability and accelerations
what can cause variable deceleration?
cord compression
what do late decelerations imply?
uteroplacental insufficiency and some degree of hypoxia
when do late decelerations occur wrt to contractions?
AFTER the contraction
when do early decelerations occur wrt to contractions?
during uterine contraction;
associated with head compression, benign
what to do when the OB tracing is abnormal?
stop oxytocin;
reposition to left/right lateral;
improve hydration with IV fluid bolus;
perform vag exam to relieve pressure;
administer oxygen by face mask;
consider internal scalp electrode on baby;
consider fetal scalp sampling;
delivery
what does the fetal scalp sample look for?
pH
note: there are non-pharmacologic obstetrical analgesias
ok
what kinds of pharmacologic analgesias can we give?
pharmacologic (NO),
narcotics,
peripheral nerve blocks (pudendal),
perineal infiltration,
regional anaesthesia (epidural)
what’s the friedman’s curve?
average length of time it takes to dilate in the cervix
define dystocia
abnormal labour or difficult childbirth
what are the 4 Ps of inadequate labour?
power,
passenger (fetal position),
passage,
psyche
what are the 4 pelvis shapes described for passage?
gynecoid, android, anthropoid, platypelloid
define episiotomy
incisions made in the vulva to make space for delivery
what are contraindications for operative vaginal delivery? (forceps/vacuum)
non-cephalic;
face/brow;
unengaged head;
incompletely dilated cervix;
what are contraindications for vacuum technique?
<34 weeks;
need for rotation;
fetal bleeding/demineralization conditions
what are the most common indications for c-sections?
dystocia, cephalopelvic disproportion, fetal distress, malpresentation
why don’t we use classical c-section so much anymore?
greater blood loss, higher risk of rupture in the future
