W11_06 Intrapartum care, abnormal labour, obstetrical emergencies Flashcards

1
Q

define labour in its two components

A

contractions and cervical change

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2
Q

what’s an effaced cervix?

A

thinned out, ready for birth

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3
Q

what’s a breech presentation?

A

baby is facing bottom down in the uterus;
complete breech is both legs and hips flexed

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4
Q

what’s a Frank breech?

A

both hips flexed

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5
Q

what’s the typical “lie” in intrapartum fetuses?

A

longitudinal, not transverse

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6
Q

what’s the body part for reference in vertex presentations?

A

occiput (anterior, posterior)

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7
Q

what’s the body part for reference in breech presentations?

A

sacrum

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8
Q

what’s the body part for reference in face presentations?

A

chin

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9
Q

define “station” in ob/gyn

A

distance of the baby’s head wrt the mother’s ischial spine

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10
Q

what’s the latent first stage?

A

0-3cm dilation

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11
Q

what’s the active first stage?

A

3-10cm dilation; dilation goes more quickly in multiparous women

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12
Q

define the time of second stage

A

time between full dilation (10cm) to complete birth;
typically within 2 hours

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13
Q

what are the 7 cardinal movements of labour?

A

engagement
descent
flexion
internal rotation (occiput facing mom pubic symphysis)
extension then crowning
external rotation/restitution
expulsion/delivery

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14
Q

define the time of the third stage of labour

A

delivery of the fetus to the placenta;
within 30 mins

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15
Q

define the time of the fourth stage of labour

A

delivery of placenta to the stabilization of the patient’s condition (6 hours)

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16
Q

what causes ferning of amniotic fluid?

A

estrogen effect

17
Q

what’s the pH of amniotic fluid?

A

7-7.5

18
Q

what does green amniotic fluid mean?

A

warning - fetus might be passing meconium. Check the fetal heart rate and see what’s going on

19
Q

changes in FHR may precede which type of injury?

A

brain injury

20
Q

what are the two types of fetal heart rate monitoring?

A

intermittent auscultation (e.g. with doppler);
continuous electronic fetal monitoring

21
Q

what’s the normal fetal heart rate?

A

110-160 bpm

22
Q

what do we look for in electronic fetal monitoring?

A

uterine activity pattern;
baseline FHR;
variability and accelerations

23
Q

what can cause variable deceleration?

A

cord compression

24
Q

what do late decelerations imply?

A

uteroplacental insufficiency and some degree of hypoxia

25
Q

when do late decelerations occur wrt to contractions?

A

AFTER the contraction

26
Q

when do early decelerations occur wrt to contractions?

A

during uterine contraction;
associated with head compression, benign

27
Q

what to do when the OB tracing is abnormal?

A

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

28
Q

what does the fetal scalp sample look for?

A

pH

29
Q

note: there are non-pharmacologic obstetrical analgesias

A

ok

30
Q

what kinds of pharmacologic analgesias can we give?

A

pharmacologic (NO),
narcotics,
peripheral nerve blocks (pudendal),
perineal infiltration,
regional anaesthesia (epidural)

31
Q

what’s the friedman’s curve?

A

average length of time it takes to dilate in the cervix

32
Q

define dystocia

A

abnormal labour or difficult childbirth

33
Q

what are the 4 Ps of inadequate labour?

A

power,
passenger (fetal position),
passage,
psyche

34
Q

what are the 4 pelvis shapes described for passage?

A

gynecoid, android, anthropoid, platypelloid

35
Q

define episiotomy

A

incisions made in the vulva to make space for delivery

36
Q

what are contraindications for operative vaginal delivery? (forceps/vacuum)

A

non-cephalic;
face/brow;
unengaged head;
incompletely dilated cervix;

37
Q

what are contraindications for vacuum technique?

A

<34 weeks;
need for rotation;
fetal bleeding/demineralization conditions

38
Q

what are the most common indications for c-sections?

A

dystocia, cephalopelvic disproportion, fetal distress, malpresentation

39
Q

why don’t we use classical c-section so much anymore?

A

greater blood loss, higher risk of rupture in the future