W11_06 Intrapartum care, abnormal labour, obstetrical emergencies

Question 1

define labour in its two components

Answer 1

contractions and cervical change

Question 2

what’s an effaced cervix?

Answer 2

thinned out, ready for birth

Question 3

what’s a breech presentation?

Answer 3

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

Question 4

what’s a Frank breech?

Answer 4

both hips flexed

Question 5

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

Answer 5

longitudinal, not transverse

Question 6

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

Answer 6

occiput (anterior, posterior)

Question 7

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

Answer 7

sacrum

Question 8

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

Answer 8

chin

Question 9

define “station” in ob/gyn

Answer 9

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

Question 10

what’s the latent first stage?

Answer 10

0-3cm dilation

Question 11

what’s the active first stage?

Answer 11

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

Question 12

define the time of second stage

Answer 12

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

Question 13

what are the 7 cardinal movements of labour?

Answer 13

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

Question 14

define the time of the third stage of labour

Answer 14

delivery of the fetus to the placenta;
within 30 mins

Question 15

define the time of the fourth stage of labour

Answer 15

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

Question 16

what causes ferning of amniotic fluid?

Answer 16

estrogen effect

Question 17

what’s the pH of amniotic fluid?

Answer 17

7-7.5

Question 18

what does green amniotic fluid mean?

Answer 18

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

Question 19

changes in FHR may precede which type of injury?

Answer 19

brain injury

Question 20

what are the two types of fetal heart rate monitoring?

Answer 20

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

Question 21

what’s the normal fetal heart rate?

Answer 21

110-160 bpm

Question 22

what do we look for in electronic fetal monitoring?

Answer 22

uterine activity pattern;
baseline FHR;
variability and accelerations

Question 23

what can cause variable deceleration?

Answer 23

cord compression

Question 24

what do late decelerations imply?

Answer 24

uteroplacental insufficiency and some degree of hypoxia

Question 25

when do late decelerations occur wrt to contractions?

Answer 25

AFTER the contraction

Question 26

when do early decelerations occur wrt to contractions?

Answer 26

during uterine contraction;
associated with head compression, benign

Question 27

what to do when the OB tracing is abnormal?

Answer 27

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

Question 28

what does the fetal scalp sample look for?

Answer 28

pH

Question 29

note: there are non-pharmacologic obstetrical analgesias

Answer 29

ok

Question 30

what kinds of pharmacologic analgesias can we give?

Answer 30

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

Question 31

what’s the friedman’s curve?

Answer 31

average length of time it takes to dilate in the cervix

Question 32

define dystocia

Answer 32

abnormal labour or difficult childbirth

Question 33

what are the 4 Ps of inadequate labour?

Answer 33

power,
passenger (fetal position),
passage,
psyche

Question 34

what are the 4 pelvis shapes described for passage?

Answer 34

gynecoid, android, anthropoid, platypelloid

Question 35

define episiotomy

Answer 35

incisions made in the vulva to make space for delivery

Question 36

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

Answer 36

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

Question 37

what are contraindications for vacuum technique?

Answer 37

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

Question 38

what are the most common indications for c-sections?

Answer 38

dystocia, cephalopelvic disproportion, fetal distress, malpresentation

Question 39

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

Answer 39

greater blood loss, higher risk of rupture in the future