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OB Exam 1 > Week 3 (Labor & Delivery) > Flashcards

Week 3 (Labor & Delivery) Flashcards

1
Q

What are the 5 P’s of L&D?

KNOW THIS!!!!!

A
  • Passenger: fetus & placenta
  • Passageway: birth canal
  • Powers: contractions
  • Position of the laboring woman
  • Psychology / Psychological Response
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2
Q

What is the passenger of the 5 P’s?

KNOW THIS!!!!!

A

Fetus & Placenta

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3
Q

What is the Passageway of the 5 P’s?

KNOW THIS!!!!!

A

Birth Canal

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4
Q

What is the Powers of the 5 P’s?

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A

Contractions

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5
Q

Anterior Fontanelle

KNOW THIS!!!!!

A
  • Closes at 12 - 18 months
  • Diamond Shaped
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6
Q

Posterior Fontanelle

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A
  • Closes by 2 - 3 months
  • Triangle shaped
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7
Q

Where is the sagittal suture located?

A

Between pareital bones

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8
Q

Cephalic

A

Toward the head

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9
Q

Breech

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A

Buttocks-first presentation of the fetus at delivery

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10
Q

Shoulder Presentation

KNOW THIS!!!!!

A

Baby is in transverse position at delivery

  • must be turned
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11
Q

Proven Pelvis

A

Pelvis that has already delivered a baby

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12
Q

Fetal Lie

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A

Relation of the fetus’ long axis (spine) to the mother’s long axis (spine)

  • longitudinal / vertical
  • transverse / horizontal
  • oblique
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13
Q

Fetal Attitude

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A

Relation of fetal body parts to one another

  • Normal: general flexion with the fetal chin flexed onto the chest & the extremities flexed
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14
Q

What is the normal fetal attitude?

A

general flexion with the fetal chin flexed onto the chest & extremities are flexed

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15
Q

Fetal Position

A

The relationship of presenting parts to the 4 quadrants of the mother’s pelvis

  • LOA, ROA
  • ROP, LOP
  • ROT, LOT
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16
Q

Leopolds Maneuvers

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A

Palpation to determine the fetal lie, fetal attitude, & fetal presentation

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17
Q

Fetal Station

KNOW THIS!!!!!

A

A measure of the degree of descent of the presenting part of the fetus through the birth canal

-5
-4
-3 Minimum to rupture; risk of prolapsed cord if not at
-2
-1
0 (baby is engaged)
+1
+2
+3
+4
+5 Birth is imminent

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18
Q

Pelvis Shapes

A
  • Gynecoid: typical, common, best for vaginal birth
  • Android: round, heart-shaped
  • Anthropoid: oval
  • Platypelloid: flattened
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19
Q

Pelvic Inlelt

A

Tip of the pubic bone to tip of the sacrum

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20
Q

Pelvic Outlet

A

Bottom of symphysis pubis to the tip of the sacrum

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21
Q

Effacement

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A

Thinning & shortening of the cervix

  • turtleneck
  • in %
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22
Q

Dilation

KNOW THIS!!!!!

A

Force of contraction & pressure from presenting part make diameter expand from closed 1 cm to complete 10 cm

  • marks the end of the first stage of labor
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23
Q

Labor Numbers (4 / 60% / -3)

A

4 cm dilation
60% effacement
-3 fetal station

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24
Q

Primary Powers

KNOW THIS!!!!!

A

Involuntary uterine contractions
* Starts labor
* Results in dilation
* adequate & coordinated

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25
Q

Secondary Powers

KNOW THIS!!!!!

A

Bearing down efforts

  • in addition to involuntary contractions

Ferguson Reflex: pushing down without trying

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26
Q

Ferguson Reflex

KNOW THIS!!!!!

A

Pushing down without trying

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27
Q

Anxiety

A

Lead to release of catecholamines = ineffective contractions

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28
Q

Signs of Labor

KNOW THIS!!!!!

A
  • Primips: uterus sinks down “dropped” lightening 2 weeks before
  • Multips: drop might not happen until true labor
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29
Q

Bloody Show

A

A small amount of blood at the vagina from ruptured capillaries when cervix effaces

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30
Q

Braxton Hicks Contractions

A

Intermittent painless uterine contractions that occur with increasing frequency as the pregnancy progresses

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31
Q

Labor

KNOW THIS!!!!!

A

Process of moving fetus, placenta, & membranes out of the uterus through the birth canal

  • Effacement & dilation of the cervix AND descent of the fetus
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32
Q

When does risk of infection increase?

KNOW THIS!!!!!

A

If amniotic sac has been ruptured for more than 18 hours

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33
Q

False Labor

KNOW THIS!!!!!

A

Regular contractions with no cervical change

  • activity has no effect on contractions or decreases
  • go away when sleeping
  • show not present
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34
Q

True Labor

KNOW THIS!!!!!

A

Contractions that cause cervical change

  • progressive in frequency & intensity
  • activity increases & continues during sleep
  • progressive effacement & dilation
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35
Q

Stages of Labor

KNOW THIS!!!!!

A

1st: onset of contractions to full dilation

2nd: time of full dilation to birth of intant

3rd: birth of intant to placenta delivered

4th: delivery of placenta till first 2 hours after birth

36
Q

What is the 1st stage of labor?

KNOW THIS!!!!!

A

onset of contractions to full dilation

37
Q

What is the 2nd stage of labor?

KNOW THIS!!!!!

A

Time of full dilation to birth of infant

38
Q

What is the 3rd stage of birth?

KNOW THIS!!!!!

A

birth of infant to placenta delivery

39
Q

What is the 4th stage of labor?

KNOW THIS!!!!!

A

delivery of placenta until first 2 hours after birth

40
Q

7 Cardinial Movements

A

1.) Engagement
2.) Descent
3.) Flexion
4.) Internal rotation
5.) Extension
6.) External rotation
7.) Expulsion

41
Q

Fetal Heart Rate

A

Reliable & predictive information about the condition of fetus related to oxygen

42
Q

Maternal Adaptation

A
  • ↑ Cardiac output 10 - 15%
  • ↑ HR
  • ↑ BP during contractions
  • ↑ WBCs
  • ↑ RR
  • ↑ Temperature (might, but not always)
  • ↑ Proteinuria (might, but not always)
  • ↓ Gastric motility
  • ↓ Blood glucose
43
Q

A —— ——– with an adequate uteroplacental circulation is able to compensate for the stress of uterine contractions.

A

Healthy fetus

44
Q

Opioids

A

Medicatiosn that readily cross the placenta & can have profound effects on the fetus

45
Q

Narcan

A

Avoid giving this in women that are opioid dependent

  • can cause seizures
46
Q

Epidural

KNOW THIS!!!!!

A
  • Causes hypotension
  • Give fluid bolus of LR 15 - 30 minutes before epidural to prevent hypotentsion
  • VS Q5 minutes
47
Q

Episiotomy

A

Incision made to widen the vaginal opening during childbirth

48
Q

Post Dural Puncture Headache (PDPH)

A

Headache that occurs when the spinal dura is accidentally punctured during an epidural causing a CSF lead

TX: epidural blood patch

49
Q

Contraindications for Epidurals

KNOW THIS!!!!!

A
  • Active hemorrhage
  • Hypotension
  • Coagulopathy
  • Infection
  • ↑ ICP
  • Allergies
  • Cardiac Conditions
  • Refusal

WBC must be > 100,000

50
Q

What is EFM?

KNOW THIS!!!!!

A

Electronic Fetal Monitoring

51
Q

Toco Transducer

KNOW THIS!!!!!

A

Measures uterine contractions

  • placed at the fundus
52
Q

Ultrasound Transducer

KNOW THIS!!!!!

A

Measures fetal HR

  • placed on baby’s back
53
Q

Intrauterine Pressure Catheter (IUPC)

KNOW THIS!!!!!

A

Catheter that measures contraction pressure

  • can only use once amniotic sac has been ruptured
54
Q

External Fetal Monitoring (EFM) Categories

A

Category I: normal
Category II: indeterminate
Category III: abnormal

55
Q

Fetal HR Variability

A
  • Absent: none (distress, hypoxic, or sleeping)
  • Minimal: < 5 beat difference from baseline
  • Moderate: 6 - 25 beat difference from baseline
  • Marked: > 25 beat difference from baseline
56
Q

Accelerations

KNOW THIS!!!!!!

A

Good indicator of fetal well-being

  • peaks at least 15 bpm for at least 15 beats
57
Q

Decelerations

KNOW THIS!!!!!

A

Decrease in FHR characterized by shapes & timing

58
Q

VEAL CHOP

KNOW THIS!!!!!!

A
  • Variable decelerations = Cord compression
  • Early decelerations = Head compression
  • Accelerations = OK
  • Late decelerations = Placental insufficiency
59
Q

Explain the first part of VEAL CHOP.

KNOW THIS!!!!!!

A

Variable decelerations = Cord compression

60
Q

Explain the second part of VEAL CHOP

KNOW THIS!!!!!!

A

Early decelerations = Head compression

61
Q

Explain the third part of VEAL CHOP

KNOW THIS!!!!!!

A

Accelerations = OK

62
Q

Explain the fourth part of VEAL CHOP

KNOW THIS!!!!!!

A

Late decelerations = Placental insufficiency

63
Q

Contraction Palpation (what does the stomach feel like on palpation during a contraction?)

A
  • mild = nose (tip)
  • moderate = chin
  • strong = forehead
64
Q

Tachysystole

KNOW THIS!!!!!!

A

5+ contractions in a 10 minute window, over a period of 30 minutes

  • too many contractions!!!

Tx: terbutaline

65
Q

Early Decelerations

KNOW THIS!!!!!!

A

Mirrors contractions

  • Cause: Cord compression (V = C in VEAL CHOP)
66
Q

Late Decelerations

KNOW THIS!!!!!!

A

Dip in the fetal heart rate AFTER the peak of the contraction

  • CAUSE: Placental insufficiency (L = P in VEAL CHOP)
67
Q
A
68
Q

Fetal HR Categories

KNOW THIS!!!!!!

A

Category I: normal
* 110 - 160 bpm
* accelerations

Category II: tachy or brady
* absence of baseline
* no accelerations
* episodic decelerations

Category III: emergent delivery
* brady
* hypoxemia
* sinusoidal pattern

69
Q

Sinusoidal Pattern

KNOW THIS!!!!!!

A

Sawtooth pattern (on fetal heart rate monitor)

  • can indicate fetal hemorrhage
70
Q

What can a sinusoidal pattern on the FHR indicate?

KNOW THIS!!!!!!

A

fetal hemorrhage

71
Q

Tachycardia (FHR)

KNOW THIS!!!!!!

A

> 160 bpm

CAUSES:
* ↑ fetal activity
* ↑ maternal fever
* chorioaminitis
* ↓ hypothyroidism
* drugs
* ↓ fetal hypoxemia, anemia, HF

72
Q

Treatment for Intrauterine Resuscitation

KNOW THIS!!!!!!

A

LIONS PIT

  • Left side lying
  • IV fluid bolus
  • Notify physician
  • 1.) Stop Pitocin

STOP PITOCIN = FIRST STEP

73
Q

Bradycardia (FHR)

KNOW THIS!!!!!

A

< 120 bpm

  • mild = 80 - 90 bpm
  • moderate = < 80 bpm
74
Q

Variability (FHR)

KNOW THIS!!!!!

A
  • Short Term: speeds up & slows down
  • Long Term: braod swings in FHR, can be stimulated with examination or loud noise
  • Reduced: can occur with narcotics, anomalies, & hypoxia
  • Persistent: in combination with another type of variability to indicate fetal jeapordy
75
Q

Short Term Variability (FHR)

A

Speeds up & slows down

76
Q

Long Term Variability (FHR)

A

Broad swings in FHR
* can be stimulated with examination or loud noise

77
Q

Reduced variability (FHR)

A

Can occur with narcotics, anomalies, & hypoxia

78
Q

Persistent Variability (FHR)

A

In combination with another type of variability to indicate fetal jeapordy

79
Q

First Stage of Labor

KNOW THIS!!!!!

A

Latent:
* early phase
* regular, painful contractions

Active:
* cervical dilation occurs
* begins @ 6 cm then increases by 1 cm/hr until 10 cm

80
Q

Spontaneous Rupture of Membranes (SROM)

KNOW THIS!!!!!

A

1.) What time?
2.) What color?
3.) Is there an odor?

  • did the cord prolapse? – check for FHR immediately
81
Q

GBS

KNOW THIS!!!!!

A

Group Beta Strep

  • vaginal / rectal culture between 35 - 37 weeks
  • Receive 2 doses abx prophylaxis (penicillin) during labor to protect the baby
82
Q

How often should moms in the 1st stage of labor void?

A

Every 2 hours

83
Q

Fetal Hypoxia

A

Meconium stained amniotic fluid

84
Q

Second Stage of Labor

KNOW THIS!!!!!

A

Full dilation (10 cm) to birth

  • Latent: delayed pushing, laboring down, passive descent
  • Active: Pushing & urge to bear down (Ferguson reflex)
85
Q

The application of what type of pressure can cause complications after birth?

A

Fundal

86
Q

Third Stage of Labor

KNOW THIS!!!!!

A

Birth of baby to expulson of placenta

  • can bolus oxytocin to clamp down uterus
  • counter pressure on the cord to pull away placenta
  • pieces of placenta left in mom can cause hemorrhage - check surface of placenta
87
Q

Fourth Stage of Labor

KNOW THIS!!!!!

A

Expulson of Placenta to 2 hours after birth

  • VS Q5 minutes
  • checking for bleeding / lochia
  • empty bladder
  • fundal checks
  • if C-section = post-op complications

OB Exam 1 (5 decks)

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