WH final Flashcards by Alora Marshall

Labor

Contractions that result in progressive DILATION and EFFACEMENT of the cervix

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Effacement

thinning of cervix

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Station

Placement of presenting part in maternal pelvis in relation to ISCHIAL SPINES

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DIRECT eval for Rupture of Membranes (3)

Fern
Amniosure
Nitrazine paper

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SUPPORTIVE eval for Rupture of Membranes

Amniotic Fluid Index or “AFI” done by Ultrasound

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Nitrazine testing

vaginal pH

not very specific, not used often

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Fern testing

Air dried sample of fluid examined under microscope

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Amniosure

“point of care test”

VERY SPECIFIC

requires only small sample

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Fetal station

position of baby’s head in the ischial spine

0 is at the ischial spine

Cephalic station is +1

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Stage 1 of labor

further divided into two phases

Contractions accomplish COMPLETE Dilation and Effacement

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Latent phase of Stage 1

slower, less predictable

0-5 cm dilation

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Active phase of Stage 2

faster, more predictable

5-10 cm dilation

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Stage 2 of labor

Expulsion of fetus

BABY IS BORN

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Stage 3 of labor

Placenta becomes detached from uterine wall and expelled

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Stage 4 of labor

MANY HEMODYNAMIC CHANGES in momma

2 hours post delivery of placenta

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Which stage of labor differs by both race and parity?

Stage 2- complete dilation and expulsion of the fetus

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Order of cardinal movements of labor

Engagement
Flexion
Descent
Internal rotation
Extension
External rotation

one fluid movement

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Major complication of 3rd stage of labor

Hemorrhage

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How long does stage 3 of labor last?

30 min or less
often aided by doc

delivery of placenta

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Complications of 3rd stage

HEMORRHAGE
retention of placenta
uterine inversion

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Signs of Placental separation

Uterus rises in abdomen
Globular configuration
Gush of blood
Lengthening of umbilical cord

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4th stage of labor

2 hours postpartum
“Transfusion” from the now contracted uterus

Particularly critical time for women with Cardiovasc or Pulm dz

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Progress of Labor

3 “Ps”

Power: maternal pushing efforts, uterine contractions

Passenger: size and position of fetus

Passage: size and shape of maternal pelvis

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Uterine contractions

increase in FREQUENCY and INTENSITY d/t prostaglandins

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Adequate labor is considered

3-5 contractions within 10 min averaged over 30 min

External tocodynamometer

measures - frequency - duration

INTERNAL tocodynamometer

measures - frequency - duration, AND - intensity

Macrosomic infant

>4,500 grams

Posterior fontanel

TRIANGULAR shaped

ANTERIOR fontanel

DIAMOND shaped

True labor

regular intervals, increasing in frequency cervical dilation back/abd discomfort labor pattern NOT altered by pain meds

CEFM

Continuous elecronic fetal monitoring external: US transducer on abdomen internal: scalp electrode on baby

Baseline fetal heart rate

110-160 bpm

Early decelearation

physiologic | d/t head compression

Variable deceleration

d/t cord compression

Late deceleration

d/t fetal hypoxia | BAD, omnious sign

Basic Antepartum Testing -done to evaluate a high risk fetus worried about Fetal Acidosis

Fetal kick counts Non stress testing Contraction stress testing Biophysical profile

Biophysical profile US eval of 4 things:

Amniotic fluid assmt Gross fetal mov Tone Fetal "breathing"

Contraction stress test Negative results

Reassuring (good) 3 contractions in 10 min with NO late deceleration

Contraction stress test Postitive results

Non-reassuring (bad) late decelerations or sig variable decel with >50% of contractions in 10 min period

First deg obs laceration

Involved vaginal mucosa or perineal skin, but NOT underlying tissue

2nd deg obs laceration

Involves underlying subQ tissue | but NOT rectal

3rd deg obs laceration

through Rectal SPHINCTER, but not rectal mucosa

4th deg obs laceration

INTO Rectal mucosa

Ways to induce labor

``` Prostaglandin Misopristol Pitocin Stripping membranes Amniotomy (rupture of membranes) ```

Induction risks

``` Dec oxygen Fetal hypoxia/acidosis Unfavorable cervix Cord prolapse Infection ```

Bishop scoring how successful will an induction be?

0-4 = likely a FAILED induction

What type of anesthesia for a C section?

Spinal- | regional anesthesia via one-time injection into spinal canal

Puerperium

6 wks postpartum

What happens to cervix in puerperium

Uterus involutes from 1000 to 50-100

How long to stay in hospital after vaginal birth?

1-2 days

How long to stay in hospital after C section?

2-4 days

Postpartum exam occurs

4-6 weeks after birth

Which pelvic shape is BEST suited for vaginal delivery?

Gynecoid

Spontaneous separation of placenta should occur within what time phrame after vaginal delivery?

30 min

What type of decelerations are physiologic?

Early are OK

What type of twins have a genetic pre-D?

Dizygotic "fraternal" this type is less risky too Diamniotic/Dichorionic

Identical twins are not influenced by

Assistive Reproductive Technology

Monozygotic have same risks as dizygotic PLUS

Twin-twin transfusion risk

Twin-twin transfusion syndrome

happens in Monochorionic/Diamniotic pregnancy

Twin-twin transfusion

imbalance in fetal-placental circulation, one twin transfuses the other