WH final Flashcards
Labor
Contractions that result in progressive DILATION and EFFACEMENT of the cervix
Effacement
thinning of cervix
Station
Placement of presenting part in maternal pelvis in relation to ISCHIAL SPINES
DIRECT eval for Rupture of Membranes (3)
Fern
Amniosure
Nitrazine paper
SUPPORTIVE eval for Rupture of Membranes
Amniotic Fluid Index or “AFI” done by Ultrasound
Nitrazine testing
vaginal pH
not very specific, not used often
Fern testing
Air dried sample of fluid examined under microscope
Amniosure
“point of care test”
VERY SPECIFIC
requires only small sample
Fetal station
position of baby’s head in the ischial spine
0 is at the ischial spine
Cephalic station is +1
Stage 1 of labor
further divided into two phases
Contractions accomplish COMPLETE Dilation and Effacement
Latent phase of Stage 1
slower, less predictable
0-5 cm dilation
Active phase of Stage 2
faster, more predictable
5-10 cm dilation
Stage 2 of labor
Expulsion of fetus
BABY IS BORN
Stage 3 of labor
Placenta becomes detached from uterine wall and expelled
Stage 4 of labor
MANY HEMODYNAMIC CHANGES in momma
2 hours post delivery of placenta
Which stage of labor differs by both race and parity?
Stage 2- complete dilation and expulsion of the fetus
Order of cardinal movements of labor
Engagement Flexion Descent Internal rotation Extension External rotation
one fluid movement
Major complication of 3rd stage of labor
Hemorrhage
How long does stage 3 of labor last?
30 min or less
often aided by doc
delivery of placenta
Complications of 3rd stage
HEMORRHAGE
retention of placenta
uterine inversion
Signs of Placental separation
Uterus rises in abdomen
Globular configuration
Gush of blood
Lengthening of umbilical cord
4th stage of labor
2 hours postpartum
“Transfusion” from the now contracted uterus
Particularly critical time for women with Cardiovasc or Pulm dz
Progress of Labor
3 “Ps”
Power: maternal pushing efforts, uterine contractions
Passenger: size and position of fetus
Passage: size and shape of maternal pelvis
Uterine contractions
increase in FREQUENCY and INTENSITY d/t prostaglandins
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
