Women's Health- Labor Day Lecture Flashcards
What is Fundal Height:
a measure of the size of the uterus used to assess fetal growth and development during pregnancy. Measured from the pubic symphysis to the fundus of the uterus
What week of pregnancy is measured at the umbilicus?
Week 20.
The fundal height should be within what?
Within +/- 2 weeks of the gestational age.
Fundal Heights applies up until week 36, what happeneds then?
The fetus drops down and the stomach starches horizontally
Changes seen during Pregnancy:
Changes seen during Pregnancy:
What GI changes occur during pregnancy?
Increase in appetite, unusual food cravings, increased salvation, increased reflux( due to baby increasing abdominal pressure), constipation (progesterone slows SM) Hemorrhoids (due to the constipation) and N/V (first trimester)
What are some pulmonary changes of pregnancy?
Runny nose, increased chest diameter, increased tital volume, increased min vent, but the rate of breathing does not change, dyspnea.
What are some CV changes during pregnancy?
Increased Blood volume, (by 40%) increased cardiac output, increased heart rate, increased stroke volume.
What are some Hematologic changes seen during pregnancy?
Increase in RBC and increase of WBC (due to increased blood volume), hypercoaguable stage ( due to the increased estrogen)/
What are some breast changes seen during pregnancy?
Increased in size within the 1st 8 weeks, colostrum ( thick yellow fluid that can be released before delivery).
What are some of the Skin changes seen in pregnancy?
Palmar erythema ( due to the increased estrogen), striae, spider vasuclosis and colasma
What are some renal changes seen in pregnancy?
Hydronephrosis ( d/t uterus impinging on ureters, increased GFR (increased blood volume) Glucosuria ( due to increased GFR)
What are some ophthalmology changes seen in pregnancy?
Corneal thickness increases.
At the time of deliver what happens to the estrogen/progesterone ratio?
The estrogen/progesterone ratio increases
What is the difference between true and false labor?
False Labor is actually Braxton Hicks: Regular intervals, intensity remains the same, lower abdomen discomfort the cervix does not dilate, can be relived from walking around
True labor: Regular intervals shortens, increased intensity, back and lower and discomfort, dilating cervix, not relieved from walking around.
How can you tell the difference between true and false labor?
Check the cervix…. Make sure you check it 2 time so you can tell if it changes.
What are the stages of Labor?
1st stage: Onset to 10 cm of cervical dilation
Latent: 0-4 cm
Active: 4-10 cm
2nd stage: 10 cm to delivery ( aka complete to delivery)
3rd stage: from delivery to placental separation
4th stage: Stabilization of mother
How long should it take for stage 3; placental separation?
No more than 30 min
If it takes longer than 30 minutes what is it called?
Retained placenta
What does ‘Complete’ mean?
When you can no longer feel any cervix around the fetal head, fully dilated to 10 cm
What are the key assessments of labor?
Fetal Activity: is it normal activity or abnormal
Bleeding
Fluid Loss
Time of onset and frequency of contractions
Any medications: to tell if there are any co-morbidities of the preg
Allergies
Risk Factors
Last oral intake: if there is need for surgical intervention
What needs to be done to prevent preterm labor?
Dehydration, Infections, Smoking
How can smoking cause preterm labor?
Vasoconstriction which will cause placental separation and uterus irritations.
If you cannot tell the position of the baby using Leopold maneuvers what do you need to do?
Do US.
What are the three different types of Breech babies?
Frank breech. The buttocks are in place to come out first during delivery. The legs are straight up in front of the body, with the feet near the head.
Complete breech. The buttocks are down near the birth canal. The knees are bent, and the feet are near the buttocks.
Footling breech. One leg or both legs are stretched out below the buttocks. The leg or legs are in place to come out first during delivery.
What is the only type of breech can be delivered vaginally?
Frank Breech
How can you asses if the ‘water has broke’?
With a sterile speculum- there will be pooling of fluid in the posterior fornix, swab and do the fern test
You can also do a Nitrazine test- which is a pH indicatory dye- the PH of amniotic fluid is 7.0-7.5, normal vaginal PH is around 3. (positive for anionic fluid is blue)
You can also check the Cervix with a digital exam.
As time increases what happened to the dilation and decent of the baby?
Dilation increases and the baby decent goes down.
Short hand OB- explain this 5/-2/C
The first number is the dilation in cm
The second number is the station- distance above the ishial spine
The third can be a c or a %- this is how thin the cervix is. C= complete.
What is the most common position for a baby to be in?
LOA
Occiput Anterior (OA):
means the occipital bone is facing upward, face is down
Left Occiput Anterior (LOA):
the fetal occipital bone is directed towards the mother’s left, anterior side.
Right Occiput Anterior (ROA):
the fetal occipital bone is directed towards the mother’s right, anterior side.
ROT or LOT-
Left Occipital Transverse or Right Occipital Transverse.
Occiput Posterior :
Occiput posterior positions, including direct OP, LOP (Left Occiput Posterior) and ROP (Right Occiput Posterior) this is LOP
7 Cardinal Movements of Labor:
- Engagement – fetal presenting part as its widest diameter reaches the level of the ischial spine of the pelvis
- Descent – movement of the bi-parietal diameter of the fetal head downwards until it reaches the pelvic inlet.
- Flexion – Fetal head reaches the pelvic floor; head bends forward onto chest, presenting the smallest anteroposterior diameter.
- Internal Rotation – fetus enters pelvic inlet to the maternal pelvis, allows longest fetal head to match the longest maternal pelvic diameter.
- Extension – Internal rotation is complete, fetal head passes beneath the synthesis pubis while in flexion.
- External Rotation – allow the shoulders to rotate internally to fit the pelvis.
- Expulsion – occurs first as the anterior, then the posterior shoulder passes under the symphysis pubis
What is the normal progression of the active phase?
1cm Q hour in the active phase- active is 4cm to 10 cm or complete.
What can you do if someone is not progressing 1cm Q hour in the active phase?
break the anionic sac
Give pitocin to increase contraction
If the pitocin does not induce labor then think C section
What is an Episiotomy?
Surgically planned incision on the perineum and the posterior vaginal wall during the active stage of labor
What are the 4 degrees of vaginal tears-
1st degree
1st degree: First-degree vaginal tears are the least severe, involving only the skin around the vaginal opening. Although you might experience some mild burning or stinging with urination, first-degrees tears aren’t severely painful and heal on their own within a few weeks
What are the 4 degrees of vaginal tears-
2nd degree
2nd degree: Second-degree vaginal tears involve vaginal tissue and the perineal muscles — the muscles between the vagina and anus that help support the uterus, bladder and rectum. Second-degree tears typically require stitches and heal within a few weeks.
What are the 4 degrees of vaginal tears-
3rd degree
3rd degree: Third-degree vaginal tears involve the vaginal tissues, perineal muscles and the muscle that surrounds the anus (anal sphincter). These tears sometimes require repair in an operating room — rather than the delivery room — and might take months to heal.
What are the 4 degrees of vaginal tears-
4th degree
4th degree: Fourth-degree vaginal tears are the most severe. They involve the perineal muscles and anal sphincter as well as the tissue lining the rectum. Fourth-degree tears usually require repair in an operating room — rather than the delivery room — and might take months to heal.
What are the two types of Operative vaginal deliveries?
The forceps or the Vaccum Extractor
What are indications for Operative vaginal deliveries?
Non- reassuring FHT
Shorten the second stage of labor
Prolonged second stage dystocia ( abnormally slow child birth)
Delivery of the head ( ONLY the forceps)
What are indications of C-section?
Baby is too big, baby is breech ( except for PIKE) Miltiple gestations (twins), CPD (cephalopelvic disproportion), non reassuring FHT, not ideal maternal health.
What is Cephalopelvic disproportion (CPD)?
occurs when a baby’s head or body is too large to fit through the mother’s pelvis.
Why are C- sections a growing trend?
ACOG use to state you could not delivery vaginally after a c-section. This may be changing depending on the incision site of the c- section.
What is the only type of C- section incision that can have a vaginal birth after?
A Pfannenstiel Incision.
