Women's Health- Labor Day Lecture

Question 1

What is Fundal Height:

Answer 1

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

Question 2

What week of pregnancy is measured at the umbilicus?

Answer 2

Week 20.

Question 3

The fundal height should be within what?

Answer 3

Within +/- 2 weeks of the gestational age.

Question 4

Fundal Heights applies up until week 36, what happeneds then?

Answer 4

The fetus drops down and the stomach starches horizontally

Question 5

Changes seen during Pregnancy:

Answer 5

Changes seen during Pregnancy:

Question 6

What GI changes occur during pregnancy?

Answer 6

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)

Question 7

What are some pulmonary changes of pregnancy?

Answer 7

Runny nose, increased chest diameter, increased tital volume, increased min vent, but the rate of breathing does not change, dyspnea.

Question 8

What are some CV changes during pregnancy?

Answer 8

Increased Blood volume, (by 40%) increased cardiac output, increased heart rate, increased stroke volume.

Question 9

What are some Hematologic changes seen during pregnancy?

Answer 9

Increase in RBC and increase of WBC (due to increased blood volume), hypercoaguable stage ( due to the increased estrogen)/

Question 10

What are some breast changes seen during pregnancy?

Answer 10

Increased in size within the 1st 8 weeks, colostrum ( thick yellow fluid that can be released before delivery).

Question 11

What are some of the Skin changes seen in pregnancy?

Answer 11

Palmar erythema ( due to the increased estrogen), striae, spider vasuclosis and colasma

Question 12

What are some renal changes seen in pregnancy?

Answer 12

Hydronephrosis ( d/t uterus impinging on ureters, increased GFR (increased blood volume) Glucosuria ( due to increased GFR)

Question 13

What are some ophthalmology changes seen in pregnancy?

Answer 13

Corneal thickness increases.

Question 14

At the time of deliver what happens to the estrogen/progesterone ratio?

Answer 14

The estrogen/progesterone ratio increases

Question 15

What is the difference between true and false labor?

Answer 15

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.

Question 16

How can you tell the difference between true and false labor?

Answer 16

Check the cervix…. Make sure you check it 2 time so you can tell if it changes.

Question 17

What are the stages of Labor?

Answer 17

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

Question 18

How long should it take for stage 3; placental separation?

Answer 18

No more than 30 min

Question 19

If it takes longer than 30 minutes what is it called?

Answer 19

Retained placenta

Question 20

What does ‘Complete’ mean?

Answer 20

When you can no longer feel any cervix around the fetal head, fully dilated to 10 cm

Question 21

What are the key assessments of labor?

Answer 21

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

Question 22

What needs to be done to prevent preterm labor?

Answer 22

Dehydration, Infections, Smoking

Question 23

How can smoking cause preterm labor?

Answer 23

Vasoconstriction which will cause placental separation and uterus irritations.

Question 24

If you cannot tell the position of the baby using Leopold maneuvers what do you need to do?

Answer 24

Do US.

Question 25

What are the three different types of Breech babies?

Answer 25

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.

Question 26

What is the only type of breech can be delivered vaginally?

Answer 26

Frank Breech

Question 27

How can you asses if the ‘water has broke’?

Answer 27

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.

Question 28

As time increases what happened to the dilation and decent of the baby?

Answer 28

Dilation increases and the baby decent goes down.

Question 29

Short hand OB- explain this 5/-2/C

Answer 29

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.

Question 30

What is the most common position for a baby to be in?

Answer 30

LOA

Question 31

Occiput Anterior (OA):

Answer 31

means the occipital bone is facing upward, face is down

Question 32

Left Occiput Anterior (LOA):

Answer 32

the fetal occipital bone is directed towards the mother’s left, anterior side.

Question 33

Right Occiput Anterior (ROA):

Answer 33

the fetal occipital bone is directed towards the mother’s right, anterior side.

Question 34

ROT or LOT-

Answer 34

Left Occipital Transverse or Right Occipital Transverse.

Question 35

Occiput Posterior
:

Answer 35

Occiput posterior positions, including direct OP, LOP (Left Occiput Posterior) and ROP (Right Occiput Posterior) this is LOP

Question 36

7 Cardinal Movements of Labor:

Answer 36

1. Engagement – fetal presenting part as its widest diameter reaches the level of the ischial spine of the pelvis
2. Descent – movement of the bi-parietal diameter of the fetal head downwards until it reaches the pelvic inlet.
3. Flexion – Fetal head reaches the pelvic floor; head bends forward onto chest, presenting the smallest anteroposterior diameter.
4. Internal Rotation – fetus enters pelvic inlet to the maternal pelvis, allows longest fetal head to match the longest maternal pelvic diameter.
5. Extension – Internal rotation is complete, fetal head passes beneath the synthesis pubis while in flexion.
6. External Rotation – allow the shoulders to rotate internally to fit the pelvis.
7. Expulsion – occurs first as the anterior, then the posterior shoulder passes under the symphysis pubis

Question 37

What is the normal progression of the active phase?

Answer 37

1cm Q hour in the active phase- active is 4cm to 10 cm or complete.

Question 38

What can you do if someone is not progressing 1cm Q hour in the active phase?

Answer 38

break the anionic sac
Give pitocin to increase contraction
If the pitocin does not induce labor then think C section

Question 39

What is an Episiotomy?

Answer 39

Surgically planned incision on the perineum and the posterior vaginal wall during the active stage of labor

Question 40

What are the 4 degrees of vaginal tears-

1st degree

Answer 40

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

Question 41

What are the 4 degrees of vaginal tears-

2nd degree

Answer 41

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.

Question 42

What are the 4 degrees of vaginal tears-

3rd degree

Answer 42

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.

Question 43

What are the 4 degrees of vaginal tears-

4th degree

Answer 43

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.

Question 44

What are the two types of Operative vaginal deliveries?

Answer 44

The forceps or the Vaccum Extractor

Question 45

What are indications for Operative vaginal deliveries?

Answer 45

Non- reassuring FHT
Shorten the second stage of labor
Prolonged second stage dystocia ( abnormally slow child birth)
Delivery of the head ( ONLY the forceps)

Question 46

What are indications of C-section?

Answer 46

Baby is too big, baby is breech ( except for PIKE) Miltiple gestations (twins), CPD (cephalopelvic disproportion), non reassuring FHT, not ideal maternal health.

Question 47

What is Cephalopelvic disproportion (CPD)?

Answer 47

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.

Question 48

What is the only type of C- section incision that can have a vaginal birth after?

Answer 48

A Pfannenstiel Incision.