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clin med3: womens health > Labor and delivery > Flashcards

Labor and delivery Flashcards

1
Q

what are signs of false labors

A

irregular contractions
interval may stay the same
walking may make less
adbominal cramping
mild sedation reduces

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2
Q

what is repetitive uterine contraction associated with progressive cervical changes

A

labor

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3
Q

what are signs of true labor

A

regular contractions
interval decreases
walking makes worse
abdomen and or back pain
mild sedation has no effect

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4
Q

If GBS is present prior to birth what is the treatment

A

Penicillin G for at least 2 doses (4hrs apart) until delivery of baby
if allergic - treat with appropriate alternative abs (depends on sensitivity and risk of anaphylaxis)

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5
Q

what is assessed on PE with a birthing person

A

vitals
fetal position and presentation (Leopolds)
contraction (CTX): frequency, duration and strength
pelvic exam: cervical exam findings, confirm rupture of membranes

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6
Q

what is the initial assessment of fetal wellbeing

A

Fetal Heart rate (FHR)
presentation/position/attitude
size

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7
Q

what is the method to assess fetal well-being

A

HR

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8
Q

What are the methods for fetal monitoring

A

external: intermittent auscultation, continuous electronic fetal monitoring
internal: fetal scalp electrode
combo is common practice

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9
Q

What is EFM

A

electronic fetal monitoring: record heartbeat of the fetus and contractions of the uterus during labor - may be external or internal

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10
Q

what is the upper and lower portions on a fetal monitor looking at

A

upper: tracing fetal HR
lower: tracing contractions

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11
Q

what may affect fetal heart rate during labor

A

fetal conditions
tests done during labor
birthing person conditions
medications or anesthesia given during labor
uterine contractions
pushing during second stage of labor

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12
Q

what are the 5 essential components of fetal heart race tracing

A

baseline
variability
accelerations
decelerations
changes or trends over time

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13
Q

how is mean fetal heart rate calculated

A

rounded to increments of 5 beats per minute during a 10-min segment - excluding accelerations and decelerations

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14
Q

what is a normal fetal baseline HR

A

110-160bmp

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15
Q

what is considered fetal bradycardia

A

less than 110 bpm

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16
Q

what is considered fetal tachycardia

A

over 160bpm

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17
Q

what is the fluctuations in FHR baseline that are irregular in amplitude and frequency

A

variability
based on at least 10-20 minutes of tracing

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18
Q

what are variable decelerations associated with on fetal monitoring

A

cord compression

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19
Q

what is seen with head compression on fetal monitoring

A

early decelerations

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20
Q

what is seen with placental insufficiency on fetal monitoring

A

late decelerations

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21
Q

what are early deceleration

A

symmetrical gradual decrease in FHR (>30 sec) and return to baseline with CTX.
nadir is at the same time as the peak of the CTX

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22
Q

what is variable deceleration

A

abrupt decrease in FHR below baseline which may or may not be associated with CTX
onset to nadir is < 30 sec

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23
Q

what is late deceleration

A

symmetrical gradual decrease in FHR (>30 sec) and return to baseline with CTX.
nadir is AFTER the peak of CTX

24
Q

What is tachysystole

A

excessive uterine activity > 5 contractions in 10 minutes, averaged over 30 minutes

25
Q

how is uterine contraction strength measured

A

montevideo units (MVU) - sum of intensity of each CTX in 10 minutes
adequate uterine activity is a CTX pattern that generates >200MVU

26
Q

What are the three P’s of labor

A

passenger
power
passage

27
Q

what is cord presentation

A

umbilical cord falls between presenting part of cervix with our without membrane rupture

28
Q

what is cord prolapse

A

umbilical cord falls through cervix next to or before presenting part with membrane rupture

29
Q

what is an obstetric emergency that requires immediate delivery by cesarean section

A

cord prolapse

30
Q

what are the breech presentations

A

frank, complete fottling

31
Q

what are the risk factors for breech presentation

A

gestational age before term
hydramnios
uterine relaxations associated with great parity
hydrocephaly and anecephaly

32
Q

what is fetal station

A

how far down fetal head is in the pelvis
narrowest section lies between two bony landmarks of pelvis called ischial spines

33
Q

what is zero station

A

geometric plane that extends though the spines and up to the pubic one is called the mid-pelvis

34
Q

what is fetal lie

A

relation of fetal spine to birthing person’s spine

35
Q

what is fetal position

A

relationship of head to the birthing persons pelvis

36
Q

what is fetal attitude

A

relationship of fetal head and fetal spine

37
Q

what power

A

uterine contractions

38
Q

what is the myocmetrium

A

interwoven bundles of smooth muscle cells in a spiral arrangement
matrix of collagen and gycosaminoglyans
gap conjucntions allow for rapid transmission of signals

39
Q

what is cervical effacement

A

thinning of cervix

40
Q

what is cervial dilation

A

enlargement of cercival opening

41
Q

what is the smallest diameter of fetal head when in correct position for delivery

A

10cm

42
Q

if a patient has a Bishop score <6, what is recommended before induction of labor

A

cervical ripening
mechanical, surgical or pharmacological

43
Q

what is Johnsons formula

A

fetal weight in grams - 155 x (fundal height in cm - k_
estimation of fetal size

44
Q

what are the stages of labor

A

prodrome, active phase
delivery of head
delivery of placenta
recovery

45
Q

what is “lightning”

A

dropping - notices more room to breathe and eat; increased urination and defication

46
Q

What are the movements of Labor

A

Every Darn Fetus Is Extremely Eager to Exit
Engagement
Descent
Flexion
Internal rotation
Extension
External rotation
Expulsion

47
Q

what is the third stage of labor

A

starts after delivery of baby - ends with delivery of placenta

48
Q

what are signs of third stage of labor

A

gush of blood
cord appears to lengthen
uterus becomes globular
uterus rises anteriorly

49
Q

what is active management of the third stage of labor

A

administration of uterotonic (oxytocin) soon after delivery of anterior shoulder
application of fundal pressure after delivery of placenta
controlled traction on umbilical cord

50
Q

what is the expectant management of the third stage of labor

A

wait for spontaneous expulsion of the placenta

51
Q

what is the 4th stage of labor

A

uterine involution
fundus is firm and midline about the seize of grapefruit immediately after delivery
rises to umbilicus for about 12 hours
drops 1cm each day for 10 days until back in the pelvis

52
Q

what is dystocia

A

abnormal (difficult) labor

53
Q

what are power causes of dystocia

A

uterine contraction dysfunction, reduced birthing person strength (exhaustion, pain)

54
Q

what are the passenger causes of dystocia

A

abnormalities of size, presentation, position

55
Q

what are the passage causes of dystocia

A

abnormalities of pelvic size or architecture

56
Q

what are some indications for a c-section

A

placental abruption, previa
failure to progress/descend
worsening birthing person disease
malpresentation
multiple gestation

clin med3: womens health (13 decks)

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