15: Normal Labor and Delivery

Question 1

Definition of Labor

Answer 1

Progressive cervical dilation resulting from regular uterine contractions occurring at least every 5 minutes lasting 30-60 sec

Question 2

False Labor/Braxton-Hicks contractions

Answer 2

Irregular contractions without cervical change

Question 3

Most optimal pelvic shapes for vaginal delivery

Answer 3

Gynecoid and Anthropoid

Question 4

Fetal Lie

Answer 4

Maternal spine to fetus spine; infant can be longitudinal, transverse, oblique

Question 5

Fetal presentation

Answer 5

Presenting part to pelvis: vertex, breech, transverse, compound

Question 6

Leopold maneuver

Answer 6

Determines station and lie; 1. Palpate fundus, 2. Palpate spine and fetal parts, 3. Palpate presenting pelvis with suprapubic palpation, 4. palpate for cephalic prominence

Question 7

Dilation of cervix

Answer 7

Check at level of internal os; complete dilation at 10 cm

Question 8

Effacement of cervix

Answer 8

Thinning of cervix reported as % change

Question 9

Station of cervix

Answer 9

Degree of descent of presenting part of the fetus; range -5 to +5; 0 when bony portion of head reaches level of ischial spines

Question 10

First stage of labor

Answer 10

Onset of true labor to complete cervical dilation (with latent and active phase)

Question 11

Second stage of labor

Answer 11

Complete cervical dilation to delivery of infant

Question 12

Third stage of labor

Answer 12

Delivery of infant to delivery of placenta

Question 13

Fourth stage of labor

Answer 13

Delivery of placenta to stabilization of patient

Question 14

During first stage of labor, how often do you perform cervical checks?

Answer 14

Q2hr

Question 15

What is meant by 4/50/-2?

Answer 15

Dilation/Effacement/Station; 4 cm dilated/50% effaced/-2 cm station

Question 16

Amniotomy (AROM) - benefits and risks

Answer 16

Artificial rupture of membranes
Benefits: augment labor, allow assessment of meconium status
Risks: cord prolapse, prolonged leads to chorioamnionitis

Question 17

Cardinal movements of labor

Answer 17

1. Engagement, 2. Descent, 3. Flexion, 4. Internal rotation, 5. Extension, 6. External rotation, 7. Expulsion

Question 18

Engagement (cardinal movements)

Answer 18

Presenting part at zero station

Question 19

Descent (cardinal movements)

Answer 19

D/t force of uterine contractions and maternal valsalva

Question 20

Flexion (cardinal movements)

Answer 20

OA-baby’s chin to chest; suboccipitobregmatic

Question 21

Internal rotation (cardinal movements)

Answer 21

Fetal head enters pelvis in transverse diameter, rotates so occiput is anterior or posterior toward pubic symphisis (usually occurs at ischial spines)

Question 22

Extension (cardinal movements)

Answer 22

Crowning occurs when largest diameter of fetal head encircled by introitus; station is +5, head born by rapid extension

Question 23

External rotation (cardinal movements)

Answer 23

Delivered head returns to original position to align with fetal back and shoulders

Question 24

Expulsion (cardinal movements)

Answer 24

Anterior shoulder then delivers under pubic symphysis; followed by posterior shoulder and rest of body

Question 25

Most common maternal position for spontaneous and operative delivery

Answer 25

Dorsal lithotomy

Question 26

Modified Ritgen maneuver

Answer 26

Stabilize perineum with towel to facilitate delivery, extend head and apply counter-pressure

Question 27

First degree perineal laceration

Answer 27

Superficial laceration involving vaginal mucosa/perineal skin

Question 28

Second degree perineal laceration

Answer 28

Laceration extending into muscles of perineal body

Question 29

Third degree perineal laceration

Answer 29

Laceration extends into or completely through anal sphincter

Question 30

Fourth degree perineal laceration

Answer 30

Involves rectal mucosa

Question 31

Retained placenta

Answer 31

Diagnosed if placenta has not delivered within 30 minutes; usually occurs within 2-10 minutes

Question 32

Most common cause of postpartum hemorrhage

Answer 32

Uterine atony

Question 33

Induction of labor

Answer 33

Process by which labor is induced by artificial means

Question 34

Augmentation of labor

Answer 34

Artificial stimulation of labor which has ALREADY BEGUN

Question 35

Bishop Score

Answer 35

Probability of labor by characteristics of cervix; measures likeihood of need for C-section

Question 36

Unfavorable Bishop score

Answer 36

Less than 6; increased likelihood of C-section

Question 37

Cervidil (dinoprostone)

Answer 37

Cervical ripening agent (PGE2); vaginal insert; Contraindicated in pt with previous C-sections

Question 38

Cytotec (misoprostol)

Answer 38

Cervical ripening agent (PGE1); oral or vaginal; Contraindicated in patients with previous C-sections

Question 39

Mechanical dilators of the cervix

Answer 39

Foley bulb, laminara japonicum

Question 40

Pitocin

Answer 40

Synthetic oxytocin, IV administration; only FDA approved drug for induction and augmentation

Question 41

Complications of pitocin

Answer 41

Uterine tachysystole (most common), antidiuretic effect (water reabsorption), uterine muscle fatigue

Question 42

Epidural

Answer 42

Most effective form of anesthesia/pain relief; large bore needle between L2-3/3-4/4-5

Question 43

When is an inhaled anesthetic indicated in delivery?

Answer 43

Emergent cases with need for rapid delivery; ALL cross placenta and associated with neonatal respiratory depression