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OBSTETRICS > 1M - Normal Labor and Delivery > Flashcards

1M - Normal Labor and Delivery Flashcards

(73 cards)

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1
Q

What is the greatest impediment when on understanding labor?

A

recognizing when labor starts

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2
Q

This is defined as the presence of regular contractions accompanied by progressive changes in in cervical dilatation and effacement?

A

Labor

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3
Q

On PE, what findings are positively associated with labor?

A

Effacement of >50% and cervical dilatation of >2cm

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4
Q

According to William’s, what is the duration of contractions during the active phase of labor?

A

duration of 30 to 90 seconds

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5
Q

According to the CPG, what is the duration and interval of contractions in labor?

A

at least 1 in every 10 minutes or 4 in 20 minutes, either by manual exam of CTG

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6
Q

What is the relationship of the fetus long axis in relation to the mother?

A

Fetal Lie

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7
Q

A singleton in transverse lie will always be delivered how?

A

CS

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8
Q

This refers to the part of the fetus closest to the exit?

A

Fetal presentation

cephalic or breech

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9
Q

This refers to the habitus of the fetus? Either flexed or extended

A

Fetal attitude

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10
Q

What is the fetal attitude when the occipital fontanel is the presenting part?

A

Vertex

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11
Q

When the neck is only partly flexed, what is anterior fontanel is the presenting part, what is the fetal attitude?

A

Sinciput

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12
Q

When the fetal neck is partially extended, what is the fetal attitude?

A

Brow presentation

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13
Q

What is the fetal attitude, if the neck is full extended?

A

Face presentation

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14
Q

This refers to the occiput of the fetal head to the maternal side either the symphysis pubis if anterior or posterior if it is facing scaral?

A

Fetal Position

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15
Q

What position of the occiput can make delivery difficult?

A

Occiput posterior

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16
Q

What is the CS incision made for those presenting in dorsoanterior and dorsoinferior position?

A

Classical CS

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17
Q

What is the grip used in Leopold’s Maneuver 1?

A

Fundal Grip

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18
Q

What grip is used in Leopold Maneuver 2

A

Umbilical Grip

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19
Q

Where is the fetal heart tone best heard?

A

Fetal back

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20
Q

What is the feeling of the fetal back?

A

Hard, resistant or convex structure

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21
Q

What leopold maneuver confirms the fetal presentation and whether the fetus is engaged or not

A

Leopold 3

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22
Q

What is the only leopold maneuver that requires the physician to face the patient’s feet?

A

Leopold 3

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23
Q

What suture can guide you in determining in locating the fontanel?

A

Sagittal suture

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24
Q

Where is the sagittal suture located?

A

Between the 2 parietal bones

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25
What is the shape of the anterior fonatanel?
Diamond
26
What is the shape of the posterior fontanel?
triangular
27
If the fetus has a well flexed head, what is probably the fetal position?
Occiput anterior
28
What is the biggest diameter of the fetal head?
Biparietal diameter
29
What is the most common position for the fetal head when entering the pelvis?
Transverse position (left occiput transverse - 40%)
30
What station will it be if the biparietal diameter has entered and passed through the pelvic inlet?
Station 0 (at the level of the ischial spine)
31
What factors affect descent?
Uterine contractions, abdominal pressure, bearing down of the mother and amniotic fluid
32
What change in fetal presentation happens during flexion?
Change from occipitoanterior to suboccipitobregmatic
33
What change in position happens during internal rotation?
occipito transverse to occipitoanterior
34
This is said to occur when the widest diameter of the fetal head successfully negotiates with the narrowest part of the maternal bony plevis?
Crowning
35
This cardinal movement causes stretching of the perineum?
Extension
36
What change in shoulder position happens during external rotation?
transverse position to and anterior posterior position of the shoulder
37
How is the traction applied during delivery of the baby?
Downward upward traction
38
A shallow sacral promontory is a sign of?
contracted pelvic diameter
39
What is the shape formed if the cervical dilatation is plotted?
Sigmoid curve
40
What is the shape formed if the descent of fetal head is plotted?
hyperbolic curve
41
When does the latent phase of cervical dilatation end?
Nulliparous women - 3-4cm Multiparous women - 4-5 cm
42
How long does the latent phase of labor last?
Nulliparous women - averages 8 1/2 hrs; to 20 hrs Multiparous women - averages 5 hours; to 14 hrs
43
What is prolonged latent phase?
Nulliparous women - >20 hrs Multiparous women - >14 hrs
44
This phase of labor is marked by increased rapidity of cervical dilatation to 10 cm?
Active phase also the period where the presenting part descends well into the pelvis
45
How long does the active phase last?
Nulliparous - 5-7 hrs with dilatation at 1.2 cm/hr Multiparous - 2-4 hrs with dilatation at 1.5 cm/hr
46
What phase from the active phase is can predict the timing of delivery of a particular labor?
Acceleration phase
47
The phase of maximum slope usually happens at what measurement of cervical dialtation?
6-8cm
48
What measurement of cervical dilatation does the deceleration phase start?
9 cm
49
What phase of active phase of labor can failure of descent happen?
deceleration phase
50
This phase of the active phase is more reflective of the fetopelvic relationship?
deceleration phase
51
What measurement of cervical dilatation is now heralded as the start of active labor according to Zhang et al?
6 cm
52
According to Zhang, how long does the second stage of labor last with and without an epidural for nulliparas?
With epidural - 3.6 hrs Without epidural - 2.8 hours
53
In general, how long does the second stage of labor last for both nullipara and multipara?
Nullipara - 2 hours; 3 hours with epidural Multiparas - 1 hour; 2 hours with epidural
54
What exam is used to check for rupture of membranes?
Speculum examination
55
If there is already rupture of membranes, what will be the color of the lithmus paper?
Blue because amniotic fluid is alkalotic
56
What shape will you see under the microscope upon viewing the vaginal discharge if amniotic fluid is present?
Ferning pattern
57
Palpation of the ischial spine or prominence suggests what condition?
Contracted mid plane
58
What findings suggests mid pelvic contraction?
Prominence of the ischial spine, pelvic sidewall are convergent, concavity of the sacrum is shallow, bi-ischial diameter is less than 8cm
59
Adequacy of the pelvis is done to multigravid? T or F?
False If there is prolonged labor in multigravid, assess the passenger (fetus)
60
What position may increase progression and comfort during labor?>
Upright position
61
What Bishop Score suggests unfavorable cervix?
< 4
62
Food can be given during labor? T or F?
False Food is withheld during labor and only clear fluids are given
63
This is the aspiration of stomach contents into the lungs during obstetric anesthesia secondary to delayed gastric emptying time in labor?
Mendelson's Syndrome
64
When there is lag in cervical dilatation, what active managements can be given?
amniotomy and oxytocin
65
Oxytocin comes from what part of the hypothalamus? Anterior or Posterior?
Posterior
66
What is the half life of oxytocin?
5-12 minutes
67
What is the physiologic dose of oxytocin to produce uterine contractions?
8-12 mU/min
68
How is low dose oxytocin given?
1-2 Mu/min increased incrementally at 30 minute intervals
69
How is high dose oxytocin given?
4-6 mU/min every 15-30 minutes
70
How is 1 mU achieved in oxytocin preparation of 10 U per 500 mL?
1 mU = 1 drop/min
71
How is 1 mU achieved in oxytocin preparation of 10 U per 1L?
1 mU = 2 drops/min
72
How is 1 mU achieved in oxytocin preparation of 5 U per 1L?
1 mU = 4 drops/min
73
What should have been done to women at 6cm cervical dilatation with ruptured membranes with 4 hours of adequate contractions before going into cesarean delivery?
at least 6 hours of oxytocin with no cervical change and inadequate contractions

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