normal labor and delivery

Question 1

What is a normal nonstress test of the fetus? What should you do if you get an nonreactive test?

Answer 1

normal: two or more 15 bpm accelerations of fetal heart rate lasting at least 15 s, each within 20 minutes
if nonreactive, go on to get a biopysical profile

Question 2

What is done as part of a biophysic profile?

Answer 2

repeat nonstress test

do an ultrasound to measure amniotic fluid index, fetal breathing rate, fetal movement, and fetal tone

Question 3

How is the biophysic profile graded?

Answer 3

1. reactive NST gets 2 pts
2. amniotic fluid index 5-23 gets 2 pts
3. 1 or mor rhythmic breathing episode lasting 20 s within 30 min period= 2 pts
4. 2 or mor episodes of fetal movement in 30 min = 2pts
5. 1 or more episode of spine and limb extension with return to flexion = 2 pts

Question 4

What is considered a reassuring biophysic profile?

Answer 4

score of 8-10. lower suggests fetal distress

Question 5

What is a contraction stress test?

Answer 5

fetal heart rate is recorded with external fetal monitor or fetal scalp electrote
-assess beat to beat variability of 5 bpm, long term heart rate variability and heart rate accelerations (2 or more 15 beat changes for at least 15 s within 20 min period) is reassuring

Question 6

What is an early decceleration and what is its significance?

Answer 6

decel begins and ends with uterine contraction

signifies head compression and is considered benign

Question 7

What is a late decceleration and what does it signify?

Answer 7

begins after initiation of contraction and ends after contraction has ended
suggests uteroplacental insufficiency (most common)
could also be due to maternal hypotension, venous compression, placental abruption, fetal hypoxia

Question 8

What is a variable decceleration and what does it signify?

Answer 8

inconsistent onset, duration, and degree

suggests umbilical cord compression

Question 9

What are the 4 stages of labor?

Answer 9

1. latent and active phases
2. full dilation until delivery of baby
3. end of baby delivery to end of placenta delivery
4. 1 hr post-partum

Question 10

What is the difference between the latent and active phases of labor?

Answer 10

1. latent: start of contractions until 4 cm dilated and completely effaced
2. active: dilation for 4 to 10 cm
   deceleration phase is the transition from active phase to stage 2

Question 11

How fast is normal for the active phase of labor?

Answer 11

first baby: 1.2 cm/hr
multip: 1.5 cm/ hr
in total should be

Question 12

What is the normal duration of the second stage of labor?

Answer 12

first baby:

Question 13

What factors are associated with greater likelihood of success for induction of labor?

Answer 13

more dilation, more effaced, station, cervical consistency, cervical position

Question 14

What are the 3 kinds of breech positioning?

Answer 14

frank breech: most common; thighs flexed and knees extended
complete breech: thighs and knees flexed
footling: one or both legs extended

Question 15

At what point in a pregnancy would you consider external cephalic versions?

Answer 15

37 wks gestation

Question 16

What are the complications of breech presentation?

Answer 16

C-section, cord prolapse, head entrapment, fetal hypoxia, placental abruption, birth trauma

Question 17

What are the indications for a vertical c-section?

Answer 17

few- low transverse is preferred
do vertical if fetus lies in transverse position, adhesions/fibroids prevent low transverse, cervical cancer is present, or post-mortem delivery of living fetus from dead mother
note that there is no VBAC or TOLAC for pts who have had a vertical c-section

Question 18

What are the indications for a c-section?

Answer 18

Mom: eclampsia (sometimes, though vaginal delivery usually preferred if possible), prior uterine surgery/prior C-section, cardiac disease of mom, obstruction of birth canal, maternal death, cervical cancer, active genital herpes,

baby: acute fetal distress, malpresentation, cord prolapse, macrosomia
both: failure to progress, placenta previa, placental abruption, cephalopelvic disproportion