Labor and delivery

Question 1

what is a bishop score? What makes it up?

Answer 1

Favorability of cervix for delivery
1. dilation (width)
2. effacement (thinning)
3. Station presenting fetus to ischial spine -2,-1,0,+1,+2
0 being the ischial spine
4. Consistency -soft/hard
5. position of the cervix-posterior or anterior

Question 2

What are some indicated reasons to induce labor?

Answer 2

ROM, IUFD, preeclampsia, chorioamnionitis, oligohydramnios, Rh factor

Question 3

Contraindications to induce?

Answer 3

nonreassuring fetal status NRFS, hypoxia, non cephalic lie (breech, transverse), vertical uterine scar, placenta previa

Question 4

What should you do to prevent a placental rupture if you have a patient who had placenta previa in the second trimester present in labor?

Answer 4

Do an ultrasound to determine where the placenta is before inserting anything into her vagina. Many patients have early previa that resolves. If still an issue do a c-section.

Question 5

How do you determine a stress test from a non stress test?

Answer 5

contractions either induced or natural

Question 6

How do you interpret fetal NST and stress test?

Answer 6

NST-FHR will accelerate with movement, you want the test to be reactive (HR) a few times during a 20 min period. If nonreactive at 40 min may indicate; sleep, narcotics, CNS depression acidosis, immature autonomics.

Question 7

What’s the next step after a non reactive NST?

Answer 7

A biophysical profile (BPP) takes other variables into account. A modified version includes the amniotic fluid volume (5-25) into account along with the NST.

Question 8

When is amniotic fluid low, naturally and abnormally? High?

Answer 8

natural-near term, or past term
abnormal-oligohydramnios from ROM, suggestive of fetal growth restriction (smoking, RX, twins),

Polyhydramnios-duodinal atresia, TEF, diabetes

Question 9

What do early late and variable decelerations indicate?

Answer 9

early- reassuring

late Insufficiency, hypoxia, meconium,
abruption=concerning

variable-Cord compression (nuchal, prolapse, knot), though it can be normal if it returns to baseline; maybe secondary to oligohydramnios

Question 10

Name the cardinal movements involved with the first and second stage of labor

Answer 10

stage 1 labor onset until full cervical dilation 
engagement
decent
flexion
internal rotation (face down)

stage 2 dilation to expulsion “pushing” 20-50 mins
extension
external rotation
expulsion

Question 11

What chemical release facilitates labor following ROM or sexual activity?

Answer 11

Prostaglandin release which ripens the cervix and can allow the fetal head to compress the cervix. It also stimulates uterine contractions.

Question 12

You deliver your first baby which comes out green what do you need to worry about?

Answer 12

Meconium aspiration syndrome, try to thin out the meconium with amnioinfusion during labor

Question 13

You saw your attending physician invert a woman uterus, how can you prevent yourself from doing the same?

Answer 13

Hold down the uterus while trying to remove the placenta. usually takes about 2-5 mins but don’t pull to hard or you could also rupture an accreta

Question 14

What’s the fourth stage of labor?

Answer 14

1hr after delivery

Question 15

What are the four degrees of vaginal lacerations?

Answer 15

1. vaginal membrane
2. • perineal body and skin
3. • anal sphincter
4. • rectal mucosa

Question 16

What is dystocia and what are the three important components of it?

Answer 16

Change with fetal presentation and the birth canal
power-weak contractions or effort
passage-contracted pelvis, or blocking tissues
passenger-big baby, abnormal presentation, multiple kids

Question 17

What are protraction and arrest disorders related to the friedman curve?

Answer 17

Protraction disorder-slow dilation and decent in active phase

Arrest disorder-NO dilation or decent for 2-4hrs in active phase

Question 18

Interventions for first stage dystocia include what?

Answer 18

oxytocin-power
decrease epidural-power
change position-passage/power

Question 19

What the hell are montevideo units?

Answer 19

measure of contraction force via intrauterine catheter

>200 adequate for most labor progression

Question 20

Second stage dystocia can last as long as 4hrs. Failure to descend can be from passage size or presentation. What can you do as a provider to facilitate a vaginal birth?

Answer 20

vacuum extraction indicated during second stage arrest or exhaustion. C/I if not 2+ station, unknown position of 3 tries rule. Same rules for forceps

Question 21

What are the signs of shoulder dystocia and why is this an issue? Where should you press to help with the delivery?

Answer 21

Turtle sign come out and then draw back
press on pubic symphysis not funds

complicaitons-brachial plexus injury, fractured clavicle or hypoxia, death, erbs palsy

Question 22

What a VBAC, yes the VBAC not the WAYBACK

Answer 22

vaginal birth after c-section

Rupture risk is low with transverse scar, but not vertical

Question 23

How long does the postpartum period last?

Answer 23

6 wks

Question 24

Your patient comes to the clinic 6 days after delivery with a fever of 100.8. She says it was 100.6 about 6 hrs prior and thinks she might be getting a cold. What are the primary concerns that you need to rule out?

Answer 24

7 Ws

wind-atelectasis, pneumonia
water-UTI
womb-endometritis 
wound-cellulitis, hematoma
walking-DVT
weaning-acute mastitis
wonder drug-drug fever

Question 25

What’s lochia?

Answer 25

not a lotion you want; contents of vaginal discharge after birth

Question 26

When do you start a woman on contraceptives postpartum?

Answer 26

6wks IUD (progesterone only), E/P non nursing mothers 
usually this is when you have your first office visit unless they have other complications.

Question 27

How do you help a woman suppress lactation?

Answer 27

Compression, ice, no stimulation, analgesics; may take a few weeks.

Question 28

Mia is has PPH and is told that she needs to be treated for its most common cause. What Rx will she be prescribed?

Answer 28

Carboplast for uterine atony

Question 29

Describe acute and delayed PPH signs

Answer 29

Acute-less than 24hrs post delivery, 90% PPH occurs at this time and involves heavy bleeding

Delayed-24hrs-12wks, usually bleeding is less heavy; infection, RPOC

Question 30

What causes uterine atony? Name some other causes of PPH

Answer 30

Atony-overdistension from big baby, polyhydramnios, chorioamnionitis, inversion, RPOC, uterine fatigue, narcotics

Abnormal placentation-accreta
Trauma-uterine rupture, episiotomy (1-4th degree)
Coagulopathies

Question 31

What are some systemic effects of PPH?

Answer 31

Sheehan syndrome, Renal failure, Shock, DIC, ARDS

Question 32

You’re rounding on a patient 4 days after their delivery of a baby boy. They’re staying a bit longer b/c the baby has jaundice. You noticed the patient taking a OCP that she states she wants to get back on quickly. At the same time she’s complaining of a pain and swelling in her upper thigh. How should you proceed.

Answer 32

This pain maybe from a DVT secondary to starting her OCP earlier than 6 wk recommended waiting period following pregnancy. Do a U.S. of the leg and if confirmed start on LMWH and warfarin.

Question 33

Vichows triad

Answer 33

stasis hypercoagulability trauma

Question 34

Pulmonary embolism symptoms

Answer 34

SOB, cough, hemoptysis, syncope

Question 35

What presentation postpartum is similar to PE but involves the heart?

Answer 35

Cardiomyopathy

dyspnea, cough, orthopnea, abdominal pain, chest discomfort, dizzy

Question 36

What’s the difference between postpartum blue vs psychosis?

Answer 36

Blue/depression early onset lasts about 2 wks, can be made worse by loss of a child, malformation, lack of financial or emotional support

psychosis is characterized by delusions, confusion, suicidal or infanticidal ideations, prior hx of depression postpartum, stoping lithium treatment for bipolar disorder (b/c it can harm the fetus [ebsteins anomaly], but patient should get back on it after delivery)