Lecture 8: Labor & Delivery

Question 1

What are the 6 cardinal movements of labor in order?

Answer 1

1. Engagement
2. Descent
3. Flexion
4. Internal Rotation
5. Extension
6. External Rotation

Question 2

What is Stage 1 of labor?
Name of the 2 phases?

Which comes first: dilation or effacement?

Answer 2

Dilation + Thinning of cervix
- latent and active phase

effacement–> dilation –> pain

Question 3

Difference b/t latent and active phase in Stage 1 of labor?

Answer 3

Active
- minimal dilation

Latent

• more rapid dilation
• occurs at 4-6 cm

Question 4

What is consider Stage 2 of labor? Stage 3?

What is another name for Stage 4?

Answer 4

2- Full dilation to delivery

3- Delivery of baby to delivery of placenta

4 - Puerperium period

Question 5

What are the 3 P’s of delayed labor?

Answer 5

1. Power - weak contractions (give oxytocin)
2. Passenger - large fetus
3. Pelvis - small

Question 6

For Operative/Assistive delivery:

which has more failure and which has more injury…. forceps or vacuum

Answer 6

more failure = vacuum

more injury = forceps

Question 7

3 indications for Operative/assistive delivery?

Answer 7

1. prolonged or shortened Stage 2 labor
2. immed/impending fetal compromise
3. breech vaginal delivery

Question 8

What the main indication for C-section

Others:

1. labor dystocia
2. Fetal distress
3. Placenta previa

Answer 8

main = breech presentation

Question 9

Which is the preferred/best type of C-section d/t less complications?

Answer 9

Low transverse Cesarean delivery (lowest)

Question 10

3 indications for emergent C-section (baby out in 5 min)

Answer 10

1. fetal distress
2. risk of hemorrhage
3. abruption

Question 11

Why should you not allow pregnancy to continue > 42 wks? (2 wks past due date)

Answer 11

increased perinatal and maternal mortality

Question 12

3 methods for cervical ripening

Answer 12

1. PGE 1 or 2
2. Transcervical Foley
3. Laminaria

Question 13

Puerperium period (6 wks after delivery)

1. what happens to uterus?
2. what happens to vaginal tone?
3. When does menstruation usu return?
4. CV: what occurs immed, gradually?
5. What psychosocial changeis norm? abn?

Answer 13

1. uterus involutes
2. gradual return of vaginal tone
3. menstruation 6-8 wks later
4. CV
   - immed incr in PVR
   - gradual return to norm CO and plasma vol
5. norm = postpartum blues
   abn = depression

Question 14

Immunologic advantage for breastfeeding infant?

3 adv for breastfeeing mother?

Answer 14

Passive immunity (mostly IgA) –> gut protection

Mother

1. decr depression
2. wt loss
3. uterine involution –> less hemorrhage/anemia

Question 15

What is the difference in color of early vs mature milk?

Other name for early milk

Answer 15

early milk = colostrum
- yellow

mature milk
- white

Question 16

What stimulates milk let down and production? how?

Answer 16

suckling –> oxytocin & PRL secretion

Question 17

What are the 4 complications of lactation?

Answer 17

1. Suppression
2. Mastitis
3. Nipple problems - cracking, thrush
4. Infant drug exposure

Question 18

Complications of Lactation:

Is pharm Tx recommended for Suppression of lactation

What is mastitis d/t

Answer 18

Pharm Tx NOT recommended for suppression (risk > benefit)

mastitis d/t too much milk supply

Question 19

What 3 meds suppress lactation

1 drug that incr lactation

Answer 19

Suppress lactation

1. Bromocriptine
2. Pseudoephedrine
3. Estrogen contraceptives

Domperidone incr lactation

Question 20

Meds that impact the infant: what does each cause?

1. Narcotics
2. Nitrofurantin

When are NSAIDs CI/why? safe?

Answer 20

1. Narcotics –> sedation
2. Nitrofurantin –> G6PD defic –> +/- hemolytic anemia

NSAIDs CI during preg –> premature closure of PDA
- safe for breastfeeding