8/20/13 Lecture Flashcards Preview

ObGyn Lecture > 8/20/13 Lecture > Flashcards

Flashcards in 8/20/13 Lecture Deck (82):
1

WHat are 3 maternal changes before onset of labor?

Braxton Hicks Contractions
Lightening
Increase cervical &/or Blood-tinged mucus "bloody show"

2

What three things are included in the initial evaluation?

Prenatal record review
Vitals signs (maternal and fetal heart tones)
Focused history

3

What are the 4 keys things of a focussed history for intrapartum care?

UC's- how often, how long?
ROM/LOF- how much fluid leaking
VB- vaginal bleeding
Decreased FM (fetal movement)

4

What is presentation?

Presenting part of the fetus in maternal pelvis. (usually the occiput)

5

What is the most typical positions for a baby to be delivered in?

left occiput transverse
right occiput transverse

6

What do you look at on a SVE (sterile vaginal exam)?

Effacement (shortening of the cervical canal)
Dilation

7

What is the longest journey in a new mom?

Effacement

8

What happens at the same time in a multigravida mom?

cervix effaces and dilates at the same time

9

Where is 0 station?

Where baby is at the ischial spines

10

What is anything above the spines?

A negative number

11

What are the 2 stages of the first stage of labor?

Latent phase
Active phase

12

What is the latent phase of the first stage of labor?

Cervical effacement to 4 cm

13

What is the active phase of the first stage of labor?

Starts at 4-5 cm to 10 cm

14

What is the transition part of active phase?

Where they get to 8 cm to 10 cm

15

What is the second stage of labor?

Pushing and birth of the infant

16

What is the third stage of labor?

Placenta expulsion

17

What is the fourth stage of labor?

Recovery 2 hours after placenta

18

What time frame should the placenta come out within?

30 minutes

19

What are the 7 mechanisms of labor?

Engagement
Flexion
Descent
Internal rotation
Extension
restitution/ external rotation
explusion

20

In order for the baby to descend what must the baby do?

Flex their head

21

What is the mechanism of labor for descent beyond pelvic inlet?

Engagement

22

What is the mechanism of labor where the small diameter of vertex presents into pelvis?

Flexion

23

What is the mechanism of labor where the vertex goes deeper into the pelvis?

Internal rotation

24

What is the mechanism of labor where the vertex reaches the introitus?

Extension

25

What is the mechanism of labor that occurs after delivery of the head. Rotation of shoulders are aligned with pelvic outlet?

Restitution/ external rotation

26

What is the mechanism of labor where there is birth of the anterior then posterior shoulder and then rest of the body?

Expulsion

27

What can occur in supine maternal position?

Supine hypotension
Obstructs venous return

28

What maternal position allows gravity to facilitate descent?

upright position

29

What maternal position is where the uterus is off teh vena cava and allows for improved cardiac output and uteroplacental blood flow?

Left lateral position

30

What is the most common position used in the US for spontaneous vaginal births (NSVD)?

Dorsal lithotomy (tilted to the left)

31

How is fetal heart rate monitored?

Intermittently by doppler (not as common)
or continuous EFM

32

What is a doulas?

"female servant"
birthing coach
helps a women relax and focus

33

What is a common nonnarcotic analgesia?

Nubain
Stadol (not as common)

34

Is it better to give morphine or fentanyl for labor?

Fentanyl
morphine has a longer 1/2 life and can lead to respiratory depression in mom and baby

35

In the first stage where is pain coming from?

Contraction of uterus and dilating cervix

36

In the second stage where does the pain come from?

Vagina and perineum stretching
compression of rectum

37

What are the three things you do in the 1st stage of labor?

Serial pelvic exams
Observing for ROM (clear, meconium, or blood)
Support and encouragement

38

What is meconium that you are worried about the baby aspirating?

Lentil-like soup

39

What begins during the 2nd stage of labor?

Pushing

40

If a women is pushing, which is better- an open glottis or valsalva (holding breath)

Open glottis- more oxygen to baby

41

What is caput succedaneum?

edema that crosses the suture line

42

Are episiotomys common?

No, not a common intervention (get more 3rd and 4th degree extension, lacerations)

43

What is a ritgen maneuver?

Rare intervention
during extension- apply pressure and lifting baby's chin

44

What are 3 signs of placenta separation? (all of these are reassuring)

uterus rises in the abdomen becomes globular
Gush of blood
Lengthening of cord

45

When is there the highest risk of PPH?

within the first hour

46

What are some uterotonins given? These help the uterus contract?

Oxytocin
misoprostol
methergine
hemabate

47

What degree laceration is skin, vaginal, subcutaneous, and muscles?

second degree

48

What degree laceration has anal and rectal spincter

third degree

49

what degree laceration involves vaginal mucosa, skin of the perineum, small labial and periurethral tear

First degree

50

What degree is there injury to the rectal mucosa?

fourth degree laceration

51

what are some maternal reasons for labor induction?

HTN
Pre-ecclampsia
GDM

52

What are some fetal reasons for labor induction?

IUGR
potterm
Oligohydramnios (small amount of amniotic fluid)

53

What are 3 methods used for induction?

1. ROM or "stripping/sweeping" manipulate amniotic sac
2. Cervical ripening: Cook's catheter or foley bulb;(mechnaically dilates, helps release prostaglandins) misoprostol (potent E2 medication)
3. Oxytocin: incremental dose increases (cervix must first be ripened)

54

What are the two types of cesarean delivery?

LTCS
Classical Cesarean Section

55

What is LTCS?

Incision through the thin lower uterine segment allows for subsequent trials of VBAC
(most common)

56

What is a classical cesarean section?

Incision through the thick, muscular upper portion of the uterus, risk of uterine rupture. TOLAC not recommended

57

Is TOLAC successful?

Usually 60-80% are. will have decreased success with dystocia, ARA (advanced reproductive age), obesity

58

What are the requirements for TOLAC?

One previous LTCS
24 hour availability of continuous EFM, OBGYN, anesthesia, and blood bank in case of emergency

59

What are the three factors involved in normal labor? (Three P's)

Power= UC's
Passenger- Fetal factors
Passage- Maternal factors

60

What is the biggest reason for not making progress in labor?

Baby positioning (posterior is harder)

61

What are some more P's?

Preparation
Psyche
Pain
Partner
Position

62

For a nulliparous women, if it taken how many hours before reaching 4 cm when is dystocia considered?

Duration of over 20 hours in nulliparous
Duration of greater than 14 hours in multiparous

63

What is a protracted labor?

Making changes, but very slowly
<1 cm an hour

64

What is active phase arrest?

Several hours with no change

65

What is protracted descent?

Women making change with baby coming down, but its slow

66

What is an amniotomy (AROM)

Artificial rupture of membranes

67

What is direct traction on the fetal head with forceps or traction to the fetal skull with a vacuum extractor?

Operative delivery

68

When can you not do VAD?

Under 34 weeks
fetal head not in pelvis
position of fetal head unknown
suspected fetal bone demineralization or bleeding disorder

69

What are some risks with forceps?

Perineal trauma, hematoma, pelvic floor injury
Fetal brain spine, musculoskeletal, coreeal abrasion

70

What are some VAD risks?

Minimal compared to forceps
Fetal- hyperbilirubinemia, cephalohematomas, intracranial hemorrhage

71

what are some risks that can lead to breech presentation?

prematurity
multiple pregnancy
polyhydramnios
hydrocephaly
anencephaly
uterine anomalies and uterine tumors

72

What is the most common breech?

Frank breech (butt first)

73

wHat is a complete breech?

Sitting almost yoga style

74

What do you do for external cephalic version (ECV)?

pressure to the mother's abdomen to turn the fetus to vertex

75

Whom does ECV not work well on?

nulliparous women

76

What are some risk of ECV?

premature ROM
placental abruption
cord accident
uterine rupture

77

What are some risks factor for shoulder dystocia?

multiparity
obesity
postterm gestation
h/o macrosomic fetus
previous h/o shoulder dystocia

78

What is the turtle sign? What does it indicate?

Baby starts to come out then retracts
sign of shoulder dystocia

79

What is the McRobers manuever, what does it help?

Put legs to ears (as far up as possible)
improve diameter of pelvis, can help should dystocia

80

What are four manuevers to help with shoulder dystocia?

McRoberts
Supra pubic pressure
Rotational
Zavanelli

81

What is a maneuver where you have tried to get the baby out, doesn't work. So you push the baby back up then call for a C-section?

Zavanelli

82

What can happen with shoulder dystocia?

brachial plexus injury (90% resolve)