Flashcards in 8/20/13 Lecture Deck (82):
WHat are 3 maternal changes before onset of labor?
Braxton Hicks Contractions
Increase cervical &/or Blood-tinged mucus "bloody show"
What three things are included in the initial evaluation?
Prenatal record review
Vitals signs (maternal and fetal heart tones)
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)
What is presentation?
Presenting part of the fetus in maternal pelvis. (usually the occiput)
What is the most typical positions for a baby to be delivered in?
left occiput transverse
right occiput transverse
What do you look at on a SVE (sterile vaginal exam)?
Effacement (shortening of the cervical canal)
What is the longest journey in a new mom?
What happens at the same time in a multigravida mom?
cervix effaces and dilates at the same time
Where is 0 station?
Where baby is at the ischial spines
What is anything above the spines?
A negative number
What are the 2 stages of the first stage of labor?
What is the latent phase of the first stage of labor?
Cervical effacement to 4 cm
What is the active phase of the first stage of labor?
Starts at 4-5 cm to 10 cm
What is the transition part of active phase?
Where they get to 8 cm to 10 cm
What is the second stage of labor?
Pushing and birth of the infant
What is the third stage of labor?
What is the fourth stage of labor?
Recovery 2 hours after placenta
What time frame should the placenta come out within?
What are the 7 mechanisms of labor?
restitution/ external rotation
In order for the baby to descend what must the baby do?
Flex their head
What is the mechanism of labor for descent beyond pelvic inlet?
What is the mechanism of labor where the small diameter of vertex presents into pelvis?
What is the mechanism of labor where the vertex goes deeper into the pelvis?
What is the mechanism of labor where the vertex reaches the introitus?
What is the mechanism of labor that occurs after delivery of the head. Rotation of shoulders are aligned with pelvic outlet?
Restitution/ external rotation
What is the mechanism of labor where there is birth of the anterior then posterior shoulder and then rest of the body?
What can occur in supine maternal position?
Obstructs venous return
What maternal position allows gravity to facilitate descent?
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
What is the most common position used in the US for spontaneous vaginal births (NSVD)?
Dorsal lithotomy (tilted to the left)
How is fetal heart rate monitored?
Intermittently by doppler (not as common)
or continuous EFM
What is a doulas?
helps a women relax and focus
What is a common nonnarcotic analgesia?
Stadol (not as common)
Is it better to give morphine or fentanyl for labor?
morphine has a longer 1/2 life and can lead to respiratory depression in mom and baby
In the first stage where is pain coming from?
Contraction of uterus and dilating cervix
In the second stage where does the pain come from?
Vagina and perineum stretching
compression of rectum
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
What is meconium that you are worried about the baby aspirating?
What begins during the 2nd stage of labor?
If a women is pushing, which is better- an open glottis or valsalva (holding breath)
Open glottis- more oxygen to baby
What is caput succedaneum?
edema that crosses the suture line
Are episiotomys common?
No, not a common intervention (get more 3rd and 4th degree extension, lacerations)
What is a ritgen maneuver?
during extension- apply pressure and lifting baby's chin
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
When is there the highest risk of PPH?
within the first hour
What are some uterotonins given? These help the uterus contract?
What degree laceration is skin, vaginal, subcutaneous, and muscles?
What degree laceration has anal and rectal spincter
what degree laceration involves vaginal mucosa, skin of the perineum, small labial and periurethral tear
What degree is there injury to the rectal mucosa?
fourth degree laceration
what are some maternal reasons for labor induction?
What are some fetal reasons for labor induction?
Oligohydramnios (small amount of amniotic fluid)
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)
What are the two types of cesarean delivery?
Classical Cesarean Section
What is LTCS?
Incision through the thin lower uterine segment allows for subsequent trials of VBAC
What is a classical cesarean section?
Incision through the thick, muscular upper portion of the uterus, risk of uterine rupture. TOLAC not recommended
Is TOLAC successful?
Usually 60-80% are. will have decreased success with dystocia, ARA (advanced reproductive age), obesity
What are the requirements for TOLAC?
One previous LTCS
24 hour availability of continuous EFM, OBGYN, anesthesia, and blood bank in case of emergency
What are the three factors involved in normal labor? (Three P's)
Passenger- Fetal factors
Passage- Maternal factors
What is the biggest reason for not making progress in labor?
Baby positioning (posterior is harder)
What are some more P's?
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
What is a protracted labor?
Making changes, but very slowly
<1 cm an hour
What is active phase arrest?
Several hours with no change
What is protracted descent?
Women making change with baby coming down, but its slow
What is an amniotomy (AROM)
Artificial rupture of membranes
What is direct traction on the fetal head with forceps or traction to the fetal skull with a vacuum extractor?
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
What are some risks with forceps?
Perineal trauma, hematoma, pelvic floor injury
Fetal brain spine, musculoskeletal, coreeal abrasion
What are some VAD risks?
Minimal compared to forceps
Fetal- hyperbilirubinemia, cephalohematomas, intracranial hemorrhage
what are some risks that can lead to breech presentation?
uterine anomalies and uterine tumors
What is the most common breech?
Frank breech (butt first)
wHat is a complete breech?
Sitting almost yoga style
What do you do for external cephalic version (ECV)?
pressure to the mother's abdomen to turn the fetus to vertex
Whom does ECV not work well on?
What are some risk of ECV?
What are some risks factor for shoulder dystocia?
h/o macrosomic fetus
previous h/o shoulder dystocia
What is the turtle sign? What does it indicate?
Baby starts to come out then retracts
sign of shoulder dystocia
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
What are four manuevers to help with shoulder dystocia?
Supra pubic pressure
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?