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ObGyn Lecture > 8/20/13 Lecture > Flashcards

8/20/13 Lecture Flashcards

1
Q

WHat are 3 maternal changes before onset of labor?

A

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

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2
Q

What three things are included in the initial evaluation?

A

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

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3
Q

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

A

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

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4
Q

What is presentation?

A

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

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5
Q

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

A

left occiput transverse

right occiput transverse

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6
Q

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

A

Effacement (shortening of the cervical canal)

Dilation

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7
Q

What is the longest journey in a new mom?

A

Effacement

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8
Q

What happens at the same time in a multigravida mom?

A

cervix effaces and dilates at the same time

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9
Q

Where is 0 station?

A

Where baby is at the ischial spines

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10
Q

What is anything above the spines?

A

A negative number

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11
Q

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

A

Latent phase

Active phase

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12
Q

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

A

Cervical effacement to 4 cm

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13
Q

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

A

Starts at 4-5 cm to 10 cm

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14
Q

What is the transition part of active phase?

A

Where they get to 8 cm to 10 cm

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15
Q

What is the second stage of labor?

A

Pushing and birth of the infant

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16
Q

What is the third stage of labor?

A

Placenta expulsion

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17
Q

What is the fourth stage of labor?

A

Recovery 2 hours after placenta

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18
Q

What time frame should the placenta come out within?

A

30 minutes

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19
Q

What are the 7 mechanisms of labor?

A 
Engagement
Flexion
Descent
Internal rotation
Extension
restitution/ external rotation
explusion
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20
Q

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

A

Flex their head

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21
Q

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

A

Engagement

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22
Q

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

A

Flexion

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23
Q

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

A

Internal rotation

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24
Q

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

A

Extension

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25
Q

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

A

Restitution/ external rotation

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26
Q

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

A

Expulsion

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27
Q

What can occur in supine maternal position?

A

Supine hypotension

Obstructs venous return

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28
Q

What maternal position allows gravity to facilitate descent?

A

upright position

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29
Q

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

A

Left lateral position

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30
Q

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

A

Dorsal lithotomy (tilted to the left)

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31
Q

How is fetal heart rate monitored?

A

Intermittently by doppler (not as common)

or continuous EFM

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32
Q

What is a doulas?

A

“female servant”
birthing coach
helps a women relax and focus

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33
Q

What is a common nonnarcotic analgesia?

A 
Nubain
Stadol (not as common)
34
Q

Is it better to give morphine or fentanyl for labor?

A

Fentanyl

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

35
Q

In the first stage where is pain coming from?

A

Contraction of uterus and dilating cervix

36
Q

In the second stage where does the pain come from?

A

Vagina and perineum stretching

compression of rectum

37
Q

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

A

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

38
Q

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

A

Lentil-like soup

39
Q

What begins during the 2nd stage of labor?

A

Pushing

40
Q

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

A

Open glottis- more oxygen to baby

41
Q

What is caput succedaneum?

A

edema that crosses the suture line

42
Q

Are episiotomys common?

A

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

43
Q

What is a ritgen maneuver?

A

Rare intervention

during extension- apply pressure and lifting baby’s chin

44
Q

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

A

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

45
Q

When is there the highest risk of PPH?

A

within the first hour

46
Q

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

A

Oxytocin
misoprostol
methergine
hemabate

47
Q

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

A

second degree

48
Q

What degree laceration has anal and rectal spincter

A

third degree

49
Q

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

A

First degree

50
Q

What degree is there injury to the rectal mucosa?

A

fourth degree laceration

51
Q

what are some maternal reasons for labor induction?

A

HTN
Pre-ecclampsia
GDM

52
Q

What are some fetal reasons for labor induction?

A

IUGR
potterm
Oligohydramnios (small amount of amniotic fluid)

53
Q

What are 3 methods used for induction?

A
  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
Q

What are the two types of cesarean delivery?

A

LTCS

Classical Cesarean Section

55
Q

What is LTCS?

A

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

56
Q

What is a classical cesarean section?

A

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

57
Q

Is TOLAC successful?

A

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

58
Q

What are the requirements for TOLAC?

A

One previous LTCS

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

59
Q

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

A

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

60
Q

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

A

Baby positioning (posterior is harder)

61
Q

What are some more P’s?

A 
Preparation
Psyche
Pain
Partner
Position
62
Q

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

A

Duration of over 20 hours in nulliparous

Duration of greater than 14 hours in multiparous

63
Q

What is a protracted labor?

A

Making changes, but very slowly

<1 cm an hour

64
Q

What is active phase arrest?

A

Several hours with no change

65
Q

What is protracted descent?

A

Women making change with baby coming down, but its slow

66
Q

What is an amniotomy (AROM)

A

Artificial rupture of membranes

67
Q

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

A

Operative delivery

68
Q

When can you not do VAD?

A

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

69
Q

What are some risks with forceps?

A

Perineal trauma, hematoma, pelvic floor injury

Fetal brain spine, musculoskeletal, coreeal abrasion

70
Q

What are some VAD risks?

A

Minimal compared to forceps

Fetal- hyperbilirubinemia, cephalohematomas, intracranial hemorrhage

71
Q

what are some risks that can lead to breech presentation?

A 
prematurity
multiple pregnancy
polyhydramnios
hydrocephaly
anencephaly 
uterine anomalies and uterine tumors
72
Q

What is the most common breech?

A

Frank breech (butt first)

73
Q

wHat is a complete breech?

A

Sitting almost yoga style

74
Q

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

A

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

75
Q

Whom does ECV not work well on?

A

nulliparous women

76
Q

What are some risk of ECV?

A

premature ROM
placental abruption
cord accident
uterine rupture

77
Q

What are some risks factor for shoulder dystocia?

A 
multiparity
obesity
postterm gestation
h/o macrosomic fetus
previous h/o shoulder dystocia
78
Q

What is the turtle sign? What does it indicate?

A

Baby starts to come out then retracts

sign of shoulder dystocia

79
Q

What is the McRobers manuever, what does it help?

A

Put legs to ears (as far up as possible)

improve diameter of pelvis, can help should dystocia

80
Q

What are four manuevers to help with shoulder dystocia?

A

McRoberts
Supra pubic pressure
Rotational
Zavanelli

81
Q

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?

A

Zavanelli

82
Q

What can happen with shoulder dystocia?

A

brachial plexus injury (90% resolve)

ObGyn Lecture (21 decks)

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