8. Normal Labor and Delivery Flashcards by Andrew Niemann

What is defined as progressive cervical dilation resulting from regular uterine contractions that occur at least every 5 minutes and last 30-60 seconds?

Labor

false labor= irregular contraction without cervical change

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The fetal skull has fontanelles which is connective tissue between the skull bones which allows for movement. The anterior fontanelle is diamond shaped and measures 2 by 3 cm, the posterior fontanelle is?

triangular shaped or Y shaped

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Cranial bones consist of occipital bone, 2 parietal bones and 2 front bones, the biparietal diameter is 9.5cm and the bitemporal diameter is?

8cm

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Match the following measurement with its match
Suboccipitobregmatic/Head wall flex
Occipitofrontal/Head deflexed/Occiput posterior
Supraoccipitomental/brow presentation
Submentobregmatic/face presentation
13.5cm
11cm
9.5cm
9.5cm

Suboccipitobregmatic/Head wall flex = 9.5cm
Occipitofrontal/Head deflexed/Occiput posterior = 11.5cm
Supraoccipitomental/brow presentation = **13.5cm (largest)
Submentobregmatic/face presentation = 9.5cm

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What is the MC type of pelvis, round at inlet, wide transverse diameter w slightly greater anteroposterior diameter, wide suprapubic arch, head rotates into occiput anterior (OA) position, Good prognosis?

Gynecoid

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What is the second MC type of pelvis, widest transverse diameter, prominent ischial spines, narrow pubic arch, occiput posterior position, amount space restricted, poor prognosis?

Android (male pelvis)

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What type of pelvis has much larger anteroposterior than transverse diameter, creates long narrow oval shape, narrow pubic arch, head engages only in anteroposterior diameter, in OP position, prognosis good?

Anthropoid (ape pelvis)

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What type of pelvis has a short AP and wide transverse diameter, wide bispinous diameter, wide suprapubic arch, head engaged transverse only, poor prognosis?

Platypelloid (flattened gynecoid pelvis)

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Diagnol conjugate determined by measuring from inferior portion of pubic symphysis to sacral promontory, if greater than 11.5 cm, AP diameter of pelvic inlet is ?

Adequate

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What conjugate is estimated by subtracting 2cm from the diagnol conjugate, it is the narrowest fixed distance through which the head must pass through during a vaginal delivery?

Obstetric Conjugate

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Pelvic outlet is assessed by measuring ischial tuberosities and pubic arch, measure between ischial tuberosities- 8.5cm+ is adequate for transverse diameter. What angle is measured by placing thumb next to each inferior pubic ramus and estimate angle at which they meet, >90 degrees is good?

Infrapubic Angle

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What is known as maternal spine to fetal spine, and determines if the infant is longitudinal, transverse or oblique?

Fetal Lie (fetal spine compared to maternal spine)

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What is the term for the presenting part of the fetus to the pelvis, termed vertex, breech, transverse or compound (vertex with hand)?

Fetal presentation

*vertex= head in pelvis/Breech= butt in pelvis

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What is a series of four maneuvers which involves …

palpating the fundus to determine fetal head vs butt
palpate for spine and fetal small parts
palpate presenting pelvis w suprapubic palpation
Palpate for cephalic prominence

Leopold Maneuvers

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A cervical exam consists of dilation- checking at internal os, effacement = thinning of cervix and recorded as % change in length, normal is 3-5cm, station is degree of descent of presenting part of fetus, measured from presenting part to ischial spines, bony head meets level of ischial spines the station is known as?

Zero! and ranges from -5 to +5

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Last part of the cervical exam is consistency and position, commonly used to calculate Bishop Score

MEOW

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SUMMARY MEOW SLIDE
1st stage: onset of labor to complete cervical dilation
2nd: complete dilation to delivery of infant
3rd: deliv of infant to deliv of placenta
4th: deliv of placenta to stabilization of pt

MEOW

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The latent phase of first stage is period between onset of labor and is characterized by slow cervical dilation, what phase is associated with faster rate of dilation and begins when cervix is dilated to 6cm-admit for labor?

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Active phase of 1st stage of labor

Duration of first stage for primiparas is typically 6-18 hours and dilate at a rate of 1.2 cm per hour. What about muliparas patients? (given birth before)

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last 2-10 hours

1.5cm per hour

managment for first stage of labor includes patient may walk or lie left lateral recumbent, IV fluids/meds, Labs, maternal monitoring and analgesia, what are the two options for fetal monitoring that are used?

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External monitoring

Internal monitoring

External fetal monitoring is usually continous or can but intermittent if preganacy is uncomplicated… q30min in active phase, q15 in 2nd stage. Intermittent in complicated preg should monitor q15 in active and q what in 2nd stage?

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q5 mins for complicated pregnancies in 2nd stage labor

In the first stage, uterine activity is monitor using an external tocodynamometer and internal pressure catheter (IUPC) which allows you to assess the strength of contractions (helpful w oxytocin = pitocin augmenation), vaginal exam q 2 hours in active phase, recorded as?

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dilation, effacement, station

What stage of labor is characterized by descent of the presenting part through the maternal pelvis = delivery, duration for primapara without epidural is 2 hours, with is 3 hours, what about for multipara women?

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Without epidural is 1 hour

with epidural is 2 hoours

Managment of second stage of labor: avoid supine maternal position, mother should bear down, vaginal exam to assess descent and confirm position, fetal monitoring - which is most common?

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Continuous
(q15min 2nd stage w no risk factors)
(q5mins 2nd stage w obstetric factors)

Managment of second stage of labor: avoid supine maternal position, mother should bear down, vaginal exam to assess descent and confirm position, fetal monitoring - which is most common?

Continuous (q15min 2nd stage w no risk factors) (q5mins 2nd stage w obstetric factors)

What procedure may be needed if a spontaneous laceration seems likely, or to expidite delivery by enlarging the vaginal outlet, either midline or mediolateral?

Episiotomy

What is the most commonly performed Episiotomy, greater risk of extension into third or fourth degree w less postpartum pain?

Midline Episiotomy

what Episiotomy has greater blood loss, is more difficult to repair, with more post partum pain and an increased risk of dyspareunia?

Mediolateral Episiotomy (use only if short distance from vag to bootyhole)

What manuever uses the fingers of the right hand to extend the head while counterpressure is applied to the occiput by the left hand to allow for a more controlled delivery? (manual support to perineum may be equally effective)

Modified Ritgen maneuver

Match the following First/Second/Third/Fourth Degree perineal laceration laceration extends into or completely through the anal sphincter but NOT into the rectal mucosa involves the rectal mucosa superficial laceration involving the vaginal mucosa or the perineal skin laceration extending into the muscles of the perineal body but does NOT involved the anal sphincter

3: laceration extends into or completely through the anal sphincter but NOT into the rectal mucosa 4: involves the rectal mucosa 1: superficial laceration involving the vaginal mucosa or the perineal skin 2: laceration extending into the muscles of the perineal body but does NOT involved the anal sphincter

What stage of labor is between infant delivery and placenta delivery where a retained placenta is diagnosed if placenta has not delivered in 30 minutes, apply counter pressure between symphysis and fundus, **DONOT pull cord until classic signs are noted?

Third stage of labor

Inappropriate cord pulling before classic signs of placental separation may result in uterine inversion... classic signs include gush of blood from vag, lengthening of umb cord, change in shape of uterin fundus from discoid to globular, and?

fundus of the uterus rises up

The fourth stage of labor one must monitor the patient, vitals, uterine fundal checks and asses for bleeding, postpartum hemorrhage commonly occurs during this time due to retained placenta, unrepaired vaginal lac or MC due to?

Uterine Atony (not contracting)

What has a goal to facilitate the process of cervical softening, thinning and dilating in hopes to reduce the rate of failed inductions?

Cervical Ripening | augmentation = artificial stimulation of labor which has already begun

What score gives you a number based on cervical dilation, effacement, consistency, position and station, less than 6 being unfavorable and more than 8 meaning the probabiliy of vaginal deliver after labor induction is similiar to that of spontaneous birth?

Bishop Score

What is a PGE2 analog as a vaginal insert and is CONTRAINDICATED in patients with previous cesarean sections?

Cervidil = Dinoprostone

What is a synthetic ocytocin which stimulates myometrial contractions, administered via IV, only FDA apporved drug for induction/augmentation, response occurs in 3-5 mins and steady level is acheived in plasma by 40 mins, dosed at 2mu/min and increase by 2mu q20-30 mins?

Pitocin

Complications of pitocin include uterine tachysystole (>5 contractions in a 10 minute period)**** MC, also has an antidiuretic effect causing increased water reabsorption and coma as well as increased risk of postpartum hemorrhage secondary to?

uterine atony (causes uterine muscle fatigue)

Uterine contractions and cervical dilation result in visceral pain from T10-T12-L1, descent of head/pressure in pelvic floor cause pain via pudendal nerve S2-S4. What anethesia refers to partial or complete loss of pain sensation below T10?

Regional Anesthesia (epidural or spinal)

What parenteral drugs are best for early first stage of labor where pain is more visceral and less intense- causes heavy sedation and crosses placenta and may lead to neonatal respiratory depression?

Parenteral Opioids: morphine, fentanyl, merperidine

What is the most effective form of pain relief used in women, a catheter is placed in spaec which allows for contunous infusion of anesthetic agents... large bore needle placed between L2-3/L3-4/L4-5?

Epidural (regional anethesia)

what regional anesthesia is a single shot analgesia which provides excellent pain relief for limited procedures (30-250 minutes)- limited use in labor since single shot?

Spinal (usually used for C-Section)

SE of regional anethesia is hypotension, headaches, fever, spinal hematomas and abscesses, contraindicated in maternal coagulopathy, bactermia, ICP d/t mass lesion or skin infection over?

area of needle placement

General anesthesia is usually with propofol, 16 fold increased risk of maternal mortality- cross placenta may cause resp distress in neonate, commonly performed for emergent cases with need for rapid delivery or when?

regional anesthesia has failed

8. Normal Labor and Delivery Flashcards

(44 cards)