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OB-gyn > Beckman Intrapartum Care > Flashcards

Beckman Intrapartum Care Flashcards

1
Q

Define Braxton Hicks contractions

A

Spontaneous uterine contractions occurring throughout pregnancy not usually felt by pt. Late in pregnancy they become stronger and more frequent = pts perception of discomfort. FALSE LABOR

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2
Q

Are Braxton Hicks contractions association with dilation of cervix?

A

No, and thus do not fit the definition of labor

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3
Q

Why can’t a physician determine true onset of labor by hx alone?

A

Braxton Hicks contractions can appear like it to pt

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4
Q

True Labor is associated with contractions that the patient feels over the ___ ____, with radiation of discomfort to ____ and ____

A

over the uterine fundus; radiation to low back and lower abdomen

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5
Q

“Lightening”, when referring to an event of late pregnancy

A

pt reports change in shape of her abdomena nd sensation that the baby is lighter, the result of fetal head descending into the pelvis (“Dropping”)

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6
Q

What sxs is “Lightening” ass. with

A

lower abdomen more prominent, increase need to urinate (bladder compressed by fetal head), breathing is easier (less P on diaphragm)

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7
Q

what is the “bloody show”

A

pt reports passage of blood-tinged mucus late in pregnancy; results as cervix begins to efface

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8
Q

when does cervical effacement occur?

A

it is common before onset of true labor, particularly in nulliparous pts

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9
Q

When to contact health care provider for evaluation of labor?

A
  1. contractions occur every 5 min for at least 1 hour
  2. if there is a sudden gush of fluid/constant leakage of vaginal fluid (ROM)
  3. significant vag bleeding
  4. dec in fetal movement
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10
Q

4 leopold manuevers

A
  1. determine whats in the fundus
  2. evaluate fetal back and extremities
  3. palpation of presenting part above symphisis
  4. determine direction/degree of flexion of head (cephalic prominence)
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11
Q

does vertex position increase or decrease chances of vaginal delivery?

A

Increases. We do ECV (external cephalic version) to turn fetus into a vertex presentation

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12
Q

who is a candidate for External Cephalic Version (convert breech to vertex) and why?

A

Pts who have completed 36 weeks are pref. 1. if spontaneous version is gonna happen, its by 36 2. risk of spontaneous reversion is decreased after term ECV

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13
Q

Selection criteria (except for gestational age) for ECV

A

Normal fetus with reassuring fetal heart tracing, adequate amniotic fluid, presenting part not in the pelvis

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14
Q

Risks of ECV

A

PROM, Placental abruption, cord accident, uterine rupture

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15
Q

criteria for vaginal breech delivery (but mostly we’ll do section)

A
  1. normal labor curve
  2. gest. age >37weeks
  3. Frank or complete breech
  4. No fetal anomalies on US
  5. adequate pelvis
  6. EFW of 2500-4000g
  7. Documentation of fetal head flexion
  8. Adequate amniotic fluid volume (3cm pocket)
  9. Availability of anesthesia/neonatal support
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16
Q

antepartum conditions ass. with shoulder dystocia:

A

multipartiy, postterm gestation, previous hx macrosomic birth, previous hx shoulder dystocia

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17
Q

is elective induction/elective section for all women suspected of carrying a fetus with macrosomia appropriate (prevention of shoulder dystocia, which arrests expulsion)?

A

NO

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18
Q

Which helps delivery when there is shoulder dystocia, suprapubic pressure or fundal pressure?

A

Suprapubic.

Fundal pressure may worsen impaction of shoulder and can result in uterine rupture

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19
Q

Brachial plexus injury is ass. with:

A

shoulder dystocia (most cases resolve).

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20
Q

procedures used to relieve shoulder dystocia

A

McRoberts: Hyperflex/abduct hips tight to the abdomen + suprapubic pressure

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21
Q

Shortening of the cervical canal from length of 2cm to small orifice with paper-thin edges

A

Effacement

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22
Q

Zero station

A

when presenting part has reached the level of the ischial spines

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23
Q

At which station has the greatest transverse diameter of the fetal skull negotiated the pelvic inlet

A

0 Station. This is when the fetal head is “engaged”

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24
Q
  • and + station relative to the ischial spines
A 
- = above
\+ = below
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25
Q

what is the 4th stage of labor

A

immediate postpartum period of approx. 2 hours after delivery of placenta

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26
Q

7 cardinal movements

A
  1. Engagement (0 station)
  2. Flexion
  3. Descent
  4. Internal Rotation
  5. Extension
  6. External rotation (restitution)
  7. Expulsion
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27
Q

the supine ___ ___ position keeps uterus off the IVC to prevent ____ ____ _____

A

left lateral position ;

Supine Hypotensive Syndrome

28
Q

which position is most commonly used for spontaneous and operative vaginal delivery in the US?

A

Dorsal Lithotomy position

29
Q

Which saline do we use?

A

typically 1/2 normal saline or D5 1/2 normal saline

30
Q

Combined spinal-epidural greatly decreases the risk of:

A

spinal headache; sympathetic blockade (hypotension); motor blockade

31
Q

complications of general anesthesia

A

maternal aspiration, neonatal depression

32
Q

why is pushing discouraged during the latter portions of the first stage of labor

A

to avoid traumatic swelling of the cervix caused by attempting to force the fetus through an incompletely dilated cervix

33
Q

when can mom start pushing?

A

once second stage of labor reached (fully dilated)

34
Q

term for edema of the fetal scalp caused by pressure on the fetal head by the cervix

A

Caput succedaneum

35
Q

2 most common causes of overestimation of the amount of decent (station)

A

Molding (alteration in relation of the fetal cranial bones)

and Caput succedaneum. both in labor stage 2, both resolve within few days

36
Q

is routine use of episiotomy recommended?

A

No, may lead to an increase in the risk of 3rd and 4th degree perineal lacerations and a delay in pts resumption of sexual activity

37
Q

3 classic signs of placental separation

A
  1. Uterus rises in the abdomen (indicating placenta has sep and entered lower uterine segment) = globular configuration
  2. Gush of blood
  3. Lengthening of umbilical cord
38
Q

why are cervical ripening agents (misoprostol/PGE2) contraindicated in pts with previous c-section or uterine surgery?

A

increased risk of uerine hyperstimulation

39
Q

Advantages of a successful vaginal delivery

A
  1. Lower risk of hemorrhage/infection
  2. shorter postpartum stay
  3. less painful, more rapid recovery
40
Q

why isnt c-section by maternal request recommended for women desiring several children?

A

increased risks of placenta previa, accreta, and gravid hysterectomy with each section

41
Q

which section of uterus do you do section through to allow for subsequent VBAC

A

the thin, lower uterine segment

vs classical section, through the thick muscular upper portion…risk of uterine rupture next time

42
Q

Do women who have GBS bacteruria in current pregnancy, or have previously given birth to neonate with early-onset GBS require GBS cultures?

A

No…give antibiotic during labor

43
Q

universal screening for GBS

A

recto-vaginal culture at 35-37 weeks

44
Q

what should you consider if IUPC is placed and significant amount of blood/amniotic fluid is seen

A

Placenta separation or uterine performation. Withdraw catheter, monior fetus, if reassuring place catheter again.

45
Q

cause of early decels

A

head compression

46
Q

cause of variables

A

cord compression (oligo increases risk)

47
Q

cause of late decels

A

uteroplacental insufficiency

48
Q

leading indication for primary cesarean

A

labor dystocia aka abnormal labor

49
Q

3 P’s of dystocia

A

Power (uterine contractions)

Passenger (position, size, or presentation of the fetus)

Passage (pelvis or soft tissues)

50
Q

how much pressure must each uterine contraction generate in order for cervical dilation and fetal descent to occur

A

minimum 25mmHg above basebline. Optimal intrauterine pressure is 50-60mmHg.

51
Q

how to calculate Mentevideo unit (another measure of contractile strength)

A

of uterine contractions in 10 minutes x average intensity (normal progress of labor ass. with 200 or more MVU)

52
Q

Protraction vs arrest (labor)

A

Protraction: labor slow to progress; Active and Latent phases

Arrest: ceases; Active only

53
Q

how long is prolonged latent phase? does this predict abnormal active phase?

A

20 hours (primip) or 14 hours (multip); Not necessarily

54
Q

whats prolonged active labor

A

cervix dilates less than 1cm/hr in primip, 1.5 in multip

55
Q

What is augmentation and how is it achieved

A

Stimulation of uterine ctxs when spontaneous ctxs fail to result in progressive cervical dilation/fetal descent. Amniotomy (AROM) + Pit

56
Q

What freq/intensity of contractions should you consider augmentation?

A

Freq< 3/10min; intensity <25mmHg above baseline

57
Q

Risks of amniotomy

A

FHR decels due to cord compression; increased incidence of chorio

58
Q

Adequate ctxs (and adequate is what is ideal)

A

max 5 ctxs/10 min with resultant dilation; or >200 MVUs if using IUPC

59
Q

No descent after 1 hour of pushing

A

second-stage arrest

60
Q

conditions ass. with breech

A

multipel pregnancy, polyhydramnios, hydrocephaly, anencephaly, aneuploidy, uterine anomlies, and uterine tumors

61
Q

most common cause of Fetal Tachycardia

A

Chorio

can also be caused by maternal fever, thyrotoxicosis, medication, fetal arrythmia

62
Q

what can you do to relieve umbilical cord compression in cases of oligo

A

Amnioinfusion

63
Q

4 techniques to stimulate fetus (and get an accel)…each of these rule out acidosis when accel follows stim

A
  1. Fetal scalp sampling
  2. allis clamp scalp stimulation
  3. digital scalp stim
  4. vibroacoustic stim
64
Q

initial measures for managing concerning decels

A

Left lateral postion, administer oxygen, correct maternal hypotension, discontinue oxytocin . Can also use tocolytics to prevent umbilical cord compression. uterine tachyststole can be treated with beta-adrenergics.

65
Q

meconium is composed of:

A

amniotic fluid, lanugo, bile, fetal skin and intestinal cells

66
Q

is meconium dangerous

A

yes but present in 10-20% of births and most neonates don’t develop problems

67
Q

meconium aspiration syndrome

A

inhaalation of meconium; occurs in 6% of meconium present births. Amnioinfusion should NOT be used as a preventive measure.

OB-gyn (16 decks)

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