CF: 1-5 Flashcards by No Name

26 yo G1P0 woman at term with an adequate pelvis on clinical pelvimetry, nonimmune rubella status, is in labor. Her cervix has changed from 4 to 7 cm dilation over 2 hr w/ uterine contractions noted every 7-10 min.
Next step in management?

Continue to observe labor

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Define latent phase of labor. Usually how many cm?

Initial part where cervix mainly effaces (thins) rather than dilates. Typically <4 cm dilation

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Define active phase of labor. Usually how many cm?

Part of labor where dilation happens more rapidly. Cervix typically >4 cm (but not 10)

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Define protraction of the active phase

Cervical dilation in the active phase that’s less than expected. Normals:

> /= 1.2 cm/hr in nulliparous
> /= 1.5 cm/hr in woman w/ at least 1 vag delivery

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Define arrest of active phase

No progress in active phase of labor for 2 hr

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Normal FHR?

110-160 bpm w/ accel and variability

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Define FHR acceleration

Episodes of FHR that increase above the baseline of at least 15 bpm and for at least 15 sec

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Normal duration of latent phase for nullipara vs multipara?

NP: </= 14 hr

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Normal duration of second stage for nullipara vs multipara?

NP: </= 1 hr (2 w/ epidural)

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Normal duration of third stage for nullipara vs multipara?

</=30 min for both

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What are the 3 P’s?

Powers
Passenger
Pelvis

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What is prolonged latent phase?

Latent phase >ULN

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2 definitions of adequate uterine contractions?

At least 200 MVU in a 10 min window

2. Contractions every 2-3 min, firm on palpation, lasting for at least 40-60 seconds

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If powers are thought to be inadequate, what drug can you start?

Oxytocin

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What are the MC type of decel and what causes them?

Variable

Cord compression

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How do you handle intermittent variable decel w/ abrupt return to baseline?

Obs

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What causes early decelerations? Are they benign or scary?

Fetal head compression

Benign

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Which type of decel is “offset” from the uterine contraction w/ their onset after the onset of the contraction?

Late decel

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What do late decels represent? What about if they’re recurrent (>50% of contractions)?

Uteroplacental insufficiency–> Fetal hypoxia

If recurrent, concern for fetal acidemia

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In arrest or protraction of active phase, what’s the major indication for C/S?

Cephalopelvic disproportion

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Define the 3 categories of FHR patterns

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Category 1: reassuring: normal baseline and variability, no late or variable decels
Category 2: may have some aspect that’s concerning but not ominous
Category 3: ominous, indicates a high likelihood of severe fetal hypoxia

What type of pelvis is defined as a pelvis w/ AP diameter > transverse diameter w/ prominant ischial spines and a narrow anterior segment?

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Anthropod pelvis

Define 0 station

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When presenting part is right at the plane of the ischial spines

How do you distinguish btwn bloody show and antepartum bleeding?

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Bloody show will have sticky mucus admixed with blood, while antepartum bleeding won’t

Which type of decels are mirror images of uterine contractions?

Early decels

Which type of decels are abrupt in decline and abrupt in resolution?

Variable decels

29 yo G2P1 woman at 20 wk gestation comes for routine prenatal care. On exam, BP is 100/60, HR 80 bpm, temp normal. Hb is 9.5 w/ elevated HbA2. Most likely Dx? Underlying mechanism?

Anemia 2/2 beta thal minor | Decreased beta globin chain production

31 yo G4P3 woman has normal SVD of baby and after slight lengthening of the cord, a reddish shaggy mass is noted bulging in the introitus. Most likely Dx? Most likely Cpx?

Uterine inversion | Postpartum hemorrhage

25 yo obese G2P1 woman is delivering at 42 wk gestation. The fetus appears clinically to be 3700 g (average weight). After a 4 hr 1st stage of labor and a 2 hr second stage of labor, the head delivers, but the shoulders don't easily deliver. Next step in management? Likely complication (1 maternal and 1 neonatal)? Predisposing maternal condition?

- McRoberts maneuver: hyperflexion of the maternal hips onto the maternal abdomen +/- subrapubic pressure - Postpartum hemorrhage - Brachial plexus injury - GDM

22 yo G3P2 woman at term is in labor w/ a cervical dilation of 5 cm. Vertex is at -3 station. Upon AROM, persistent fetal bradycardia to 70-80 bpm range is noted for 3 min. Next step?

Vaginal exam to assess for umbilical cord prolapse

Treatment of mild microcytic anemia in pregnant woman w/o RF for thalassemia?

Trial of iron + recheck h/h in 3 wk

Next step for mild microcytic anemia in pregnant woman who didn't respond to iron trial?

Iron studies + HFE

Hb less than ____ qualifies as anemia in pregnancy? | -Define mild vs severe

Why can babies with beta thal appear healthy at birth?

HbF is present

Pregnant women with sickle cell disease will have worsening and/or incr freq of what 4 complications?

1. Anemia 2. Pain crisis 3. Infections 4. Pulm Cpx

Name two fetal complications with incr risk in pregnant women with sickle cell disease. How do you monitor for these?

1. IUGR 2. Perinatal mortality Serial US

Major cause of megaloblastic anemia in pregnancy?

Folate deficiency

Which two meds commonly used for UTIs in pregnancy could cause hemolysis in G6PD deficient women?

1. Nitrofurantoin | 2. TMP-SMX

Anemia w/ elevated A2 suggests?

beta thal

Anemia w/ elevated HbF suggests?

alpha thal

4 signs of placental separation?

1. Gush of blood 2. Lengthening of the cord 3. Firm, globular uterus 4. Uterus rises up to anterior abdominal wall

In uterine inversion, what's the reddish bulging shaggy mass seen adjacent to the placenta?

Endometrial surface (shaggy= big clue)

MCC of uterine inversion?

Undue traction on the cord before complete placental separation

What defines an abnormally retained placenta?

3rd stage of labor >30 min

Name 4 RFs for uterine inverion

1. Undue traction on the cord before complete placental separation 2. Grand multiparosity 3. Placenta accreta 4. Placenta implantation in uterine fundus

1st step in treating uterine inversion?

Secure 2 large bore IV lines! Remember that even with proper tx, profuse hemorrhage is almost certain.

After securing your IVs, name the 3 major steps in treating uterine inversion

1. Uterine relaxants 2. Replace uterus (with hand) 3. Stop relaxants and start uterotonics

Name 3 major uterine relaxants used in uterine inversion

Halothane MgSO4 Terbutaline

How do you treat an abnormally retained placenta?

Attempt manual extraction

Mechanism of hemorrhage in uterine inversion?

Inverted uterus--> uterus can't establish normal tone and contract--> myometrial fibers can't exert tourniquet effect on spiral arteries--> placental bed pours out blood

CF: 1-5 Flashcards

1: Done 2: 3: 4: 5: (50 cards)