[CLMD] Normal Labor and Delivery [Moulton]

Question 1

What is the definition of labor?

Answer 1

Progressive cervical dilation resulting from regular uterine contractions that occur at least every 5 minutes and last 30-60 seconds

Question 2

What is false labor?

aka?

Answer 2

Irregular contractions without cervical change

AKA= Braxton-Hicks contractions

Question 3

Cranial bones consist of:

Answer 3

Occipital bone

(2) Parietal bones
(2) Frontal bones

Question 4

Anatomica characteristics of the FETAL Head

What diameter has the LONGEST length (hardest to deliver)?

Answer 4

Supraoccipitomental (13.5cm)

Question 5

Anatomica characteristics of the FETAL Head

Which (2) diameters have the SHORTEST length (easiest to deliver)?

Answer 5

Submentobregmatic diameter

Suboccipitobregmatic diameter

Question 6

What is the most common/has best prognosis for delivery pelvic shape of the maternal pelvis?

Answer 6

GYNECOID

Question 7

What pelvis shape is classic male type of pelvis shape and has a poor prognosis for delivery?

Answer 7

ANDROID

Question 8

What pelvis shape resembles an ape pelvis and has a good prognosis for delivery?

Answer 8

ANTHROPOID

Question 9

What is the least common pelvic shape that has a poor prognosis for delivery?

Answer 9

PLATYPELLOID

Question 10

Define:

Fetal lie

Answer 10

Reference is maternal spine in relation to fetus spine

Determines if fetus is longitudinal, transverse or oblique

Question 11

Define:

Fetal presentation

Answer 11

Presenting part to the pelvis

(Vertex, breech, transverse or compound)

Question 12

What are leopold maneuvers?

Answer 12

A series of 4 maneuvers used to determine the positioning of the fetus

1. Fundus
2. Spine
3. Presenting to pelvis
4. Head

Question 13

What is the difference between a longitudinal vs transverse lie fetus?

Answer 13

Question 14

Dilation

Where do you check for dilation?

What is the range?

Answer 14

Internal os

Closed - 10 cm

Question 15

Effacement

What is it?

What is normal?

Range?

Answer 15

Thinning of the cervix occurs and is reported as a % change in length

3-5cm

Thick - 100%

Question 16

Station

What is it?

When is the station “zero”?

Range?

Answer 16

Degree of descent of the presenting part of the fetus

When the bony portion of the head reaches the level of the ischial spine

-5 to +5cm

Question 17

How many stages of labor are there?

Answer 17

4

Question 18

Which stage of labor has two substages?

Answer 18

First stage

(Latent phase, Active phase)

Question 19

What occurs in the FIRST stage of labor?

Answer 19

Onset of true labor to complete cervical dilation

Includes two substages (Latent and active phase)

Question 20

What occurs in the SECOND stage of labor?

Answer 20

Complete cervical dilation to delivery of infant

Question 21

What occurs in the THIRD stage of labor?

Answer 21

Delivery of infant to delivery of placenta

Question 22

What occurs in the FOURTH stage of labor?

Answer 22

Delivery of placenta to stabilization of patient

Question 23

Describe the latent phase of the FIRST stage of labor

Answer 23

B/w onset of labor and SLOW cervical dilation

Question 24

What characterizes the ACTIVE phase of the FIRST stage of labor?

Answer 24

Faster rate of dilation

+

Cervix is dilated to 6cm

Question 25

For vaginal examinations, what are the three key measurements you want to take?

Answer 25

***Dilation, effacement, station*** DES example: 4/50/-2 = 4cm dilated/50% effaced/-2cm station

Question 26

Describe how you determine **FETAL POSITION**

Answer 26

The reference point is always relative to the OCCIPUT Whereever the fetal **occiput** is, name the position for where it points: eg: Occiput is toward the left on a horizontal angle...LOT (left occiput transverse)

Question 27

How does an epidural affect the time it takes for delivery?

Answer 27

And epidural usually extends the duration of labor by an hour

Question 28

What are the 7 **cardinal movements** of labor?

Answer 28

Engagement Descent Flexion Internal rotation Extension External rotation Expulsion "Every Descent Family In England Eats Eggs"

Question 29

What is an episiotomy?

Answer 29

Surgical incision to assist in delivery

Question 30

What is the **modified ritgen maneuver?**

Answer 30

Method of delivering baby (Fingers of the right hand are used to extend the head while **counterpressure** is applied to the occiput by the left hand to allow for a more controlled delivery)

Question 31

Describe what the following perineal lacerations involve: First degree Second degree Third degree Fourth degree

Answer 31

First degree = Superficial Second degree = Extends to **muscles of perineal body**, does NOT involve anal sphincter Third degree = Extends into or **through anal sphincter** but NOT rectal mucosa Fourth degree = Involves **rectal mucosa**

Question 32

When is a **retained placenta** diagnosed?

Answer 32

If placenta has not been delivered within **30 MINUTES**

Question 33

What are **contraindications** to **INDUCTION** of labor?

Answer 33

Unstable fetal presentation Acute fetal distress Placental previa or vasa previa Previous classical C-section HIV w/ high viral load

Question 34

What is the **bishop score?**

Answer 34

Assesses how favorable a cervix is for delivery 0= least favorable 13= most favorable Bishop score \<6 is unfavorable Bishop score \>8 favorable

Question 35

What is the most commonly used **cervical ripening** agent?

Answer 35

Cervidil (DINOPROSTONE) Vaginal insert, easy to remove

Question 36

What is the only FDA approved drug for both INDUCTION and AUGMENTATION?

Answer 36

Pitocin (synthetic oxytocin)