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REPRO II Exam 2 > Dunn OB/GYN II > Flashcards

Dunn OB/GYN II Flashcards

1
Q

uterine contractions

A

number of contractions present in a 10 minute window averaged over 30 minutes

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2
Q

normal contractions

A

5 or less in 10 minutes

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3
Q

tachysystole

A

more than 5 contractions in 10 minutes

averaged over 30 minute window

both spotaneous and induced labor

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4
Q

category 1

A

normal - all of the following:

baseline 110-160
moderate variability
accelerations +/-
no late/variable deceleration
possible early decelerations

normal acid base status

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5
Q

category 2

A

indeterminate

any of the following:
tachycardia
bradycardia without absent variability
minimal variability
etc.
  • not predictive of abnormal fetal acid-base status
  • requires continuous surveillance and reevaluation
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6
Q

category 3

A

abnormal

either of the following:

  • sinusoidal pattern OR
  • absent variability with recurrent decelerations, recurrent variable decelerations, or bradycardia

abnormal fetal acid base status**
efforts should be made to resolve abnormal FHR

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7
Q

vaginal tears during childbirth

A

common

skin around vagina- heal few weeks

some longer to heal

excessive pain - infection

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8
Q

first degree vaginal tear

A

only skin around vaginal opening

heal on own

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9
Q

second degree vaginal tear

A

vaginal tissue and perineal muscle

require closure

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10
Q

third degree vaginal tear

A

posterior vaginal tissues, perineal muscle, capsule of anal sphincter

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11
Q

fourth degree vaginal tear

A

perineal muscles, anal sphincter, rectum tissue

require repair - operative setting

complications - fecal incontinence and painful intercourse

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12
Q

breastfeeding

A

make food perfect for baby

protects baby
benefits mothers health
benefits society

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13
Q

predicting outcome in labor

A

difficulty

limited clinical exam, X-ray and CT are disappointing, estimates for fetal weight wide margin of error, antenatal risk screening is still important

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14
Q

risk factors for labor problems

A 
younger/older nulliparas
short stature
previous C-section
previous stillbirth
multi pregnancy
nutritional
large for dates
pelvic deformity
malpresentation
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15
Q

when to induce labor

A

risk of continuing pregnancy outweigh risks of induction

  • at 41+ weeks
  • within 96 hours rupture membrane at term
  • pre-eclampsia at term
  • maternal diabetes at term (including gestational)
  • IUGR at term when there is absent doppler EDF

intrauterine growth restriction with absent doppler end diastolic flow

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16
Q

labor induction

A

prolonged pregnancy - sweep/strip membranes

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17
Q

ruptured membranes induction

A

oxytocin IV infusion

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18
Q

induction options

A

vaginal prostagladins

amniotomy followed by oxytocin infusion 3-12 hours later (when cervix is ripe)

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19
Q

induction after C section

A

no prostaglandins - risk 1:40

spontaneous labor 1:200 risk
oxytocin 1:100 risk

foley catheter - acceptable alternative -placed in uterine cervix

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20
Q

oxytocin infusion

A

single standard dilution in normal saline

  • IV infusion pump
  • start low dose - increase 30 minute intervals

review at 16-20 mU/min

discontinue after 5 units**

monitor fetus

21
Q

Ps

A

power
passenger
presentation
position

22
Q

when to intervene in second stage of labor

A

few patients should not push at all

  • no reason to intervene unless:
  • failure to progress
  • arrest after 60 minutes of pushing
  • not just full dilation + 2 hours
23
Q

second stage of labor

A

begins when the cervix is completely dilated (open), and ends with the birth of your baby

24
Q

no maternal death

A

from scar rupture

25
Q

scar rupture

A

rate 1:200

rate same whether VBAC or elected CS

vaginal birth after cesarean = VBAC

26
Q

rate of perinatal death

A

11x higher with VBAC vs. elective CS

2x higher than for multiparas having vaginal birth

27
Q

more likely with cesarean

A 
hospital stay
ICU stay
death
bladder/ureter damage
thromboembolism
placenta previa
stillbirth
placenta accreta
28
Q

no difference cesarean vs. vaginal

A 
postpartum bleed
endometritis
genital tract injury
fecal incontinence
postnatal depression
back pain
dyspareunia
29
Q

more likely after vaginal birth

A

perineal pain
urinary incontinence
uterovaginal prolapse

30
Q

passive second stage

A

time of full dlation to commencement of involuntary expulsive effort

31
Q

active second stage

A

commencement of expulsive effort by woman

plus symptoms or signs of full dilation

or baby is visible

32
Q

2nd stage >4 hours

A 
increase rate of CS
assisted birth
chorioamnionitis
3/4th degree trauma
5 min APGAR <7
33
Q

does review of normal second stage duration help?

A

no

very variable

multiparas - longer
nulliparas - shorter

34
Q

nullipara second stage length

A

2.5 without epidural

3 with epidural

35
Q

multiparous second stage length

A

60 minute without epidural

120 minute with epidural

36
Q

nullipara not delivered 2 hours second stage

A

consult OB

and 1 hour in multipara

37
Q

reassess all patients with an epidural who do not push

A

within 1 hour after fully dilated

38
Q

position for second stage of labor

A

sitting, semi-recumbent, lateral
vs. supine or lithotomy

reduced length
few assisted birth
fewer episiotomies
reduced pain
more frequent secondary tears
39
Q

recommendations for maternal position second stage

A

discouraged from lying supine/semi-supine

encouraged to adopt position most comfortable

40
Q

recommendations about pushing in second stage

A

guided by their own urge to push

if ineffective
-provide support/encouragement, change position, empty bladder

41
Q

perineal massage

A

midwife massage between contraction - no effect on any measure of obstetric trauma, pain, return to coitus, or urinary and bowel function

42
Q

hot compress on perineum

A

reduced need for episiotomy in nulliparas

also reduced rate secondary tears

not considered by another study

43
Q

hands on or hands poised for fetal head delivery

A

NICE concludes either is appropriate

44
Q

less trauma

A

when head delivers between contractions

45
Q

lidocaine

A

no effect

NICE- should not be used

46
Q

episiotomy

A

less posterior trauma
more anterior trauma
fewer 3 and 4 tears

overall - more intact perineum

  • less perineal pain
  • quicker return to coitus

no difference
-sexual function or bladder function

47
Q

spontaneous birth

A

no episiotomy

NICE recommendation

48
Q

episiotomy should be performed

A

when clinically indicated

fetal compromise suspected

49
Q

best episiotomy

A

mediolateral

start at posterior fouchette and proceed at angle of 45-60 degrees

REPRO II Exam 2 (21 decks)

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