Exam 2 Labor/Delivery, Peurperium Flashcards Preview

Q4 Women's Health > Exam 2 Labor/Delivery, Peurperium > Flashcards

Flashcards in Exam 2 Labor/Delivery, Peurperium Deck (40):
1

True Labor characteristics? (5)

Regular intervals, gradual ↑ frequencies
↑ intensity
Cervical dilation
Back and abd discomfort
No relief from sedation

2

Labor and Delivery eval should include? (6)

Review hx/physicals
Take brief hx
Vitals
Cervical
Membrane status
Fetal monitoring

3

Amniotic Fluid status: Signs of rupture? (5)

Use sterile speculum to examine
Pooling in vagina
Visible fluid leak thru cervix
Nitrazine test
Fern test

4

Nitrazine Test is?

Test of fluid's pH
pH of 5 - 6 = intact membrane
pH of 6.5 - 8 = ruptured membrane

5

Fern Test is?

Amniotic fluid appears in "fern" pattern on slide

6

1st stage of labor is?

Phases based on?

Onset to full cervical dilation

Rate of cervical dilation

7

1st stage of labor:

Latent phase?

Active phase?

Latent: First regular contraction thru 4cm dilation
Dilation is slow, <0.5cm/hr

Active: from 4cm to full dilation
Dilation is fast, 1cm/hr

8

2nd stage of labor is?

Complete dilation to delivery of baby (pushing phase)

9

3rd stage of labor is?

Delivery of baby to delivery of placenta (U w/i 30 min)

10

Progress of labor: Power is?

Strength/frequency controlled by?

uterine contractions

prostaglandin E2 and F2-α ->
↑ uterine sensitivity to oxytocin

11

Adequate labor is what?

3 to 5 contractions/10 min

12

Tocodynamometry measures what?

Contractions

External = freq/duration
Internal = freq/duration/intensity

13

Progress of labor: Passenger

Size?

> 4500 gm = macrosomic infant

14

Progress of labor: Passenger

Presentation options? (5)

Vertex (crown of head)
Face/brow
Breech (frank, complete, footling)
Transverse lie
Compound (2 body parts)

15

Progress of labor: Passenger

Position is?

Relation of presenting part to R or L of mom's pelvis

Occiput Anterior (OA) is normal
(face down)

16

Progress of labor: Passage is?

Pelvis size/shape

17

Cardinal mvmts of labor are?

Changes in fetus position as passes thru birth canal

18

Cardinal mvmts of labor: Engagement is?

Passage of presenting part's widest diameter to below pelvic inlet

19

Cardinal mvmts of labor: Flexion is?

Complete flexion of head presents smallest head diameter

20

Cardinal mvmts of labor: Descent is fastest when?

stage 2 of labor

21

Cardinal mvmts of labor: Internal rotation is?

Rotation of presenting to anteroposterior as it passes thru pelvis

22

Cardinal mvmts of labor: Extention is?

Once below introitus, head extends beneath pubic symphysis and delivers

23

Cardinal mvmts of labor: External rotation is?

Head rotates 45°, line up w/ shoulders

24

3rd stage of labor: Signs of placental separation? (4)

Uterus ↓ in size
Uterus rises in abdomen
Globular configuration
Gush of blood/Lengthening of umbilical cord

25

Fetal monitoring should include? (3)

Intermittent auscultation
US transducer on abdomen
Internal scalp ECG

26

Fetal monitoring: Heart rate?

120 - 160 = N
> 180 = severe tachy
< 100 = severe brady

27

Fetal monitoring: Heart rate variations? (4)

Short term: beat-to-beat amp ∆s
Long term: wave pattern ∆s Q 4-6 cycles/min
Acceleration: ↑ 15bmp above baseline for 15 sec
Deceleration (see next card)

28

Fetal monitoring: Heart rate deceleration caused by

Early?

Variable?

Late?

Early:
from head compression during contractions

Variable:
from cord compression during contractions

Late:
from hypoxia, insuff placenta, or mom hypoTN

29

Labor pain relief options? (3)

Psychoprophylaxis: Lamaze

Meds:
Sedatives (Vistaril)
Narcotics (Demerol, Stadol, Nubain)
Dissociative (Ketamine)

Blocks:
Paracervical
Pudendal
Epidural

30

Perineal lacerations: 1°?

vag mucosa or perineal skin
but not underlying tissue

31

Perineal lacerations: 2°?

underlying SQ tissue
but not rectum

32

Perineal lacerations: 3°?

thru rectal sphincter
but not rectal mucosa

33

Perineal lacerations: 4°?

thru rectal mucosa

34

Induction of labor: Highest likelihood of success if? (5)

Dilation 5+ cm
Effaced >80%
Station +1
Soft cervix
Anteriorly-positioned cervix

35

Methods of inducing labor? (5)

Membrane stripping (finger in os)
Amniotomy
Prostaglandin gel
Oxytocin
Misoprostol/Cytotec (abortion pill)

36

Complications of Oxytocin? (3)

Hyperstim to >5 contractions/10min
Fetal distress
Water intoxication

37

Puerperium is?

Post baby/placenta delivery thru 6 wks post

38

Puerperium anatomic resolution includes? (4)

Uterus from 1000gm to 50gm

Cervix loses vascularity, gland hypertrophy, hyperplasia

No ovulation via prolactin 3+ months if lactating

Vagina shrinks but walls stay thin/inelastic/dry until ovulation returns

39

Puerperium management?

Hospital 1-2 days vaginal, 2-4 days CSec
Post exam 4-6wks

40

Postpartum Blues vs Depression?

Blues should resolve w/i 2 wks