Exam 2 Labor/Delivery, Peurperium

Question 1

True Labor characteristics? (5)

Answer 1

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

Question 2

Labor and Delivery eval should include? (6)

Answer 2

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

Question 3

Amniotic Fluid status: Signs of rupture? (5)

Answer 3

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

Question 4

Nitrazine Test is?

Answer 4

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

Question 5

Fern Test is?

Answer 5

Amniotic fluid appears in “fern” pattern on slide

Question 6

1st stage of labor is?

Phases based on?

Answer 6

Onset to full cervical dilation

Rate of cervical dilation

Question 7

1st stage of labor:

Latent phase?

Active phase?

Answer 7

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

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

Question 8

2nd stage of labor is?

Answer 8

Complete dilation to delivery of baby (pushing phase)

Question 9

3rd stage of labor is?

Answer 9

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

Question 10

Progress of labor: Power is?

Strength/frequency controlled by?

Answer 10

uterine contractions

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

Question 11

Adequate labor is what?

Answer 11

3 to 5 contractions/10 min

Question 12

Tocodynamometry measures what?

Answer 12

Contractions

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

Question 13

Progress of labor: Passenger

Size?

Answer 13

> 4500 gm = macrosomic infant

Question 14

Progress of labor: Passenger

Presentation options? (5)

Answer 14

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

Question 15

Progress of labor: Passenger

Position is?

Answer 15

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

```
Occiput Anterior (OA) is normal
face down
~~~

Question 16

Progress of labor: Passage is?

Answer 16

Pelvis size/shape

Question 17

Cardinal mvmts of labor are?

Answer 17

Changes in fetus position as passes thru birth canal

Question 18

Cardinal mvmts of labor: Engagement is?

Answer 18

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

Question 19

Cardinal mvmts of labor: Flexion is?

Answer 19

Complete flexion of head presents smallest head diameter

Question 20

Cardinal mvmts of labor: Descent is fastest when?

Answer 20

stage 2 of labor

Question 21

Cardinal mvmts of labor: Internal rotation is?

Answer 21

Rotation of presenting to anteroposterior as it passes thru pelvis

Question 22

Cardinal mvmts of labor: Extention is?

Answer 22

Once below introitus, head extends beneath pubic symphysis and delivers

Question 23

Cardinal mvmts of labor: External rotation is?

Answer 23

Head rotates 45°, line up w/ shoulders

Question 24

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

Answer 24

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

Question 25

Fetal monitoring should include? (3)

Answer 25

Intermittent auscultation US transducer on abdomen Internal scalp ECG

Question 26

Fetal monitoring: Heart rate?

Answer 26

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

Question 27

Fetal monitoring: Heart rate variations? (4)

Answer 27

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)

Question 28

Fetal monitoring: Heart rate deceleration caused by Early? Variable? Late?

Answer 28

Early: from head compression during contractions Variable: from cord compression during contractions Late: from hypoxia, insuff placenta, or mom hypoTN

Question 29

Labor pain relief options? (3)

Answer 29

Psychoprophylaxis: Lamaze Meds: Sedatives (Vistaril) Narcotics (Demerol, Stadol, Nubain) Dissociative (Ketamine) Blocks: Paracervical Pudendal Epidural

Question 30

Perineal lacerations: 1°?

Answer 30

vag mucosa or perineal skin | but not underlying tissue

Question 31

Perineal lacerations: 2°?

Answer 31

underlying SQ tissue | but not rectum

Question 32

Perineal lacerations: 3°?

Answer 32

thru rectal sphincter | but not rectal mucosa

Question 33

Perineal lacerations: 4°?

Answer 33

thru rectal mucosa

Question 34

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

Answer 34

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

Question 35

Methods of inducing labor? (5)

Answer 35

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

Question 36

Complications of Oxytocin? (3)

Answer 36

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

Question 37

Puerperium is?

Answer 37

Post baby/placenta delivery thru 6 wks post

Question 38

Puerperium anatomic resolution includes? (4)

Answer 38

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

Question 39

Puerperium management?

Answer 39

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

Question 40

Postpartum Blues vs Depression?

Answer 40

Blues should resolve w/i 2 wks