Fetal heart rate and labor Flashcards Preview

Year2 Repro exam II > Fetal heart rate and labor > Flashcards

Flashcards in Fetal heart rate and labor Deck (35):
1

what can cause late deceleration assoc with presercation of beat-to-beat variability

mediated by arterial chemo R in mild hypoxia

2

etiologies of late decelerations

excessive uterine contractions, maternal hypotension or maternal hypoxemia
reduced placental exchange as in HTN disorders, DM, IUGR, abruption

3

what do we do for management of late decelerations

patient on side
discontinue oxytocin
correct any hypotension
IV hydration
administer O2 by tight face mask
if late decelerations persist for more than 30 min, fetal scalp pH is indicated

4

obsercation of recurrent late decelerations with no variability

expeditious delivery is needed unless believed to be from maternal condition such as DM keoacidosis or pneumonia with hypoxemia

5

how do you mange variables

change position to where FHR pattern is most improved
discontinue oxytocin
check for cord prolapse or imminent delivery by vaginal exam
administer 100% O2 by tight face mask

6

how are uterine contractions quantified

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

7

what is tachysystole

more than 5 contractions in 10 minutes, averaged over a 30 minute window

8

what is category I in the FHR interpretation system

normal: moderate variability, +/- accelerations, no late or variable decelerations

9

What is category II in FHR interpretation system

indeterminate
FHR tracing shows: tachy, brady without absent variability, minimal variability, absent variability without recurrent decelerations, etc
requires continued surveillance and re-evaluation

10

What is cateogry III in FHR interpretation system

abnormal
FHR shows
-sinusoidal pattern
-absent variability with recurrent late decelerations, recurrent variable decelarations or bradycardia

11

what does abnormal fetal heart tracing preduct

abnormal fetal-acid base status at time of observation
depending on clinical situation

12

1st degree vaginal tear

least severe
involve only skin around vaginal opening
patient might have some burning or stinging with urination
heal on own within few weeks

13

2nd degree vaginal tear

involved vaginal tissue and perineal muscles that help support uterus, bladder and rectum
typically require closure and heal within a few weeks

14

3rd degree vaginal tear

involve posterior vaginal tissues, perineal muscles and the capsule of the anal sphincter

15

4th degree vaginal tear

perineal muscles and anal sphincter as well as tissue lining rectum
require repair, sometimes in operative setting

16

complications of 4th degree vaginal tears

fetal incontinence and painful intercourse

17

postpartum care with lacerations includes what

vaginal soreness, discharge, contractions, urination problems, hemorrhoids and bowel movements, sore breast and leaking milk, hair loss and skin changes, mood changes, weight loss

18

antenatal risk factors for problems with labor

-young and older nulliparas
-short stature
-previous difficult birth or c-section
-previous stillbirth or neonatal death
-multiple pregnancy
-nutritional deficiency, severe anemia
-large for dates
-obvious pelvic deformity
-malpresentation
-high parity

19

when do you induce labor

-when risks outweigh risks of induction
-at 41+ weeks
-within 96 hr of ruptured membranes at term
-for pre-eclampsia at term
-for maternal DM at term
-absent doppler end diastolic function

20

how do we induce labor for prlonged pregnancy

-sweep/stripe membranes

21

how do we induce labor for ruptured membranes

oxytocin by IV infusion

22

induce labor in majority patients

vaginal PGs
amniotomy with oxytocin infusions

23

what should you not do to induce labor in women who previously had c section

PG

24

discontinue oxytocin at what amount if patient has not gone into labor

5 units

25

what is failure to progress in the second stage of labor

arrest after 60 minutes of active pushing

26

what sequelae are more likely in vaginal birth than CS

perineal pain
urinary incontinence
uterovaginal prolapse

27

what sequelae occur, no difference between CS or vaginal birth

postpartum hemorrhage
endometritis
genital tract injury
fecal incontinence
post natal depression
back pain
dyspareunia

28

what sequelae more likely with C section

hospital stay, ICU, death, bladder or ureter damage, hysterectomy, thromboembolism, placenta previa, stillbirth in next pregnancy, placenta acreta

29

what is passive second stage labor

time of full filatation to commencement of involuntary expulsive effort by woman

30

what is active second stage labor

from commencement of expuslive effots by woman and if any Sx signs full dilatation or baby is visible

31

If second stage of labor is lasting over 4 hours, there is now increased risk of

CS
assisted birth
chorioamnionitis
3rd and 4th degree trauma
5 min Apgar <7 min

32

how long is second stage labor averaged in a nullipara woman

2.5 hrs w/o epidural
3 hrs w/ epidural

33

how long is second stage labor averaged in parous patient

60 min w/o epidural
120 min w/ epidrual

34

if pushing is eneffectual what can you change

position
empty bladder

35

when to do episiotomy, what kind

when clinically indicated
mediolateral