FPC: labor and delivery

Question 1

What does G1P1 mean?

Answer 1

1 pregnancy, 1 child

Question 2

What does G1P1001 mean?

Answer 2

1 pregnancy with 1 full term delivery, no preterm deliveries, no abortions, and 1 living child

Question 3

What is the acronym after GxPx?

Answer 3

TPAL (term, preterm, abortions, living kids)

Question 4

On a fetal HR graph, what does the space between red lines represent?

Answer 4

1 minute

Question 5

On a fetal HR graph, what do the small boxes represent?

Answer 5

10 seconds

Question 6

What is normal fetal HR range?

Answer 6

110-160

Question 7

On the lower panel of fetal HR graph, what do the pumps indicate?

Answer 7

Maternal contraction; external monitors will just show presence, internal will show strength

Question 8

What is baseline fetal HR?

Answer 8

Average fetal HR over 10 mins

Question 9

What is variability of fetal HR?

Answer 9

Degree of fluctuation over/under the baseline

Question 10

What is ideal variability of fetal HR?

Answer 10

Moderate variability aka 6-25 bpm variation

Question 11

What does moderate variability in fetal HR indicate?

Answer 11

Less likely that the fetus is acidotic

Question 12

What is minimal variability?

Answer 12

Less than 5 bpm variability

Question 13

What might minimal variability indicate?

Question 14

What is absent variability?

Answer 14

No detectable variation around baseline HR

Question 15

What is marked variability?

Answer 15

More than 25 bpm variation around baseline HR

Question 16

What are accelerations?

Answer 16

Abrupt increases in FHR above baseline; these are good!

Question 17

What is considered an acceleration at or less than 32 weeks?

Answer 17

10 bpm above baseline for more than 10 seconds but less than 2 mins

Question 18

What is considered an acceleration when it is more than 32 weeks?

Answer 18

15 bpm above baseline for more than 15 seconds but less than 2 mins

Question 19

What are decelerations?

Answer 19

Abrupt decreases in FHR below baseline

Question 20

What are early decelerations?

Answer 20

Decelerations before the peak of contraction resulting from head compression in labor; these are good!

Question 21

What are variable decelerations?

Answer 21

Decelerations occurring at different times relative to contractions that are due to cord compression

Question 22

What are late decelerations?

Answer 22

Decelerations occurring after the peak of contraction that result from placental insufficiency

Question 23

What are prolonged decelerations?

Answer 23

Decelerations lasting longer than 2 minutes that are immediate cause for concern and lead to stat c section

Question 24

Describe category I FHR tracing.

Answer 24

Baseline rate 110-160, moderate variability, no late/variable accelerations and possible early decelerations, accelerations may or may not be present

Question 25

Describe category III FHR tracing.

Answer 25

Absent baseline variability with either recurrent late decelerations, recurrent variable decelerations, or bradycardia

Question 26

What is the definition of labor?

Answer 26

Regular, often painful contractions and cervical change

Question 27

What are the 3 stages of labor?

Answer 27

1. Onset to complete dilation 2. Complete dilation to fetal expulsion 3. Fetal expulsion to placental expulsion

Question 28

What are the cardinal movements of labor?

Answer 28

Engagement, descent, flexion, internal rotation, extension, external rotation, expulsion

Question 29

What is considered active phase of labor?

Answer 29

6cm or more dilation

Question 30

What is considered prolonged latent phase of labor?

Answer 30

More than 20 hours

Question 31

What is effacement?

Answer 31

Gradual thinning, shortening, and drawing up of the cervix measured from 0-100%

Question 32

What is fetal station?

Answer 32

The relation of the bony part of the baby’s skull to the maternal ischial spines

Question 33

What is positive fetal station?

Answer 33

Below ischial spines aka closer to being out of the body

Question 34

What is occiput anterior?

Answer 34

Back of baby’s head is at the maternal pubic symphysis; this is ideal

Question 35

What is occiput posterior?

Answer 35

Back of baby’s head is at the maternal sacrum; this is harder but possible for vaginal delivery

Question 36

What is protracted labor?

Answer 36

Cervix over 6 cm dilated and continuing to dilate less than 1 cm over 2 hours

Question 37

What do we do for protracted labor?

Answer 37

Pitocin and amniotomy

Question 38

What is arrest of dilation?

Answer 38

More than 6cm dilated with ruptured membranes and 6 hours of no cervical change with inadequate contractions or 4 hours of no change with adequate contractions

Question 39

What do we do for arrest of dilation?

Answer 39

C section

Question 40

How long do we give moms who have never had a baby to be actively pushing before we consider c section? Moms who have had a baby?

Answer 40

3 hours; 2 hours

Question 41

What are signs of placental separation?

Answer 41

Gush of blood, lengthening of umbilical cord, anterior movement of uterus

Question 42

What is important in preventing post-delivery hemorrhage?

Answer 42

Delivery of placenta

Question 43

What are some pharmacologic options for pain management?

Answer 43

Narcotics, nitrous oxide, epidural

Question 44

What are the 4 big OB triage questions?

Answer 44

1. Contractions 2. Vaginal bleeding 3. Leakage of fluid 4. Fetal movement changes

Question 45

What are preeclampsia labs?

Answer 45

CBC, CMP, urine protein/Cr

Question 46

How do we workup for preterm labor?

Answer 46

Check the cervix