Intrapartum Flashcards
(95 cards)
1
Q
face presentation with chin towards mother’s symphysis
A
mentum anterior (MA)
2
Q
face presentation with chin towards mother’s perineum
A
mentum posterior (MP)
3
Q
face presentation that makes vaginal birth very unlikely
A
mentum posterior (MP)
4
Q
inlet with a short anteroposterior diameter and a wide transverse diameter is characteristic of this pelvic type
A
platypelloid
5
Q
first portion of the fetus to enter to pelvis is the:
A
presentation
6
Q
occurs as the result of the untwisting of the neck after birth of the head
A
Restitution
7
Q
positional changes the fetus undergoes to accommodate itself to the maternal pelvis
A
mechanisms of labor
8
Q
BPD has passed through the inlet
A
engagement
9
Q
top of the head is at the level of the ischial spines
A
engagement
10
Q
To determine the position of the fetus you would, identify the:
A
sagittal suture
11
Q
Three types of presentation:
A
breech, shoulder, cephalic
12
Q
evidence is conflicting on whether epidurals increase risk of:
A
C/S
13
Q
___-___% of women with epidurals develop fevers
A
11-14%
14
Q
According to Friedman, active labor is defined as the point when:
A
rate of cervical dilation increases sharply
15
Q
According to Friedman, prolonged latent phase labor is defined as > ___ hrs in nulliparous and > ___ hrs multiparous women
A
> 20 hrs in nulliparous and > 14 hrs multiparous women
16
Q
Active labor begins when the:
A
RATE of cervical dilation sharply increases.
17
Q
medication usually used for early labor rest since other medications such as sleeping pills have no pain relieving properties.
A
Narcotic analgesics (morphine)
18
Q
Friedman’s criteria for normal latent phase for nulliparas
A
< 20 hrs
19
Q
Friedman’s criteria for normal active phase for nulliparas
A
1.2 cm/hr
20
Q
Friedman’s criteria for normal latent phase for multiparas
A
< 14 hrs
21
Q
Friedman’s criteria for normal active phase for multiparas
A
1.5 cm/hr
22
Q
Friedman’s criteria for arrest of 1st stage (latent + active) of labor
A
no progress x 2 hrs
23
Q
Friedman’s criteria for normal 2nd stage for nulliparas
A
1 cm/hr descent
24
Q
Friedman’s criteria for normal 2nd stage for multiparas
A
2 cm/hr descent
25
Friedman's criteria for arrest of 2nd stage of labor
no progress x 1 hr
26
Contemporary research normal progress of active labor
0.5 cm/hr
27
Contemporary research on diagnosing and managing slow labor does not provide clear recommendations for:
appropriate timing of interventions
28
narcotic used in labor with the longest half-life
Demerol
29
reflex that results in a surge of oxytocin that enhances contraction strength and pushing effectiveness in second stage labor
Ferguson Reflex
30
evidence-based technique for perineal management during birth that decreases or minimizes genital tract trauma is:
working with the woman to facilitate a gentle, controlled birth of the baby.
31
prenatal perineal massage will reduce risk of genital tract trauma...T or F?
true
32
max dose of Hemabate during severe PPH
8 doses q15 min
33
Pit should never be given IV because:
it can cause severe hypotension
34
dosage/route for Hemabate
250 mcg IM
35
1st line medication for PPH
Pitocin
36
Pitocin can cause this adverse effect
water intoxication
37
dosage range for Cytotec
600-1000 mcg
38
SE of Cytotec:
maternal fever + shivering
39
2nd line med for GBS prophylaxis for patient with Low Risk PCN allergy
Cefazolin 2 gm loading dose then...
| 1 gm q8 hrs
40
2nd line med for GBS prophylaxis for patient with High Risk PCN allergy
*Request clindamycin susceptibility on GBS swab culture*
Susceptible: clindamycin 900 mg q 8 hrs
Resistant: Vancomycin 20 mg/kg q8 hrs (max 2 gm)
41
Dosage for Procardia for PTL
20-30 mg PO in divided doses
| Then...10-20 mg PO q3-8 hrs
42
```
SE of __________:
**peripheral vasodilator**
transient nausea
flushing
HA
palpitations
dizziness
hypotension
tachycardia
```
Procardia
43
Do not give Procardia with these meds:
terb or MgSO4
44
```
Contraindications for __________:
preload-dependent cardiac disorder
left ventricular dysfunction
congestive heart failure
hemodynamic instability
```
Procardia
45
Dosage of Indocin for PTL
50-100 mg loading dose PO or rectally
| Then...25-50 mg PO q6 hrs x 48 hrs
46
```
SE of _________:
GI: N+V
reflux
gastritis
platelet dysfunction
```
Indocin
47
Fetal Effects of ________:
premature closing of ductus arteriosus
oligohydramnios
Indocin
48
```
Contraindications for _________:
platelet dysfunction
bleeding diathesis
hepatic dysfunction
GI ulcerative dx
asthma (if sensitive to ASA)
> 48 hrs of use
> 32 wks gestation
```
Indocin
49
Dosage of MgSO4 for PTL
Loading dose 4-6 gm IV over 20-30 min
| Then...2 gm/hr IV infusion
50
MOA of ________:
| COX inhibitor that reduces prostaglandin production by COX
Indocin
51
MOA of _______:
| Unknown but probably competes with Ca+ at cell membrane which reduces Ca+ available for myometrial ctx
MgSO4
52
```
SE of ___________:
flushing
nausea
blurred vision
HA
lethargy
muscle weakness
hypotension
Rare: pulmonary edema, respiratory/cardiac arrest
```
MgSO4
53
Fetal Effects of __________:
neuroprotective
decreased FHR variability
decreased neonatal tone
MgSO4
54
```
Contraindications for ___________:
impaired renal function
myasthenia gravis
cardiac conduction defects
toxicity: loss of patellar reflex, decreased urine output, respiratory rate < 12 (risk increases w/ creatinine > 1.0)
```
MgSO4
55
MOA of __________:
beta-agonist binds to beta-2 receptors causing chain reaction resulting in depletion of intracellular Ca+ thereby blocking myometrial receptors (can become desensitized w/ prolonged use thereby diminishing effectiveness)
Terb
56
Dosage for Terb
0.25 mg SQ q20-30 min (max 4 doses)
Then...0.25 mg SQ q3-4 hrs
*May be given by continuous IV infusion
57
```
SE of __________:
tachycardia
peripheral vasodilation
hypotension
bronchial relaxation
pulmonary edema
hyperglycemia
MI
```
Terb
58
Fetal Effects of _______:
tachycardia
neonatal hypoglycemia
Terb
59
```
Contraindications for ___________:
cardiac disease
HTN
poorly controlled DM/GDM
Caution in PPH
> 72 hrs
Do not give PO
```
Terb
60
ACOG states ____ may be used for short term inpatient use for PTL
Terb
61
```
Symptoms of __________:
Diffuse swelling
swelling appears to shift independent of movement
unresponsive
thready pulse rate of 180
shallow rapid respiration
pale, cool skin.
```
subgaleal hemorrhage
62
Order of Cardinal Movements (DFIERE)
```
Descent
Flexion
Internal Rotation
Extension
Restitution
External Rotation
```
63
denominator for breech presentation
sacrum
64
bony landmark on the presenting part used to denote the position of a fetus
denominator
65
anterior parietal bone (meaning the parietal bone that is in the anterior part of the pelvis) descends first and the sagittal suture is closest to the sacrum
anterior asynclitism
66
posterior parietal bone (meaning the parietal bone that is in the posterior part of the pelvis) descends first and the sagittal suture is closest to the symphysis pubis
posterior asynclitism
67
abrupt decrease in FHR of >15 bpm lasting > 15 sec and < 2 min
variable decel
68
the most favorable diameter of the head to present in labor
suboccipitobregmatic
69
most common position for fetus to enter pelvis for birth
LOA
70
BP should be assessed q____ min in 2nd stage
15 min
71
optimal timing for administration of pudendal anesthesia in a multiparous woman
just prior complete dilation
72
largest group of muscles in the pelvic musculature
levator ani
73
FHR variability is controlled by:
autonomic (parasympathetic/sympathetic) nervous system
74
```
Risk Factors for ____________:
maternal obesity
excessive weight gain
late term/post term gestation
GDM
fetal macrosomia (>4000 gm)
precipitous 2nd stage
operative vag delivery
prolonged 2nd stage (increased risk of forceps/vacuum)
```
Shoulder Dystocia
75
Risk Factors for ____________:
| preterm birth
Retained Placenta
76
Order of medications for PPH (ACOG):
Pitocin 10-40 units IM; up to 60 units IV
Methergine 0.2 mg IM q2-4 hrs (if BP normotensive)
Hemabate 250 mcg q15-90 min up to 8 doses (DO NOT give to asthma pt.)
Cytotec 600-1000 mcg x 1 dose PO, SL or rectally
77
Hemodynamic changes in initial PP period:
elevated cardiac output (60-80%) up to 48 hrs after birth
78
```
Risk Factors for ____________:
preterm birth
hx uterine curettage
preeclampsia
augmented labors
birth in dorsal position
nulliparity
use of Methergine
```
Retained Placenta
79
Steps for Shoulder Dystocia:
```
McRoberts position
Suprapubic pressure
Rubin's maneuver
Delivery of posterior arm
Gaskin maneuver
Woods' Screw (Rotational) maneuver
Zavanelli maneuver
```
80
Length of time before transferring to OR for shoulder dystocia:
5 min
81
Length of 3rd stage should be less than ____ min
20 min
82
at the onset of labor, ___________ invade the myometrium, cervix, chorio-decidua, and amnion
leukocytes
83
pulses of oxytocin occurs ___x per 30 min in 1st stage and ___x per 30 min in 2nd stage
4x per 30 min in 1st stage and 7x per 30 min in 2nd stage
84
restitution is rotation of the fetal head ____ degrees to left or right
45 deg
85
External rotation allows the bisacromonial diameter to align with the _________ diameter of the outlet
anteroposterior
86
birth of the shoulders occurs by ___________ to accomodate the Curve of Carus
lateral flexion
87
birth of the shoulders occurs by ___________ to accommodate the Curve of Carus
lateral flexion
88
deep, somatic pain is usually:
dull, aching
89
superficial somatic pain is usually:
sharp
90
physiological urge to push occurs at station:
+1
91
Friedman's average length of 2nd stage for nullipara
46 min
92
Friedman's average length of 2nd stage for multipara
14 min
93
fFN is not typical between ___-___ wks gestation
24 & 34 wks
94
90% of placentas are spontaneously expelled within ___ min of birth
15
95
maternal position that makes cord traction contraindicated
upright/squatting
