Intrapartum Flashcards by VISITACION, ALMIRA ANDREA D.

Series of events by which uterine contractions and abdominal pressure expels the fetus and other by products of pregnancy via the birth canal

Labor

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Descent and settling of the fetal head into the pevis

Engagement

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Spaces b/n bones of the fetal head

Fontanels

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Division b/n bones f the fetal head

Sutures

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What are the 5 theories in labor

Uterine stretch theory
Oxytocin theory
Progesterone deprivation theory
Prostaglandin cascade theory
Theory of aging placenta

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The idea of this theory is based on the concept that any hollow body organ, when stretched to its capacity will inevitably contract to expel its contents

Uterine stretch theory

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According to this theory, the uterus, a hollow organ, bcms stretched due to the growing fetal structures, in return, the pressure increases causing physiologic changes (uterine contractions) that initiate labor.

Uterine stretch theory

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According to this theory, pressure on the cervix stimulates the hypophysis to release oxytocin from the maternal posterior pituitary gland.

Oxytocin theory

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What is released due to the pressure on the cervix which would then stimulate the hypophysis to release it

Oxytocin

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The presence of this hormone causes the initiation of contraction of the smooth muscles of the body

Oxytocin

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According to this theory, progesterone has the ability to inhibit motility, thus, if its amount decreases, labor pains occur

Progesterone deprivation theory

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This hormone is designed to promote pregnancy and is believed to inhibit uterine motility

Progesterone

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What theory indicates that increase in prostaglandin causes uterine contraction thus, labor is initiated

Prostaglandin Cascade theory

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What hormone does fetal membrane and uterine increase?

Prostaglandin

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A decrease in progesterone amounts also elevates what hormone?

Prostaglandin

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According to this theory, Uterine contractions is caused by the decrease in blood supply to the uterus due to advance placental age

Theory of aging placenta

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What are the 6 steps in initiation of labor

Baby moves deeper into mother’s birth canal
Pressoreceptors in cervix of uterus excited
Afferent impulses to hypothalamus
Hypothalamus sends efferent impulses to posterior pituitary, where oxytocin is stored
Posterior pituitary releases oxytocin to blood; oxytocin targets mother’s uterine muscle
Uterus responds by contracting more vigorously

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What are the 7 preliminary signs of labor

lightening
activity level
braxton hick’s contraction
overt loss of weight
ripening of cervix
Buttersoft ruptured BOW
Show

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Does activity during labor increase or decrease?

Increase

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Does false labor would later on turn into true labor?

Yes

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False labor or True labor:
Contractions remain irregular

False labor

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False labor or True labor:
Contractions may be slightly irregular at first but become regular and predictable in a matter of hours

True labor

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False labor or True labor:
The pain is generally confined to the abdomen

False labor

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False labor or True labor:
The pain is first felt in the lower back and sweep around to the abdomen in a girdle like fashion

True labor

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False labor or True labor: There is no increase in contractions in terms of duration, frequency, and intensity. Interval remain long

False labor

False labor or True labor: There is an increase in contractions in terms of duration, frequency, and intensity. Intervals remain short

True labor

False labor or True labor: Contractions often disappear if the mother ambulates, relieved when walking

False labor

False labor or True labor: Contractions continue no matter what the woman's level of activity and is not relieved by walking

True labor

False labor or True labor: Absent cervical changes

False labor

False labor or True labor: Accompanied by cervical effacement and dilation

True labor

False labor or True labor: Absent or brownish discharge

False labor

False labor or True labor: Show:present:pink tinged

True labor

What is considered as the Passenger

Fetus

It is the largest part of the fetal body, most frequent presenting part, and least compressible of all parts

Fetal head

Alteration of the shape of fore-coming head while passing through the resistant birth passage during labor

Moulding

What are the 4 sutures of the fetal head

1. Sagittal or longitudinal 2. Coronal 3. Frontal 4. Lambdoid

Suture b/n the two parietal bones

sagittal or longitudinal suture

Suture b/n parietal and frontal bones on either side

Coronal suture

Suture b/n two frontal bones

Frontal suture

Suture that separates occipital bone and the two parietal bones

Lambdoid sutures

Wide gap in the suture line

Fontanel

What are the two fontanels

Anterior and Posterior fontanels

This fontanel has a diameter of 3 cm

When is the ossification of the anterior fontanel

18 months after birth

This fontanel is found on the junction of sagittal suture anteriorly and lambdoid suture on either side

Posterior fontanel

The measurement of this fontanel is 1.2 x 1.2 cm

Posterior fontanel

When does the posterior fontanel close

3-4 months after birth

In the transverse diameter of the fetal head, what is the measurement of: Biparietal:__________ Bitemporal:_________ Bimastoid:___________

Biparietal: 9.25cm Bitemporal:8 cm Bimastoid: 7 cm

In the anterior-posterior diameter of the fetal head, what is the measurement of: Suboccipitobregmatic: Occipitofrontal: Occipitomental: Subementobregmatic:

Suboccipitobregmatic: 9.25 cm Occipitofrontal: 12 cm Occipitomental: 13.5 cm Subementobregmatic: 9.5 cm

What is the smallest AP diameter

Suboccipitobregmatic

This is when the mother is having difficulty in labor; the fetal head goes in and out repeatedly resulting in an elongated fetal head

Caput succedaneum

Formation of diffuse, boggy swelling due to stagnation of sero-sanguineous fluid in the layers of the scalp beneath girdle of contract crossing midline suture

Caput succedaneum

the formation of diffuse, boggy swelling in caput succedaneum is due to the stagnation of?

sero-sanguineous fluid

Refer to the fetal part that is above the pelvic inlet

Fetal presentation

What are the three types of fetal presentation

1. Cephalic 2. Breech 3. Shoulder

It is also called as the mucus plug

Operculum

What are the 4 types of cephalic presentation

1. Vertex 2. Brow 3. Face 4. Mentum (sinciput or military presentation)

What are the 3 types of breech presentation

1.Complete 2. frank 3. footling

This presentation is where the head is showing first

Cephalic presentation

This presentation is where the head is showing first

Cephalic presentation

This presentation is where the butt or foot of the fetus is showing

Breech presentation

This presentation is where the butt or foot of the fetus is showing

Breech presentation

This presentation is where the fetus is lying transveraslly

Shoulder presentation

What are the two types of shoulder presentation

1.acromium 2. Hand or elbow

Relationship of the long axis (spine) of the fetus to the long axis of the mother

Fetal lie

Three types of fetal lie

Longitudinal Transverse Oblique

The relationship of the fetal parts to one another

Attitude or Habitus or Posture

True or false: The fetus forms an ovoid mass that corresponds to the shape of the uterine cavity

True

What are the 4 fetal attitudes

Complete flexion Moderate flexion Poor flexion Full flexion

Relationship of he fetal reference point to specific quadrant of the mother's pelvis

Fetal Position

Identify what each letter means according to fetal position: L- R- Fetal presentation: O- M- Sa- A- Fetal landmark: A- P- T-

L- Left R- Right Fetal presentation: O- Occiput M- Mentum Sa- Sacrum A- Acromium Fetal landmark: A- Anterior P- Posterior T- Transverse

In Fetal position, what are the first letters

L or R

In Fetal position, what are the second letters

O, M, Sa or A

In Fetal position, what are the third letters

A, P or T

4 parts of fetus as landmarks: VERTEX – (2) BREECH – (1) SHOULDER – (2)

VERTEX – OCCIPUT, MENTUM BREECH – SACRUM SHOULDER – SCAPULA, ACROMIUM PROCESS

Measure of descent of the presenting part

Station

What part is considered as station 0

Pelvic inlet / Ischial spine

If the fetus is on stations -3, -2, -1, the fetus is what?

Floating

If the fetus is on stations +3, +2, +1, the fetus is what?

At outlet / nearing in delivery

What stations are considered as the inlet

-3 and -2

What stations are considered as the midpelvis

-1, 0, +1

What stations are considered as the outlet

+2 and +3

when the widest part of the baby’s presenting part (usually the head) enters the pelvic brim or inlet

Fetal Engagement

Invisible line that is b/n the true and false pelvis

Linea Terminalis

What is the direction of the upper part and lower part of the passageway

Upper: Downward backward Lower: Downwards forward

Superior half of the pelvis

FALSE PELVIS

Supports the uterus during late months pregnancy

FALSE PELVIS

Aids in directing the fetus into the true pelvis

FALSE PELVIS

Inferior half of the pelvis

TRUE PELVIS

Imaginary line from sacral prominence at the back of the pelvis to the superior aspect of the symphysis pubis at the from

LINEA TERMINALIS

Also called as Pelvic Brim (Pelvic Inlet)

LINEA TERMINALIS

3 major parts of the pelvic passageway

1. PELVIC INLET 2. PELVIC OUTLET 3. PELVIC CAVITY

Part of the pelvic passageway: Entrance to the true pelvis

PELVIC INLET

Part of the pelvic passageway: At the level of Line terminalis

PELVIC INLET

Part of the pelvic passageway: Appears heart shaped

PELVIC INLET

Part of the pelvic passageway: Wider transversely than anterio-posterior diameter

PELVIC INLET

Part of the pelvic passageway: Inferior Portion

PELVIC OUTLET

Part of the pelvic passageway: At the level of Linea terminalis

PELVIC OUTLET

Part of the pelvic passageway: Greatest Diameter is the anterio-posterior diameter

PELVIC OUTLET

Part of the pelvic passageway: Mid pelvis

PELVIC CAVITY

Part of the pelvic passageway: Curved Passage to slow down and control speed of birth

PELVIC CAVITY

the only way to assess the dimensions of the pelvis in labor.

CLINICAL PELVIMETRY

What are the 3 AP diameters of the pelvic inlet

1. Diagonal Conjugate 2. Obstetric Conjugate 3. Conjugate Vera

AP diameter between anterior sacral prominence and posterior Symphysis Pubis

Diagonal Conjugate

What is the measurement of the Diagonal Conjugate

Measurement: 12.5cm to 13cm

Smallest AP Diameter

Obstetric Conjugate

AP diameter that is a Sacral promontory to the inner surface of the symphysis pubis

Obstetric Conjugate

How is the Obstetric Conjugate solved?

OC= DC – (1.5 to 2cm)

What is the measurement of the Obstetric Conjugate?

Measurement: 10.5cm – 11cm

AP diameter that is Between the posterior aspect of the symphysis pubis and the promontory of the sacrum

Conjugate Vera

How is the Conjugate Vera solved?

CV= DC– (1 to 1.5cm)

What is the measurement of the Conjugate Vera?

Measurement: 10.5 – 11 cm

The pelvic inlet diameter that is the greatest Distance between the linea terminalis on either side

Transverse Diameter

The pelvic inlet diameter that is the Segment posterior to the intersection

Transverse Diameter

The pelvic inlet diameter that Facilitates the descent of fetal head

Transverse Diameter

What is the measurement of Transverse Diameter of the Pelvic Inlet

Measurement: 13.5 cm

The pelvic inlet diameter that Extends from sacroiliac joint on one side to ilio eminence on other side

Oblique Diameter

What are the two sides of the Oblique Diameter of the Pelvic Inlet

Left OD Right OD

What are the two points of the pelvic inlet that indicates the oblique diameter

sacroiliac joint on one side to ilio eminence on other side

What is the measurement of Oblique Diameter of the Pelvic Inlet

Measurement: 13 cm

The pelvic Cavity diameter is Mid-symphysis to fused S2, S3

AP Diameter

What is the measurement of the AP diameter of the pelvic cavity

Measures: 11.5 to 12 cm

The Transverse or Interspinous Diameter is found b/n the base of what?

Between the base of ischial spines

The pelvic Cavity diameter that is the Smallest Diameter of pelvis

Transverse or Interspinous Diameter

What is the measurement of the Transverse or Interspinous Diameter of the pelvic cavity

Measures: 10cm

The pelvic Cavity diameter is the Midpoint between ischial spines and sacrum

Posterior Sagittal Diameter

What is the measurement of the Posterior Sagittal Diameter of the pelvic cavity

Measures: 4.5 to 5 cm

The AP Diameter of the pelvic outlet is on the Inferior border of ________ to posterior aspect of ___________

pubic symphysis sacrum tip

What is the measurement of the AP Diameter of the Pelvic Outlet

Measures: 9.5 to 11.5 cm

The Transverse or Interspinous Diameter is found b/n the base of inner edges of what?

ischial tuberosities

What is the measurement of the Transverse or Interspinous Diameter of the Pelvic Outlet

Measures: 9 to 11cm

The Posterior Sagittal Diameter is found at midpoint b/n ___________ and ___________ of the tip of the sacrum

ischial tuberosities external surface

What is the measurement of the Posterior Sagittal Diameter of the Pelvic Outlet

Measures: 7.5 cm

A disorder where a pelvis with a measurement of less than 1.5 to 2 cm in any of its important diameters

CONTRACTED PELVIS

Contracted Pelvis is suspected if: ✓ __________ has not yet taken place after 37 weeks in primis ✓ there is a history of ______, _______ and _______ in multi

lightening stillbirth difficult labor forceps delivery

Contracted pelvis is suspected if lightening has not yet taken place after how many weeks in primis?

37 weeks

True or false: Mothers with contracted pelvis can still have a vaginal delivery?

False

Refer to the force generated by the contraction of the uterine myometrium

Power Uterine contractions

Power Uterine contractions refer to the force generated by the contraction of the __________

uterine myometrium

3 types of Power Uterine contractions

Mild Moderate Strong

A power where uterine muscle are somewhat tense but can be indented by a gentle pressure

Mild

A power where uterus is moderately firm and a firmer pressure is needed to indent

Moderate

A power where the uterus becomes very firm that at the height of contraction cannot be indented

Strong:

The abdomen of the mother is compared to be _____________ when she is having strong power uterine contractions

board-like

2 kinds of Power

1. PRIMARY POWER 2. SECONDARY POWER

Primary or Secondary power: * Physiologic * Involuntary urge * Uterine muscular contractions * Measurable

PRIMARY POWER

Primary or Secondary power: * Psychologic * Voluntary urge * Use of abdominal muscles to push

SECONDARY POWER

PHASES OF CONTRACTION

o Increment o Acme o Decrement

A phase of contraction when the intensity of the contraction increases

Increment

A phase of contraction when the contraction is at its strongest

Acme

A phase of contraction when the intensity decreases

Decrement

Between contractions, the uterus ________

Relaxes

What labor is where the cervix is at 0 - 3 cm

LATENT-EARLY LABOR

What labor is where the cervix is at 4 -7 cm.

ACTIVE LABOR

What labor is where the cervix is at 8 -10 cm

TRANSITION LABOR

LATENT-EARLY LABOR Duration: ____________secs Frequency: ________ mins

Duration: 20-40 secs Frequency: 5-10 mins

ACTIVE LABOR Duration: ____ secs Frequency: _____ mins ___ hr ____hr

Duration: 40-60 secs Frequency: 3-5 mins 3 hr 2 hr

TRANSITION LABOR Duration: ____ secs Frequency: _____ mins

Duration: 60-90 secs Frequency: 2-3 mins

What power uterine contraction is experienced in latent-early labor

Mild

What power uterine contraction is experienced in active labor

Moderate

What power uterine contraction is experienced in Transition labor

Strong

What Power and Labor is this: Excited, euphoric with some apprehension but still with ability to communicate

MILD LATENT-EARLY LABOR

What Power and Labor is this: Takes up 6 - 12-hour 1ST stage

MILD LATENT-EARLY LABOR

What Power and Labor is this: Mother fears losing control of herself

MODERATE ACTIVE LABOR

What Power and Labor is this: Feeling of losing control, anxiety, panic, irritability

STRONG TRANSITION LABOR

What Power and Labor is this: Perspiration, neck vein distention

STRONG TRANSITION LABOR

What Power and Labor is this: N and v due to decreased gastric motility, urge to push

STRONG TRANSITION LABOR

In the contour changes of the uterine, it is separated by what?

physiologic retraction ring

What portion of the uterine becomes thicker and active during labor

Upper portion

What portion of the uterine becomes thin-walled, supple, and passive during labor

Lower portion

Uterine Changes o Contour changes - Round, ovoid uterus to _________

elongate

What are the two Cervical Changes

Effacement Dilatation

A cervical change that is the Shortening and thinning of the cervical canal

Effacement

Why must effacement occur at the peak of dilation

cervical tearing may happen

When does effacement happen in primipara

occur before cervical dilation

A cervical change where there is Enlargement or widening of the cervix canal

Dilatation

What are the 2 main methods of cervical ripening

Non-Pharmacologic methods Pharmacologic methods

What are the 3 Non-Pharmacologic methods

Membrane stripping Foley bulb Amniotomy

A Non-Pharmacologic method where it needs favorable cervix, if cervix is favorable it can get labor started

Amniotomy

Is the artificial rupturing of membranes

Amniotomy

This scoring system is used to identify if the cervix is favorable by measuring its parameters

Bishop’s score

What pharmacologic agents aid in cervical ripening

Dinoprostone (Prepadil and Cervadil) PGE₂ oxytocin Misoprostol (Cytotec) PGE₁

What PGE is important for cervical maturation

PGE₂

What PGE causes myometrial contractions

PGF ₂ alpha

Ultrasound grading system of the placenta based on its maturity

PLACENTAL GRADING

Placental grading is related to what?

gestational age.

At what weeks (AOG) is where blood flow is easily demonstrable

12–13 weeks

At what weeks (AOG) is where Placenta is well established

14–15 weeks

What are the 4 placental grades

Grade 0, 1, 2, 3

What placental grade is this: Homogenous placenta, uniform echogenicity—first and early second trimester

Grade 0

What is uniform in grade 0 of placental grading

echogenicity

What placental grade is this: Occasional hypo-/hyperechoic areas—late second trimester

Grade 1

What placental grade is this: Larger calcifications along the basal plate—early third trimester

Grade 2

What placental grade is this: Larger and denser calcifications along with compartmentalization of placenta—late third trimester

Grade 3

It is based on the Readiness of the mother

PSYCHE

what trimester is where the mother Accept the pregnancy; Fetus as part of self

1st Tri

what trimester is where there is Quickening, mother accepts

2nd Tri

what trimester is where the mother prepares for child birth; baby layette

3rd tri

12 positions in labor (Wa, Si, Ta, Se, Ha, Sta, Squa, Kne, Li, La, Up, Si)

1. Walking 2. Sitting/leaning 3. Tailor sitting 4. Semi-recumbent 5. Hands and knees 6. Standing 7. Squatting 8. Kneeling and leaning forward with support 9. Lithotomy 10. Lateral recumbent 11. Upright 12. Side lying

7 Mechanisms of Labor (Cardinal Movements)

1. ENGAGEMENT 2. DESCENT 3. FLEXION 4. INTERNAL ROTATION 5. EXTENSION 6. EXTERNAL ROTATION 7. EXPULSION

A mechanism of labor where there is Settling of the presenting part of the fetus far enough into the pelvis to be at the level of the ischial spine

ENGAGEMENT

A mechanism of labor where there is Downward movement of the biparietal diameter of the fetal head to within the pelvic inlet

DESCENT

A mechanism of labor where it Allows the longest fetal head diameter (anteroposterior) to conform to the longest diameter of the maternal pelvis

INTERNAL ROTATION

A mechanism of labor where the head meets resistance from the soft tissues of the pelvis

FLEXION

A mechanism of labor where the Head bends forward to present the smallest antero-posterior diameter (suboccipito-bregmatic diameter) to the birth canal

FLEXION

A mechanism of labor that Occurs as a result of negotiation of the fetal head to the curve of the pelvis

EXTENSION

A mechanism of labor where there is Rotation of the head, immediately after it was born, back to the diagonal or transverse position

EXTERNAL ROTATION

A mechanism of labor where the rotation Brings the shoulder into an anteroposterior position

EXTERNAL ROTATION

External rotation of the head accompanies ___________ of the shoulders

internal rotation

A mechanism of labor where the baby is delivered

EXPULSION

What are the stages of labor

Stage 1, 2, 3, 4

LENGTH OF LABOR in PRIMI First Stage Second Stage Third Stage Fourth Stage

First Stage: 12-14 hours Second Stage: 80 minutes Third Stage: 10 mins Fourth Stage: 2-4 hours

Total of hours of labor in primis

14-16 HOURS

LENGTH OF LABOR in MULTI First Stage Second Stage Third Stage

First Stage: 7 hours Second Stage: 20-30 minutes Third Stage: 10 mins

Total of hours of labor in multi

8 hours

What stage of labor is where there is Onset of labor to full dilatation

STAGE 1

Duration of stage 1 in nullipara (average and range)

8-10 hours average; 6-18 hours range

Duration of stage 1 in multipara (average and range)

6-7 hours average; 2-10 hours range

Cervical dilation per hour of stage 1 in nullipara

1.2 cm/hr

Cervical dilation per hour of stage 1 in Multipara

1.5 cm/hr

labor curve; used to identify & monitor progression of cervical dilation

Friedman’s curve

3 phases of stage 1 of labor

LATENT ACTIVE TRANSITION

What phase of stage 1 is: Onset of labor until cervix starts to make change

LATENT

What phase of stage 1 is: Greater rate of cervical change

ACTIVE

What phase of stage 1 is: 8-10 cm dilation

TRANSITION

What are the care given in first stage: Latent: E- B- A-

Latent: E- elimination, voiding B- breathing - chest breathing A- ambulation

What are the care given in first stage: Active: A- D- A- N-

Active: A- assessment inc: v/s, cervix, FHT D- Dry lips (oral care) A- Abdominal breathing N- By mouth

What are the care given in first stage: Transient: T- I- R- E- D-

Transient: T- Tired I- Inform of progress R- Rest and breathing technique E- Encourage and praise D- Discomforts

DURATION CONTRACTION (LATENT) Strength/ Intensity Rhythm Frequency Duration Show/Mucus Plug Color

S: Mild to moderate R: Irregular F: 5-30 min apart D: 30-45 sec Show: Brownish discharge, or pale pink mucus

DURATION CONTRACTION (ACTIVE) Strength/ Intensity Rhythm Frequency Duration Show/Mucus Plug Color

S: Moderate to strong R: more regular F: 3-5 min apart D: 40-70 sec Show: Pink to bloody mucus

DURATION CONTRACTION (TRANSITION) Strength/ Intensity Rhythm Frequency Duration Show/Mucus Plug Color

S:Strong to very strong R:Regular F:2-3 min apart D:45-90 sec Show: Bloody Mucus

What stage of labor is where there is Full dilation to delivery

STAGE 2

This stage of labor Begins from full cervical dilation to fetal expulsion

STAGE 2

Duration in nullipara and multipara of stage 2 of labor

Nullipara—30-min to 3 hours multipara—5-30 minutes

Contractions change from the characteristic ___________

crescendo-decrescendo

This stage of labor is where Perspiration and the blood vessels in the neck may become distended

STAGE 2

Signs of imminent delivery (5)

1. Mother feels as if to move her bowel 2. “The baby is coming!”—classic sign 3. Intense and unstoppable need to push 4. Bulging perineum to crowning 5. Increased bloody show

Extracting the fetal head, using one hand to pull the fetal chin from between the maternal anus and the coccyx, and the other on the fetal occiput to control speed of delivery.

Modified Ritgen’s Maneuver

a cut (incision) through the area between your vaginal opening and your anus

Episiotomy

This stage of labor is where there is: Modified Ritgen’s Maneuver Episiotomy Perineal Bulging Care of the newborn

STAGE 2

This stage of labor is when the placenta is delivered

STAGE 3

Delivery of placenta-can take up to ____

30 minutes

This stage of labor Begins from expulsion of the baby to placental expulsion

STAGE 3

Duration of stage 3 of labor

5-10 minutes

What is the normal blood loss of stage 3 of labor

300-500 mL

What are the two phases of stage 3 of labor

Signs of Placental separation Placental expulsion

What are the 4 signs of Placental separation

✓Rising of the fundus ✓Lengthening of the umbilical cord ✓Sudden gush of vaginal blood ✓Globular shape of the uterus (Calkin’s sign)

Globular shape of the uterus

Calkin’s sign

What placental presentation appears shiny and glistening from the fetal membranes

Schultze presentation

What placental presentation appears raw, red, and irregular, with the ridges or cotyledons that separate blood collection spaces showing

Duncan presentation

This stage of labor Begins from the delivery of placenta to the first 1-2 hours after birth

STAGE 4

This stage of labor is where the Contracted uterus is below the level of umbilicus

STAGE 4

vaginal discharges after birth

Lochia

What should you WOF in stage 4 of labor

bleeding

What kind of lochia is seen at the first 3 days after birth, consists almost entirely of blood, with only small particles of decidua and mucus

lochia rubra

What kind of lochia is seen at the 4th day where involved in the cast-off tissue decreases and leukocytes begin to invade the area, the flow becomes pink or brownish

lochia serosa

What kind of lochia is seen at the 10th the amount of the flow decreases and becomes colorless or white

lochia alba

Pharmacologic Management of Discomforts (6)

1. Local anesthesia 2. Intravenous – narcotic analgesic 3. Paracervical block 4. Pudendal block 5. Epidural block 6. General anesthesia

Median or Mediolateral: Easy to repair

Median

Median or Mediolateral: More difficult to repair

Mediolateral

Median or Mediolateral: Faulty healing rare

Median

Median or Mediolateral: Less painful in puerperium

Median

Median or Mediolateral: Faulty healing more common

Mediolateral

Median or Mediolateral: Pain in 1/3 cases for few days

Mediolateral

Median or Mediolateral: Dyspareunia rarely follows

Median

Median or Mediolateral: Dyspareunia occasionally follows

Mediolateral

Median or Mediolateral: Anatomic end results almost always excellent

Median

Median or Mediolateral: Anatomic end results more or less faulty in some 10% of cases

Mediolateral

Intrapartum Flashcards

(268 cards)