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Intrapartum ObGyn > Intrapartum Obgyn > Flashcards

Intrapartum Obgyn Flashcards

1
Q
  • Uterine contractions regular, before 37 weeks gestation , and associated with cervical changes
  • Can result in premature birth
A

Preterm Labor

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2
Q

Birth types
spontaneous - intact membranes or PPROM
indicated - d/t maternal or OB complications (eclampsia)

A

Preterm Labor

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3
Q

Risk Factors: multifetal gestation and prior preterm birth
Causes:
1. Maternal or fetal stress trigger HPA axis (maternal substance abuse, short interpregnancy)
2. Decidual-chorioamniontic inflammation/infection
3. Decidual hemorrhage
4. Patho uterine distention

A

Causes of Preterm Labor

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4
Q

Signs and Symptoms (6)

  • Menses like cramps
  • Abdominal / pelvic pressure
  • Change in vaginal discharge
  • Abd pain with or without diarrhea
  • Dull low back pain
  • Painless contractions
A

s/s of Preterm Labor

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5
Q

Evaluation of :
US - cervical length, location of placenta
GBS culture, STD culture
Amniocentesis (check for infxn)

A

Evaluate pre term labor

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6
Q

Management
STOP UC- use of tocolytic therapy and prolong pregnancy for 48 hours (BETHAMETHASONE, or DEXAMETHASONE)
- C/I in : advanced maternal age, vaginal bleed, severely anomalous fetus, severely pre -eclamptic, chorioamnionitis
- MgSO4
- ABX prophlyaxis of GBS or PPROM

A

Manage of Pre term labor

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7
Q

Preterm 42 weeks

A

Classify pregnancy

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8
Q

Relates to immediate and extended maternal care after delivery (puerperium)

  • From end of L&D through first 6 weeks after delivery
  • Postnatal care = neonatal concerns after birth
A

Post partum care

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9
Q

sensation felt when “baby drops” = time when presenting (lowermost) part of the fetus descends into maternal pelvis

  • aka engagement
  • 2-3 weeks before labor
A

lightening - intrapartum care

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10
Q

False UC, NO cervical dilation

A

Braxton hicks - intrapartum care

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11
Q

increase cervical mucus and or blood-tinged mucus

A

Bloody Show

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12
Q

Call doc if

  1. UC q 5 min x 1 hour
  2. vaginal fluids: sudden gush or continuous leakage
  3. Vaginal bleeding
  4. Decreased FM
A

intrapartum care

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13
Q

PN record review - confirm GA week, day
aware problems/ risk during pregnancy
review lab results

focused maternal hx: UCs, ROM, LOF (leak of fluid), bleeding, decreased FM, focal sx
va: maternal
Abdomen - UCs (mild moderate severe), fetal lie, presentation, position

A

initial eval for labor

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14
Q
  1. The relation of the long axis of the fetus to the maternal long axis, longitudinal 99% of time.
  2. the portion of the fetus lowest in the birth canal, palpated during the exam (most common: head is sharply flexed onto the fetal chest such that the occiput or vertex shows)
  3. relation of the fetal presenting part to the Right or Left side of the maternal pelvis
A
  1. Fetal Lie
  2. Presentation
  3. Position
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15
Q

The OCCIPUT-ANTERIOR POSITION is deal for…..

A

BIRTH!!

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16
Q
  1. fundal component
  2. fetal back and extremities
  3. presenting part/ symphysis
  4. direction and degree of flexion of head
A

Leopold Maneuvers - intapartum care

17
Q

Cervical consistency - soft or firm

  • Cervical effacement - shortening of cervical canal = % of thinning
  • Cervical dilation= opening of cervix
A

PE/ vaginal/ digital exam - intrapartum care

18
Q

Fetal station : fetal presenting part in relation to ischial spines

  • Spines separate pelvic inlet from outlet
  • -> FETAL PART AT THE SPINES = STAGE 0 (ZEROO)
A

Intrapartum care - initial eval for labor

19
Q

Stage 1.
The interval between onset of labor and full dilation of cervix
- Latent phase –> cervical effacement up to 4cm
- Active phase –> cervical effacement starting at 4-5cm to 10 cm
- Transition –> 8-10 cm

Stage 2
Starting from full dilation through delivery of the baby

Stage 3
Starting from delivery of baby through delivery of placenta

Stage 4
Immediate 2 hours after delivery of placenta

A

Stages of Labor - intrapartum care

20
Q

Changes of fetal position thru birth canal.
1. Engagement
descent of biparietal diameter into pelvic outlet

  1. Flexion:
    smaller diameter of vertex presents into pelvis
  2. Descend
    vertex reaches ischial spine
  3. Internal rotation
    Vertex deeper into pelvis (anterior or posterior presentation of head)
  4. Extension
    vertex reaches introitus
    - Flexed head extends to fit upward curve
  5. External rotation
    head rotates to “face forwards” to align with shoulders and pelvic outlet (Restitution)
  6. Expulsion
    delivery of body
A

Mechanisms of labor - Cardinal movements

21
Q

Management - normal L&D

  • Maternal ambulation and position
  • -> allow to ambulate or assume any position
  • > left lateral position if recumbent

Dorsal Lithotomy position - most commonly used in US for spontaneous vaginal births

A

intrapartum -care management

22
Q

why minimize maternal fluids?

give - ice chips /clear fluids , parenteral : IV w/ 1/2 NS or D5 1/2 NS

A

because d/t decrease GI peristalsis, aspiration can occur during admin of anesthesia

23
Q

Labor pain

  • 1st stage d/t contraction of uterus and dilating cervix
  • 2nd stage d/t vagina and perineum stretching; compression of rectum
A

Maternal analgesia

24
Q

No pharm - breathing, hypnosis, ball, peanuts, rocking chairs, hydrotherapy

Pharm: NUBAIN, STADOL, MORPHINE, FENTANYL

Regional blocks : anesthetic or narcotic in epidural or subarachnoid space
- combined spinal-epidural = rapid initial relief

Local block - to vagina or perineum (pudendal block)

General anesthesia - IV or inhaled

A

Maternal analgesia , normal L&D

25
Q

Intermittent monitor: Doppler (low risk)
q 30 min / active phase - 1st stage
q 15 min - 2nd stage

-Continuous electronic fetal monitoring (EFM) - external or internal

A

Fetal well being evaluation

26
Q

Management of Labor
Stage based on 1st stage (onset of labor thru dilation)
- serial pelvic exams
- observe for ROM (clear, meconium, blood)
-Support and encourage

Stages based on 2nd stage (dilation thru delivery)

  • Voluntary pushing and involuntary UCs
  • Fetal Head = molding and caput succedaneum (common cause overestimation of station)
  • Crowning
  • Episiotomy and Ritgen maneuver rare interventions
Episiotomy 
1st degree - vagina mucosa /perineal skin
2nd degree- subq tissue
3rd degree- rectal sphincter
4th degree- rectal mucosa 
Stage Based on 3rd stage (placenta)
signs of placenta separation
1. Uterus rises
2. Gush of blood
3. Cord lengthen
4. Wait 30 min for it to come out
5. Gentle downward traction, opposite pressure on suprapubic counterpart
Staged based on 4th stage
First hour risk of PPC
- Risk factors: rapid labor, protracted labor, polyhydramnios, macrosomia, multi-fetal gestation, intrapartum chorioamnionitis
- inspect lacerations and repair
- uterine massage 
- uterotonins - oxytocin ,misoprostol methergine, carbopost
EBL (est. blood loss)
- Monitor maternal VS
A

manage l and d

27
Q

Induction of labor
-benefit risk mom or fetus vs continued preg
- Maternal: HTN, GDM, preeclampsia
- Fetal : IUGR, post-term, oligohydramnios
Options: OXYTOCIN, CERVICAL RIPENING, MEMBRANE MANIPULATION

A

Induction of labor

28
Q

Minimize uterine overstimulation: lower and less frequent OXYTOCIN

Reduce incidence chorionamnionitis or C-section d/t dystocia = Higher and More Frequent OXYTOCIN

A

Oxytocin - induction of labor

29
Q

Cervical Ripening
- For unfavorable cervix
- MISOPROSTOL: E2 prostaglandine, insert vaginal or intracervical
C/I - hx uterine surgery or Csection

LAMINARIA in internal os
- Risks: failure to dilate, lacerate cervix, accidental ROM, infection
Synthetic dilation - 30 ml foley cath/canal

A

Cervical Ripening

30
Q

Membranous manipulation

  • AKA STRIPPING, SWEEPING
  • Free chorionic membrane from decidua/lower uterine segment
  • Risks: infection, bleeding, accidental ROM
A

Membranous manipulation

31
Q

C-seciton

  • maternal mortality rate 2-4x vaginal birth
  • Indications :
    1. labor dystocia ; NR FHS status
    2. Elective repeat/ primary c/s
    3. Abnormal fetal presentation
    4. Placenta previa or abruption , cord prolapse
A

C-section indication

32
Q

C section types

  1. Low Transverse LTCS = incision thru thin lower uterine segment allows for VBAC
  2. Classical : incision thru thick, muscular upper portion of uterus - risk of uterine rupture - no TOLAC
A

C section types

33
Q

trial of labor c-section

1. rate of uterine rupture

A

Trial of labor c-section (TOLAC)

34
Q

TOLAC requirements

  1. continuous EFM
  2. OBGYN
  3. anesthesia
  4. blood bank
A

TOLAC requirements

Intrapartum ObGyn (1 decks)

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