Labor and delivery

Question 1

what are signs of false labors

Answer 1

irregular contractions
interval may stay the same
walking may make less
adbominal cramping
mild sedation reduces

Question 2

what is repetitive uterine contraction associated with progressive cervical changes

Answer 2

labor

Question 3

what are signs of true labor

Answer 3

regular contractions
interval decreases
walking makes worse
abdomen and or back pain
mild sedation has no effect

Question 4

If GBS is present prior to birth what is the treatment

Answer 4

Penicillin G for at least 2 doses (4hrs apart) until delivery of baby
if allergic - treat with appropriate alternative abs (depends on sensitivity and risk of anaphylaxis)

Question 5

what is assessed on PE with a birthing person

Answer 5

vitals
fetal position and presentation (Leopolds)
contraction (CTX): frequency, duration and strength
pelvic exam: cervical exam findings, confirm rupture of membranes

Question 6

what is the initial assessment of fetal wellbeing

Answer 6

Fetal Heart rate (FHR)
presentation/position/attitude
size

Question 7

what is the method to assess fetal well-being

Answer 7

HR

Question 8

What are the methods for fetal monitoring

Answer 8

external: intermittent auscultation, continuous electronic fetal monitoring
internal: fetal scalp electrode
combo is common practice

Question 9

What is EFM

Answer 9

electronic fetal monitoring: record heartbeat of the fetus and contractions of the uterus during labor - may be external or internal

Question 10

what is the upper and lower portions on a fetal monitor looking at

Answer 10

upper: tracing fetal HR
lower: tracing contractions

Question 11

what may affect fetal heart rate during labor

Answer 11

fetal conditions
tests done during labor
birthing person conditions
medications or anesthesia given during labor
uterine contractions
pushing during second stage of labor

Question 12

what are the 5 essential components of fetal heart race tracing

Answer 12

baseline
variability
accelerations
decelerations
changes or trends over time

Question 13

how is mean fetal heart rate calculated

Answer 13

rounded to increments of 5 beats per minute during a 10-min segment - excluding accelerations and decelerations

Question 14

what is a normal fetal baseline HR

Answer 14

110-160bmp

Question 15

what is considered fetal bradycardia

Answer 15

less than 110 bpm

Question 16

what is considered fetal tachycardia

Answer 16

over 160bpm

Question 17

what is the fluctuations in FHR baseline that are irregular in amplitude and frequency

Answer 17

variability
based on at least 10-20 minutes of tracing

Question 18

what are variable decelerations associated with on fetal monitoring

Answer 18

cord compression

Question 19

what is seen with head compression on fetal monitoring

Answer 19

early decelerations

Question 20

what is seen with placental insufficiency on fetal monitoring

Answer 20

late decelerations

Question 21

what are early deceleration

Answer 21

symmetrical gradual decrease in FHR (>30 sec) and return to baseline with CTX.
nadir is at the same time as the peak of the CTX

Question 22

what is variable deceleration

Answer 22

abrupt decrease in FHR below baseline which may or may not be associated with CTX
onset to nadir is < 30 sec

Question 23

what is late deceleration

Answer 23

symmetrical gradual decrease in FHR (>30 sec) and return to baseline with CTX.
nadir is AFTER the peak of CTX

Question 24

What is tachysystole

Answer 24

excessive uterine activity > 5 contractions in 10 minutes, averaged over 30 minutes

Question 25

how is uterine contraction strength measured

Answer 25

montevideo units (MVU) - sum of intensity of each CTX in 10 minutes adequate uterine activity is a CTX pattern that generates >200MVU

Question 26

What are the three P's of labor

Answer 26

passenger power passage

Question 27

what is cord presentation

Answer 27

umbilical cord falls between presenting part of cervix with our without membrane rupture

Question 28

what is cord prolapse

Answer 28

umbilical cord falls through cervix next to or before presenting part with membrane rupture

Question 29

what is an obstetric emergency that requires immediate delivery by cesarean section

Answer 29

cord prolapse

Question 30

what are the breech presentations

Answer 30

frank, complete fottling

Question 31

what are the risk factors for breech presentation

Answer 31

gestational age before term hydramnios uterine relaxations associated with great parity hydrocephaly and anecephaly

Question 32

what is fetal station

Answer 32

how far down fetal head is in the pelvis narrowest section lies between two bony landmarks of pelvis called ischial spines

Question 33

what is zero station

Answer 33

geometric plane that extends though the spines and up to the pubic one is called the mid-pelvis

Question 34

what is fetal lie

Answer 34

relation of fetal spine to birthing person's spine

Question 35

what is fetal position

Answer 35

relationship of head to the birthing persons pelvis

Question 36

what is fetal attitude

Answer 36

relationship of fetal head and fetal spine

Question 37

what power

Answer 37

uterine contractions

Question 38

what is the myocmetrium

Answer 38

interwoven bundles of smooth muscle cells in a spiral arrangement matrix of collagen and gycosaminoglyans gap conjucntions allow for rapid transmission of signals

Question 39

what is cervical effacement

Answer 39

thinning of cervix

Question 40

what is cervial dilation

Answer 40

enlargement of cercival opening

Question 41

what is the smallest diameter of fetal head when in correct position for delivery

Answer 41

10cm

Question 42

if a patient has a Bishop score <6, what is recommended before induction of labor

Answer 42

cervical ripening mechanical, surgical or pharmacological

Question 43

what is Johnsons formula

Answer 43

fetal weight in grams - 155 x (fundal height in cm - k_ estimation of fetal size

Question 44

what are the stages of labor

Answer 44

prodrome, active phase delivery of head delivery of placenta recovery

Question 45

what is "lightning"

Answer 45

dropping - notices more room to breathe and eat; increased urination and defication

Question 46

What are the movements of Labor

Answer 46

Every Darn Fetus Is Extremely Eager to Exit Engagement Descent Flexion Internal rotation Extension External rotation Expulsion

Question 47

what is the third stage of labor

Answer 47

starts after delivery of baby - ends with delivery of placenta

Question 48

what are signs of third stage of labor

Answer 48

gush of blood cord appears to lengthen uterus becomes globular uterus rises anteriorly

Question 49

what is active management of the third stage of labor

Answer 49

administration of uterotonic (oxytocin) soon after delivery of anterior shoulder application of fundal pressure after delivery of placenta controlled traction on umbilical cord

Question 50

what is the expectant management of the third stage of labor

Answer 50

wait for spontaneous expulsion of the placenta

Question 51

what is the 4th stage of labor

Answer 51

uterine involution fundus is firm and midline about the seize of grapefruit immediately after delivery rises to umbilicus for about 12 hours drops 1cm each day for 10 days until back in the pelvis

Question 52

what is dystocia

Answer 52

abnormal (difficult) labor

Question 53

what are power causes of dystocia

Answer 53

uterine contraction dysfunction, reduced birthing person strength (exhaustion, pain)

Question 54

what are the passenger causes of dystocia

Answer 54

abnormalities of size, presentation, position

Question 55

what are the passage causes of dystocia

Answer 55

abnormalities of pelvic size or architecture

Question 56

what are some indications for a c-section

Answer 56

placental abruption, previa failure to progress/descend worsening birthing person disease malpresentation multiple gestation