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Clin Med > Labor and Delivery > Flashcards

Labor and Delivery Flashcards

(59 cards)

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1
Q

Premature rupture of membranes (PROM)

A

rupture of membranes before the onset of labor

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2
Q

Preterm, premature rupture of membranes (PPROM)

A

rupture of membranes before 37wks

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3
Q

Prolonged PROM

A

when PROM occurs more than 18hrs before labor, puts mother and fetus at risk for infection

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4
Q

Rupture of Membranes Dx

A

SSE showing pooling, +nitrizine and ferning

  • Amnisure: rapid test that identifies placental alpha-microglobulin-1 via immunoassay
  • Amino dye test: amniocentesis used to inject dilute idigo carmine dye into the amniotic sac to look for leakage from cervix onto tampon
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5
Q

Components of Cervical Exam

A 
Dilation 
Effacement 
Fetal Station 
Cervical Position 
Consistency of Cervix
  • determine if patient is in labor, phase of labor and how labor is progressing
  • Bishop score >8= cervix favorable for induced labor
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6
Q

Dilation

A

how open cervix is at level of internal os (0-10cm)

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7
Q

Effacement

A

subjective measurement of length of cervix (0-100%)

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8
Q

Fetal Station

A

relation of fetal head to ischial spines of maternal pelvis (-3 to +3)

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9
Q

Vertex

A

head down (cephalic)

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10
Q

Breech

A

buttocks down

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11
Q

Transverse

A

laying across

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12
Q

Compound presentation

A

vertex presentation with fetal extremity

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13
Q

Fetal position in vertex presentation

A

based on relationship of fetal occiput to the maternal pelvis
-determined by palpating sutures and fontanelles

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14
Q

Labor

A

regular uterine contractions that cause cervical changes in either effacement or dilation

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15
Q

Prodromal labor

A

false labor

irregular contractions that yield little/no cervical change

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16
Q

Signs of Labor

A

bloody show, N/V, palpability of contractions, patient discomfort

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17
Q

Induction agents

A

prostaglandins, oxytocin, mechanical dilation of the cervix, artificial rupture of membranes

Pitocin: synthesized version of the octapeptide oxytocin that is normally released from the posterior pituitary that causes uterine contractions

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18
Q

Indications to Induce Labor

A 
post dates 
preeclampsia 
PROM 
non reassuring fetal testing 
IUGR
  • Bishop score 5 or less may lead to failed induction up to 50% of the time
  • cervical ripening with PGE2 gel
  • cervidil or misprostol
  • mechanical foley
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19
Q

Augmentation of Labor

A

intervening to increase the already present contractions

indications similar to those for IOL, plus inadequate contraction or prolonged phase of labor

Pitocin or amniotomy

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20
Q

Cervical change

A

indirect measure of adequacy of contraction

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21
Q

Intrauterine pressure catheter (IUPC)

A

directly measures chance in pressure during contractions

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22
Q

Electronic fetal monitoring

A

standard of care

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23
Q

Baseline fetal heart rate

A

110-160BMP

Tachy >160
Brady <110

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24
Q

Variability: fluctuations in the baseline of FHR

Study These Flashcards
A
  • Absent -amplitude undetected
  • Minimal- amplitude range 5BPM or less
  • Moderate-amplitude range between 6-25 BPM
  • Marked- amplitude range greater than 25BPM
25
Accelerations
increased in FHR (onset to peak <3secs) at 32wks: accelerations must be 15x15
26
Early Decelerations
symmetrical gradual decrease and return of FHR associated with uterine contraction
27
Late Deceleration
deceleration with nadir occurring after peak of contraction then slowly return to baseline
28
Variable deceleration
abrupt decrease in FHR
29
Prolonged deceleration
Lasts 2 minutes or more
30
FHR interpretation
Category I: normal Category II: monitor Category III: abnormal+ must intervene
31
Fetal Scalp Electrode (FSE)
* small electrode attached directly to fetal scalp * senses potential differences created by depolarization of fetal heart * C/I maternal hepatitis/HIV, fetal thrombocytopenia
32
Intrauterine pressure catheter (IUPC)
* catheter threaded past fetal head into uterine cavity to measure pressure changes during uterine contraction * measured in Montevideo units in a 10min period
33
Fetal Scalp pH
fetal blood is obtained from small nick in fetal scalp to directly asses fetal hypoxia and acidemia non reassuring: <7.20 >7.25 normal
34
Cardinal Movements of Labor
``` Engagement Descent Flexion Internal rotation Extension External rotation (restitution) ```
35
Engagement
fetal presenting part enters pelvis
36
Descent
head descends into pelvis
37
Flexion
allows smallest diameter to present
38
Internal rotation
rotation from an OT position, usually | to OA
39
Extension
vertex passes beneath pubic symphysis
40
External Rotation
once head is delivered | restitution
41
Labor progression
Assessed by: 1. the progress of cervical effacement 2. cervical dilation 3. descent of fetal presenting part
42
Stage 1 of Labor
onset of labor until complete dilation of cervix nulliparous: 10-12 hours mutiparious 6-8hrs
43
Latent phase (stage 1)
from onset of labor to 3-4cm
44
Active phase (stage 1)
from latent phase to beyond 9cm , slow of cervical change against time increases 1cm/hr nulliparous 1.2cm/hr for multiparous
45
the 3 Ps
affect transit time during active phase of labor * powers -strength and frequency of uterine contractions * passenger- size and position of fetus * passage/pelvis size and shape (maternal)
46
cephalopevic disproportion
passenger is too large for pelvis
47
Stage 2 of labor
complete cervical dilation to delivery of infant * Prolonged if: - >2hrs in nulliparous pt (3hrs with epidural) - >1hr in multiparous pt (2hrs with epidural) *Repetitive early and variable decels are common *Repetitive late decels, bradycardia or loss of variability are non-reassuring
48
Stage 3 of labor
from delivery of the infant until delivery ofthe placenta completed (5-30 mins)
49
3 signs of placental separation
1. cord lengthening 2. gush of blood 3. uterine fundal rebound as placenta detaches
50
Episiotomy
incision made in the perineum to facilitate delivery
51
Median Episiotomy (midline)
vertical midline incision | from the posterior fourchette into the perineal body
52
Mediolateral Episiotomy
oblique incision from 5 or 7 | o’clock on perineum cut laterally
53
Operative Vaginal Delivery indications
Prolonged second stage, maternal exhaustion, or the need to hasten delivery ``` Necessary conditions: full dilation ruptured membranes engaged head at least 2 station knowledge of fetal position no evidence of CPD adequate anesthesia empty bladder ```
54
Operative Vaginal Delivery | Types:
Forceps and Vacuum Extraction
55
Retained Placental
Placenta not delivered within 30 minutes after infant * Risk Factors: - preterm, pre-viable deliveries - precipitous delivery - placenta accreta (placenta invaded endometrial stroma * Manual removal - hand placed intrauterine, fingers used to shear placenta from surface of uterus *Curettage if manual extraction fails
56
1st degree perineal laceration
superficial, confined to vaginal mucosal layer
57
2nd degree perineal laceration
into the body of the perineum
58
3rd degree perineal laceration
into the anal sphincter
59
4th degree laceration
into the rectum

Clin Med (2 decks)

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