Labor and Delivery (Moulton)

Question 1

Labor

Answer 1

progressive cervical dilation resulting from regular uterine contractions that occur at least every 5 mins and last 30-60 seconds

Question 2

Braxton-Hicks contractions

Answer 2

false labor; irregular uterine contractions with no cervical dilation

Question 3

What is the longest anterior-posterior diameter of the head?

Answer 3

Supra-occipitomental (13.5cm)

Question 4

What is the best diameter of the fetal head?

Answer 4

Sub-occipitobregmatic (9.5cm); the head is well flexed

Question 5

What is the most favorable pelvic shape for vaginal delivery?

Answer 5

Gynecoid; classic female pelvis; head generally rotates into OA position
**Anthropoid also favorable “ape” pelvis

Question 6

Which pelvis shapes are unfavorable for vaginal delivery?

Answer 6

Android - narrow pubic arch; fetal head forced to be in OP position

Platypelloid - short AP; fetal head has to engage in the transverse diameter

Question 7

How is the pelvic outlet assessed?

Answer 7

measuring the ischial tuberosity and pubic arch (8.5 cm is adequate)

Question 8

Infrapubic angle

Answer 8

> 90 degrees is adequate

Question 9

Fetal lie

Answer 9

maternal spine in reference to fetus spine; can be longitudinal, transverse or oblique

Question 10

Fetal presentation

Answer 10

the fetal presenting part in reference to the pelvis; can be vertex, breech, transverse or compound

Question 11

Leopold maneuvers

Answer 11

series of 4 maneuvers
1. palpate mom’s fundus
2. palpate for fetal spine and fetal small parts
3. palpate for what fetal part is presenting in the pelvis
4. palpate of cephalic prominence (chin or occipital protuberance)

Question 12

Dilation

Answer 12

level of the cervical internal os; can range from closed to 10cm (completely dilated)

Question 13

Effacement

Answer 13

thinning of the cervix; ranges from thick to 100% effaced

Question 14

What is the normal non-pregnant cervix length?

Answer 14

3-5cm

Question 15

Station

Answer 15

degree of descent of the presenting part of the fetus; measured in cm from presenting part to the ischial spine; when reaches the ischial spine station is “zero”; ranges from - 5cm to +5cm

Question 16

Station of “zero”

Answer 16

when the fetal part reaches ischial spine during delivery

Question 17

the 4 stages of labor

Answer 17

stage 1: onset of true labor (latent and active)
stage 2: phase between complete cervical dilation to delivery
stage 3: phase between delivery of infant to delivery of the placenta
stage 4: phase between delivery of placenta to stabilization of the patient

Question 18

Latent phase of stage 1

Answer 18

early labor - slow cervical dilation

Question 19

Active phase of stage 1

Answer 19

faster rate of cervical dilation; cervix is dilated to 6 cm (most is 10cm); admit for labor at this stage

Question 20

Management of first stage of labor

Answer 20

mom is to lie left lateral recumbent position; IV fluids (maybe oxytocin); labs, monitoring, and analgesia, continuous external fetal monitoring (does not allow you to assess strength of contractions) - need internal pressure catheter

Question 21

What are the normal durations of the first stage of labor and dilation?

Answer 21

Duration: Primiparas 6-18 hrs, Multiparas 2-10 hrs
Dilation: Primiparas 1.2 cm/hr, Multiparas 1.5cm/hr

Question 22

The 7 cardinal movements of labor

Answer 22

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1. Engagement - at “zero” station
2. Descent
3. Flexion
4. Internal rotation
5. Extension - station “+5cm”
6. External rotation
7. Expulsion - anterior shoulder then posterior shoulder

Question 23

What is the most common position for spontaneous and operative deliveries

Answer 23

maternal position of dorsal lithotomy

Question 24

Episiotomy

Answer 24

enlarging the vaginal outlet; in cases when expedited delivery is indicated; midline episiotomy is most common - less postpartum pain

Question 25

Modified Ritgen Maneuver

Answer 25

fingers of the right hand are used to extend the head while counterpressure is applied to the occiput by the left hand to allow for a more controlled delivery

Question 26

Perineal lacerations

Answer 26

1st degree - superficial lesion; vaginal mucosa and/or perineal skin 2nd degree - extending to the muscles but does not involve the anal sphincter 3rd degree - extends completely through the anal sphincter but not rectal mucosa 4th degree: involves rectal mucosa

Question 27

First degree perineal laceration

Answer 27

superficial lesion; vaginal mucosa and/or perineal skin

Question 28

Second degree perineal laceration

Answer 28

extending to the muscles but does not involve the anal sphincter

Question 29

Third degree perineal laceration

Answer 29

extends completely through the anal sphincter but not rectal mucosa

Question 30

Fourth degree perineal laceration

Answer 30

involves rectal mucosa

Question 31

Retained placenta diagnosis

Answer 31

if placenta has not been delivered within 30 mins after fetal delivery during the 3rd stage of labor

Question 32

Classic signs of placental separation

Answer 32

Gush of blood from the vagina Lengthening of umbilicord Fundus of the uterus rises up Change in the shape of fundus from discord to globular ***DO NOT pull on cord unless these signs are noted

Question 33

Why should you NOT pull on umbilical unless classic placental signs are noted during the 3rd stage of labor?

Answer 33

inappropriate pulling may result in uterine inversion

Question 34

What is something you need to watch for during the 4th stage of labor?

Answer 34

Postpartum hemorrhage; monitor pt closely (BP & pulse); vaginal and uterine checks

Question 35

A bishop score of what is unfavorable for induction of labor?

Answer 35

< 6

Question 36

A bishop score of what is favorable for induction of labor?

Answer 36

>8

Question 37

Pitocin complications

Answer 37

uterine tachysystole (most common); ADH effect (severe water intoxication - convulsions and coma); uterine muscle fatigue

Question 38

Visceral pain of uterine contractions

Answer 38

T10-T12 through L1

Question 39

Somatic pain from descent of fetal head through pelvis out the vagina

Answer 39

S2-S4

Question 40

Regional anesthesia

Answer 40

partial or complete loss of pain sensation below T10

Question 41

Indication for general anesthesia during delivery

Answer 41

Propofol is most common agent; loss of maternal consciousness; need for airway management; increased risk for maternal mortality; indicated in emergent cases with need for rapid delivery