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Ob/Gyn Clerkship > Labor and Delivery Pearls > Flashcards

Labor and Delivery Pearls Flashcards

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1
Q

Define the baseline FHR pattern.

A

The mean FHR rounded to increments of 5 bpm during a 10 minute segment; must be a minimum of 2 minutes in any 10 minute segment

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2
Q

Define baseline variability in the FHR pattern.

A

Fluctuations in the FHR of two cycles per minute or greater

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3
Q

How is baseline variability quantified?

A

Amplitude of peak-to-trough in bpm

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4
Q

What are the 4 definitions of baseline variability?

A

Absent
Minimal
Moderate (normal)
Marked

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5
Q

Define absent baseline variability.

A

Amplitude range undetectable

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6
Q

Define minimal baseline variability.

A

Amplitude range detectable but less than or equal to 5 bpm

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7
Q

Define moderate (normal) baseline variability.

A

Amplitude range 6-25 bpm

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8
Q

Define marked baseline variability.

A

Amplitude range >25 bpm

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9
Q

Define acceleration of FHR.

A

Increase in the FHR from the most recently calculated baseline

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10
Q

How is the duration of a FHR acceleration defined?

A

Time from initial change in FHR from the baseline to the return to baseline

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11
Q

Define FHR acceleration from 32 weeks and beyond.

A

Acme of 15+ bpm above baseline, duration of 15+ seconds, but less than 2 minutes

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12
Q

Define FHR acceleration before 32 weeks.

A

10 bpm or more above baseline, duration of 10+ seconds, but less than 2 minutes

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13
Q

Defined prolonged acceleration.

A

Longer than 2 minutes but shorter than 10 minutes

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14
Q

Define baseline change in FHR.

A

If an acceleration lasts 10 minutes or longer, it is a baseline change

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15
Q

Define FHR bradycardia.

A

Baseline FHR <110 bpm

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16
Q

Define early deceleration.

A

Deceleration associated with a uterine contraction; gradual (onset to nadir 30 seconds or more) decrease with return to baseline; nadir of the deceleration occurs at the same time as the peak of the contraction

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17
Q

Define late deceleration.

A

Deceleration associated with a uterine contraction, gradual (onset to nadir 30 seconds or more) decrease with return to baseline; onset, nadir, and recovery occur after the beginning, peak, and end of the contraction, respectively

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18
Q

Define FHR tachycardia.

A

Baseline FHR >160 bpm

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19
Q

Define variable acceleration.

A

Abrupt (onset to nadir less than 30 seconds) decrease in the FHR below the baseline; decrease is 15+ bpm, with a duration of 15+ seconds but less than 2 minutes

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20
Q

Define prolonged deceleration.

A

Visually apparent decrease in the FHR below the baseline; deceleration is 15 bpm or more, lasting 2 minutes or more but less than 10 minutes from onset to return to baseline

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21
Q

Define a reactive nonstress test.

A

2+ accelerations occur in 20 minutes.

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22
Q

Define a non-reactive stress test.

A

No accelerations noted over 40 minutes.

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23
Q

How is a contraction stress test performed?

A

Administer pitocin or stimulate nipples until 3 contractions in 10 minutes

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24
Q

Define a positive (non-reassuring) contraction stress test.

A

Late decelerations following 50% or more of the contractions

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25
Define a negative (reassuring) contraction stress test.
No late or significant variable decelerations
26
Define an equivocal-suspicious pattern of a contraction stress test.
Intermittent late or significant variable decelerations
27
Define an equivocal-hyperstimulatory contraction stress test
Decelerations with contractions more frequent than q2 minutes or lasting >90 seconds
28
Define an unsatisfactory contraction stress test.
Tracing is uniterruptable or contractions are fewer than 3 in 10 minutes
29
How is a biophysical profile assessed and scored?
2 points for each of the following in a 30 minute period: 1. NST 2. Fetal breathing (1+ episodes of breathing lasting 30+ seconds) 3. Fetal movements (3+ discrete body or limb movements) 4. Fetal tone (1+ episode of extension of extremity with return to flexion or opening or closing of the hand) 5. AFI (amniotic fluid index) (single vertical pocket >2cm)
30
How is a biophysical profile interpreted?
8-10: reassuring 6: equivocal - deliver if mature; if not, administer steroids and repeat in 24 hours 4 or less: delivery unless extremely preterm
31
What are the components of a modified biophysical profile (BPP)?
BPP = NST + AFI
32
Define the phases/stages of labor.
First: onset of labor to complete dilation *Latent: cervical effacement; variable *Active: rapid dilation, relatively fixed time Second: complete dilation to delivery Third: delivery of infant to delivery of placenta
33
Define fetal lie.
Axis of the fetus (longitudinal, transverse, oblique)
34
Define presentation.
Fetal part at the cervix (cephalic, breech, shoulder)
35
Define attitude.
Flexed or extended
36
Define position/point of direction.
Named for occiput, sacrum, acromion, or mentum in relation to maternal pelvis.
37
Describe Leopold's maneuver.
1. Feel the top of the uterus; identify the fetal pole in the fundus 2. With the hands on either side of the uterus, determine the location of the back and small parts 3. Lower uterine segment between thumb and first finger - determines engagement 4. Fingers pointed toward patient's feet to determine position
38
List the cardinal movements of labor.
1. Engagement 2. Descent 3. Flexion 4. Internal rotation 5. Extension 6. External rotation/restitution 7. Expulsion
39
Define engagement.
Biparietal diameter has passed pelvic inlet, 0 station
40
___ often begins with engagement in multiparous women.
Descent
41
Define flexion.
Brings shorter AP diameter into pelvis from resistant forces of pelvic walls, pelvic floor, etc.
42
Define internal rotation.
Fetus faces maternal spine
43
Define extension.
Head extends under pubic bone
44
How is membrane ruptured diagnosed?
1. Pooling 2. +Nitrazine with pH > 6.5 (dark blue) - amniotic fluid pH 7.0-7.5, normal vaginal pH 3.5-4.5 3. Ferning (due to NaCl, proteins, and carbs) 4. AFI (amniotic fluid index)
45
What can cause a false positive nitrazine?
Blood, semen, bacterial vaginosis
46
Define the degrees of perineal laceration.
1st - fourchette, perineal skin, and vaginal mucosa 2nd - involves fascia and muscles of perineal body 3rd - involves anal sphincter 4th - involves rectal mucosa
47
List the 4 main causes of postpartum hemorrhage.
1. Atony 2. Retained placenta 3. Lacerations 4. Uterine inversion
48
4 medical agents for postpartum hemorrhage?
1. Oxytocin 2. Methergine (Ergonovine and Methylergonovine) 3. Hemabate (Carboprost Prostaglandin F2a) 4. Cytotec (misoprostol) - 1000 mcg rectally
49
When is methergine contraindicated in postpartum hemorrhage?
HTN
50
When is hemabate contraindicated in postpartum hemorrhage?
Asthma
51
What is the Bishop score used for?
To determine if cervical ripening is needed; should be calculated for all inductions
52
What qualities get a Bishop score of 0?
``` Dilation: closed Effacement: 0-30 Station: -3 Consistency: firm Position: posterior ```
53
What qualities get a Bishop score of 1?
``` Dilation: 1-2 Effacement: 40-50 Station: -2 Consistency: medium Position: mid ```
54
What qualities get a Bishop score of 2?
``` Dilation: 3-4 Effacement: 60-70 Station: -1 Consistency: soft Position: anterior ```
55
What qualities get a Bishop score of 3?
``` Dilation: 5+ Effacement: 80+ Station: +1, +2 Consistency: n/a Position: n/a ```
56
Modified Bishop Score - add 1 point for ___ and ___? Deduct 1 point for ___, ___ ___, or ___?
Add 1: preeclampsia, each prior vaginal delivery | Deduct 1: postdates, nulliparity, preterm, prolonged PROM
57
Interpret the Bishop score.
0-4: 45-50% failure 5-9: 10% failure 10-13: 0% failure >8 probability of vaginal delivery similar to spontaneous labor
58
List 6 cervical ripening agents.
1. Cervidil (prostaglandin E2/dinoprostone) 2. Cytotec (prostaglandin E1/misoprostol) 3. Transcervical catheter 4. Extra-amniotic saline infusion (EASI) 5. Hygroscopic dilators 6. Oxytocin
59
What is the dose of Cervidil given for cervical ripening?
One 10mg insert q 12 hrs, max 3 doses (also available as Prepidil gel)
60
What is the dose of Cytotec given for cervical ripening?
25 mcg (1/4 of 100 mcg pill) vaginally q 4 hrs
61
Define tachysystole.
More than 5 contractions in 10 minutes or 7 contractions in 15 minutes
62
How is tachysystole or uterine tetany corrected?
Decrease or discontinue uterine stimulant, IV fluids, maternal repositioning, maternal oxygen, consider terbutaline if it persists
63
List 5 tocolytics.
1. Magnseium sulfate 2. Indomethicin (Indocin) 3. Nifedipine (Procardia) 4. Terbutaline (Brethine) 5. Atosiban (Antocin)
64
MOA - Magnesium sulfate?
Decreases calcium needed for uterine contraction
65
MOA - Indomethicin?
Cyclooxygenase inhibitor
66
MOA - Nifedipine?
CCB
67
MOA - Terbutaline?
Betamimetic
68
MOA - Atosiban?
Pitosin antagonist
69
What medications are indicated in pre-term labor and why?
1. Steroids for fetal lung maturity 2. Tocolytic medication to allow administration of steroids 3. Fetal fibronectin - used between 24 and 32 weeks to determine probability of pre-term labor
70
What are the 2 steroids that can be given for fetal lung maturity? What are the doses?
Betamethasone - 12mg IM q 25 hrs x 2 doses | Dexamethasone 6 mg IM q 12 hrs x 4 doses
71
Fetal fibronectin has a high ___ predictive value. What can cause a false positive?
Negative; blood and semen
72
Only women with prior ___ incisions can attempt VBAC. Rupture rate is <1%.
Low transverse uterine
73
What are the types of uterine incisions?
Classical, Low Vertical, or Low Transverse
74
What are the types of skin incisions?
Midline Vertical vs. Pfannenstiel
75
Define labor.
Uterine contractions resulting in progressive effacement and dilation of the cervix.
76
3 signs of placental separation?
1. Lengthening of cord 2. Gush of blood 3. Change in uterine shape
77
Normal length of first stage, active phase, and second stage for a primipara?
First - 8 hours Active - 1.2 cm/hour Second - 2 hours
78
Normal length of first stage, active phase, and second stage for a multipara?
First - 4-6 hours Active - 1.5cm/hour Second - 1-1.5 hours
79
List the 7 descriptors of fetal position.
1. Lie 2. Presentation 3. Point of direction 4. Asynclitism 5. Attitude 6. Station 7. Leopold's Maneuvers
80
What are the 4 governing forces of labor?
Powers, Passages, Passenger Psyche
81
List the bones of the pelvis.
Sacrum, coccyx, innominate, ilium, ischium
82
What are the three planes of the pelvis through which the fetus must navigate?
Inlet, Midplane, Outlet
83
What are the 4 types of pelvis?
Gynecoid, Android, Anthropoid, Platypelloid
84
List the 3 types of abnormal Friedman's curves.
1. Prolonged latent phase 2. Protracted active phase 3. Secondary arrest of labor
85
List the steps/options in managing postpartum hemorrhage.
1. Massage and express clots. 2. Check for retained placenta. 3. Check for lacerations and hematomas. 4. Simultaneously give pitocin or methergine or prostaglandin 5. Hysterectomy

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