Lecture 2 - Normal Labor/Delivery

Question 1

labor:

biochemical Connective tissue changes of the ____ occur prior to uterine contractions/cervical dilation

Answer 1

cervix

Question 2

labor:
increased _____ activity; ie change from _____ (long-lasting low freq activity) to _____ (high intensity, high freq activity)

Answer 2

myometrial;

contractures, contractions

Question 3

clinically, labor is defined by the triad of regular ____ contractions, progressive cervical ___ and ____, and ____ show

Answer 3

painful;
effacement, dilation;
bloody show (whatever that means)

Question 4

cervical ____ is painful cervical dilation in absence of uterine contractions in the _____ trimester

Answer 4

insufficiency;

second

Question 5

braxton-hicks contractions (false labor) are uterine contractions in absence of ____ _____

Answer 5

cervical change

Question 6

grivada is the number of ____;

para is the number of _____

Answer 6

pregnancies;

deliveries ( > 20 weeks)

Question 7

successful navigation through the pelvis dependent on the 3 P’s: ____, ____, and ____

Answer 7

powers, passenger, passage

Question 8

labor physiology:
increased _____ synthesis/release;
increase in ____ gap junction formation;
upregulation of myometrial ____ receptors

Answer 8

prostaglandin;
myometrial;
oxytocin

fetus also involved (ie physical distention of uterus)

Question 9

____ is the force generated by uterine muscles during contractions. you can use a ___ to measure this

Answer 9

powers;

tocometer (or intrauterine pressure catheter)

Question 10

adequate labor is defined as ___ contractions in 10 minutes.

Answer 10

3-5

Question 11

_____ units are calculated by multiplying the avg peak strength of contractions in mm Hg by the number of contractions in 10 minutes. an adequate range is what?

Answer 11

montevideo units;

200-250 units

Question 12

passenger factors affecting labor:
____ = long axis of fetus relative to longitudinal axis of uterus;
_____ = degree of flexion/extension of fetal head;
____ = fetal part directly over pelvic inlet

Answer 12

lie;
attitude;
presentation

Question 13

passenger factors affecting labor:
____ = degree of descent of leading edge of presenting part between leading bony edge of fetus and ischial spines;
_____ fetus refers to a lateral deflection of the head, so sagittal suture is deflected anteriorly

Answer 13

station;

asynclitic

Question 14

pelvimetry:

one can use vaginal examination to determine the ____ _____

Answer 14

diagonal conjugate (not the true conjugate)

Question 15

1st stage of labor:
interval between onset of labor and full ____ ____;
divided into 3 phases in relation to rate of ____ ____

Answer 15

cervical dilation;

cervical dilation

Question 16

friedman’s curve of normal labor:

very different between ____ and _____ women

Answer 16

nulliparous, multiparous

Question 17

the second stage of labor is the interval between ____ and ____

Answer 17

full cervical dilation, delivery

Question 18

the third stage of labor is the interval between _______ and _____

Answer 18

delivery of fetus, separation/expulsion of placenta

Question 19

what is the primary complication with the 3rd stage of labor?

retention of placenta more than ___ at term indicates the need for intervention

Answer 19

hemorrhage;

30 minutes

Question 20

the cardinal movements of labor refers to changes in position of the ____ ____ during passage through the birth canal. Can occur because of assymetry in shape of fetus and maternal bony pelvis

Answer 20

fetal head

Question 21

cardinal movements:

_____ is when the widest diameter of the presenting part passes below the plane of the pelvic inlet

Answer 21

engagement

Question 22

what is the largest transverse diameter in a cephalic flexed head engagement?

Answer 22

biparietal diameter (ie diameter between parietal sutures)

Question 23

cardinal movements:
descent is the downward passage of presenting part through the pelvis; greatest descent occurs during decelleration of the ____ Stage of labor and during the ____ stage

Answer 23

first, second

Question 24

cardinal movements:
____ occurs passively as head descends to resistance from shape of bony pelvis. this allows the fetus to present the smallest diameter of the ___

Answer 24

flexion;
head

complete flexion occurs (i.e. on to chest)

Question 25

cardinal movements: internal rotation is rotation of the presenting part from the orginal position to a ___ position as it passes through the pelvis. its a (passive or active) movement

Answer 25

anteriorposterior; | passive

Question 26

cardinal movements: _____ occurs once the fetal head descends into introitus, causing the base of the occiput to contact the inferior margin of the ____ ____

Answer 26

extension; | pubic symphysis

Question 27

cardinal movements: after the head extends (Deflexes), it undergoes ____ ____ to the correct anatomic position. is this a passive or active movement>?

Answer 27

``` external rotation (restitution); passive ```

Question 28

the last cardinal movement of labor is _____

Answer 28

expulsion

Question 29

placental separation: the ___ phase is the time between delivery of fetus to start of myometrial contractions causing separation. then, there is the contraction phase, _____, and expulsion. which is the primary dictator of length of the third stage?

Answer 29

latent; detachment; latent phase

Question 30

post partum hemorrhage chances ____ as duration of placental separation increases. what is the primary influencing factor for the length of the third stage?

Answer 30

``` increases; gestational age (pre terms = longer third stage term) ```

Question 31

active management of the third stage of delivery include giving prophylactic _____ agent ____ delivery of the placenta

Answer 31

uterotonic; | before

Question 32

what is a commonly used uterotonic agent that is also produced by the mother?

Answer 32

oxytocin

Question 33

____ ____ are uterotonic agents that last longer and have increased contractions relative to oxytocin, but cause ____ bp, vomiting, and pain

Answer 33

ergot alkaloids; | increased

Question 34

misoprostol is a _____ analog used for several pregnancy related functions, including hemorrhage, ____ ripening, induction of abortion. main side effect is _____

Answer 34

prostaglandin; cervical; diarrhea

Question 35

___ ____ drainage reduces risk of retained placenta

Answer 35

umbilical cord

Question 36

_____ _____ are used to diagnose fetal presentation and position

Answer 36

leopold's maneuvers