Module 5 Intrapartum Flash Cards

Question 1

What is the only measurable diameter of the pelvic inlet? And its favorable length

Answer 1

The diagonal conjugate

11.5+cm

Question 2

What is the widest part of the fetal head?

Answer 2

Biparietal diameter

Question 3

What is the most ideal diameter presentation?

Answer 3

Well flexed: suboccipitobregmatic 9.5cm

Question 4

What presentation has the largest diameter and is not conducive to a vaginal birth?

Answer 4

Brow: occipitomental diameter 12.5cm

Question 5

What diameter is a face presentation and which position can be delivered vaginally?

Answer 5

Submentobregmatic-9.5cm

MA is “OK”

Question 6

Where are heart tones found for all vertex presentations?

Answer 6

below the umbilicus

Question 6

Describe engagement.

Answer 6

Definition is when the biparietal diameter negotiates the inlet. We measure it clinically by the tip of the vertex being at zero station.

Question 6

Describe descent

Answer 6

Moving down

Question 7

Describe flexion

Answer 7

Chin moves towards the thorax

Question 8

Describe internal rotation

Answer 8

Baby has to rotate from transverse to sagittal suture in AP diameter of pelvis to fit through the midplane and dodge those ischial spines

Question 9

Describe extension

Answer 9

Is when the occiput moves towards the fetal back (Chin moves up)

Question 10

Describe restitution

Answer 10

Newborn head aligns with the shoulders

Question 11

Describe External rotation

Answer 11

We see it as a head movement, but what is really happening is the shoulders are now negotiating the midplane and the getting around those ischial spines

Question 12

A baby in OA position is born by:

Answer 12

Extension (the face will sweep the curve of carus)

Question 13

A baby in OP position is born by:

Answer 13

Flexion

(the occiput is sweeping the curve of carus)

Question 14

A baby in MA/Face position is born by:

Answer 14

Flexion

(the occiput is sweeping the curve of carus)

Question 15

What should be avoided when PROM is suspected?

Answer 15

AVOID DIGITAL EXAMS!!!!*****

Question 16

What is the classic method for assessing ROM?

Answer 16

The fern test is the classic method for assessing ROM

sterile spec
fluid from posterior vaginal fornix for 10-15 seconds
DO NOT TOUCH THE CERVICAL OS
spread thinly onto a slide
DRY THOROUGHLY for 10 minutes
inspect without a coverslip at 10x power
fern-like pattern (arborization)

Question 17

Per ACOG, when should AROM not be performed?

Answer 17

amniotomy should NOT be performed in women with normally progressing labor
UNLESS required to facilitate monitoring

Question 18

What are true indications of AROM?

Answer 18

tx of labor dystocia
for clear indication for induction of labor or
when internal monitoring is required

Question 19

How can we assess “adequate” contractions without an IUPC?

Answer 19

“adequate” labor contractions typically do not allow for indentation of the uterine fundus when palpated abdominally at their acme

Question 20

What MVU is considered adequate?

Answer 20

200-250 MVUs

Question 21

How often should IA occur?

Answer 21

Minimum: auscultate FHR every 15-30 minutes in active phase labor and every 5 minutes in second stage

Question 22

What is the most common side effect of an epidural?

Answer 22

Epidural headache

Question 23

How should you respond to a patient who presents with PTL signs and a CL of <20mm, 20-29mm, and >30mm?

Answer 23

<20mm: admit for PTL
20-29mm: send FFN
>30mm: D/C home

Question 24

What patients should not be given indocin?

Answer 24

> 32w because it causes premature closure of the ductus arteriosis

Question 25

What are the signs of mag toxocity?

Answer 25

Toxicity: loss of patellar reflexes, dec UO <30 mL/hr, RR<12/min. Toxicity inc w/ serum creatinine > 1.0 mg/dL

Question 26

What is the BBW associated with terb?

Answer 26

Black Box warning: do Not use for more than 72 hrs s/t risk of cardiac problems

Question 27

When can steroids be repeated?

Answer 27

can be repeated once as a “rescue dose”
–if more than 2 weeks has passed
the GA is less than 33 weeks
And the person has a risk of giving birth within 7 days

Question 28

What patients should receive mag for neuroprotection?

Answer 28

<32 weeks delivery

Question 29

Does ACOG recommend for or against tocolytics in the case of PPROM?

Answer 29

ACOG recommends AGAINST the use of tocolytics

Question 30

When should a PPROM patient be delivered?

Answer 30

at 34+ weeks

Question 31

What is protracted labor?

Answer 31

Progress less than the “recommended” times

Question 32

Define active labor arrest.

Answer 32

At 6 cm or more with ROM and no cervical change for 4 hours or more with MVUs over 200. OR no cervical change in 6 hours with inadequate contractions

Question 33

What is the therapeutic range of mag?

Answer 33

Therapeutic range 4.8-8.4 mg/dL or 4 to 7 mEq/L

Question 34

What is the treatment for mag toxicity?

Answer 34

Mag tox: Tx with calcium gluconate or calcium chloride 1 g IV

Question 35

When should rescue maneuvers occur for a shoulder?

Answer 35

By 5 minutes

Question 36

Describe frank presentation

Answer 36

Feet to forehead

Question 37

Describe complete breech

Answer 37

Criss cross/”Cannon ball”

Question 38

What is important to document about a planned breech delivery?

Answer 38

Fetal head flexion by ultrasound

Question 39

What is the expected drop in hgb and hct with a 500cc EBL?

Answer 39

1pt Hgb
3% Hct