Normal L&D Flashcards by Katherine Miller

Definition of labor

Progressive cervical effacement or dilatation or both resulting from regular uterine contractions that occur at least every 5 minutes and last 30-60 seconds

How well did you know this?

Not at all

Perfectly

Definition of lightening

When fetal head settles into brim of pelvis
“Baby has dropped”
Primigravids - 2 wks before labor
Multigravids - in early labor

How well did you know this?

Not at all

Perfectly

False labor

Braxton Hicks

Irregular contractions without cervical change

How well did you know this?

Not at all

Perfectly

Cervical effacement

Thinning of cervix as it is taken up into the lower uterine segment
Results in the bloody show where mucous plug from cervix mixes with blood

How well did you know this?

Not at all

Perfectly

Molding

Alteration of the shape of the fetal head during labor

How well did you know this?

Not at all

Perfectly

Caput

Localized edematous swelling of the fetal scalp

Caused by pressure of cervix on the presenting portion of fetal head

How well did you know this?

Not at all

Perfectly

Induction of labor

Process whereby labor is initiated by artificial means

How well did you know this?

Not at all

Perfectly

Augmentation of labor

Artificial stimulation of labor that has begun spontaneously

How well did you know this?

Not at all

Perfectly

Stages of labor

First - from onset of true labor to complete cervical dilatation
Second - Complete cervical dilatation to birth of baby
Third - From birth of baby to delivery of placenta
Fourth - From delivery of placenta to stabilization of pt (usually 6 hours post partum)

How well did you know this?

Not at all

Perfectly

Two phases of the first stage of labor

Latent phase - cervical effacement and early dilatation. Considered completed at 3 cm dilatation

Active phase - begins when cervix is 2-4 cm dilated in presence of regular contractions. Consists of an acceleration, max slope, and theoretical deceleration

How well did you know this?

Not at all

Perfectly

Management of first stage

May ambulate with intermittent monitoring
IV fluids ONLY
High risk necessitates continuous monitoring
If pt on pitocin for induction or augmentation should be monitored extensively

How well did you know this?

Not at all

Perfectly

Amniotomy

Artificially breaking the bag of water

How well did you know this?

Not at all

Perfectly

Six cardinal movements

Descent
Flexion
Internal rotation
Extension
External rotation
Expulsion

How well did you know this?

Not at all

Perfectly

Descent

Results from force of uterine contraction

Continuous until delivery of fetus

How well did you know this?

Not at all

Perfectly

Flexion

Natural m. tone of fetus

Resistance from cervix, walls of pelvis, and pelvic floor

How well did you know this?

Not at all

Perfectly

Internal rotations

When fetal head turns anteriorly towards the symphysis pubis from transverse or oblique diameter
Occurs at pelvic floor when head meets muscular sling

How well did you know this?

Not at all

Perfectly

Extension

During descent fetal head will extend as it meets the vaginal outlet (which is direct upward and forwar)

How well did you know this?

Not at all

Perfectly

Crowning

Bulging of the perineum which indicates that the largest diameter of fetal head is encircled by vulvar ring

External rotation

Rotation of fetal head back to it’s original position at time of engagement to realign itself with it’s back and shoulders

Expulsion

Usually ant. shoulder under pubic symphysis
Posterior shoulder
Rest of fetus in rapid succession

Ritgen’s maneuver

Controls delivery of head
Fingers of one hand press posterior to rectum extending the fetal head
Counterpressure is applied to the occiput

Two types of episiotomies

Midline

Mediolateral

Signs of imminent placental delivery

Fresh show of blood
Lengthening of umbilical cord
Elevation of fundus
Uterus becomes firm and globular

Why should you not pull on the cord?

Inversion of uterus

Laceration types

1st degree - vaginal epithelium or perineal skin 2nd degree - extends into subepithelial tissues of vagina or perineum w/ or w/o perineal body 3rd degree - anal sphincter 4th degree - rectal mucosa

What should be watched for in the 1st hour after delivery?

Bleeding, hematoma (pelvic or rectal pain) | Increased pulse rate out of proportion to decreased blood pressure

Maternal indications for induction of labor

Pre-eclampsia Diabetes Heart disease

Maternal indications for augmentation of labor

``` Abnormal labor (inadequate contractions) Prolonged latent phase Prolonged active phase ```

Fetoplacental indications for induction/augmentation of labor

``` Prolonged pregnancy IUGR Abnormal fetal testing RH incompatibility Fetal abnormality PROM Chorioamnionitis ```

Absolute maternal contraindication for induction/augmentation

Contracted pelvis

Which type of c-section is NOT a contraindication for induction/augmentation?

Low transverse

Relative maternal contraindications for induction/augmentation

Prior uterine surgery Classic C-section Complete transection of uterus Overdistended Uterus

Fetal contraindications for induction/augmentation

Preterm fetus w/o lung maturity Acute fetal distress Abnormal presentation Placenta previa

When is it ok to induce prior to 37 weeks?

Indicated only if continuation of pregnancy is a risk to mom or baby

If there is no medical indication for induction, what MUST be present and documented prior to 39 weeks?

Fetal lung maturity

What does the BISHOP SCORE indicate?

``` Whether or not there is a good chance of the induction working High score (9-13) = high likelihood of vaginal delivery Low score (<5) = decreased likelihood ```

BISHOP must be taken prior to what?

Cervical ripening

Prior to induction what needs to be done?

BISHOP | Cervical ripening

What is used to ripen the cervix?

Prostaglanding gel; PGE 2 gel, cervidil, and prepidil | Osmotic dilator - laminaria

Induction should not exceed how long?

72 hours

When to do c-section after an induction

If membranes ruptured and no progress after 12 hours may do c-section

Complications of induction

``` Hyperstimulation Rupture of uterus Antidiuretic effect can lead to water intoxication, convulsions, coma especially if > 24 hours Muscle fatigue Postpartum uterine atony ```

Puerperium

Period following delivery to approx 6 weeks postpartum

What are the major proteins synthesized in breast milk that are not in cow's milk?

Casein Lactalbumin B-lactoglobulin