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Flashcards in Normal Labor Deck (75)
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1
Q

What are the components of GTPAL?

A
  • Gravidity
  • Term
  • Preterm
  • Abortions
  • Living children
2
Q

What is AROM and SROM?

A

Artificial or spontaneous Rupture of Membranes

3
Q

What is the definition of term?

A

Delivery after 37 weeks

4
Q

What is the definition of preterm?

A

20-37 weeks

5
Q

What is the definition of abortion?

A

Losses prior to 20 weeks

6
Q

What is the definition of labor?

A

An increase in myometrial activity resulting in effacement and dilatation of the uterine cervix

7
Q

True or false: abortions in the GTPAL include spontaneous miscarriages etc

A

True

8
Q

What is the mean duration of a singleton pregnancy?

A

40 weeks from 1 day of LMP

9
Q

What is the range for term babies?

A

36-42 weeks

10
Q

How do you diagnose labor? (3)

A

Clinically

  • Regular, painful contractions
  • Progressive cervical effacement
  • Bloody show
11
Q

What is the definition of post-term?

A

Continuing beyond 42 weeks

12
Q

True or false: factors responsible for the initiation and maintenance of labor at term are not well defined

A

True

13
Q

What is phase 0 of labor? What are the three hormones utilized here?

A

Functional quiescence through inhibitors:

  • Progesterone
  • Prostacyclin
  • Relaxin
14
Q

What is phase 1 of labor?

A

Cervical softening–slow progressive structural changes of the ECM

15
Q

What is phase 2 of labor? What is the major hormone here, and what does it do?

A

Myometrial changes–myometrial oxytocin receptors increased, causing an increase in uterine irritability and responsiveness to uterotonins

16
Q

What is the lightening of labor?

A

Fetal presenting part descends into the pelvis

17
Q

What is cervical ripening, and in what stage of labor does this occur?

A

Occurs in phase 2

18
Q

What hormone produced by the placenta helps induce prostaglandins for contractions? What hormones withdraws at this time?

A

CRH

Progesterone

19
Q

What are the three hormones that have an influence on phase 3 of labor?

A
  • oxytocin influence

- prostaglandins/relaxin

20
Q

What is phase 4 of labor? What is the major hormone involved?

A

The puerperium or postpartum interval, where the myometrium becomes rigid and in a state of constant contraction

-oxytocin

21
Q

What are the 3 P’s of the mechanics of labor?

A
  • Power
  • Passenger
  • Passage
22
Q

What are the three descriptive characteristics of uterine activity?

A
  • Frequency
  • Intensity
  • Duration
23
Q

What is the classic definition of adequate uterine activity in labor?

A

3-5 contractions in a 10 minute period

24
Q

What is the lie of the fetus? What is the best lie?

A

Spatial relationship of fetal spine to the maternal spine

Vertically oriented lie is optimal

25
Q

What is the presentation of the fetus?

A

Fetal part the directed overlies the pelvic inlet

26
Q

What is a compound presentation?

A

More than 1 fetal part presents

27
Q

What is malpresentation?

A

Any presentation that is not cephalic with occiput leading

28
Q

What are the three major lies of the fetus?

A

Longitudinal
Oblique
Transverse

29
Q

What is longitudinal lie? Transverse? Oblique?

A
  • Longitudinal = maternal spine and fetal spine are parallel
  • Transverse= maternal spine and fetal spine are perpendicular
  • Oblique = anywhere in between
30
Q

What is position?

A

Description of the relationship between a fetal denominator (head) and the maternal pelvis

31
Q

What does the middle initial stand for in the description of the position?

A

Fetal denominator (head)

32
Q

What do the first and last initials in the description of fetal position stand for?

A

Maternal pelvic quadrants toward which the fetal denominator points

33
Q

What is station?

A

Relationship of the presenting part of the maternal ischial spines

34
Q

How do you communicate station?

A

-5 to +5, with the midpoint (0) defined as the plane of the ischial spines, and negative numbers being closer to the mother’s pelvic outlet

35
Q

What is passage?

A

Bony and soft tissues of the maternal pelvis

36
Q

What is the diagonal conjugate?

A

Sacral promontory to inferior margin of the pubic symphysis

37
Q

What is the true (obstetric) conjugate?

A

-Sacral promontory to superior aspect of the pubic symphysis

38
Q

What is the smallest diameter of the inlet?

A

True (obstetric) conjugate

39
Q

What is an anthropoid pelvis?

A

Oval pelvic opening with the long axis in the sagittal plane

40
Q

What is a gynecoid pelvis?

A

Circular pelvis

41
Q

What is an android pelvis?

A

Heart-shaped pelvic opening

42
Q

What is a platypelloid pelvis?

A

Oval pelvic opening, with the long axis in the coronal plane

43
Q

What is the limiting factor in the mid cavity of the pelvis?

A

Interspinous diameter

44
Q

What is the clinical significance of the pelvis outlet?

A

Rarely of clinical significance

45
Q

What is the most common shape of the pelvis opening, and which is the most conducive to birth?

A

Gynecoid, for both

46
Q

What is the first stage of labor?

A

Interval between onset of labor and full cervical dilation

47
Q

What are the three Friedman phases of the first stage of labor?

A

Latent
Active
Descent

48
Q

What is the latent phase of the first stage of labor? How long does this last?

A

Between onset of labor and a point at which a change in the slope of the rate of cervical dilation is noted

Variable duration, but hours

49
Q

What is the active phase of the first stage of labor?

A

-Greater rate of dilatation, with onset at approximately 4 cm (highest slope on the chart)

50
Q

What is the descent phase of the first stage of labor?

A

Usually coincides with the second stage of labor–onset between 9-10 cm

51
Q

When doe active pushing occur in labor?

A

2nd phase

52
Q

How long does the second stage of labor last for nulliparous and multiparous women?

A
Nulliparous = 1 hour ish
Multiparous = 20 minutes ish
53
Q

True or false: labors past the first labor are usually significantly shorter

A

Yes

54
Q

What spinal levels mediate the pain of uterine contractions?

A

T10-L1

55
Q

What are the spinal levels that mediate the perineal pain of contractions?

A

S2-S4

56
Q

What is combined spinal-epidural analgesia?

A

Needle advanced into the dural space, but then a catheter is left in place to provide ongoing analgesia

57
Q

What are the side effects of epidurals? (3)

A
  • Hypotension
  • Fever
  • Transient fetal heart deceleration
58
Q

What are the hemodynamic factors that are an absolute contraindication for epidurals?

A
  • Refractory hypotension
  • Coagulopathies
  • Thrombocytopenia
59
Q

Is increased ICP a contraindication to epidurals

A

Yes

60
Q

LMH within what time frame is an absolute contraindication to neuraxial analgesia?

A

Within 12 hours

61
Q

What is the effect of spinal analgesia on the second stage of labor?

A

Increases by an hour for both multiparous and nulliparous women

62
Q

What is the second stage of labor?

A

Interval between full cervical dilatation and delivery of the infant

63
Q

How do the lengths of the Third stage of labor compare for nulliparous and multiparous women

A

Both are 5-30 minutes

64
Q

What, generally, are the cardinal movements of labor?

A

Changes in the the position of the fetal head during passage through the birth canal

65
Q

What is the order of the cardinal movements of labor?

A
  • Engagement
  • Descent
  • Flexion
  • Internal rotation
  • Extension
  • External rotation
  • Expulsion
66
Q

What are the labs that should be obtained in the initial assessment of labor? (Blood x2, infectious x3)

A
  • Type and screen
  • HIV, Hep B, syphilis
  • AB screen
67
Q

How often should fetal heart rate be obtained during the first stage of labor? What about after a contraction?

A

q 30 minutes and immediately after a contraction for approx 2 minutes

68
Q

How often should fetal heart rate be obtained during the second stage of labor? What about after a contraction?

A

q 15 minutes, and after a contraction for approx 2 minutes

69
Q

True or false: pts should be NPO during labor

A

False- limit oral intake, but not NPO

70
Q

What is the role of electronic fetal monitors during labor?

A

No evidence for routine use

71
Q

How often should a cervical check be performed, besides at admission? (3)

A
  • q 1-4 hours
  • When patient feels urge
  • Prior to analgesia
72
Q

What are the two major reasons to limit cervical checks?

A
  • Infection

- Discomfort for mom

73
Q

What indicates that imminent delivery of the placenta? (3)

A
  • Lengthening of the umbilical cord
  • Gush of blood from the vagina
  • Change in shape of uterine fundus
74
Q

What are the two active management factors of placental delivery?

A
  • Oxytocin

- Controlled cord traction

75
Q

What is the third stage of labor? How long does this usually last?

A

Delivery of the placenta–10-30 minutes