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ENRP Exam 1 > Normal Labor And Delivery > Flashcards

Normal Labor And Delivery Flashcards

1
Q

What is labor?

A

Progressive cervical dilation resulting from regular uterine contractions that occur at least every 5 mins and last 30-60 seconds

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2
Q

What is false labor?

A

Braxton-Hicks contractions; irregular contractions without cervical change

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3
Q

What is the suboccipitobregmatic diameter?

A

9.5cm; head well flexed

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4
Q

What is the occipitofrontal diameter?

A

11cm; head deflexed; occiput posterior position

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5
Q

What is the supraoccipitomental diameter?

A

13.5cm; brow presentation; is the longest anterioposterior diameter of the head

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6
Q

What is the submentobregmatic diameter?

A

9.5cm; face presentations

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7
Q

What is the average circumference of a term fetal head measured in the occipitofrontal plane?

A

34.5cm

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8
Q

What are the difference pelvic shapes?

A

Gynecoid, android, anthropoid, platypelloid

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9
Q

What are the characteristics of a gynecoid pelvis shape?

A

Classic female type of pelvis; round at the inlet, wide transverse diameter and wide suprapubic arch

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10
Q

What are the characteristics of an android pelvis shape?

A

Classic male type of pelvis; widest transverse diameter closer to the sacrum, prominent ischial spines, narrow pubic arch; fetal head forces to be in OP position (restricts space and arrest of descent can occur)

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11
Q

What are the characteristics of an anthropoid pelvis shape?

A

Resembles ape pelvis (20% of females); much larger AP than transverse diameter, creates a long narrow oval shape, narrow pubic arch;

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12
Q

What are the characteristics of a platypelloid pelvis shape?

A

Described as flattened gynecoid pelvis; short AP and wide transverse diameter, wide bispinous diameter and suprapubic arch

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13
Q

Which pelvis shapes have a poor prognosis for delivery?

A

Platypelloid and android

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14
Q

Which pelvis shapes have a good prognosis for delivery?

A

Gynecoid and anthropoid

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15
Q

How is clinical pelvimetry assessed?

A

Diagonal conjugate, obstetric conjugate, palpate, measuring the ischial tuberosities and pubic arch, radiographically via MRI or CT

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16
Q

What is the diagonal conjugate?

A

Is approximated by measuring from the inferior portion of the pubic symphysis to the sacral promontory; if >11.5cm the AP diameter of pelvic inlet is adequate

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17
Q

What is the obstetric conjugate?

A

Estimated by subtracting 2cm from the diagonal conjugate; is the narrowest fixed distance thru which the fetal bead must pass thru during vaginal delivery

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18
Q

Which structures should be palpated when assessing clinical pelvimetry?

A

Anterior surface of the sacrum which is usually concave; ischial spines to assess prominence

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19
Q

How is the pelvic outlet assessed?

A

By measuring the ischial tuberosities (8.5cm distance is considered adequate transverse diameter) and pubic arch (>90 degrees infrapubic angle is good)

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20
Q

When should pelvimetry be assessed via MRI or CT?

A

If clinical or obstetrical hx suggestive of pelvic abnormalities or hx of pelvic trauma; rarely performed

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21
Q

What components are a part of the obstetric exam?

A

Fetal lie, fetal presentation, cervical exam

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22
Q

What is fetal lie?

A

Reference is maternal spine to fetus spine; determines if infant is longitudinal, transverse or oblique

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23
Q

What is fetal presentation?

A

Presenting part to the pelvis (vertex, breech, transverse or compound)

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24
Q

What is assessed during a cervical exam?

A

Dilation, effacement, station, position, consistency

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25
Q

What is the first Leopold maneuver?

A

Palpate the fundus; fetal head vs buttocks vs transverse position

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26
Q

What is the 2nd Leopold maneuver?

A

Palpate for spine and fetal small parts

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27
Q

What is the 3rd Leopold maneuver?

A

Palpate what is presenting in the pelvis with suprapubic palpation

28
Q

What is the 4th Leopold maneuver?

A

Palpate for cephalic prominence; can feel chin or occipital protuberance if head is not deep in pelvis

29
Q

How dilation assessed during a cervical exam?

A

Check at level of internal os; range from closed to completely dilated at 10cm

30
Q

What is effacement?

A

Thinning of the cervix occurs and is reported as a % of change in length; normal cervical length is 3-5cm; range is thick to 100% effaced

31
Q

What is the station component of a cervical exam?

A

Degree of descent of the presenting part of the fetus; measured in cm from presenting part to ischial spines; range -5 to +5cm

32
Q

When is the station considered to be zero?

A

when the bony portion of the head reaches the level of the ischial spines

33
Q

What is commonly used to calculate bishop score?

A

Consistency and position

34
Q

What is the duration of the first stage of labor?

A

Primiparas typically 6-18 hours; multiparas typically 2-10 hours

35
Q

What is the rate of cervical dilation for a female who is primiparas?*

A

1.2cm per hour

36
Q

What is the rate of cervical dilation for a woman who is multiparas?

A

1.5cm per hour

37
Q

What are the 7 cardinal movements of labor?

A

Engagement, descent, flexion, internal rotation, extension, external rotation and expulsion

38
Q

What is engagement (1st cardinal movement)?

A

Defined as presenting part at zero station

39
Q

What is descent (2nd cardinal movement)?

A

Brought about by the force of uterine contractions and maternal valsalva efforts

40
Q

What is flexion (3rd cardinal movement)?

A

OA- baby’s chin to chest thus changing the presenting part from occipitofrontal to the smaller suboccipitobregmatic

41
Q

What is internal rotation (4th cardinal movement)?

A

Occurs usually at the ischial spines; fetal head enters pelvis in transverse diameter, rotates so the occiput turns anteriorly or posteriorly toward the pubic symphysis

42
Q

What is extension (5th cardinal movement)?

A

Crowning occurs when the largest diameter of the fetal head is encircled by the vaginal introitus; station is +5; head is born by rapid extension

43
Q

What is external rotation (6th cardinal movement)?

A

The delivered head now returns to its original position at the time of engagement to align itself with the fetal back and shoulders

44
Q

What is expulsion (7th cardinal movement)?

A

The anterior shoulder then delivers under the pubic symphysis followed by the posterior shoulder and the remainder of the body

45
Q

What are the indications for an episiotomy?

A

Likelihood of spontaneous laceration seems high; to expedite delivery by enlarging the vaginal outlet

46
Q

What are the features of a midline episiotomy?

A

Most commonly performed; greater risk of extension into 3rd or 4th degree; less postpartum pain

47
Q

What are the features of a mediolateral episiotomy?

A

Greater blood loss, more difficult to repair, more postpartum pain and increased risk of dyspareunia

48
Q

What is the modified Ritgen maneuver?

A

Fingers of the right hand are used to extend the head while counter pressure is applied to the occiput by the left hand to allow for a more controlled delivery; simple manual support to the perineum may be equally effective

49
Q

What is a first degree perineal laceration?

A

A superficial laceration involving the vaginal mucosa and/or the perineal skin

50
Q

What is a second degree perineal lacerations?

A

Laceration extending into the muscles of the perineal body but doesn’t involve the anal sphincter

51
Q

What is a 3rd degree perineal laceration?

A

Laceration extends into or completely thru the anal sphincter but not into the rectal mucosa

52
Q

What is a 4th degree perineal laceration?

A

Involves the rectal mucosa

53
Q

If induction is indicated and cervix is unfavorable what can be done?

A

Agents for cervical ripening can be used

54
Q

What is the goal of cervical ripening?

A

To facilitate the process of cervical softening, thinning and dilating in hopes to reduce the rate of failed inductions

55
Q

What is the induction of labor?

A

The process by which labor is induced by artificial means

56
Q

What is augmentation?

A

The artificial stimulation of labor which has already begun

57
Q

What are some indications for induction?

A

Abruptio placentae, chorioamnionitis, fetal demise, preeclampsia/eclampsia, gestational HTN, PROM, post term pregnancy, fetal compromise

58
Q

What are the contraindications to induction?

A

Unstable fetal presentation, acute fetal distress, placental previa or vasa previa, previous classical C section or transfundal uterine surgery (i.e. myomectomy) or any contraindications to vaginal delivery (HIV with high viral load, active genital HSV outbreak, etc)

59
Q

What do uterine contractions and cervical dilation result in?

A

Visceral pain (T10-12 through L1)

60
Q

Descent of fetal head and pressure from the pelvic floor, vagina and perineum generate somatic pain via which nerve?

A

The pudendal nerve (S2-4)

61
Q

What is regional anesthesia?

A

Partial or complete loss of pain sensation below level of T10

62
Q

How is dilation, effacement and station recorded?

A

Ex. 4/50/-2 (4cm dilated/50% effacement/-2cm station)

63
Q

What are the benefits for amniotomy (AROM)?

A

Augment labor and allows assessment of meconium status

64
Q

What are the risks associated with amniotomy (AROM)?

A

Cord prolapse, prolonged rupture is associated with chorioamnionitis

65
Q

What are the goals for obstetric anesthesia?

A

To provide effective pain relief for mother during the course of labor and delivery that is safe for her and her baby

66
Q

How does obstetric anesthesia affect uterine blood flow?

A

Regional anesthesia may decrease uterine blood flow if hypotension occurs and is not promptly treated; adequate hydration prior may mitigate the risk for hypotension (if it does occur can give vasopressor)

ENRP Exam 1 (10 decks)

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