Normal Labor and Delivery, Puerperium

Question 1

What is labor?

Answer 1

Progressive effacement and/or dilation of the cervix caused by regular uterine contractions that occur every 5 min. and last about 30-60 seconds

Question 2

What is obstetric Lightening and when does it occur?

Answer 2

When the fetal head settles into the brim of the pelvis, “baby has dropped”.

Primigravids: occurs 2 weeks before labor
Multigravids: occurs in early labor

Question 3

What is Braxton Hicks Labor?

Answer 3

False Labor

-regular uterine contractions that don’t cause any cervical change

Question 4

What is the “Bloody Show”?

Answer 4

Mixing of the cervical mucous plug with blood resulting from cervical effacement. Can occur prior to labor.

Question 5

What is molding?

Answer 5

Alteration of the shape of the fetal head during labor. Caused by compressive forces exerted by the maternal bony pelvis on cranial bones.

Question 6

What is caput?

Answer 6

Localized, edematous swelling of the fetal scalp caused by pressure of the cervix on the presenting portion of the fetal head.

Question 7

What is augmentation of labor?

Answer 7

Artificial stimulation of labor that began spontaneously (naturally).

Question 8

Briefly describe the 4 stages of Labor.

Answer 8

1. Onset of true labor to cervical dilation
2. Cervical dilation to delivery of the baby
3. Delivery of the baby to delivery of the placenta
4. Deilvery of the placenta to stabilization of the patient (can be 1-6 hours after delivery)

Question 9

Describe the 2 phases of the 1st stage of labor.

Answer 9

Latent Phase: cervical effacement and dilation to 3cm

Active Phase: cervical dilation to 2-4 cm with regular uterine contractions. (sigmoidal curve plot of cervical dilation vs. time)

Question 10

What labs are ordered in the first stage of labor?

Answer 10

CBC, blood type and Rh, urine glucose and protein

Question 11

What are the six cardinal movements in delivery during stage 2 of labor?

Answer 11

1. Descent
2. Flexion
3. Internal Rotation
4. Extension
5. External Rotation
6. Expulsion

(1-5 refer to head and neck motion and 6 refers to deliver of head and both shoulders)

Question 12

What is crowning and during which cardinal movement does it occur?

Answer 12

It is the bulging of the perineum which indicates that the largest diameter of the fetal head is encircled by the vulvar ring. Occurs during the “Extension” movement.

Question 13

What is the Ritgen Maneuver?

Answer 13

Control of delivery of the head. Fingers of one hand press posterior tot he rectum extending the fetal head while counterpressure is applied to the occiput.

Question 14

What does the physician check on the baby once the head is delivered?

Answer 14

Check nuchal cord, downward traction, upward traction, traction of shoulders.

Suction of mouth and nose performed

Question 15

What 3 medications can control bleeding during stage 3 of labor?

Answer 15

1. Pitocin (oxytocin)
2. Methergine
3. PG F2 alpha

Question 16

Describe the 4 degrees of laceration that can occur during stage 3 of labor.

Answer 16

1st degree: vaginal epithelium or perineal skin

2nd: extends to subepithelial tissue of vagina or perineum. W/ or w/o perineal body
3rd: anal sphincter
4th: rectal mucosa

Question 17

What is the one thing that is worse about choosing a midline episiotomy vs. mediolateral?

Answer 17

Midline is more likely to extend beyond the surgical incision.

Mediolateral seems to be worse in every other category.

Question 18

In which 3 maternal conditions is induction of labor indicated?

Answer 18

Pre-Eclampsia
Diabetes
Heart Disease

Question 19

In which 7 fetoplacental conditions is induction of labor indicated?

Answer 19

1. Prolonged pregnancy
2. Intra-Uterine Growth Restriction
3. Abnormal Fetal Testing
4. Rh Incompatibility
5. Fetal Abnormality
6. Premature Rupture of Membranes (rupture of amniotic sac and/or chorion)
7. Chorioamnionitis

Question 20

What is the absolute maternal contraindication for induction or augmentation of labor?

Answer 20

Contracted Pelvis

Question 21

What is the Bishop score?

Answer 21

Assesses condition of the cervix (position, consistency, effacement %, dilations and fetal head position) to determine probability of a successful vaginal delivery. Higher score increases likelihood of vaginal delivery.

Question 22

What is the Puerperium?

Answer 22

The period following deliver to approximately 6 weeks postpartum.

Question 23

During Puerperium, what can foul smelling discharge indicate?

Answer 23

Possible endometritis

Question 24

What are the 3 major proteins found in breast milk that are not in cow’s milk?

Answer 24

Casein
Lactalbumin
Beta-lactoglobulin