OB PLE Flashcards
(111 cards)
1
Q
Pelvis:
Anything below the linea terminalis
Bounded anteriorly by pubic bones, laterally by inner surface of ischial bones and posteriorly by sacral promontory
A
True Pelvis
2
Q
Represents the shortest diameter of the pelvic cavity which is an important landmark in assessing level to which presenting part has descended
A
Ischial spines
3
Q
Pelvis:
Anything above the linea terminalis
Bounded anteriorly by lower abdominal wall, laterally by iliac fossa
And posteriorly by lumbar vertebrae
A
False pelvis
4
Q
2 important diameters in pregnancy
A
Obstetrical conjugate and diagonal conjugate
5
Q
Shortest distance bet. Symphysis pubis and sacral promontory
Cannot be measured directly
Approximately 10cm
A
Obstetrical conjugate
6
Q
Distance between midportion of sacral promontory to upper margin of symphysis pubis
A
True conjugate
7
Q
Distance from lower margin of symphysis pubis to the sacral promontory
Can be assessed clinically
Approximately 11.5-12cm
A
Diagonal conjugate
8
Q
Distance bet. the farthest two points of the pelvic brim over linea terminalis
A
Transverse Diameter
9
Q
If the lowest part of occiput is at/below the level of the ischial spine
A
Engagement
10
Q
Inadequate midpelvis/midpelvic contraction
A
Narrow sacrosciatic notch
prominent ischial spine
Convergent sidewalls
11
Q
Pelvic outlet contraction
A
Bituberous diameter <8cm
Narrow suprapubic arch
12
Q
Pelvis that is most suitable for normal delivery
Round shape
Sacral angle >90 inclined backwards
A
Gynecoid pelvis
13
Q
Pelvic bones
A
Ischium
Pubis
Ilium
Sacrum
14
Q
3 muscles of the pelvic floor
Covered by parietal layer of pelvic fascia
A
Levator Ani
Iliococcygeus
Pubococcygeus
15
Q
Heart shaped pelvis, suprapubic arch <90,
More common in males
A
Android Pelvis
16
Q
AP diameter > transverse diameter
Narrow sidewalls, wide inclination of sacrum, ischial spines not prominent
A
Anthropoid pelvis
17
Q
Supports the pelvic organs
Controls the external anal sphicter through puborectalis
Stabilizes sacroiliac and sacrococcygeal joints through ischiococcygeus
A
Pelvic diaphragm
18
Q
Most common type of malpresentation
A
Breech
19
Q
Hips are flexed, knees extended over anterior surface of the body
Most common type
Ideal for vaginal delivery
A
Frank breech
20
Q
Hips flexed and knees flexed
A
Complete breech
21
Q
Hyperextension of fetal head
Occiput is at the same side
Mentum/chin is the presenting part
A
Face presentation
22
Q
Military attitude
Head is partially flexed
A
Sinciput presentation
23
Q
Neck is fully flexed, chin in contact with thorax
A
Vertex/Occiput presentation
24
Q
Lateral deflection of the head in labor that the sagittal suture is not at midline
A
Asynclitism
25
Longitudinal axis of fetus to that of the mother
Fetal lie
26
Sagital suture approaches the sacral promontory
Anterior Asynclitism/Naegele's Obliquity
27
Sagital suture approaches the symphysis Pubis
Posterior asynclitism
28
Irregular contractions with long intervals and same intensity
Does not radiate to lumbosacral area
Sedation stops contraction
False labor
29
Regular contractions with shortening intervals
Intensity increases
With cervical effacement and dilation
True labor
30
Most common injury associated with shoulder dystocia
Brachial plexus injury
31
Maneuver:
Remove legs from stirrups and sharply flexing them up onto the abdomen
Decreasing the angle of inclination
Flattens/straightens sacrum
McRobert's Maneuver
32
Maneuver:
Cephalic relacement into pelvis followed by CS
Reversal of cardinal movements of labor
Zavanelli maneuver
33
Maneuver:
| Insert hand under symphysis pubis, reach for the accessible shoulder and push towards anterior surface of chest
Rubin's maneuver
34
Cardinal Movements of labor
```
(E-D-F-IR-E-ER-E)
Engagement
Descent
Flexion
Internal rotation
Extension
External rotation
Expulsion
```
35
Maneuver:
Hand is used to exert forward pressure on the chin of the fetus through the perineum just front of the coccyx and other hand exerts pressure posteriorly against the occiput
Ritgen maneuver
36
Stages of labor:
Onset of regular contraction and ends at 4cm dilation
Nullipara: <20hrs
Myltipara: <14hrs
Stage 1: Latent phase
37
Stages of labor:
Starts at 4cm until complete cervical dilation
Nullipara: >1.2cm/hr
Multipara: >1.5cm/hr
Stage 1: Active phase
38
Functional Phases of Labor
Preparatory
Dilational
Pelvic Division
39
Active Phase of labor:
Predictive of the outcome of labor
4-6cm
Acceleration Phase
40
Active Phase of labor:
Measures the overall efficiency of the machine
7-8cm
Maximum Slope
41
Active Phase of labor:
Reflective of the fetopelvic relationship
8-10cm
Deceleration Phase
42
Lacerations of birth canal:
| Involves the fourchette, perineal skin, vaginal mucous membrane
First Degree
43
Lacerations of birth canal:
Extends to the external anal sphincter
Third degree
44
Lacerations of birth canal:
Extends into the rectal mucosa
Fourth degree
45
Lacerations of birth canal:
Involves the fascia and perineal muscles
Second degree
46
Separation of placenta occurs at the periphery first
Blood collects between the membranes and uterine wall and escapes from vagina
Duncan
47
Detachement of placenta starts from the central portion
Blood does not escape externally until extrusion of the placenta
Schultze
48
Episiotomy:
Easier to repair
Heals better
Less postoperative pin
More likely to extend to rectum
Midline episiotomy
49
Episiotomy:
More room for delivery
More blood loss
More difficult to repair
More dyspareunia
Mediolateral episiotomy
50
Signs of placental separation
Calkin's sign
Sudden gush of blood from vagina
Lengthening of the cord
Uterus rises to abdomen
51
Active management of labor
Oxytocin 10U IM
(+) contractions, controlled traction on umbilical cord while other hand places counter suprapubic pressure
Start oxytocin drip
52
Forceps delivery:
Most common type used
For delivery of fetus with molded head
Simpson forceps
53
Forceps delivery:
For fetus with a rounded head (common in multipara)
Tucker McLane Forceps
54
Forceps delivery:
Ideal for rotating head
Head is engaged but is not at the level of perineal floor
Kielland forceps
55
Forceps delivery:
The double pelvic curve facilitates application to the after-coming head in BREECH presentation
Piper forceps
56
Forceps delivery:
Leading point of head is at station +2 but not on the pelvic floor
Rotation - >45 degrees
Low Forceps delivery
57
Forceps delivery:
Leading point of head is above +2 or head is engaged
Fetal and maternal risks are greater
Midforceps delivery
58
Forceps delivery:
Fetal head or scalp is VISIBLE AT THE INTROITUS
Rotation - <45 degrees
Outlet forceps
59
Indications for Forceps Delivery
Fetal:
Non-reassuring FHR pattern
```
Maternal:
Prolonged 2nd stage of labor
Exhaustion
Heart disease
Pulmonary disorders
```
60
Most common indication for primary cesarean delivery
Dystocia
61
Breech delivery:
Usually used for small babies
Breech is allowed to deliver spontaneously up to navel
Fetal body held against symphysis pubis
Bracht maneuver
62
Breech delivery:
2 fingers are placed on malar areas of the fetus
Flexes fetal head in order to permit pelvic passage
Other arm acts as a splint for the nect to prevent hyperextension of neck and exerts downward traction
Mauriceau-Smellie-Viet Maneuver
63
Breech delivery:
Shoulder's back pressure
Pull baby posteriorly until chin is under symphysis pubis and will act as a fulcrum to allow delivery
Prague maneuver
64
Abortion:
Sx: minimal bloody vaginal discharge, no pain or very minimal hypogastric pain
Cervix: closed
Bag of water: Intact
Uterus compatible with AOG
Management: complete bed rest and Pain relief
Threatened Abortion
65
Abortion:
Sx: minimal to moderate bloody vaginal discharge, minimal hypogastric pain
Cervix: admits tip
Bag of water: Intact
Imminent Abortion
66
Abortion:
Sx: moderate bloody vaginal discharge, moderate hypogastric pain
Cervix: open
Bag of water: Ruptured
Inevitable Abortion
67
Abortion:
Sx: profuse bloody vaginal discharge, severe hypogastric pain
Cervix: open WITH PASSAGE OF MEATY TISSUE
Bag of water: Ruptured
Management: elective D&C
Incomplete abortion
68
Abortion:
Sx: minimal or absent bloody vaginal discharge
Cervix: closed
Uterus: uterus INCOMPATIBLE with AOG
Management: elective D&C
Missed abortion
69
Abortion:
Three or more consecutive spontaneous abortion
Recurrent Abortion
70
Painless vaginal bleeding
Cervical dilation (2nd or early 3rd trimester)
Balooning of membranes
Incompetent Cervix
Do cerclage
71
Most commonly involved site of ectopic pregnancy?
TUBAL
72
Most commonly involved site of tubal ectopic pregnancy?
Ampulla
73
Most commonly involved site of ruptured ectopic pregnancy?
Isthmus
74
Gold standard in diagnosis and subsequent management of ectopic pregnancy
Laparoscopy
75
Most frequent symptom of ectopic pregnancy
Abdominal pain
76
Candidates for medical management with Methotrexate in Ectopic pregnancy
Pregnancy <6weeks
Tubal mass less 3.5cm
Absent fetal heart tone
Serum B-hcg <15000mIU/ml
77
Increase in cardiac output is attributed to which physiologic change?
Decrease systemic vascular resistance and increase heart rate
78
Principal prostaglandin of endothelium
Regulates BP and platelet function
Decrease in preeclampsia
Prostacyclin (PGI2)
79
Potent VASOCONSTRICTOR in endothelial and vascular smooth muscle cells
Regulates local vasomotor tone
Stimulates secretion ANP, aldosterone and catecholamine
Endothelin
80
Potent VASODILATOR released by endothelial cells
Modifies vascular resistance during pregnancy
Nitric Oxide
81
Normal blood loss in normal singleton spontaneous vaginal delivery?
500ml
82
Normal blood loss in normal cesarean delivery and twin delivery?
1000ml
83
Maternal blood expands most rapidly during what trimester?
2nd trimester
84
Pulmonary anatomic changes during 2nd half pregnancy
transverse diameter of the thoracic cage increases by 2cm
Diaphragm rises about 4cm
Thoracic circumference increases about 6cm
Greater diaphragmatic excursion
85
Changes in the lung volume during pregnancy
Increased: TV and IC
Decreased: FRC, RV and ERV
86
Softening of the uterine isthmus
Hegar's sign
87
Softening and cyanosis due to increased vascularity and edema of the entire cervix
Goodell's sign
88
Increased vascularity affecting vagina and results in violet discoloration
Chadwick's sign
89
Melasma gravidarum
"Mask of Pregnancy"
Chloasma
90
Primarily secreted by adipose tissue
Plays a role in body fat and energy expenditure regulation
Help regulate fetal growth
Deficiency: anovulation and infertility
Abnormally Elevated: preeclampsia and GDM
Leptin
91
Secreted by the stomach in response to hunger
Has a role in fetal growth and cell proliferation
Ghrelin
92
Major determinant of maternal insulin resistance after midpregnancy
Secreted by syncitiotrophoblasts
Placental Growth Hormone
93
Intraabdominal remnants of the umbilical vein
Ligamentum venosum and falciform ligament
94
Presence in the amniotic fluid is evidence of fetal lung maturity (after 34 weeks)
Pulmonary surfactant
95
Most active component of pulmonary surfactant
Dipalmitoylphosphatidylcholine
96
Test for uteroplacental function
Contraction stress test
97
Test for fetal condition
Non-stress test
98
Components of Biophysical profile
```
Non-stress test
Fetal breathing
Fetal tone
Fetal movement
Amniotic fluid volume
```
99
Onset, nadir and recovery of deceleration are coincident with the beginning, peak and ending of a contraction, respectively
Early deceleration
100
Onset, nadir and recovery of deceleration are after the beginning, peak and ending of a contraction, respectively
Late deceleration
101
Most common deceleration pattern
Onset, nadir and recovery of decelerations vary with successive contractions
Variable deceleration
102
Decrease in fetal heart rate >15bpm, lasting for more than 2mins but less than 10minutes
Prolonged deceleration
103
Phases of Parturition:
Prelude to parturition
Uterine quiescence, cervical softening
Phase 1 quiescence
104
Phases of Parturition:
Uterine preparedness for labor, cervical ripening
Phase 2 Activation
105
Phases of Parturition:
Uterine contraction, cervical dilation
Phase 3 Stimulation
106
Phases of Parturition:
Uterine involution, cervical repair, breastfeeding
Phase 4 Involution
107
Shortening of the cervical canal
Causes expulsion of the mucus plug
Cervical effacement
108
Quantifiable method used to predict labor induction
Bishop Score
109
What is the direct cause of most maternal deaths involving regional anesthesia?
High spinal blockade
110
What anesthetic is associated with neurotoxicity and cardiotoxicity at virtually identical serum drug levels?
Bupivacaine
111
Most common complication encountered during epidural anesthesia
Hypotension
