PRENATAL CARE Flashcards by Kash Yap

Complications of cordocentesis

Cord vessel bleed
Fetal maternal bleed
Fetal bradycardia
Fetal loss

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Amniocentesis complications

Fetal loss

Amniotic leak

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Chorionic villous sampling indication

Karyotyping

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Chorionic villous sampling complications

Fetal loss
Limb reduction defects
Oromandibular limb hypoplasia

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Amniocentesis (15-20 wks) indications

Karyotyping
FISH
Relieves hydramnios

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Fetal blood sampling (cordocentesis) indication

Fetal anemia

Tx of platelet alloimmunization

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Conditions which increased hCG

Multiple pregnancy
Molar pregnancy 
Exogenous injection
Impaired renal clearance
hCG secreting tumors from GI, ovary, bladder, lungs

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What produced hCG

Syncytiotrophoblasts

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Sonographic recognition of gestation sac begins at

4-5 weeks

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Sonographic recognition of yolk sac begins at

5-6 weeks

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What does the presence of fetal Yolk sac indicate?

Intrauterine location

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Sonographic recognition of embryonic pole with cardiac motion begins at

6 weeks

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Sonographic recognition of crown-rump length begins at

Up to 12 weeks

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What does crown-rump length indicate?

AOG within 4 days

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Most accurate tool for gestational age assignment

Crown-rump length

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Fetal heart sounds can be heard by doppler at

10 weeks

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Fetal heart sounds can be heard with stethoscope at

16 weeks

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Recommended weight gain for underweight (BMI <18.5)

12.5 to 16 kgs
28 to 40 lbs
1 lb/week

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Recommended weight gain for Normal (BMI 18.5 to 24.9)

11.5 to 16 kgs
25 to 35 lbs
1 lb/week (0.8-1 kg)

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Recommended weight gain for Overweight (BMI 25-29.9)

7 to 11.5 kg
15 to 25 lb
0.6 lb/week

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Recommended weight gain for Obese (BMI 30 and up)

5 to 9.1 kg
11 to 20 lb
0.5 lb/wk

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RDA calories

100-300 kcal/day

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RDA protein

5-6 g/day

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RDA iron

27 mg/day (low risk)

60-100 mg/day in large women, twin, anemia

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RDA iodine

220 ug/day

Cretinism is associated with which mineral deficiency?

Iodine

RDA calcium

``` 900 mg (quart of milk) 1000 mg (ages 19-50) ```

RDA folate for all women

400 mcg to prevent NTD | 0.4 to 0.8 mg for ALL women

RDA folate for women with previous NTD baby

4 mg

RDA vitamin C

80-85 mg

Frequency of prenatal check up

Monthly until 28 wks Every 2 wks until 36 wks Every wk until term

Total weight gain in Underweight (BMI <18.5)

Single - 28-40 | Twins

Total weight gain in normal (BMI <18.5 to 24.9)

Single: 25 to 35 lbs Twins: 37 to 54 lbs

Total weight gain in Overweight (BMI 25 to 29.9)

Single: 15 to 25 lbs Twins: 31 to 50 lbs

Total weight gain in Obese (BMI 30)

Single 11 to 20 | Twin: 25 to 42 lbs

Average weight gain in pregnancy

28. 6 lbs | 4. 8 kg

Weight loss at delivery

12 lbs | 5.5 kg

Weight loss 2 to 6 wks postpartum

5. 5 lbs | 2. 5 kg

Weight loss 2 wks postpartum

9 lbs | 4 kg

Average retained weight

3 lbs | 1.4 kg

Caffeine intake

3 cups of 5 oz percolated coffee

Safe to travel until when?

36 wks AOG

Immunization schedule in pregnancy

Tdap (inactivated) Influenza Hep B

Vaccines contraindicated in pregnancy

``` Measles Mumps Rubella Varicella HPV ```

Safe vaccines

``` Rabies (killed) Hep A Pneumococcus (for asplenia, cardiac dse) Meningococcus (outbreaks) Varicella Ig (post exposure) ```

OGTT 75 is done at?

24 to 48 eeks

Hormon e which causes insulin resistance lipolysis, increased fatty acids

HPL

When to ask for BPP

24-28 weeks

Test of fetal health

Non stress test

Test of uteroplacental function

Contraction stress test

Negative NST

normal | Fetal heart acceleration in respons to fetal movement

Positive NST

Late decelerations following 50% or more of contractions

Negative CST

3 or more contractions 40 sec or more 10 mins No late decelerations

What are the five components of BPP?

``` Nonstress test Fetal breathing Fetal movement Fetal tone Amniotic fluid volume ```

Which component of the BPP may be omitted if the other four are normal

Nonstress test

Which component of BPP requires further evaluation, if abnormal, regardless of the BPP composite score?

Amniotic fluid volument | If largest vertical amniotic fluid pocket is less than 2 cm (score 0)

BPP scores

0 or 2

BPP interpretation | BPP score: 10

Normal, non-asphyxiated fetus

BPP interpretation | BPP score: 8/10 (normal AFV)

Normal, non-asphyxiated fetus

BPP interpretation | BPP score: 8/8 (NST not done)

Normal, non-asphyxiated fetus

BPP interpretation | BPP score: 8/10 (decreased AFV)

Chronic fetal asphyxia — DELIVER

BPP interpretation | BPP score: 6

Possible fetal asphyxia

BPP interpretation BPP score: 6 AFV abnormal What is the next best step?

Deliver | Possible fetal asphyxia

``` BPP interpretation BPP score: 6 AFV normal >36 wks AOG with favorable cervix What is the next best step? ```

Deliver

BPP interpretation BPP score: 6 REPEAT TEST 6 or Less What is the next best step?

DELIVER

BPP interpretation BPP score: 6 REPEAT TEST: >6 What is the next best step?

Observe and repeat Weekly TWICE weekly In DM and postterm

BPP score: 4 interpretation? Intervention?

Probable fetal asphyxia | Repeat on the same day

``` BPP score: 4 Repeat test (same day): 6 or less ```

Deliver

BPP score 0-2

Almost certain asphyxia | Deliver

Hypoxia cascade in Biophysical score activity

Fetal heart reactivity *1st Fetal breathing Fetal movement Fetal tone *last

Normal FHR

110-160 bpm | min of 2 minutes

Normal baseline variability

6-25 bpm (moderate)

Normal acceleration | At <32 weeks AOG

Acceleration more than 10 bpm from baseline lasts for 10 secs But <2 mins from onset

Normal Acceleration | At 32 weeks or more AOG

Acceleration more than 15 bpm from baseline lasts for >15 secs But <2 mins from onset

Prolonged acceleration

Lasts >2 minutes but <10

Baseline change

Acceleration lasts 10 mins or more

Early deceleration indicates

Fetal head compression

Late deceleration indicates

Uteroplacental insufficiency

Variable deceleration indicates

Umbilical cord occlusion

CTG tracing with onset, nadir and recovery of decelerations coincident with the beginning, peak and ending of a contraction, respectively

Early deceleration

Most common deceleration pattern

Variable

Describe a prolonged deceleration

Decrease in FHR if 15 bpm or more Lasting 2 minutes or more But less than 10 mins

CTG tracing with onset, nadir and recovery of decelerations varying with successive uterine contractions

Variable deceleration

CTG tracing with onset, nadir and recovery of decelerations occuring after the beginning, peak and ending of a contraction, respectively

Late deceleration

Increases ICP leading to deceleration

Fetal head compression

Stimulates chemoreceptors leading to decelerations

Decrease in uteroplacental O2 transfer

Visually apparent, smooth, sine wave like undulating pattern in FHR baseline with a cycle frequency if 3-5 bom which persists for 20 mins or more

Sinusoidal pattern

Category I CTG intervention

Routine monitoring | Normal fetal acid base status

Category II CTG intervention

Improve fetal O2 and uteroplacental blood floow Diminish uterine activity Relieve umbilical cord compression

Category III CTG intervention

Improve fetal O2 and uteroplacental blood floow Diminish uterine activity Relieve umbilical cord compression

Interventions to improve fetal oxygenation and uteroplacental blood flow involve

Lateral decubitus positioning Maternal O2 Administer IV fluid bolus Decrease oxytocin to reduce uterine contraction frequency

Interventions to diminish uterine activity

Discontinue oxytocin or prostaglandins Give tocolytics — terbutaline — MgSO4

Interventions to relieve cord compression

Reposition mother Amnioinfusion If with prolapse, manually elevate the presenting part while preparing for immediate delivery

Of the four phases of parturition, phase 3 is characterized by which of the following? A. Uterine activation, cervical ripening B. Uterine contraction, cervical dilatation C. Uterine quiescence, cervical softening D. Uterine involution, cervical remodeling

B. Phase 3 Stimulation A. 2 - activation C. 1 - quiescence D. 4 - parturient recovery

Which of the following cervical functions and events take place during phase 1 of parturition, EXCEPT? A. Maintenance of cervical competence despite growing uterine weight B. Maintenance of barrier between uterine contents and vaginal bacteria C. Alteration in extracellular matrix to gradually increase cervical tissue compliance D. Alteration of cervical collagen to stiffen the cervix

D. Alteration of cervical collagen to stiffen the cervix

Which stage of parturition corresponds to the clinical stages of labor

Phase 3

Lower segment thinning with concomitant upper segment thickening

Physiologic retraction ring

Bandl ring

Pathologic retraction ring

When thinning of the lower uterine segment is extreme

Bandl ring

Stage of fetal descent | 10 cm to delivery

Second stage

Weakest layer of placenta

Decidua spongiosa

placental expulsion mechanism wherein blood from the placental site pours into the membrane sac and does not escape externally until extrusion of the placenta

Schultze mechanism

placental expulsion mechanism wherein placenta separates first at the periphery and blood collects between the membranes and escapes from the vaginal. The placenta descends sideways and its maternal surface appears first.

Duncan mechanism

Signs of placental separation

- fundus becomes globular and firm (Calkins sign) - Sudden gush of blood - elongation of cord - Uterus rises in the abdomen

``` A 39 week AOG patient with a breech presenting fetus agrees to an externwl cephalic version. Prior to performing the maneuver, 0.25 mg terbutaline subcutaneously was administered. The drugs binds to B adrenergic receptors to cause which of the following cellular reactions to cause uterine relaxation? A. Increased ecf Mg B. Increased iCa C. Increased cAMP D. Increased cGMP ```

C. Increased cAMP

``` Changes in maternal blood flow and cardiac output in pregnancy mimic which of the following disease states? A. Hypertension B. Thyrotoxicosis C. Diabetes insipidus D. Chronic renal disease ```

B. Thyrotoxicosis

Between which ages of gestation does the fundic height (in cm)correlate closely with gestational age?

Between 20-34 weeks

When does the uterus become abdominal?

12 weeks AOG

When is the fundus located midway between the pubis symphysis and umbilicus?

16 wks

Fundus ia at the level of the umbilicus

20 weeks

Which leopold maneuver answer the question, what fetal pole occupies the fundus?

Fundal grip - L1

Which leopold maneuver answer the question, on which side is the fetal back?

Umbilical grip - L2

Which leopold maneuver answer the question, what fetal part lies above the pelvic inlet?

Pawlicks grip - L3

Which leopold maneuver answer the question,on which side is the fetal prominence?

Pelvic Grip - L4

Fetal posture or habitus?

Fetal attitude

Predisposing factors for transverse lie

Multiparity Placenta previa Hydramnios Uterine anomalies

Predisposing factors for face presentation

``` Fetal malformation (anencephaly) Cord coil High parity (lax abdomen) ```

Vertex

Occiput

Face

Mentum

Breech

Sacrum

Shoulder

Scapula | Back up, back down

Local edema

Caput succedaneum

Bony changes in fetal head which result in shortened suboccipitobregmatic diameter

Molding

both hips flexed and both knees extended and the feet close to the head.

Frank breech

Most common type of breech presentation

Frank breech

Hips flexed, knees flexed

Complete breech, canonball position

What are the cardinal fetal movements in correct order?

``` Engagement. Descent Flexion Internal rotation Extension External rotation Expulsion ```

``` A 20 year old G1P0 at 39 weeks aog presents complaining of strong contractions. Her cervix is dilated 1 cm. She is given sedation and 4 hours later contractions have stopped. Her cervix is still 1 cm dilated, which of the following is the most likely diagnosis? A. False labor B. Prolonged latent phase of labor C. Arrest of latent phase D. Arrest of active phase ```

A. False labor

Factors affecting latent phase duration

Excess sedation or epidural Unfavorable cervix False labor

1st stage of labor is the latent phase which encompasses

Onset of labor to 3-5 cm

In nulliparous women, when is latent phase considered prolonged?

>20 hours

In a G3P2 (2002) woman, when is latent phase considered prolonged?

>14 hours

Active phase of labor begins at:

3 to 5 cm up to full dilatation

What is the normal rate of cervical dilatation in a G1P0 woman?

1.2 cm/hr

What is the normal rate of cervical dilatation in a G3P2 woman?

1.5 cm/hr

Which factors increase the duration of the active phase?

Epidural anesthesia - up to 1 hour Maternal obesity - up to 30 to 60 mins Maternal fear - up to 45 mins

Greatest transverse diameter in occiput presentation

Biparietal diameter

Lateral deflection of the sagittal suture either posteriorly toward the promontory or anteriorly toward the symphysis

Asynclitism

Sagittal suture lies close to the symphysis, more of the posterior parietal bone will present.

Posterior asynclitism

Sagittal suture approaches the sacral promontory, more of the anterior parietal bone presents itself to the examining fingers

Anterior asynclitism

This measurement involves the promontory to the upper margin of symphysis

True/anatomic conjugate

Normal diameter for true/anatomic conjugate

11 cm

This is measured manually from promontory to lower margin of symphysis

Diagonal conjugate

Normal diagonal conjugate

>11.5 cm

This is measured indirectly by subtracting 1.5 to 2 cm from the diagonal conjugate

Obstetric conjugate

This is a measurement of the promontory to the posterior symphysis

Obstetric conjugate

Mechanical stretching of the cervix enhances uterine activity

Ferguson reflex

``` Contractions are painful possible because of the following except? A. Hypoxia of the myometrium B. Compression of the nerve ganglia C. Cervical stretching during dilatation D. None of the above ```

D. None of the above A. Hypoxia of the myometrium B. Compression of the nerve ganglia C. Cervical stretching during dilatation And stretching of the peritoneum overlying the fundus

The most important force in fetal expulsion is produced by?

Maternal intraabdominal pressure

Describes the descent of the fetal biparietal diameter in relation to a line drawn between two maternal ischial spines

Station

``` This is the first requisite for the birth of a newborn A. Flexion B. Engagement C. Descent D. Extension ```

C. Descent

The appreciably shorter suboccipitobregmaric diameter is substituted for the longer occipitofrontal diameter

Flexion

``` This is essential for completion of labor A. Extension B. Flexion C. Descent D. Internal rotation ```

Internsl rotstion

``` On palpation of the fetsl head during vaginal examination, you note that the sagittal suture is transverse and close to the pubic symphysis. The posterior ear can be easily palpated. Which of the following best describes this orientation? A. Anterior asynclitism B. Posterior asynclitism C. Mento-anterior position D. Mento-posterior position ```

B. Posterior asynclitism

``` Goals of a successthird stage of labor include which of the following? A. Prevention of uterine inversion B. Prevention of shoulder dystocia C. Completion of episiotomy repair D. All of the above ```

A. Prevention of uterine inversion

``` Goals of a successthird stage of labor include all of the following, EXCEPT? A. Prevention of uterine inversion B. Prevention of postpartum hemorrhage C. Delivery of an intact placenta D. None of the above ```

D. None of the above

Components of Unang Yakap

Immediate and thorough drying Early skin to skin contact Properly timed cord clamping Non separation for early breastfeeding

Identify the degree of perineal laceration | Extension of laceration through skin mucous membrane, perineal body, and anal sphincter

Third degree

Identify the degree of perineal laceration Laceration extends from skin and mucous membrane to the fascia and muscles of the perineal body

2nd degree

Identify the degree of perineal laceration | Fourchette, perineal skin, vaginal mucous membrane but no the underlying fascia and muscle

1st degree

Identify the degree of perineal laceration | Extension of laceration through the rectal mucosa to expose the lumen of the rectum

4th degree

``` The functional divisions of labor include all of the following except A. Preparatory B. Dilatational C. Acceleration D. None of the above ```

C. Acceleration Functional divisions of labor include: Preparatory Dilatational Pelvic

Effective first line uterotonic prophylactic drug

Oxytocin

This uterotonic is contraindicated in hypertensive patients

Mergonovine (ergot alkaloids)

``` The following criteria must be met prior to vaginal delivery: A. Membranes ruptured B. Cervix completely dilated C. Regional anesthesia placed D. Fetal head position determined ```

C. Regional anesthesia

Which of the following describes forceps that are applied to the fetal head with the scalp visible at the introitus without manual separation of the labia? A. Low B. Mid C. High D. Outlet

D. Outlet

The following are indications for operative vaginal delivery except? A. Prolonged second stage B. Suspicion of immediate or potential fetal compromise C. Shortening of the 2nd stage for maternal benefit D. None of the above

D, none of the above

Criteria for outlet forceps (5)

- scalp is visible at introitus without separating the labia - fetal skull has reached the pelvic floor - sagittal suture is in AP diameter or ROA/LOA or ROP/LOP - fetal head is at or on perineum - rotation does not exceed 45 degrees

``` Which of the following is applied to reduce the nuchal arm in breech delivery? A. Loveset maneuver B. Zavanelli maneuver C. McRobert maneuver D. Piper forceps maneuver ```

A. Loveset maneuver

The following describes the cardinal movements of breech delivery except A. The fetal head is born by flexion B. The back of the fetus is directed posteriorly C. The anterior hip usually descends more rapidly than the posterior hip D. Engagement and descent usually occur with the bitrochanteric diameter in an oblique plane

B. The back of the fetus is directed posteriorly

``` Which of the following best describes a breech fetus that delivers spontaneously up to the umbilicus, but whose remaining body is delivered with operator traction? A. Breech decomposition B. Total breech extraction C. Partial breech extraction D. Spontaneous breech delivery ```

C. Partial breech extraction — breech spontaneously delivered up to umbilicus — posterior hip will deliver from 6 o’clock position — anterior hip delivers next — external rotation to sacrum anterior — fetal bony pelvis grasped with both hands, using cloth towel

``` A patient presents in preterm labor at 32 weeks gestation. Her cervix is completely dilated, and the fetus is breech. You are unable to deliver the fetal head. What procedure is applied to resolve this complication? A. Symphysiotomy B. Zavanelli maneuver C. Duhrssen incision D. Mauriceau maneuver ```

C. Duhrssen incision — incision on cervix at 2 and 10 o’clock — or additional at 6 (Symphysiotomy is done for delivery of entrapped aftercoming head. Divides symphyseal cartilage up to 2.5 cm

The following criteria must be met prior to planned vaginal breech extraction, except? A. Oxytocin induction if with hypotonic uterine dysfunction B. Passive 2nd stage without active pushing for 90 minutes C. Continuous EFM D. none of the above

A. Oxytocin induction if with hypotonic uterine dysfunction Criteria for planned vaginal breech A. Oxytocin AUGMENTATION if with hypotonic uterine dysfunction. INDUCTION is NOT recommended B. Passive 2nd stage without active pushing for 90 minutes to allow breech to descend into pelvis C. Continuous EFM D. EFW 2.5 to 4kg E. Skilled OB with facilities for cs CS is recommended when active pushing commences and delivery is not imminent within 60 MINUTES

Cardinal movements in BREECH

- Extension - Descent - Internal Rotation (45 degree rotation of hip; anterior hip toward the pubic arch; bitrochanteric diameter in AP diameter of outlet) - Lateral flexion (posterior hip over perineum) - External rotation (fetal back turns anteriorly) - Internal rotation (bisacromial diameter in ap plane) - Expulsion (posterior neck under symphysis, head born in flexion)

Pinard maneuver

In breech decomposition, 2 fingers will push knee away from midline, after spontaneous flexion Lateral rotation of thighs Flex knees

In the cardinal movements of breech, the bitrochanteric diameter in oblique diameter and the anterior hip descends more rapidly. Which step is described?

Engagement and descent

After delivery of the aftercoming head, the assistant applies suprapubic pressure to favor flexion and engagement of the fetal head. Which maneuver is applied? A. Loveset maneuver B. Zavanelli maneuver C. Duhrssen incision D. Mauriceau maneuver

D. Mauriceau-Smellie-Veit

Between which ages of gestation does the fundic height (in cm)correlate closely with gestational age?

Between 20-34 weeks

When does the uterus become abdominal?

12 weeks AOG

When is the fundus located midway between the pubis symphysis and umbilicus?

16 wks

Fundus ia at the level of the umbilicus

20 weeks

Which leopold maneuver answer the question, what fetal pole occupies the fundus?

Fundal grip - L1

Which leopold maneuver answer the question, on which side is the fetal back?

Umbilical grip - L2

Which leopold maneuver answer the question, what fetal part lies above the pelvic inlet?

Pawlicks grip - L3

Which leopold maneuver answer the question,on which side is the fetal prominence?

Pelvic Grip - L4

Fetal posture or habitus?

Fetal attitude

Predisposing factors for transverse lie

Multiparity Placenta previa Hydramnios Uterine anomalies

Predisposing factors for face presentation

``` Fetal malformation (anencephaly) Cord coil High parity (lax abdomen) ```

Vertex

Occiput

Face

Mentum

Breech

Sacrum

Shoulder

Scapula | Back up, back down

Local edema

Caput succedaneum

Bony changes in fetal head which result in shortened suboccipitobregmatic diameter

Molding

both hips flexed and both knees extended and the feet close to the head.

Frank breech

Most common type of breech presentation

Frank breech

Hips flexed, knees flexed

Complete breech, canonball position

What are the cardinal fetal movements in correct order?

``` Engagement. Descent Flexion Internal rotation Extension External rotation Expulsion ```

D. Mauriceau-Smellie-Veit

In the cardinal movements of breech, the bitrochanteric diameter in oblique diameter and the anterior hip descends more rapidly. Which step is described?

Engagement and descent

Pinard maneuver

In breech decomposition, 2 fingers will push knee away from midline, after spontaneous flexion Lateral rotation of thighs Flex knees

Cardinal movements in BREECH

C. Duhrssen incision — incision on cervix at 2 and 10 o’clock — or additional at 6 (Symphysiotomy is done for delivery of entrapped aftercoming head. Divides symphyseal cartilage up to 2.5 cm

B. The back of the fetus is directed posteriorly

``` Which of the following is applied to reduce the nuchal arm in breech delivery? A. Loveset maneuver B. Zavanelli maneuver C. McRobert maneuver D. Piper forceps maneuver ```

A. Loveset maneuver

Criteria for outlet forceps (5)

D, none of the above

Which of the following describes forceps that are applied to the fetal head with the scalp visible at the introitus without manual separation of the labia? A. Low B. Mid C. High D. Outlet

D. Outlet

``` The following criteria must be met prior to vaginal delivery: A. Membranes ruptured B. Cervix completely dilated C. Regional anesthesia placed D. Fetal head position determined ```

C. Regional anesthesia

This uterotonic is contraindicated in hypertensive patients

Mergonovine (ergot alkaloids)

Effective first line uterotonic prophylactic drug

Oxytocin

``` The functional divisions of labor include all of the following except A. Preparatory B. Dilatational C. Acceleration D. None of the above ```

C. Acceleration Functional divisions of labor include: Preparatory Dilatational Pelvic

Identify the degree of perineal laceration | Extension of laceration through the rectal mucosa to expose the lumen of the rectum

4th degree

Identify the degree of perineal laceration | Fourchette, perineal skin, vaginal mucous membrane but no the underlying fascia and muscle

1st degree

Identify the degree of perineal laceration Laceration extends from skin and mucous membrane to the fascia and muscles of the perineal body

2nd degree

Identify the degree of perineal laceration | Extension of laceration through skin mucous membrane, perineal body, and anal sphincter

Third degree

Components of Unang Yakap

Immediate and thorough drying Early skin to skin contact Properly timed cord clamping Non separation for early breastfeeding

D. None of the above

A. Prevention of uterine inversion

B. Posterior asynclitism

``` This is essential for completion of labor A. Extension B. Flexion C. Descent D. Internal rotation ```

Internsl rotstion

The appreciably shorter suboccipitobregmaric diameter is substituted for the longer occipitofrontal diameter

Flexion

``` This is the first requisite for the birth of a newborn A. Flexion B. Engagement C. Descent D. Extension ```

C. Descent

Describes the descent of the fetal biparietal diameter in relation to a line drawn between two maternal ischial spines

Station

The most important force in fetal expulsion is produced by?

Maternal intraabdominal pressure

A. False labor

D. None of the above A. Hypoxia of the myometrium B. Compression of the nerve ganglia C. Cervical stretching during dilatation And stretching of the peritoneum overlying the fundus

Mechanical stretching of the cervix enhances uterine activity

Ferguson reflex

This is a measurement of the promontory to the posterior symphysis

Obstetric conjugate

This is measured indirectly by subtracting 1.5 to 2 cm from the diagonal conjugate

Obstetric conjugate

Normal diagonal conjugate

>11.5 cm

This is measured manually from promontory to lower margin of symphysis

Diagonal conjugate

Normal diameter for true/anatomic conjugate

11 cm

This measurement involves the promontory to the upper margin of symphysis

True/anatomic conjugate

Sagittal suture approaches the sacral promontory, more of the anterior parietal bone presents itself to the examining fingers

Anterior asynclitism

Sagittal suture lies close to the symphysis, more of the posterior parietal bone will present.

Posterior asynclitism

Lateral deflection of the sagittal suture either posteriorly toward the promontory or anteriorly toward the symphysis

Asynclitism

Greatest transverse diameter in occiput presentation

Biparietal diameter

Which factors increase the duration of the active phase?

Epidural anesthesia - up to 1 hour Maternal obesity - up to 30 to 60 mins Maternal fear - up to 45 mins

What is the normal rate of cervical dilatation in a G3P2 woman?

1.5 cm/hr

What is the normal rate of cervical dilatation in a G1P0 woman?

1.2 cm/hr

Active phase of labor begins at:

3 to 5 cm up to full dilatation

In a G3P2 (2002) woman, when is latent phase considered prolonged?

>14 hours

In nulliparous women, when is latent phase considered prolonged?

>20 hours

1st stage of labor is the latent phase which encompasses

Onset of labor to 3-5 cm

Factors affecting latent phase duration

Excess sedation or epidural Unfavorable cervix False labor

PRENATAL CARE Flashcards

(248 cards)