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32 Cards in this Set
- Front
- Back
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True labor and false labor can feel the same for a patient. To differentiate the two, what must you check on physical exam?
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Cervical dilation
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What is lightening?
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When patient gets close to delivery she may feel the baby change positions "drop" and notice a change in the shape of her uterus
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What is bloody show?
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Result of the cervix thinning (effacement) with extrusion of mucus from endocervical glands.
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What is Fetal Lie?
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Relation of the long axisof the fetus with the maternal long axis
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What does the Leopold maneuver "presentation" refer to?
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Portion of the fetus lowest in the birth canal
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What does the term Fetal position refer to?
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Relation of the fetal presenting part to the right or left of the pelvis.
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What is PROM?
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Premature Rupture of membranes
Occurs in 10% of pregnancies where the membranes surrounding the fetus rupture at least 1 hour before onset of labor. Puts patient at increased risk for infecion |
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Three tests to differentiate rupture of membranes from incontinence:
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Pool test (use of speculum in vaginal vault)
Nitrazine paper (turns blue) Fern (check crystals in amniotic fluid) |
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Five components of the cervical exam:
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Dilation
Effacement Cervical position Consistency Fetal Station |
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What are the criteria for a formally reactive accelerated fetal heart tracing:
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Two accelerations of at least 15 beats per minute over the baseline that last for at least 15 seconds within 20 minutes.
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Three types of decelerations:
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Early
Variable Latent |
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What causes early decelerations?
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Increased bagal tone secondary to head compression
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What causes variable decelerations?
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Umbilical cord compression
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What causes late decelerations?
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Begin at the peak of of a contraction. Result in utero-placental insufficiency.
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Of all of the types of decelerations, which is the most worrisome:
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Late decelerations as they may degrade into bradiacardia
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In the are of repetitive decels or fetuses that are difficult to trace with a doppler you can use a fetal scalp electrode (FSE)
What re the contraindications for FSE? |
Hepatitis, HIV, or fetal thromocytopenia
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IF a fetal heart tracing is nonreassuring, what can you do?
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You can check ultrasound
Also consider fetal scalp pH Fetal pulse oximetry is being investigated as well |
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What are the cardinal movements of labor?
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Engagement
Descent Flexion Internal rotation Extension External rotation |
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Definition of the first stage of labor:
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Onset of labor until complete dilation of the cervix
Typically lasts 10 to 12 hours for nulliparous women; or 6 to 8 hours in multiparous women |
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The first stage of labor can be divided into two parts. What are they?
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Latent: Onset to 3-4 cm of dilation (slow change)
Active: Extends to cervix is 9 cm dilated. occurs much quicker. |
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During the active phase of the first stage of labor, what is the expected rate of dilation?
This is a k-n-o-w |
1.0 cm /hr in ulliparous and 1.2 cm/hr in multiparous women.
Average dilation is 2 to 3 cm. |
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In the second stage of labor, what is considered prolonged?
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If duration is longer than 2 hours in a nulliparous ( or 3 if epidural), In multiparous women it is rare for 2nd stage to last more than 30 minutes.
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What is an episiotomy?
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Incision made in the perineum to facilitate delivery.
Must avoid the rectal sphincter. |
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Normal limits for third stage of labor
(delivery of placenta) |
Up to 30 minutes is considered normal;
however 5 to 10 minutes is more likely. |
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Advantages to using oxytocin during the third stage of labor?
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Strengthens uterine contractions to decrease time until delivery and blood loss.
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Is morbidity lower or higher for c-sections?
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Higher
Includes higher risk of infections, dehiscence, and recovery time |
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What is the most common indication for primary c-section?
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Failure to progress in labor
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Which is more common during c-section - epidurals or spinals?
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Spinals
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Placental indications for C-section (3):
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Placenta previa
Vasa previa Abruptio placentae |
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Fetal indications for c-section (lots)
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Nonreassuring fetal testing
Bradycardia Scalp pH < 7.2 Cord prolapse Fetal malpresentations Breech, transverse lie Nonvertex first twin |
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Maternal indications for c-section (lots):
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Genital herpes
Cervical cancer Untreated HIV Uterine surgery Hx full-thickness myomectomy Prior uterine rupture Obstruction of birth canal fibroids Ovarian tumors |
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Maternal / Fetal indications for C-section (2):
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Cephalopelvic disproportion
Failed induction of labor |
