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32 Cards in this Set

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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?
Cervical dilation
What is lightening?
When patient gets close to delivery she may feel the baby change positions "drop" and notice a change in the shape of her uterus
What is bloody show?
Result of the cervix thinning (effacement) with extrusion of mucus from endocervical glands.
What is Fetal Lie?
Relation of the long axisof the fetus with the maternal long axis
What does the Leopold maneuver "presentation" refer to?
Portion of the fetus lowest in the birth canal
What does the term Fetal position refer to?
Relation of the fetal presenting part to the right or left of the pelvis.
What is PROM?
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
Three tests to differentiate rupture of membranes from incontinence:
Pool test (use of speculum in vaginal vault)

Nitrazine paper (turns blue)

Fern (check crystals in amniotic fluid)
Five components of the cervical exam:
Dilation
Effacement
Cervical position
Consistency
Fetal Station
What are the criteria for a formally reactive accelerated fetal heart tracing:
Two accelerations of at least 15 beats per minute over the baseline that last for at least 15 seconds within 20 minutes.
Three types of decelerations:
Early
Variable
Latent
What causes early decelerations?
Increased bagal tone secondary to head compression
What causes variable decelerations?
Umbilical cord compression
What causes late decelerations?
Begin at the peak of of a contraction. Result in utero-placental insufficiency.
Of all of the types of decelerations, which is the most worrisome:
Late decelerations as they may degrade into bradiacardia
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
IF a fetal heart tracing is nonreassuring, what can you do?
You can check ultrasound
Also consider fetal scalp pH
Fetal pulse oximetry is being investigated as well
What are the cardinal movements of labor?
Engagement
Descent
Flexion
Internal rotation
Extension
External rotation
Definition of the first stage of labor:
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
The first stage of labor can be divided into two parts. What are they?
Latent: Onset to 3-4 cm of dilation (slow change)

Active: Extends to cervix is 9 cm dilated. occurs much quicker.
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.
In the second stage of labor, what is considered prolonged?
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.
What is an episiotomy?
Incision made in the perineum to facilitate delivery.

Must avoid the rectal sphincter.
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.
Advantages to using oxytocin during the third stage of labor?
Strengthens uterine contractions to decrease time until delivery and blood loss.
Is morbidity lower or higher for c-sections?
Higher

Includes higher risk of infections, dehiscence, and recovery time
What is the most common indication for primary c-section?
Failure to progress in labor
Which is more common during c-section - epidurals or spinals?
Spinals
Placental indications for C-section (3):
Placenta previa
Vasa previa
Abruptio placentae
Fetal indications for c-section (lots)
Nonreassuring fetal testing
Bradycardia
Scalp pH < 7.2
Cord prolapse
Fetal malpresentations
Breech, transverse lie
Nonvertex first twin
Maternal indications for c-section (lots):
Genital herpes
Cervical cancer
Untreated HIV
Uterine surgery Hx
full-thickness myomectomy
Prior uterine rupture
Obstruction of birth canal
fibroids
Ovarian tumors
Maternal / Fetal indications for C-section (2):
Cephalopelvic disproportion
Failed induction of labor