Labor And Delivery

Front 1

Preferred anesthesia for laboring patient

Back 1

Epidural > General

Front 2

Disadvantages/risks of general anesthesia

Back 2

concern re: effects on fetus

Incr risk of aspiration (pregnancy relaxes gastroesophageal sphincter)

Front 3

Disadvantages/risks of epidural anesthesia

Back 3

Can interfere with Mom's ability to push

Increased risk of hypotension

Front 4

If mom gets anesthesia she will need to have

Back 4

tocometer and pushing coach

Front 5

Preferred anesthesia for c-section

Back 5

Epidural

Front 6

Indicates uteroplacental insufficiency

Back 6

Late decelerations

Front 7

Uteroplacental insufficiency

Back 7

Baby not getting enough O2, risk of metabolic acidosis

Front 8

Indicates head compression

Back 8

Early decelerations

Front 9

Indicates cord compression

Back 9

Variable decelerations

Front 10

Deceleration considered normal/benign

Back 10

Early

Front 11

Deceleration considered worrisome only if severe

Back 11

Variable

Front 12

Deceleration considered worrisome if repetitive

Back 12

Late

Front 13

Tx for variable compression

Back 13

Correct mom's position (Lateral decubitus), give O2 and stop oxytocin if administered

If d/t oligohydramnios give amnio infusion

Front 14

How to determine severity of variable compression

Back 14

Graded by their duration

Front 15

Correction for fetal bradycardia

Back 15

Determine cause & correct OR start general measures to improve fetal O2

Determine if c-section or intervention req'd

Front 16

Length of Normal Labor

Back 16

UP TO - Prima: 20 hours, Gravida: 14 hours

P 6.5-20, G 4-11

Front 17

Latent phase of labor

Back 17

Start of contractions until 4cm dilation

Front 18

Active phase of labor

Back 18

Up to maximal cervical dilation (10cm)

Front 19

Stage I of Labor

Back 19

Latent and Active phases

Front 20

Stage II of Labor

Back 20

Max dilation up to delivery of baby

Front 21

Stage III of Labor

Back 21

From birth to delivery of placenta

Front 22

What is a protracted active phase

Back 22

EITHER active phase longer than 12 hours

OR cervical dilation slower than expected

Front 23

Expected cervical dilation speed

Back 23

Prima: 1.2cm/hr (5 hours)

Gravida: 1.5cm/hr (4 hours)

Front 24

Risks of protracted active phase

Back 24

Intrauterine infxn, need for c-section

Front 25

Iatrogenic cause of prolonged latent phase

Back 25

Analgesics given to mom

Front 26

What is a prolonged latent phase

Back 26

>20 hour PRIMA, >14 hours MULTI

Front 27

Risks of prolonged latent phase

Back 27

None, although overall no stage of labor should continue indefinitely

Front 28

Causes of prolonged or arrested Stage I Labor?

Back 28

Iatrogenic or 3 Ps

Front 29

3 Ps of Labor

Back 29

Power

Passenger

Pelvis

Front 30

Which of the 3Ps can we modify? What is done?

Back 30

Power - Give pitocin (oxytocin)

Front 31

Tx for arrested active phase

Back 31

C-section

Front 32

Tx for prolonged active phase

Back 32

Try pitocin

If not resolved, consider c-section

Front 33

Tx for prolonged latent phase

Back 33

Iatrogenic - rest and wait

Dilation - Balloon dilation of cervix

Contractions - pitocin

Front 34

Tx if pelvis is too small or passenger is too big

Back 34

C section

Front 35

Causes of arrested Stage II Labor?

Back 35

Pelvis or passenger

Front 36

Tx of Arrested Stage II Labor?

Back 36

Give pitocin, unlikely to resolve

Intervention to remove baby

Front 37

Intervention if baby is at Stage 0 or less?

Back 37

C-section

Front 38

Intervention if baby is at Stage +1 or +2?

Back 38

Vaccuum or forceps

Front 39

Causes of arrested Stage III Labor?

Back 39

Power/tired uterus

Front 40

Risks of arrested Stage III Labor?

Back 40

High risk of converting to post-partum hemorrhage

Front 41

Tx for arrested Stage III Labor?

Back 41

External/internal uterine massage

Pitocin (to allow uterus to keep working)

Manual manipulation

Front 42

Causes of protracted active phase

Back 42

Excess anesthesia, low power/ineffective contractions, fetopelvic disproportion, fetal malposition, ROM before onset of labor

Front 43

Causes of prolonged latent phase

Back 43

Low power/ineffective contractions, fetopelvic disproportion, Excess anesthesia

Front 44

Cardinal movements of delivering fetus

Back 44

Engagement, descent, flexion, internal rotation, extension, external rotation and expulsion

Front 45

Engagement

Back 45

Baby's head contacts the cervix, stimulating dilation

Front 46

Flexion & Internal rotation

Back 46

Baby enters vaginal canal, worming through

Front 47

Extension and external rotation

Back 47

Prior to exit of baby

Front 48

Expulsion

Back 48

Birth complete

Front 49

What's a Bishop score

Back 49

How ready is mom for delivery, and how soon will it occur (also if its time to prepare an emergent c-section in abnormal L&D)

Front 50

Steps to correct fetal bradycardia in utero during labor?

Back 50

Primarily expectant, tx with pacemaker after birth

Front 51

Labor

Back 51

progressive effacement and dilation of uterine cervix resulting from contractions of uterus

Front 52

Dystocia

Back 52

Difficult labor, d/t Shoulder stuck, consider the 3 Ps

Front 53

Friedman's curve

Back 53

The stages and phases of labor

Front 54

Indications for operative OB: vacuum/forceps

Back 54

Fetus descended far enough (+1/+2) but labor stalled

Front 55

Indications for operative OB: c-section

Back 55

Fetus no further than 0, labor stalled

Front 56

Preterm labor is?

Back 56

Baby is NOT ready, but mom is having cervical changes +/- contractions

Front 57

True contractions

Back 57

=< 10 m intervals

=> 30 sec duration

@20-36 weeks gestation

with cervical effacement, dialtion +/- descent of baby into pelvis