Labor And Delivery

Front 1

What are the fetal presentations?

Back 1

vertex: head down
breech: buttocks down
transverse: neither down

Front 2

Name the ways in which labor is induced?

Back 2

prostaglandins
oxytocic
mechanical dilation of the cervix
articical rupture of membranes

Front 3

Early deceleration

Back 3

-began and end at the same time as contractions

-are the result of increased vagal tone secondary to head compression during contractions

Front 4

Variable deceleration

Back 4

can occur at any time

they are the result of umbilical cord compression

Rx: with amnioinfusion

Front 5

Late decelerations

Back 5

begin at the peak of contraction and slowly return to baseline after contraction has finished

-care caused by uteroplacental insufficiency and are

Front 6

Fetal scalp scalp electrode

Back 6

that sense the pot difference created by the depolarization of the fetal heart

Front 7

Fetal scalp pH

Back 7

directly asses fetal hypoxia and acidemia

-fetal blood by making a nick in the scalp

Front 8

What are the dates of the different trimesters

Back 8

1st: up to 12 weeks
2nd: 12-28 wks
3rd: 28- delivery

Front 9

What is considered preterm

Back 9

24- 37 wks

Front 10

What is Nageles rule for calculating the estimated date of confinement?

What is used if the LMP is uncertain

Back 10

(-)3 months from the LMP and add 7 days
- can us US but the further in trimester the less reliable it is
- US should be within one week of the LMP in 1st trimester, 2 weeks for 2nd, 3 weeks for 3rd

Front 11

What are the CV and pulmonary changes in preg

Back 11

CV: cardiac output increase by 30%, decrease systemic vascular resistance

pulmonary: 30-40% increase in tidal volume causing increase in minute ventilation
increase in vital capacity

Front 12

Gastro

Back 12

Gastro: nausea caused by elevated estrogen and progesterone
Reflux esophagitis
cholestasis
hepatic liver functions increase

Front 13

What is hyperemesis gravidarum?

Back 13

sever form of morning sickness in which women lose greater than 5% of their preppregnancy wt and go into ketosis

Front 14

What are some first trimester labs

Back 14

CBC
VDRL/RpR
Rubell
Hep B
Gonorrhea
Chlamydia
UA
HIV
Be

Front 15

What urinary problems are pregnant women at increase risk for

Back 15

UTI and phyelonephritis due to urinary stasis

Front 16

What is done during the visit in the second trimester

Back 16

Labs:
Triple screen: alpha fetal protiens, , BhCG, estriol

Screening ultrasound:look for common abnormalities, amniotic fluid volume, placental location, gestational age

Amniocetesis- to determine if they want to keep the preg

Front 17

What are the third trimester labs

Back 17

CBC
RPR
CLT
Group B strep

Front 18

When is RhoGAM given?

Back 18

28 weeks if mother is nonsensitized and then again most postpartum

-given during any procedure where maternal blood can mix with fetus

-

Front 19

What are braxton hicks contractions?

Back 19

irregular contractions that do not lead to cervical changes

occur several times an hour

Front 20

What should a person that has vaginal bleeding and abd pain be evaluated for?

Back 20

Ectopic pregnancyW

Front 21

What are risk factor for ectopic pregnacy?

Back 21

History of STD
prior ectopic preg
Previous tubal surgery
edometriosis

Front 22

What lab value can help you tell the difference between an ectopic preg and IUP?

Back 22

B-hcg
b/c it doubles every 48hrs in a normal preg. If it does not most likely an ectopic

-

Front 23

What beta hcg levels can you see a fetus transvaginaly?

fetal heart beat?

Back 23

- 1,500

- 5,000

Front 24

What pt are able to have methotrexate

Back 24

for 4 cm or less ectopics
uncomplicated
without a fetal heart beat
reliable for follow up

Front 25

What is a complete abortion?


What is incomplete abortion?

Back 25

- complete expulsion of all products of conception (POC) before 20 weeks gest

- partical expulsion of but not all POC before 20 weeks of gest

Front 26

What is an inevitable abortion?

Back 26

no expulsion o POC but vaginal bleeding and dilation of the cervix that a viable preg is unlikely

Front 27

What is a threatened abortion?

What is a missed abortion?

Back 27

- any vaginal bleeding before 20 weeks without dilation of the cervix or expulsion of any POC


-death of the embryo or fetus before 20 week with complete retention of al POC

Front 28

What is the differ for 1st trimester bleeding?

Back 28

Spontaneous abortion
postcoital bleeding
Ectopic preg
Vaginal or cervical lacerations
extrusion of molar preg
nonpreg caus of bleeding

Front 29

What are some cause of 2nd trimester bleeding?

Back 29

infection
cervical defects
exposure to fetotoxins
trama

Front 30

What is an incompetent cervix?

Back 30

presents with painless dilation and effacement of the cervix

-infection, vaginal discharge and rupture of membranes are common findings

Front 31

When is an amniocentesis done and what does it do?

Back 31

- offered at beyond 15 weeks gest
Indications:
Fetal anomaly on US
Abnormal msAFP
family hx of cong abnormalitis
pt > 35 year of age
Assessment of lung maturity

-good to obtain a fetal karyotype

-rate of fetal loss is <.5%

Front 32

What is chorionic villus sampling?

Back 32

- given 9-12 weeks
- involves placing a catheter into the intrauterine cavity to get fluid from the chorionic villi

Allow for chromosomal status, fetal karyotyping, DNA test
- increase risk .5%

Front 33

What is PUBS?

Back 33

fetal blood sampling

- preformed by placing a needle transabdominall into the uterus and phlebotomizing the umbilical cord

Front 34

What is the best time to screen for GDM?

Back 34

between the 24th and 28th week of gestation

Front 35

What is the initial test done to screen for DM?

Back 35

50g glucose load and measure the plasma glucose 1 hr if:
> 130 thatn you do a GGT

Front 36

What is a GGT?

Back 36

100g glucose load, 3 hr oral glucose tolerance test
- gucose is measured at 1, 2, 3 hrs after load

Front 37

What are the 5 aspects of labor?

Back 37

Dilation-how open cervix @ os (1-10)
effacement
fetal station-fetal head @ ishchial spines
cervical position
consistency of cervix

-All make up teh Bishop Score, score > 8 consistent with favorable labor

Front 38

What are the different ways to determine fetal position?

Back 38

leopolds meneuvers
cervical examination
U/S

Front 39

What are the ways in which labor is induced?

Back 39

prostaglandins
Oxyytocic agents
mechanical dilation (foley bulb)
artifical rupture of memebranes (amniotomy)

Front 40

What are some common reasons for induction?

Back 40

posterm preg
preeclampsia
PROM
nonreassuring fetal testing
intrauterine growth restrictions

Front 41

What are some things that can help with unsuccessful induction

Back 41

prostaglandin E2 gle
PGE2 pessary (cervidil)
PGE1M misoprostol

-all help to ripen the cervix

Front 42

What is considered augmentation of labor

Back 42

helping a pt that is already in labor

-pitocin and amniotomy

Front 43

What are the normal fetal HR and when does it get to be concerning?

Back 43

Normal range: 110-160

Tachy: > 160 fetal distress

Brad> 90 for greater than 2 min

Front 44

What is considered fetal heart rate variablility

Back 44

Absent: < 3 beats per min
minimal 3-5 beats per min
moderate 5-25 beat per min
marked 25 beats per min

Front 45

What are the cardinal movements?

Back 45

Engagement
Decent
internal rotation
extend
external rotation

Front 46

What are the stages of labor?

Back 46

Stage 1: begins at the onset of labor and last 10cm dilated

Stage 2: full dilation --> delivery

Stage 3: delivery --> placenta delivery

Front 47

How long should the stage 1 labor last?

Back 47

6-20 hrs in nulliparous pt
2-12 hrs in a multiparous
Latent phase: onset of labor until 4 cm
active phase
1.2 cm/hr for nulliparous
1.5 cm/hr for multip

Front 48

Some thing to note

Back 48

if there is no change in cervical dilation or station for 2 hrs during active phase of labor deemed active phase arrest
-need cesarean delivery

Front 49

What is an Episiotomy?

Back 49

-incision in the perineum to facilitate delivery

Front 50

How long should stage 2 labor take?

Back 50

Nullip with epidurals: 3hrs
Nullp w/o epidurals: 2hrs

Mult with epi: 2hrs
Muli w/o epi; 1 hr

Arrest of descent if the fetal head descends <1cm/hr null, <2cm/hr mult

Front 51

What are tocolysis?

Back 51

used before < 34 wks

is an attempt to prevent contractions and the progression of labor
- only help in prolonging gestation of 48 hrs so that steroids can be given

Front 52

At what age is it good to start betamethasone t?

Back 52

24- 34 weeks in those in preterm labor

-to check for fetal maturity an amiocentesis can be preformed

Front 53

T or F
In the case of preterm contractions without cervical change hydration can often decrease the # and strength of contractions

Back 53

TRUE!!!

Front 54

What are the different types of tocolytics?
and when are they used?

Back 54

Are used in <34 wks gestation

Beta mimetics
Magnesium sulfate
calcium channel blockers
Prostaglandin inhibitors
Oxytocin antagonist

Front 55

Beta-mimetics

Back 55

-help in halting preterm contractions
-increase the level of CAMP

-Ritodrine and terbutaline

Front 56

Magnesium sulfate

Back 56

decrease uterine contractions by acting as a calcium antagonist

Side effects: depressed reflexes, pulmonary edema, fatiuge
Tx: calcium gluconate

Front 57

Calcium channel blockers

Back 57

decrease the influx of calcium into the smooth muscle by diminishing uterine contractions
- Nifedipine

Front 58

Prostaglandin inhibitors

Oxytocin antagonist

Back 58

1. decrease the intracellular Ca mostly indomethacin

2. atosiban

Front 59

PROM vs PPROM

Back 59

PPROM is rupture of memebranes before 37wks

-most would prolong pregnancy in < 32-36 wks

-Tx is with ampicillin w or wo erthromycin

Front 60

What are the options for breech delivery

Back 60

1. external cephalic version of the breech
2. trail of breech delivery: flexed pelvis, EFW 2,000-3800, frank or complete breech
3. elective cesarean delivery

Front 61

Fetal bradycardia

Back 61

Prolonged deceleration: fetal heart rate is below 100 to 110 for longer than 2 min

-longer than 10 min is bradycardia

Front 62

Shoulder Dystocia

Back 62

impaction of the ant. shoulder behind the pubic symphysis

-risk macrosomia, GDM, maternal obesity, postterm preg,

- complications: fracture of humurs, clavical, brachial plexus nerve injury, phrenic nerve palsy, hypoxic brain injury
- look on pg 75 for maneuvers

Front 63

Uterine Rupture

Back 63

- risk: more than one c/s, treated with uterotonic agents fibroids, uterine malformation, obstructed labor

Front 64

What are the signs of preeclampsia

Back 64

triad: edema, hypertension, proteinuria
-classical presentation: nulliparous in her 3rd trimester

Front 65

What is gestational hypertension?

Back 65

BP: > 140/90 after the 20th week of gestation

-Pt was normotensive prior to preg and return 10 days after delivery

Front 66

What is mild pre-eclampsia

Back 66

BP: > 140/90, edema of face and hands, protenuria (>300/hr or 1 or 2 + on dipstick)

Front 67

What is sever preeclampsia?

Back 67

-BP: > 160/110, protenuria > 5g/hr or 3 0r 4+ on dipstick)
- end organ damage:
headache
visual changes
RUQ pain
impaired liver functions
Oliguria (<400 ml)
pulmonary edeam
thrombocytopenia

Front 68

What is HELLP syndrome

Back 68

H: Hemolysis (increase LDH, total bilirubin, schistocytes)
EL: elevated liver enzymes
LP: low platelets

Ass. with:
High mortality
multiparous mothers
Mothers older than 25
Less than 37 weeks gestation
-deteriorating liver functions and thrombocytopenia

Front 69

What is the treatment for mild, sever pre ecplamsia and HELLP syndrome

Back 69

- delivery is the ultimate tx

- Mild: start mag for 12 to 24 hrs after delivery
- severe: mag, hydralazine or labetalol or labetalol

-if gest is 24 to 32 do expectant management
- 30% recurrence rate

Front 70

T or F

You can take aspirin as a prophylaxis to prevent pre eclampsia with a second preg

Back 70

True

Front 71

Placenta previa

Back 71

abnormal implantation of the placenta over the internal cervical os

Front 72

Placenta accreta

increta
percreta

Back 72

accreta: abnormal invasion of the placenta into the uterine wall

Increta: placenta invades the myometrium

Percreta placenta invades through the myometrium into the serosa

Front 73

How do you treat UTI?

Back 73

amoxicillin
nitrofurantoin
Bactrim
cephalexin

Front 74

What is the treatment for pyelonephritis?

Back 74

hydratioin
Antibiotics
-cephalosporins
-ampicillin and gentamicin

-tx until afebrile for 24-48 hrs

Front 75

When is GBS tested and how is it treated?

Back 75

Given around 35-37 wks
- can cause UTI, chorio, endomyometritis

-tx: IV penicillin or ampicillin

Front 76

what are some ss of chorioam

Back 76

materinal fever, elevated wbc count, uterine tenderness and fetal tachycardia

- the gold standard is culture of amniotic fluid via amniocentesis

- tx: cephalosporin or ampicillin and gentamicin

Front 77

What is considered to be LGA

Back 77

- greater than 4,500
- higer risk of shoulder dystocia, hypoglycemia, polycythmia

Front 78

What is the cause of macrosomic infants?

Back 78

gestational DM, maternal obesity, , posterm pregnancy, multiparity adn advanced materanl age

-if 3cm greater than fundus size date need an ultrasound

Front 79

Tell me about amniotic fluid measurements?

Back 79

- max volume 800ml @ 28 weeks gest then falls to 500ml @ 40 wks

AFI < 5 is oligo
AFI > 20 or 25 poly

Front 80

Oligohydramnios

Back 80

amniotic fluid is produced by the fetal kidneys and lungs

Ass with an AFI: < 5

-ass with congenital GU anomalies, potters sydnrome, rupture of membranes

Front 81

Polyhdramnios

Cause
What is the AFI
dx

Back 81

most common in preg: diabets, hydrops, multiple gestations, neural tube defect
AFI: > 20
- is dignosised by ultrasound

Front 82

RH incompatibility

Back 82

IgG antibodies cross the placenta and cause hemolysis of fetal RBC

-cause Erythroblastosis fetalis a syndrome that cause HF, ascites anemai

-can tx with Rho-GAM

Front 83

What is considered Posttterm pregnancy

Back 83

-last longer than 42 wks
- increase risk o macrosomic infants, meconium, IUFD, dysmaturity

tx: is to induce

Front 84

What are is placental abruption and what are some risk factors

Back 84

Premature separation of placenta from uterine wall before the delivery of baby

Risk:
Trauma
Preeclampsia (maternal HTN)
smoking
cocaine abuse
previous hx of abruption

Front 85

What are some clinical presentation of placental abruption

Back 85

vaginal bleeding
constant and sever back pain
irritable, tender, and hypertonic uterus
Evidence of fetal distress

Dx: with ultrasound
Tx: expectant management, or perform C section

Front 86

What is the clinical presentation placenta previa

Back 86

painless profuse bleeding in T3
Postcoital bleeding
Spotting during T1 and T2
cramping

Front 87

What is Vasa Previa

how does it present?

Back 87

fetal cord vessels unprotectedly pass over the internal os, making them susceptible to rupture and bleeding

Present: rapid bleeding, fetal distress

Front 88

What is velamentous cord insertion

Back 88

insertion of the umbilical cord into the fetal membrane.

Front 89

What are some caused of third trimester bleeding?

Back 89

Placental abruption (most common)
Placenta previa (most common)
Vasa previa
Uterine rupture
circumvillate placenta
blood show
cervicitis
polpys
neoplasm

Front 90

What is the difference between the:
Apt test
Kleihauer Bettke test
Wright stain

Back 90

Apt test: blood from the vagina turns brown if maternal and pink if fetal

KB:blood from air to determine % of fetal RBC im maternal ciruclation

Wright: vaginal blood, nucleated if fetal

Front 91

How do you mange and dx, tx placenta previa?

Back 91

Dx: with transabdominal ultrasound

mang: cesearean section

Front 92

What is associated with placenta privia

Back 92

placental accreta superfical invasion of the placenta into the uterine myometrium

Front 93

How does endometritis present?

Back 93

mostly 2-3 days after c/s
with fever, elevated white blood count
uterine tenderness

-Tx:give IV

Front 94

What are the risk factors for endometritis

Back 94

meconium
chorioamnionitis
prolonged rupture of membrane

Front 95

What are some causes of postpartum infections

Back 95

prolonged rupture of memebranes
C section
colonization of lower genital tract
premature labor
vaginal exams
foreign body
diabetes

Front 96

What is the difference in Di-Di, Mo-Di, Mo-Mo-

Back 96

Di-Di: two chorions, two amnions

Mo-Di: single placenta, one chorion, two amnions

Mo-Mo: one placenta, one chorion, one aminon

Front 97

What values are elevated with multiple births?

Back 97

b-hCG
HPL
MSAFP

Front 98

What disease and what type of twins are at risk for a certain disease/problem?

Back 98

Mo-Di twins

Twin to twin transfusion

Front 99

What is twin to twin transfusion?

Back 99

Baby A: small anemic, oligohydram, growth restrictions, hypovolemia

Baby B: large, plethoric, polycythemic, cardiomegaly, ascities, hypervolemia, edema

due to unequal flow withing vascualr

Man: serial ultrasounds with AFI
and amioreduction

Front 100

what are they manifestations of Toxo?

Back 100

Fetus: symmetrical IUGR, microcephaly, intracranial calcification

Neonate: chorioretinitis, seizures, throbocytopenia

Front 101

What is the tx for Toxo?

Back 101

Pyrimethamine and sulfadiazine

-Spiramycin is to prevent vertical transmission