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35 Cards in this Set
- Front
- Back
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you have a 26 yo G1P0 at 39 weeks who gets admitted for labor
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She's having uterine contractions every 7 to 10 minutes
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She was found in her pregnancy course to be non-immune to Rubella
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ok
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She continues to progress normally.
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ok
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What is the next step in mgmt?
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you should just observe and let the labor course proceed naturally
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What is considered the active phase of labor?
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beyond 4 cm dilation
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So i think that latent vs. active phase have less to do with stages of labor
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ok
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What is considered a term pregnancy?
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37 to 42 weeks
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What rate of dilation per hour should you see in a nulliparous patient?
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1.2 cm dilation per hour
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What is clinical pelvimetry?
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digital exam of the pelvis, not very precise
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What is labor?
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it's the onset of contractiosn that is ACCOMPANIED BY CERVICAL DILATION
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What is the latent phase of labor?
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the initial part of labor where the purpose is basically to efface the cervix
continues up to 4cm dilation of the cervix |
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How is the active phase different?
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it gives very rapid dilation of the cervix
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What is it called when the cervical dilation is not as rapid or marked as expected?
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this is called arrest of the active phase
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o First stage- onset of UCTx’s to full cervical dilation
o Second- dilation to fetal delivery o Third stage- fetal delivery to placental delivery o Fourth stage- placental delivery plus 2 hours. |
ok
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How do you tell early vs variable vs late decels?
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early= exactly mirror the UCtxs on the monitor
Late- start at the peak of contraction Variable- just kind of all over the place |
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What is considered an accel?
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anything over 15 bpm
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remember they have to be 15x15 to be accels
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ok
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Normal labor is based upon cervical change vs. time
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normal labor should be expectantly managed
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What do you do if a normal labor is not progressing like you expect?
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you address the 3 Ps
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What are the 3 Ps?
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pelvic disproportion
power passenger |
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So how do you assess power?
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IUPC
you may need to give augmentation with Pit |
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so again, what rate of active phase do you expect?
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at least 1.2 cm dilation per hour
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What time period is required to dx arrest of active phase?
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2 hours where you fall under the 1.2 cm per hour cutoff
so in this case it was normal because she showed 3 cm dilation in 2 hours |
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What is the treatment if you suspect a cephalopelvic disproportion?
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C/S
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What is the minimum value to call it good power?
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have to see 200 montevideo units in ten minutes on the IUPC
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or you can go more clinical with it-
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contractions every 2 to 3 minutes that are firm on palp and lasting more than 40 to 60 seonds
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So how do you calc MVUs?
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you look at the contraction power above bseline in that 10 minute time period
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What does +accels, baseline 110 to 160 tell you about the fetus?
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it's doing well- it's being well oxygenated
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How should you interpret fetal tachycardia?
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could be an indication of infection- maternal fever
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What type of decel can you just observe?
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mild variable decels with abrupt return to baseline
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In these cases, C/S is mostly reserved for pelvic disproportion
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If the powers are adequate but you have an arrest, then you probably have to go do a C/S
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What do persistent late decels most likely indicate?
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fetal hypoxia
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So remember: power is above 200 montevideo units in 10 minutes or firm contractions every 2 to 3 minutes for at least 40 seconds or so
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yep
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A variable decel is like huge and returns to baseline
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immediately generally
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Late decels may or may not be real obvious
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ok
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