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44 Cards in this Set
- Front
- Back
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rate at which the cervix should dilate in labor...
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at least 1.2 cm/hr for nulliparous and 1.5 cm/hr for multiparous
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what is the latent phase of labor...
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initial part where cervix mainly effaces rather than dilates
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normal fetal heart rate...
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110-160bpm
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definition of accelerations...
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fetal HR incr above baseline for at least 15 bpm and last for at least 15 seconds
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protraction of active phase is...
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cervical dilation in active phase is below 1.2cm/h or non-parous or 1.5cm/hr for multiparous
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arrest of active phase is...
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when cervix does not dilate for 2 or more hours
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lower limits of nml for duration of latent phase...
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< or = 18-20h in non-parous or 14 hrs in multiparous
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Lower limits of normal for duration of 2nd phase of labor... (full dilation to delivery)
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< or = 2h for non-parous (3h if epidural) or 1h for multiparous (2h if epidural)
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definition of adequate uterine contrxns w/ respect to frequncy, PE, and duration...
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contrxns q 2-3 min, firm on palp, lasting at least 40-60s
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assessment tools to evaluate power in labor... what are nml values...
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measure contrxn rise above baseline for 10 min. at least 200 MU is adequate
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what defines decelerations due to cord compression...
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variable decelerations that are intermittant with abrupt return to baseline. they can be observed
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what are early decelerations caused by...
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fetal head compression, they are benign
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late decelerations indicate...
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possible fetal hypoxia and acidemia
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which pelvis shape predisposes to OP position delivery... what characterizes this position...
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anthropoid which has an AP diameter > transverse diameter w/ prominent ischial spines and narrow anterior segment
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station refers to...
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relationship of presenting bony part of head to ischial spines
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engagement refers to...
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relationship of widest diameter of presenting part and its location w/ reference to the pelvic inlet
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bloody show... what is it a sign of and how distinguish it from other things...
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dark, vaginal blood mixed with some mucus associated with labor. The sticky mucus helps differentiate as does the timing (previa, abruption, vasa previa are all antepartum)
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for what situations is C-section in abscence of CP disproportion reserved...
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arrest of active phase w/ adequate uterine contrxns
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hcG threshold for US to be able to pick up intrauterine pregnancy...
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1500-2000 mIU/mL
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how can serial hCG levels show if pregnancy is nml intrauterine... what is another option...
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if after 48 hrs the hCG level has risen by 66% or more. also, a single progesterone level of 25ng/mL is indicative of nml (<5 is bad)
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when ectopic prego suspected and there is abnormal hCG rise or progesterone < 5, what is the usually next step to rule out ectopic...
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uterine curretage to look for villi indicating intrauterine pregnancy but probably miscarriage or no villi (ectopic)
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Women who have an asymptomatic 3.5cm or less ectopic pregnancy are ideally txd with…
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IM methotrexate
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What are the options for tx for a nonviable intrauterine pregnancy…
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Managed expectantly, D/C, or vaginal misprostol
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Risk of ectopic prego when hCG elevated and sonogram shows no intrauterine sac… next step…
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85%. Next step is laproscopy (avoid MTX due to chance of nml intrauterine pregnancy)
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Increase the risk of ectopic pregnancy…
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Prior EP, PID, chlamydial infxn
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Placenta accrete…
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Abnormal adherence of placenta to uterine wall due to abnorm of deciduas basalis w/ placental villi attached to myometrium
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Placenta increta…
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Abnormally implanted placenta penetrates into the myometrium
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Placenta percreta…
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Abnormally implanted placenta penetrates entirely thru myometrium into the serosa and sometimes to the bladder
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RFs for placental adherence…
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Low lying &/or anterior placentation or placenta previa, prior c-sxn or uterine curettage, prior myomectomy, fetal Down Syndrome
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Transmigration of the placenta…
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Low-lying placenta or placenta previa diagnosed in 2nd trimester may resolve in 3rd trimester cuz lower segment of uterus grows more rapidly
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Physical exam findings suggestive of gonorrhea infxn going to adenexa… uterus…
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Adenexal tenderness for salpingitis and ab tenderness and heavy menses for uteritis
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Mucopurulent cervicitis…
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Yellow exudative discharge arising frm endocervix w/ 10 or more pmns. Most common organism is chylamidia
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Risk factors for salpingitis…
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Use of IUD, previous infxn with gonorrhea or Chlamydia, surgery or anything that breaks cervical barrier
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Why is Chlamydia not a common cause of pharyngitis…
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Because it lacks the pili that gonorrhea has to attach to columnar epithelium on back of throat
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Bacteria that when vertically transmitted can cause blindness and time of presentation…
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Gonorrhea between 2-5th day; Chlamydia between 5-14thday
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Findings that are consistent with completed abortion…
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Passage of tissue, resolution of cramping ab pain and bleeding, and closed cervical os
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How might one assure all the trophoblastic tissue of a spontaneous abortion was removed/expelled…
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Follow hCG levels, they should half q 48-72hrs
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Threatened abortion…
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Pregnancy <20 wks associated w/ vaginal bleeding w/o cervical dilation
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Inevitable abortion…
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Pregnancy <20 wks assoc with cramping, bleeding, cervical dilation but no passage of tissue
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Missed abortion…
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Pregnancy <20 wks w/ embryonic or fetal demise but no symptoms of bleeding or cramping
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How differentiate between incompetent cervix or inevitable abortion… how is each treated…
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Uterine contrxns in inevitable abortion cause cervical os to open and there is pain from the contrxns. Tx inevitable abortion w/ D/C. In incompetent cervix there is painless dilation of the os. Tx it with cerclage
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Clinical presentation of molar pregnancy… tx of molar pregnancy
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Vaginal spotting, absence of fetal heart tones, size greater then dates, markedly elevated hCG levels. Diagnosis is made by US and tx is suction curettage
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RFs for incompetent cervix…
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Cervical conization, congenital manifestations (short cervix or collagen disorder), trauma to cervix, prolonged 2nd stage of labor, uterine overdistension
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What are the 2 most common causes of antepartum bleeding…
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Placenta previa or placental abruption (severe ab pain, assess w/ speculum)
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