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56 Cards in this Set

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How many stages of labor are there?
3
What is the first stage of labor?
First stage: From the onset of contractions causing progressive cervical dilation to complete dilation of the cervix.
What is the second stage of labor?
From complete cervical dilatation to the birth of the fetus.
What is the third stage of labor?
from the birth of the fetus to the delivery of the placenta.
What are the two phases of the first stage of labor?
latent and active
describe the latent phase.
cervical effacement and early dilatation.
Describe the active phase of labor.
slope of cervical dilatation increases; usually begins when the cervix is 3-4 cm dilated and contractions are regular.
How long does the latent phase of labor last?
Primigravidas: up to 20 hours
Multiparas: up to 14 hours.
What is the normal progress of cervical dilatation during the active phase of labor?
primigravidas: at least 1.2 cm/hr
Multiparas: at least 1.5cm/hr
How long should the second stage of labor last?
Primigravidas: 30 mins to 2 hours; with epidural analgesia, approximately 3 hours.
Multiparas: 45 mins(avg)
What are the cardinal movements of labor?
Engagement (usually occurs before the onset of true labor), descent, flexion, internal rotation, extension, external rotation, and expulsion.
How long does the third stage of labor last?
no more than 30 minutes.
What are the stages of placental delivery?
Separation of the placenta from the uterine wall,
expulsion from the vagina.
What are the signs of placental separation?
1) the uterus becomes firm and globular
2) a gush of blood flows from the vagina.
3) The umbilical cord lengthens outside the vulva
4) The uterine fundus rises in the abdomen.
What is the a first degree laceration?
Involves the vaginal mucosa or perineal skin
What is a second degree laceration?
extends into the submucosal tissue of the vagina or perineum with or without involvement of the muscles of the perineal body.
What is a third degree laceration?
involves the anal sphincter.
what is a fourth degree laceration?
involves the rectal mucosa.u
How does 'Secrets' define preterm labor?
Strictly defined as frequent uterine contractions with or without pain in the face of progressive cervical dilatation or effacement, occurring oafter the 20th week up to 37 weeks gestation.
What are the common symptoms of preterm labor? How are they evaluated?
* Regular uterine contractions w/ or w/out pain more frequently than q 15 min, each > 30-40s long, for > 1-hour duration.
* Pelvic pressure
* Dull, constant back pain
* Change in vaginal discharge
* Intermittent abdominal cramping
* spotting or vaginal bleeding
These symptoms may be evaluated w/ external tocodynamometry, which documents the frequency of contractions.
What is the management for preterm labor?
* Elimination of risk factors
* bed rest
* antenatal glucocorticoid tx
* parenteral and oral tocolytics have been used.
* Tocolytics are routinely used at < 34 weeks if there are no contraindications to treatment. Treatment is individualized from 34-37 weeks. Therefore, gestational age must be carefully documented prior to initiating tocolytic therapy.
* in the setting of intact membranes, antibiotics have not had any demonstrated benefit.
How is hypertension during pregnancy defined?
same as in non-pregnant adults
How are hypertensive disorders in pregnancy classified?
1) Chronic HTN
2) gestational htn
3) preeclampsia
4) chronic htn w/ superimposed preeclampsia
Define preeclampsia.
defined as hypertension and proteinuria.
in a pregnant woman without chronic htn, at what levels of HTN and proteinuria is preeclampsia defined?
HTN: as in normal adults (>140 / >90, either/or).
Proteinuria: > 300mg protein in a 24h collection
What is the most common way to determine proteinuria in pregnancy?
since most practictioners don't obtain a 24h urine, the consistent presence of more than trace protein on urine dipstick correlates well with proteinuria of 300mg in 24h.
What is gestational htn?
HTN occurring after 20 weeks w/out accompanying proteinuria.
What is the definition of chronic HTN with superimposed preeclampsia?
in a woman with known chronic htn developing increased blood pressure along with proteinuria.
What are risk factors for preeclampsia?
* nulliparity
* extremes of reproductive age (<15 and >35)
* African-american race
* hx of preeclampsia in a first-degree female relative
* hx of prex in a prior pregnancy
* diabetes
* chronic vascular or renal dz
* chronic htn
* multiple gestations
WHat are the classifications of prex?
mild and severe.
What defines severe prex?
* sys bp >160 or dias bp >110 on 2 occasions at least 6 hours apart
* Proteinuria >= 5mg/24h
* Oliguria < 500cc/24h
* cerebral or visual symptoms
* Epigastric or RUQ pain
* pulmonary edema or cyanosis
* low platelets
* elevated LFTs
* fetal growth restriction
How is pre-x managed?
1) delivery of the fetus "cures" preeclampsia. All signs and sx resolve in time w/ delivery. the difficulty is in deciding whether or not to deliver.
2) if < 32 weeks gest age, administer steroids (48 hour course)
3) if preterm and are not being delivered, they must be admitted for observation and treatment.
What is HELLP syndrome?
* acronym for Hemolysis, Elevated Liver function, and/or Low Platelets.
* Thought to be a subcategory of severe preeclampsia. patients may or may not have other signs of pre-x.
* HELLP often has a rapidly accelerating downhill course. Most clinicians deliver infants quickly regardless of gestational age.
What causes midepigastric pain in HELLP sydnrome?
liver capsule distention produces it, often w/ associated nausea and vomiting. Liver capsule distention can lead to hepatic rupture, w/ poor maternal and fetal outcomes.
What is the puprose of treatment with MgSO4?
purpose is to reduce the likelihood of seizures.
What are the side effects of MgSO4?
many, most significant is respiratory compromise due to respiratory suppression and pulmonary edema.
what are the two types of twin pregnancies?
Dizygotic (aka fraternal): pregnancy results from fertilization of two ov; comprises 2/3 of twin pregnancies
Monozygotic (aka identical): pregnancy results from the fertilizatoinof one ovum and then cleavage; 1/3 of twin pregnancies
What types of placentasa exist in twin pregnancies and how is the type determined?
Dizygotic: always dichorionic-diamniontic
Monozygotic: depends on the timing of embryo cleavage.
1) at fertilization: di-di (30%)
2) at 4-8 days: monochorionic/diamniotic (68%)
3) at 8-13 days: monochorionic/monoamniotic (<2%)
4) at > 13 days: conjoined twins.
How is nausea and vomiting differentiated from hyperemesis gravidarum (HG)?
no universally accepted definition for HG, most consider this dx in the setting of compromised fluid, electrolyte, and nutritional status. Large range of laboratory abnormalities may be seen. HG is much less common than nausea and vomiting.
What are some etiologies of hyperemesis gravidarum?
factors include psychosocial, thryoid disease, and trophoblastic disease.
Is gestational diabetes mellitus symptomatic?
nope.
How is gestational DM detected?
with a modified glucose tolerance test.
How is the modified glucose tolerance test performed?
A 50-gram oral glucose load is given. Blood is then sampled for glucose measurement 1 hour after the glucose load.
When is the modified glucose tolerance test usually performed?
at about 28 weeks gestation.
What is an abnormal blood glucose level result of the modified glucose tolerance test?
>140 mg/dL
Is the modified glucose tolerance test diagnostic of gestational DM?
nope
What is used to dx gestational DM?
standard glucose tolerance test.
How is the standard glucose tolerance test performed?
A 100-g glucose load is given after morning fasting. To ensure accurate test results, the patient must be healthy and eating an appropriate diet. Blood samples are teaken immediately following the glucose load (fasting value) and at 1, 2, and 3 hours after the glucose load.
What are the normal values of the glucose tolerance test?
Fasting < 105mg/dL
1 hour < 190 mg/dL
2 hour < 165 mg/dL
3 hour < 145 mg/dL
What results of a glucose tolerance test are diagnostic for gestational DM?
abnormal fasting value or two abnormal values in either the 1-, 2-, or 3-hour samples.
Risk factors for gestational DM?
* Obesity
* age > 30
* hx of large infant (s)
* hx of unexplained stillbirth
* Ethnicity (American Indians)
Who should be screen for gestational DM?
* women w/ risk factors
* some experts advocate universal screening.
How is gestational DM managed?
* Dietary and/or insulin management to achieve euglycemia.
Indications for forceps assisted delivery?
maternal: Exhaustion: inability to expel the fetal head, medical conditions, Cardiac disease (e.g. Mitral stenosis), pulmonary disease
Fetal: Failure of the head to rotate completely, Control of the fetal head during a vaginal breech delivery, fetal heart rate decelerations w/ complete cervical dilatation and adequate station.
What are the indications for vacuum assisted delivery?
same as those for forceps, except for:
* face or breech delivery
* assisting fetal rotation
* vacuum can also be used in multiparas in whom a small rim of cervix remains and the rim will displace easily over the fetal head.
Indications for operative delivery?
Maternal/fetal: dystocia
Maternal: maternal disease ( eclampsia/severe pre-x, DM, cervical cancer), previous uterine surgery (Previous classic C-section, previous uterine rupture, myomectomy, more than one previous low transverse c-section), Obstruction in birth canal, fibroids, ovarian tumors.
Fetal: Fetal distress, cord prolapse, fetal malpresentation (breech, transverse, brow)
Placental: placenta previa, abruptio placentae