Ob/gyn Labor And Delivery

Front 1

Leopold Maneuver

Back 1

Determine the position, presentation, and engagement of the fetus in a woman's uterus

Front 2

Fetal Lie

Back 2

Whether the infant is longitudinal or transverse. Can be determined with Leopold maneuvers.

Front 3

PROM

Back 3

Premature rupture of membranes at least 1 hour before onset of labor.

*Don't confuse this with PPROM, which is preterm premature rupture of the membranes, which occurs before 37 weeks

Front 4

Nitrazine test

Back 4

Dx of PROM: nitrazine paper turns blue. Vaginal secretions are usually acidic, but amniotic fluid is alkaline.

Front 5

Fern test

Back 5

Dx of PROM: Estrogens in amniotic fluid cause crystallization of salts in the amniotic fluid, leading to the appearance of "fern blades" under microscope

Front 6

Pool test

Back 6

Dx of PROM: collection of fluid in the vagina

Front 7

5 components of a cervical examination

Back 7

Dilation
Effacement
Fetal Station
Cervical position
Cervical consistency

Front 8

Bishop Score

Back 8

Grades Dilation, Effacement, Station, Cervical position, and Cervical consistency

Dilation: 0-10 cm
Effacement: 0-100%
Station: -3 to +3
Cervical Consistency: Firm - Soft
Cervical Position: Posterior - Anterior

-Each are graded from 0 to 2
- Greater than 8 = cervix favorable for spantaneous labor
- Less than 6 = cervix not favorable for spontaneous labor

Front 9

Fetal Station

Back 9

Relationship of fetal head to ischial spine. Negative when above, Positive when below

Front 10

3 types of fetal presentations

Back 10

vertex: head down (cephalic)
breech: buttocks down
transverse: neither down

Front 11

Fetal position vs. Cervical position

Back 11

Fetal position: Relation of fetal occiput to maternal pelvis
(OA= normal, OP/OT= abnormal)

Cervical Position: Posterior/mid/anterior

Front 12

How do you determine the fetal position?

Back 12

Palpation of the sutures and fontanelles.

Front 13

What distinguishes the anterior and posterior fontanelles?

Back 13

Anterior fontanelle is larger and diamond shaped (2 frontal + 2 parietal bones)

Posterior fontanelle is smaller and triangle shaped (2 parietal + ONE occipital)

Front 14

Cervidil

Back 14

PGE2 pessary, used to ripen the cervix (dilate the cervix to increase chances of successful vaginal delivery)

Front 15

Amniotomy

Back 15

puncture of the amniotic sac around the fetus to release amniotic fluid as a way to induce labor

Front 16

Pitocin

Back 16

Used to augment labor and contractions

Front 17

Intrauterine Pressure Catheter (IUPC)

Back 17

Determines absolute change in pressure during a contraction --> estimates strength of contraction.

Front 18

Fetal Heart Rate (FHR) Baseline, normal range

Back 18

110-160 bpm

Front 19

FHR variability: definition, ratings

Back 19

FHR variability is the moment-to-moment change from baseline

Absent: 0-3
minimal: 3-5
moderate: 5-25
marked: >25

Front 20

Early deceleration (when does it occur? What is it indicative of?)

Back 20

occurs at same time as contraction, due to *head compression*

Front 21

Variable deceleration (When does it occur? What is it indicative of?)

Back 21

occurs at any time (relative to contractions), due to *umbilical cord compression*

Front 22

Late decelerations (When does it occur What is it indicative of?)

Back 22

occurs at peak of contraction, slowly returns to baseline after contraction has finished. Due to *uteroplacental insufficiency*

Front 23

What are two causes of reduced FHR variability?

Back 23

1) Reduced fetal CNS function
2) Fetal sleep

Front 24

More sensitive information about fetal heart: doppler or fetal scalp electrode?

Back 24

fetal scalp electrode. no risk of coming loose.

*think about the electrode you saw on the scalp for the vaginal delivery!*

Front 25

absolute values of contractions: external tocometer or intrauterine pressure catheter?

Back 25

Intrauterine pressure catheter

Front 26

Montevideo unit

Back 26

unit of uterine contractions

montevideo unit = [average of the variation of the intrauterine pressure from the baseline] * [contraction #/10 minutes]

Front 27

Name, in order, the 6 cardinal movements of labor

Back 27

1) engagement: presenting part enters pelvis
2) descent: presenting part dives into pelvis
3) flexion
4) internal rotation (OT --> OA)
5) extension
6) external rotation (this occurs after the head delivers)

Front 28

Labor: Stage 1

-definition
-time

Back 28

definition: From onset of labor to complete dilation of cervix. Split into *latent phase* and *active phase*

time: 10-12 hours nulliparous, 6-8 multiparous

Front 29

latent phase

-definition
-characterization of cervical change

Back 29

labor stage 1, from onset of labor until 3-4 cm cervical dilation. characterized by slow cervical change.

Front 30

active phase

-definition
-characterization of cervical change
-rate of change in nulliparous vs. multiparous woman

Back 30

labor stage 2, from 3-4 cm to >9 cm cervical dilation. characterized by increasingly rapid cervical change

-1.0 cm/hr nulliparous
-1.2 cm/hr multiparous

Front 31

3 factors affecting transit time during active phase of labor

Back 31

-Power
-Passenger
-Pelvis

Front 32

Cephalopelvic disproportion

Back 32

if the "passenger" is too large for the pelvis

Front 33

Labor: Stage 2

-definition
-time

Back 33

definition: stage 2 occurs from when the cervix has completely dilated to when the infant has been delivered.

time (maximum):
-multiparous: rare to last longer than 30 minutes
-nulliparous: 2 hours w/out epidural, 3 hours w/ epidural

Front 34

A patient who is laboring shows repetitive late decels, bradycardia, and loss of variability. What can the obstetrician do to help reverse these nonreassuring fetal signs?

Back 34

1) put patient on 02
2) turn patient on side to decrease IVC compression
3) stop giving pitocin

Front 35

tachysystole

Back 35

greater than 5 contractions in a 10 minute period

Front 36

uterine hypertonus

Back 36

one contraction lasting 2+ minutes

Front 37

A1DM

Back 37

Diet alone controlled blood glucose during pregnancy

Front 38

A2DM

Back 38

Diet + Insulin controlled blood glucose during pregnancy

Front 39

Labor: Stage 3

-definition
-tim

Back 39

definition: begins once the infant has been delivered. Completed with delivery of the placenta

time: 10-30 minutes

Front 40

3 signs that should be noted before delivering the placenta?

Back 40

1) cord lengthening
2) gush of blood
3) uterine fundal rebound

Front 41

1st degree laceration

Back 41

mucosa/skin

Front 42

2nd degree laceration

Back 42

muscosa/skin tear that extends into perineal body

Front 43

3rd degree laceration

Back 43

tear extending into or through the anal sphincter

Front 44

4th degree laceration

Back 44

tear that occurs through the anal mucosa

Front 45

Primary indication for a cesarean section

Back 45

failure to progress in labor (the 3 P's)

Front 46

VBAC/TOLAC

Back 46

Trial of labor after ceserean --> vaginal birth after cesarean

Front 47

spinal anesthesia vs. epidural

Back 47

spinal anesthesia: region is similar to epidural, but given in one -time dose direclty into spinal canal. *more rapid onset of anesthesia.* Not as long lasting

epidural: region is similar to spinal. longer lasting.

Front 48

forms of operative vaginal delivery

Back 48

forceps delivery, vacuum extraction

Front 49

most common form of anesthesia for vaginal delivery? c section?

Back 49

vaginal: epidural
spinal: c section