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34 Cards in this Set
- Front
- Back
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What is the station of normal delivery? |
○ location of the presenting part relative to the ischial spines ○ spines = 0; if above → 1 cm, 2 cm; if its below → +1cm, +2cm |
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What is the first stage of labor? |
1st stage ○ **Usually preceded by bloody show ○ Defined as period of regular contractions to full cervical dilation ○ Lasts 6-20 hours for nulliparous; 2-14 hours for multiparous (multips) |
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What is the second stage of labor? |
2nd stage ○ From full dilation to delivery of infant ○ Lasts 30 min 3 hours for nulliparous; 5-60 mins for multips |
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What is the third stage of labor? |
● 3rd stage ○ From delivery of infant to delivery of placenta ○ Lasts 0-30 mins |
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What is the fourth stage of labor? |
● 4th stage: hour after delivery ○ Treat lacerations, tears, hemorrhage |
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What is the significance of late decelerations? |
● **Late decels = BAD → sign of uteroplacental insufficiency ● If concerned about fetal heart rate (FHR) → change mom’s position, give oxygen, stop oxytocin |
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What is the provider's role in the 3rd stage of delivery? |
● After head out → may suction nose/mouth ● Once body is out → clamp and cut cord ● Keep the infant warm ● Episiotomy may be used to “protect” perineum (see below) ● Wait for the placenta (will usually separate on its own) ○ Signs of separation: cord lengthens, fresh blood flow, uterus becomes firm/globular, fundus rises ● Examine placenta and cord (normal = 3 vessels: 2 arteries, 1 vein) ● **Retained placenta = source of infection |
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How to measure apgar? |
● Assess Apgar scores at 1 and 5 minutes ● Criteria (5): color, heart rate, respiration, reflex response, muscle tone ● Scale 0-2 for each criteria ○ 0 = absent; 2 = normal (1= “in between”) |
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What is dystocia? What are causes? Treatment? |
● General: defined as “abnormal labor” ○ i.e. cervix not dilating, fetus not descending ● “Real” dystocia: full dilation and can’t deliver ● Can be anatomical: mom (i.e. pelvic anatomy too small), baby, contractions ● Treatment: plan for Csection (if predicted prior to delivery), Oxytocin (enhance contractions), Forceps/vacuum (if pushing is inadequate or fetal distress) |
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How to treat nuchal cord? |
○ If loose → gently reduce manually ○ If tight → clamp and cut cord, but will need to proceed rapidly with delivery |
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How to manage cord prolapse? |
● Tx: immediate Csection ● Kneechest position or Trendelenburg to may help keep pressure off cord |
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How to manage shoulder dystocia? |
○ Help! (OB, neonatology, anesthesia) ○ Episiotomy cut perineum to make more room (possible episioproctotomy) ○ Legs Flexed (McRoberts’ maneuver) ○ Pressure suprapubic pressure, shoulder pressure ○ Enter vagina Rubin’s maneuver (rotate shoulder) or Wood’s maneuver ○ Remove posterior arm splint, sweep, grasp, and pull to extension ● **Last possible maneuver break infant’s clavicle |
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What is a breech presentation? What are complications? How to manage? |
● Breech presentations: feet first (different forms, i.e. “Frank”) ● Call for help: OB and NICU ● Increased risk for prolapsed cord or rupture of membrane ● Maneuvers to make “more room” for delivery ○ Episiotomy, knee flexion and sweeping out of legs ○ Episiotomy midline incision or mediolateral incision |
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Define post partum. What happens physiologically? |
● Definition: the first 6 weeks after delivery ● Physiology: uterus shrinks in 2 days, descends back in pelvis in 2 weeks, and is back to normal by 6 weeks ● Lochia: sloughing of decidual tissue; normal (similar to period) ● First OB visit at 6 weeks ● Tx: vitamins (if breastfeeding), contraception |
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Define post partum hemorrhage. What are causes? |
● Definition: Blood loss requiring transfusion or 10% drop in hematocrit ○ 500 milliliters after vaginal birth; 1 liter after Caesarean section (Csection) ● Causes: uterine atony, uterine rupture, retained products of conception (POC), lacerations, coagulopathy, uterine inversion |
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Early vs late post partum hemorrhage causes |
○ Early: < 24 hours after delivery; lacerations, retained POC, abnormal involution ○ Late: > 24 hours after delivery; retained products |
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How to manage uterine atony? |
○ General: most common cause in first 24 hours ○ Tx: uterine massage, oxytocin, IV fluids/transfusion |
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What is placental apruption? When is it most commone? |
Premature separation of the placenta ● Most common cause of third trimester bleeding |
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What are risk factors for placental abruption? |
sympathomimetic use (cocaine, meth), trauma, smoking, hypertension, heavy alcohol use, previous abruption, advanced maternal age, high parity |
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What are symptoms of placental abruption? How to diagnose? What are complicatons? How to treat? |
● Complications: DIC, fetal demise ● Apparent vs Concealed ○ Apparent: seen on ultrasound, presents with vaginal bleeding ○ Concealed: not seen on ultrasound, no vaginal bleeding ● Sx: painful vaginal bleeding (typical, but not all cases), back pain, abdominal pain ● Diagnosis: fetal stress testing; ultrasound not sensitive enough ● Tx: Csection preferred |
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How does placenta previa present? Wha are risk factors? How to diagnose? When it is common? How to treat? |
● Placenta partially or completely covering cervical os ● NO pelvic exam ● Risk factors: advanced maternal age, smoking, high parity, scarring ● Sx: painless vaginal bleeding ● Diagnosis: ultrasound ● Can be seen <20 weeks gestation, but 50% will resolve and move up uterine wall ● Tx: expectant management, Csection preferred delivery method |
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What is is PROM and PPROM? |
● Rupture of amniotic membranes before onset of labor at > 37 weeks ● Preterm PROM (PPROM): PROM at < 37 weeks ● Occurs in 30% of preterm deliveries ● Sx: gush of fluid followed by leak ● Complications: infection (chorioamnionitis, endometritis), cord prolapse |
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How to diagnose PROM? How to treat? |
● Diagnosis: confirm rupture of membranes with visualization, nitrazine paper (pH > 7), fern test ● Physical exam: avoid digital examination; use sterile speculum ● Treatment ○ PROM: hospitalize, fetal monitoring, induce, hasten deliver ○ <27 weeks: if no infection or distress → expectant management ○ < 34 weeks: corticosteroids to hasten lung maturity |
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What tocolytics should be given in preterm lanbor? |
Magnesium sulfate (46 grams, then infusion) and Terbutaline |
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What are contradinciations to tocolysis? |
○ Absolute contraindications to tocolysis: acute vaginal bleeding, fetal distress, lethal fetal anomaly, chorioamnionitis, preeclampsia or eclampsia, sepsis, DIC ○ Relative contraindications: chronic hypertension, cardiopulmonary disease, placenta previa, cervical dilation > 5cm, placenta abruption |
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DD of hypertension in pregnancy? |
● Chronic hypertension ○ If <20 weeks ○ Treat with methyldopa or labetalol ○ Follow with BP checks, US, urine protein
● Pregnancyinduced hypertension ○ If >20 weeks but no other symptoms (ie edema, proteinuria) ○ Treat same as chronic htn in pregnancy ○ Also needs to be followed as above
● Preeclampsia/eclampsia ○ If >20 weeks +symptoms |
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What are risk factors for preeclampsia/eclampsia? |
○ 1st preg, age extremes (<20 or >35), multiple gestation, HTN, DM |
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What is the classic triad of preeclampsia? |
HTN, proteinuria, edema* (not needed for dx) |
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Definition of mild preeclampsia |
● BP: 140160/90110 ● Proteinuria: >300mg/24h but <5g/24h ● May have hyperreflexia |
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Definition of severe preeclampsia |
● BP: 160180 systolic or >110 diastolic on 2 occasions at least 6h apart + on bed rest ● Proteinuria: 5g/24h or cath urine dip with 4+ protein ● Creatinine and liver enzymes elevated |
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What are complications of severe preeclampsia? |
progression of disease to eclampsia, DIC, ICH, pulmonary edema, abruptio placentae, renal failure, fetal hypoxia, low birth weight, preterm L&D |
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How to treat severe preeclampsia? |
○ Delivery! ○ Hydralazine/labetalol to closely regulate BP ○ Corticosteroids if <36w to promote fetal lung maturity ○ Magnesium sulfate IV inpt to prevent/treat seizures ○ Severe disease – delivery fast! |
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What is HELLP syndrome? How to diagnose and treat? |
● Preeclampsia variant – can occur with severe dz ● Can present with epigastric/RUQ pain ● Dx: Hemolysis, Elevated Liver enzymes, Low Platelets (<100K) ○ schistocytes on smear (fragmented RBCs) ● Tx: bedrest, delivery, control BP, corticosteroids if <36 weeks |
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How does Rh incompatbility work? |
● Rhesus factor most common blood incompatibility (98%) ● 15% of the population is Rh negative ● Rh () mom and Rh (+) baby mom can make antibodies to baby’s blood resulting in hemolysis ● Tx: Rh immunoglobulin (RhoGam) ○ Given at 2829 weeks to Rh () moms AND with any chance that fetal blood entered mom’s circulation (i.e. vaginal bleeding) ○ Also given again at delivery if baby is Rh (+) ● Complications: fetal hydrops (fetal anemia) if antibodies attack baby’s RBCs |
