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21 Cards in this Set

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Biophysical Profiles (BPP)
1. 5 Components using U/S scoring from 0 - 2:
a. amnionic fluid volume
b. fetal tone
c. fetal activity
d. fetal breathing movements
e. nonstress test (NST)
2. BPP of 8-10 is reassuring
Differential Diagnosis of First-Trimester Bleeding:
1. Spontaneous abortion
2. Postcoital bleeding
3. Ectopic pregnancy
4. Vaginal or cervical lesions or lacerations
5. Extrusion (pushing out) of molar pregnancy
6. Non-pregnancy causes of bleeding
Risk factors for cervical incompetence:
1. History of cervical surgery, such as cone biopsy or dilation of the cervix
2. History of cervical lacerations with vaginal delivery
3. Uterine anomalies
4. History of DES exposure
Recurrent SABs:
1. Chromosomal abnormalities
2. Maternal systemic disease
3. Maternal anatomic defects
4. Infection
5. ~15% have antiphospholipid antibody syndrome
6. Luteal phase defect (lack of adequate level of progesterone to maintain the pregnancy
7. 30-50% etiology is never found
FHR Baselines above 160 bpm - Concern for Fetal distress secondary to:
a. Infection
b. Hypoxia
c. Anemia
FHR Variability defined as: Absent
< 3 bpm of variation
Flat tracing
Worrisome and demands another test to determine fetal well-being
FHR Variability defined as: Minimal
1. 3 to 5 bpm of variation
2. Not reassuring
3. Could occur while:
a. the fetus is asleep or inactive
b. After maternal drug intake
c. Reduced fetal CNS function
d. Asphyxia
FHR Variability defined as: Moderate
5 to 25 bpm of variation
FHR Variability defined as: Marked
more than 25 bpm of variation
FHR is considered reactive if:
• At least 2 accelerations of at least 15 bpm over the baseline that last for at least 15 seconds within a 20 minute period
Early decelerations:
1. Begin and end at approximately the same time as contractions
2. Etiology - ↑ Vagal tone secondary to head compression during contractions
Variable decelerations
1. Can occur any time and tend to drom more precipitously than either early or later decels (i.e., more spikey
2. Etiology: Result of umbilical cord compression
a. Repetitive variables with contractions can be seen when the cord is entrapped either under a fetal shoulder or around the deck and is compressed with each contraction
Late decelerations
1. MOST worrisome type of deceleration
2. Begin at the peak of a contraction and slowly return to baseline after the contraction has finished
3. Etiology: uteroplacental insufficiency
4. May degrade into bradycardias as labor progresses, particularly with stronger contractions
Pre-eclampsia → Ask about
1. Headache (HA)
2. RUQ pain (liver toxicity)
3. Vision changes
a. Usually scomata vs blurred vision
Magnesium Sulfate Adverse Effects:
1. Serious Reactions:
a. Cardiovascular collapse/depressed cardiac function
b. Pulmonary edema / Resp. paralysis
c. Hypothermia
d. Depressed
2. Common Reactions
a. Depressed reflexes
b. Hypotension
c. Flushing
d. Drowsiness
e. Depressed cardiac function
f. Diaphoresis
g. Hypocalcemia
h. Hypophosphatemia
i. Hyperkalemia
j. Visual changes
Complications of pre-eclampsia:
1. Eclampsia
2. Placental Abruption – placenta separates from the uterus
3. HELLP
4. ↓ blood flow to placenta
5. ↑ risk for future cardiovascular disease
Homan’s Sign:
1. Checks for DVT
2. Dorsiflex the foot and ask about pain
3. For DVT you might also notice swelling of legs
4. U/S can pick up a DVT
Current pregnancy complications (list of things that can complicate a pregnancy:
1. Past C-section
2. Asthma
3. Cigarette smoking
4. Incarceration (they’re in jail)
5. Preeclampsia
4 Questions for pregnant mother:
a. Any blood loss?
b. Any fluid loss?
c. Has the baby been moving/kicking?
d. Having any contractions?
Bishop Score Components
i. Cervical Dilation
ii. Cervical Effacement
iii. Station
iv. Cervical Consistency - Cervix feels firm, soft, or somewhere in
between
v. Cervical Position

--> Bishop Score > 8 is consistent with a cervix favorable for both spontaneous labor and, as it is commonly used, induced labor.
The Cardinal Movements of Labor (Mechanisms of Labor)
i. Engagement
1. When the fetal presenting part enters the pelvis it has undergone engagement
ii. Descent
1. After engagement, the head will descend into pelvis, followed by flexion
iii. Flexion
1. Allows the smallest diameter to present to the pelvis
iv. Internal Rotation
1. With descent into the midpelvis, the fetal vertex undergoes internal rotation from an occiput transverse (OT) position so that the sagittal suture is parallel to the anteroposterior diameter of the pelvis commonly to the occiput anterior (OA) position
v. Extension
1. As vertex passes beneath and beyond the pubic symphysis, it will extend to deliver
vi. External Rotation (aka restitution or resolution)
1. Once the head delivers, external rotation occurs and the shoulders may be delivered