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40 Cards in this Set

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  • Back
What 4 things does the Obstetric examination contain beyond the standard physical examination?
1. Maternal abdominal examination for contractions & the fetus (Leopold maneuvers)
2. Cervical examination
3. Fetal heart tones
4. sterile speculum examination if rupture of membranes is suspected
This procedure determines the position of a fetus in a pregnant woman
Leopold maneuver
Explain how to do a Leopold maneuver
1. Palpate first at the fundus of the uterus in the maternal upper abdominal quadrant
2. Palpate on either side of the uterus
3. Palpate just above the pubic symphysis
What does the Leopold maneuver determine?
Fetal lie = whether the infant is longitudinal or transverse within the uterus
Define Fetal Presentation
either breech or vertex positioning of the fetus
Define Premature Rupture of Membranes (PROM)

Define Prolonged Premature Rupture of Membranes
-what does it put the mother & infant at increased risk for?
1. fetus rupture of membranes at least 1 hour prior to the onset of labor

2. When PROM occurs more than 18 hours before labor
What is PPROM?
Preterm, Premature Rupture of Membranes
-before 37 wks gestational age
What makes one suspect a diagnosis of Rupture of Membranes?
history of a gush or leaking of fluid from the vagina
How does one confirm a diagnosis of ROM?
Pool test = + if there is a collection of fluid in the vagina
-can be augmented by asking the patient to cough or bear down

Nitrazine = amniotic fluid is basic & turns nitrazine paper blue as opposed to the acidic vaginal secretions

Fern test = estrogens in the amniotic fluid cause crystallization of the salts in the amniotic fluid when it dries
What may cause a false positive in the Fern test?
taking a sample directly from the cervix b/c cervical mucus also ferns

Also blood, semen, & vaginitis
What examination allows the obstetrician to determine whether a patient is in labor, the phase of labor & how labor is progressing?
Cervical examination
What are the 5 components of the Cervical Examination? What do these 5 components comprise?
1. Dilation
2. Effacement
3. Station
4. Cervical position
5. Consistency of Cervix

Bishop Score
A Bishop Score greater than what is consistent with a cervix favorable for both spontaneous & induced labor?
How is Dilation assessed in Bishop Scoring?
by using either one or two fingers of the examining hand to determine how open the cervix is at the level of the INTERNAL OS
-Closed = 0 cm
-1 score = 1-2 cm
-2 score = 3-4 cm
-3 score = < 5 cm
What centimeter dilation on average is necessary to accomodate the term infant's biparietal diameter?
10 cm
Describe Effacement
is a subjective measurement made by the examiner & determines how thinned out the cervix is

Eg. the typical cervix is 3-5 cm in length; thus, if the cervix feels like it is about 2 cm from external to internal os = 50% effaced

Complete or 100% effacement occurs when the cervix is as thin as the adjoining lower uterine segment
Define Station in the Bishop Scoring system
relation of the head to the Ischial Spines of the female pelvis

-level of Ischial Spines = 0
-head higher than Ischial Spines = negative #
-head below level of ischial spine = positive #
Describe Cervical Constitency in the Bishop Scoring system
Firm = 0
Medium = 1
Soft = 2
Describe the Cervical Position in the Bishop Scoring system
Posterior = 0
Midposition = 1
Anterior = 2
List the 3 types of Fetal Position
1. Vertex = head down

2. Breech = buttocks down

3. Transverse = neither down
How is Fetal Position in the vertex presentation determined?
by palpation of the sutures & fontanelles
How does one identify the Anterior Fontanelle?

How does one identify the Posterior Fontanelle?
Larger & diamond-shaped
-jxn b/w the 2 frontal bones & 2 parietal bones

Smaller & more triangular-shaped
-jxn b/w the 2 Parietal bones & Occipital bone
Vertex presentations
In the setting of extensive molding of the fetal skull (Asnclitism), where the sagital suture is not midline within the maternal pelvis, palpation of what can be used to determine position?
Fetal Ear
With face presentations, what is used as the reference point?
Fetal chin or mentum
What is the reference point for Breech presentations?
Fetal Sacrum
What is the strict definition of labor?
regular uterine contractions that cause cervical change
Describe the difference b/w Induction of labor & Augmentation of labor
Induction = the attemp to bein labor in a NON-laboring patient

Augmentation = intervening to increase the already present contractions
What 4 general things can labor be induced by?
1. Prostaglandins

2. Oxytocic agents

3. mechanical dilation of the cervix

4. Artificial rupture of membranes
List 5 indications for induction of labor
1. Postterm pregnancy
2. Preeclampsia
3. Premature ROM
4. Nonreassuring fetal testing
5. Intrauterine growth restriction
What are 2 maternal contraindications for use of Prostaglandins?
1. Glaucoma

2. Asthma
What are 2 Obstetric contraindications for Prostaglandin use?
1. having had more than one prior C-section

2. nonreassuring fetal testing
Induction is usually done pharmacologically with ______

How is it administered?
Pitocin = synthetic but identical version of the octapeptide Oxytocin normally released from the Posterior Pituitary

IV since it is rapidly metabolized
Other than Pitocin, what else can be done to induce labor? What is this? What are the precautions?

Performed with an Amnio hook to tear the Amniotic sac around the fetus & release some of the Amniotic fluid

After Amniotomy is performed, examination should be performed to ensure that prolapse of the umbilical cord has not occurred
-when doing Amniotomy, it is important not to lift the fetal head b/c cord prolapse may occur
What is the normal range for the fetal heart rate?

What should be suspected if the rate is above this range? (3)

Any bradycardia of greater than what length of time & HR are of great concern?
Normal = 110 - 160

1. Infection
2. Hypoxia
3. Anemia

> 2 min & HR < 90
What are External Tocometers most useful for measuring?
FREQUENCY of contractions & comparing the fetal heart rate tracing to determine the type of decelerations occurring
What 4 things are considered when determining if FHT's are reassuring?
1. Baseline (normal = 110-160 bpm)
2. Variations from the baseline
3. there should be atleast 3-5 cycles per minute of the HR around the baseline
4. 2 ACCELERATIONS OF ATLEAST 15 BPM over the baseline that last for 15 SECONDS within 20 minutes
Describe an Early Deceleration

What do they result from?
begin & end at approximately the same time as contractions

Head compression
Describe Variable Decelerations

What do they result from?
occur at any time & tend to drop more precipitously than either early or late decels

Umbilical cord compression during contractions
Describe Late Decelerations

What are they the result of?
What may they degrade into?
Begin at the peak of contractions & slowly return to baseline after the contraction has finished

Uteroplacental insufficiency = most worrisome type

Bradycardias as labor progresses, particularly with stronger contractions