Repro: 12. Wright :labor And Delivery

Front 1

What is the Leopold's maneuver?

Back 1

allows you to palpate the baby within momma

helps telly you how the baby is oriented

Front 2

what are the 5 components of the cervical exam?

Back 2

Dilation: in cm how open is the internal os

Effacement: how thin is the cervix (%)

Station: relation of fetal head to ischial spines
When most descended aspect of presenting part is at the level of ischial spine = 0 station
If it is above it is (-) // if it is below it is (+)

Consistency: soft, medium, firm

Position: relation of cervix within the vagina
--Posterior to mid to anterior

Front 3

What is the bishop score?

Back 3

predictor of vaginal delivery

low scores (0-3)--> more likely to have C section

high score (7-10)-->more likely to be vaginal delivery

Front 4

What is labor

**

Back 4

CONTRACTIONS WITH CERVICAL CHANGE

so you have to check the cervix

Front 5

What is stage 1 of labor?

Back 5

Onset to complete cervical dilation

Nulliparous pt: ave 10-12 hours (range 6-20hrs)
Multiparous pt: ave 6-8 hours (range 2-12hrs)

Front 6

what are the 3 P's of stage 1 of labor

Back 6

power (Labor must develop as a series of rhythmic contractions such that a net vector force is out.

passenger (The size and position of the baby are crucial factors in assuring a vaginal delivery)

pelvis (When the Power pushes the Passenger against a small Passageway, labor progress will stop.--cervical changes stop)

Front 7

The following are pelvis types..please describe them

Gynecoid:
Anthropoid:
Android:
Platypelloid:

Back 7

Gynecoid: Ideal shape, with round to slightly oval (obstetrical inlet slightly less transverse) inlet: best chances for normal vaginal delivery.
Anthropoid: inlet transverse is greater than inlet obstetrical diameter.
Android: triangular inlet, and prominent ischial spines, more angulated pubic arch.
Platypelloid: Flat inlet with shortened obstetrical diameter.

Front 8

2 tests for rupture status (water break)

Back 8

Nitrazine testing
pH indicator –vaginal pH is normally acidic, a pH above 7.0 indicates that the amniotic sac has ruptured

Fern testing
The estrogens in amniotic fluid cause crystallization of the salts during drying giving a fern pattern on a microscope slide

Front 9

What is Friedman's curve?

Back 9

The Friedman curve, the gold standard for rates of cervical dilation and fetal descent during active labor, was developed almost 60 years ago.

As with anything, it is a guide to help along the way but should not be the only reference utilized for labor progression

Front 10

when do you augment labor?

Back 10

When its not progressing

Front 11

when do you add IUPC – intrauterine pressure catheter for child birth?

Back 11

Must first have rupture of membranes

Place the IUPC within the amniotic sac to monitor the true intensity of the contraction

Front 12

Adequate labor should be noted if Montevideo units (MVU’s) are ....

if they are not at this level what do you need to do?

Back 12

greater than 200

If not greater than 200 then need to increase the power – need to increase oxytocin --->nipple stimulation or add IV pitocin

Front 13

What is Stage 2 of labor?

Back 13

the Pushing phase

Complete cervical dilation to delivery of baby
Nulliparous pt: ave 2 hours (3hr if epidural)
Multiparous pt: ave 1 hours (2hrs if epidural)

Front 14

what is stage 3 of labor?

Back 14

Delivery of baby to delivery of placenta

Separation usually occurs in 5-10 minutes; can take up to 30 minutes
Signs of separation: cord lengthening, gush of blood and uterine fundal changes

Front 15

when delivering, what pressure do you apply to the shoulders?

Back 15

Place hands over ears and apply downward traction to deliver anterior shoulder

Apply upward traction to deliver the posterior shoulder over perineum

Front 16

describe a first through 4th degree perineal laceration

Back 16

First degree tear
Superficial tear of vaginal / perineal mucosa

Second degree tear
Into the body of the perineum

Third degree tear
Into the anal sphincter (fecal incontinence)

Fourth degree tear
Into the rectum

Front 17

why do you try and avoid the episiotomy?

Back 17

cutting the perineum can lead to fecal incontence, prolapse of the uterus and a whole slew of problems

Front 18

what is operative vacuuming?

Back 18

External traction to the fetal scalp --> head for increased force for descent with traction and compression of fetal head

used with forceps (to help rotation of the head)

Front 19

what are some of the indications of operative vaginal delivery?

Back 19

prolonged PUSHING

maternal exhaustion

MEDICAL CONDITIONS: High BP, HTN, aneurysm

fetal distress

Front 20

what are some of the pre-requisites for vacuum or forceps?

Back 20

Cervix must be completely dilated
Exact position of baby’s head must be known
Baby’s head must be engaged within the canal
Membranes must be ruptured
Size of the baby & shape of the birth canal must be estimated and the doctor must believe the passenger will fit thru the pelvis
Pregnancy must be near term or term

Front 21

what is a cephalohematoma?

Back 21

bleeding confined to the space under the fibrous covering of the skull

complication of operative vaginal delivery

Front 22

what is a subgaleal hematoma?

Back 22

bleeding accumulates under the scalp thereby injuring the underlying veins

complication of operative vaginal delivery

Front 23

indication for C-section?

Back 23

Vaginal delivery is not feasible or would impose undue risk to fetus or mother.

Front 24

if during birth you have umbilical cord prolapse, what is indicated?

Back 24

C-section

the head will push on the cord and cut off supply to the baby

Front 25

what is a breech birth?

Back 25

feet/bum come out first instead of head

Front 26

what are Placenta accreta, increta, percreta? what is indicated when this is present?

Back 26

Accreta: abnormal adherence placenta to uterine wall – seen more with previa

Increta: when placenta invades myometrium

Percreta: when placenta invades thru myometrium to uterine serosa / adjacent organs

C section

Front 27

What is placenta previa?

Back 27

Painless bright red bleeding – usually spotting in 1st & 2nd trimester / sudden, profuse bleeding in 3rd trimester`

Front 28

what is Placental abruptio

Back 28

Unremitting pain
Irritable, tender, hypertonic uterus
+/- bleeding / +/- fetal monitoring changes

Front 29

if you suspect abruption, what should you screen for? What else can predispose to abruption?

Back 29

COCAINE

others:
Previous hx of abruption
Hypertensive state
Advanced maternal age
Multiparity
Uterine distention
Multiple gestation, polyhydramnios
Vascular disease
Diabetes, systemic lupus
MVA

Front 30

when is a cesarean hysterectomy indicated?

Back 30

Major indication – inability to stop bleeding

Abnormal placental implantation
Uterine atony
Ruptured uterus
Large uterine myomas

Significant risk of blood loss & usually requires transfusion of pRBC’s
Significant risk of injury to bladder and ureter

Front 31

Treatment of AIHA

Back 31

(1) Treat underlying cause!;
(2) Transfuse PRBCs if severe anemia is present or patient is hemodynamically compromised;
(3) Folate supplements (folate is quickly depleted in hemolysis)

Front 32

What are the Cardinal movements of labor? (6)

Back 32

Engagement (start of birthing, usually paired with flexion)
Flexion
Decent (baby starts to push out, paired with internal rotation)
Internal rotation
Extension (baby is starting to come out)
External rotation / restitution (head is out body is turning)

Don't Forget I Enjoy Really Expensive Equipment

Front 33

What is rupture of membranes

Back 33

heads up! this def is from wikipedia, but this was an objective so i wanted a clear def

term used during pregnancy to describe a rupture of the amniotic sac[1]. Normally, or "spontaneously", it occurs at full term at the onset of, or during, labor. This is colloquially known as "breaking water." A premature rupture of membranes (PROM) is a rupture that occurs prior to the onset of labor.