Repro Exam 2: Normal Labor

Front 1

what are the 4 major phases of uterine activity?

Back 1

quiescence (during pregnancy)
activation
stimulation
[parturition]
involution

Front 2

name the 4 phases of uterine activity during pregnancy/labor

Back 2

quiescence --> actvivations --> stimulation --> involution

Front 3

what are the hormones responsible during the quiescent phase of uterine activity?

Back 3

inhibitors: progesterone, prostacycline, relaxin, NO, PTHrp, CRH, HPL

Front 4

what are the hormones responsible during the activation phase of uterine activity?

Back 4

uterotrophins: estrogen, progesterone, prostaglandins, CRH

Front 5

what are the hormones responsible for the stimulation phase of uterine activity?

Back 5

uterotonins: prostaglandins, oxytocin

Front 6

after parturition comes the involution stage of uterine activity. what hormones are important here?

Back 6

oxytocin and thrombin

Front 7

fetal increased DHEA is important in what?

Back 7

initiation of labor.

Front 8

explain the regulation of parturition

Back 8

increased CRH (placental) --> ACTH (fetal) --> DHEA (fetal) --> E3 (fetal) --> increases oxytocin receptors, increased PG, increased uterine muscle gap jcns --> increased uterine contractions

Front 9

initiation of labor is associated with placental conversion of estradiol to ___, (increased/decreased) decidual PGF2a, (inc/decreased) gap junctions, (inc/decreased) oxytocin, (inc/dec) PG receptors, (inc/dec) progesterone receptors

Back 9

estradiol to ESTRIOL, INCREASED decidual PGF2a, INCREASED gap jcns, INCREASED oxytocin, INCREASED PG receptors, DECREASED progesterone receptors

Front 10

oxytocin is required for labor. where does it come from?

Back 10

fetal production and mother's post pituitary, maternal serum increase occurs in 2nd stage of labor.

Front 11

oxytocin actions in labor

Back 11

stimulate uterine contractions, stimulate PG production from amnion/decidua

Front 12

where are there oxytocin receptors?

Back 12

fundus of the uterus. increased in # by 100-200x during pregnancy

Front 13

what happens w/cardiac output in labor

Back 13

it INCREASES. auto-transfusion w/contractions of 300-500 ml. part of CO increase related to pain and anxiety

Front 14

cardiac output is very ___ during labor

Back 14

preload-based. CO increased w/lateral v. supine position

Front 15

__ + ___ = labor

Back 15

regular uterine contractions (30-60s duration, q5min) + progressive cervical dilatation

Front 16

explain effacement and dilation. which comes first?

Back 16

cervix is effaced first --> involves thinning out the cervix and shortening the cervical canal. dilation is then just the opening of the cervix.

Front 17

3 ps of labor

Back 17

Powers (uterine activity), Passage, Passenger

Front 18

uterine contractions in normal labor should last ___ and occur ___. they are measured in ___. adequate uterine contractions is ___

Back 18

should last 30-60 seconds, occur every 2-5 minutes (3-5 contractions/10 min), measured in montevedeo units (by intrauterine catheter). want to have >200-250 MVU in 10 minutes.

Front 19

when evaluating passage, what are some dimensions that you care about?

Back 19

pelvic inlet, pelvic midcavity, and pelvic outlet width (want all of these to be in the 10-12 cm range)

Front 20

here are 4 descriptions of pelvises. which 2 are not so good for labor? gynecoid, anthropoid, android, platypelloid

Back 20

android and platypelloid are more difficult

Front 21

what is the cutoff for macrosomia?

Back 21

4500 grams

Front 22

name 6 important things to evaluate in the passenger aspect of labor

Back 22

SLPAPS: size, lie, presentation (e.g., vertex or not), attitude (fetal position), position (degree of vertication), station.

Front 23

name the cardinal movements of labor

Back 23

descent, flexion, internal rotation, externsion, external rotation, expulsion

Front 24

what are the 2 components of the 1st stage of labor?

Back 24

latent phase --> onset to rapid cervical change; active phase --> rapid cervical change to complete dilation

Front 25

the latent phase usually lasts around __ in nulliparous women, and ___ in multiparous women

Back 25

7-8.5 hrs in nulliparous, 4-5.5 hrs in multiparous

Front 26

what is the 2nd stage of labor?

Back 26

complete dilatation to delivery of neonate

Front 27

how long does the second stage of labor take, on average?

Back 27

53-57 min in nulliparous women w/o an epidural, 17-19 min in multiparous women w/o an epidural. takes longer w/an epidural (79min, 45 min)

Front 28

what is the third stage of labor?

Back 28

delivery of the placenta

Front 29

what is the average length of time that it takes to deliver a placenta? what's a long time (start to worry)?

Back 29

avg: 6 min. 30 min is prolonged

Front 30

what are bad things assoc w/long 3rd stage of labor

Back 30

EBL >500, need for D&C, drop in HCT by 10% (do you know what these things stand for? because you should. estimated blood loss, dilation and curettage, hematocrit)

Front 31

name some patterns of fetal heart rate monitoring

Back 31

baseline, variability, periodic changes: accelerations, decelerations (variable, early, late)

Front 32

what is normal baseline fetal heart rate? what is normal variability for fetal heart rate?

Back 32

120-160 bpm. moderate variability is defined as 5-25bpm.

Front 33

deceleration monitoring - what are you looking at?

Back 33

fetal heart rate and uterine contractions

Front 34

variable decelerations: think __

Back 34

umbilical cord compression. (UV compression --> decreases cardiac return, fetal hypotension, fetal increased HR; UA compression --> increased SVR, decreased fetal heart rate - is protective)

Front 35

early decelerations occur in 5-10% of labors. this should make you think about __ and ___

Back 35

vagal reflex and cervical compression on fetal head

Front 36

late decelerations should make you think of what?

Back 36

uteroplacental insufficiency - hypoxia, reflex late (low O2 in CNS, increased symp tone, increased BP, baroreceptor medicated bradycardia), and myocardial depression. LATE DECELERATIONS ARE WORRISOME

Front 37

management of fetal heart rate problems. the mainstay is to remove potential etiologies. how can you do this?

Back 37

treat hypotension (maternal in L lat recumbent position, IVF hydration, ephedrine), maternal O2 administration, cessation of contractions (d/c oxytocin, uterine relaxants), amnioinfusion, expedite delivery (?c-section)

Front 38

name the spinal cord segments associated with pain during labor.

Back 38

uterine pain: T10-T12. delivery pain:S2-S4. cesarean pain: T4.

Front 39

how do you manage pain in labor?

Back 39

psychoprophylaxis (TENS, acupuncture, prenatal education), systemic opioid, regional analgesia/anesthesia

Front 40

what are risks associated w/giving opioids in labor?

Back 40

neonatal depression, delayed gastric emptying (aspiration)

Front 41

where is an epidural given? what is it usually?

Back 41

L2-L5, usually a local anesthetic, bupivicaine common example

Front 42

3 types of regional pain meds for analgesia/anesthesia

Back 42

epidural, spinal (often CSE), local/pudendal

Front 43

name 4 interventions for abnormal labor

Back 43

augmentation (oxytocin to stimulate uterine contractions and PG production from amnion/decidua, AROM), therapeutic rest, operative vaginal delivery, cesarean delivery

Front 44

name indications for operative vaginal delivery

Back 44

prolonged 2nd stage, fetal compromise, aftercoming fetal head/breech, maternal indications (cardiac dz, CNS dz)

Front 45

requirements for operative vaginal delivery (name 6)

Back 45

consent, completely dilated, ruptured membranes, adequate anesthesia, empty bladder, known fetal position

Front 46

what has a higher success rate for operative vag delivery: obstetrics forceps or vaccuum?

Back 46

forceps (but increased maternal trauma). 1 advantage is that they allow rotational maneuvers.

Front 47

what's the cesarean rate in the US?

Back 47

32.9% in 2009. this is super duper high.

Front 48

what are maternal indications for cesarean delivery

Back 48

CNS/cardiac disease

Front 49

what are fetal indications for cesarean delivery?

Back 49

NR fetal status, malpresentation, HSV

Front 50

what are maternal-fetal indications for cesarean delivery?

Back 50

arrest of labor, abruption, placenta previa

Front 51

what is the success rate of VBAC? who has higher success?

Back 51

60-80%. high success assoc. w/prior vaginal birth, prior malpresentation, spontaneous labor

Front 52

who are candidates for VBAC?

Back 52

1-2 prior uncomplicated low-transverse cesareans, o/w uncomplicated, no contraindications (duh)

Front 53

what is the risk assoc w/VBAC?

Back 53

uterine rupture (LTCS: 0.5-1.0%, classical 4-9%)

Front 54

you should think of labor as starting with the ___

Back 54

FETUS (although it's really maternal-fetal-placental interactions)