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24 Cards in this Set
- Front
- Back
What are the four stages of uterine activity during pregnancy?
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quiescence --> activations--> stimulation --> involution
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Initiation of labor in humans:
- DHEA inc/dec? What does the placenta do w/ it? - what does this lead to re: PGF and gap junctions? oxytocin and PG receptors? Progesterone receptors? |
increased; converted to estradiol.
increased, increased, decreased. |
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What does oxytocin do? Re: PG production from amnion/decidua?
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stim uterine contractions and ^^ PG production from amnion/decidua.
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Regular uterine contractions
(duration 30-60 seconds, every 5 minutes) and Progressive cervical dilatation ... this defines what? |
Labor.
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What are the three "P's" of labor?
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Powers (uterine actv), passage, passenger.
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What is considered "adequate" montevedeo units for labor power?
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>200-250 MVU
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What are the cardinal movements of labor?
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DFIEEE
Descent Flexion Internal rotation Extension External rotation Expulsion |
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The first stage (of three) in labor encompasses what?
- what are it's two phases? Second stage? 3rd? |
onset to complete dilatation.
- latent and active complete dilatation to delivery of neonate Delivery of placenta, mean ~6m long. |
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What is the most common way to assess fetal health during labor?
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external monitoring.. can also use internal monitoring w/ catheter. Both give us fetal HR monitor strip & contraction monitor.
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Typical fetal HR strips have _____ variability?
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moderate (5-25bpm). [Marked is classed as over 25bpm)
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What are the periodic changes seen in the fetal HR during labor?
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accelerations (10-15 bpm over baseline normal, depending on wks of gestation)
decelerations |
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What is the cause of a variable deceleration in fHR monitoring?
- do these cause adverse prog? |
umbilical cord compression
- UV compression: decreased cardiac return --> fetal hypotension --> initial increase in HR --> big valley in HR - UA compression: increased SVR --> decreased fetal HR is protective. Not if there aren't lots of 'em. |
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Which decelerations mirror the uterine contractions? Cause?
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Early decelerations. Vagal reflex due to cervical compression on fetal head --> mirror the uterine contractions.
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Which decelerations CAN portend adverse prog for the baby?
- why? what are they indicative of? |
Late.
- Uteroplacental insufficiency – hypoxia Reflex late low O2 in CNS, increased sympathetic tone, increased BP, baroreceptor medicated bradycardia Myocardial depression |
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Which of the 3 types of decelerations usually req intervention? What do we do?
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late ones.
- Remove potential etiologies Hypotension Maternal position – left lateral recumbent IVF hydration, ephedrine Maternal O2 administration Cessation of contractions Discontinue oxytocin Uterine relaxants – terbutaline Amnioinfusion Expedite delivery |
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@ what lvl do we get uterine pain? Delivery pain? Cesarian pain?
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T10-12
S2-4 T4 |
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Most common analgesia in labor?
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regional anesthetic --> epidural, spinal, or local/pudendal.
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What are the indications for operative vaginal delivery?
- req for it? Is doing this with suction/vacuum more beneficial for the mother or the fetus? Obstetrics foreceps? |
Prolonged second stage
Fetal compromise Aftercoming fetal head/breech Maternal indications Cardiac disease CNS disease Completely dilated Ruptured membranes Adequate anesthesia Empty bladder Known fetal position Lower success rate Lower maternal trauma Increased fetal trauma Higher success rate Increased maternal trauma Allow rotational maneuvers |
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CNS/Cardiac dz in mom, NR fetal status, Malpresentation, HSV, arrest of labor, abruption... all are indications for what?
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C-section.
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What is the risk of VBAC?
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uterine rupture.
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does 1st trimester bleeding put the pt at risk for preterm birth?
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yes.
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What are tocolytics? Are they a primary, secondary, or tertiary prevention of preterm labor?
- examples of tocolytics? |
anti-contraction meds.
- secondary. - Magnesium sulfate ß mimetics terbutaline Nifedipine Indomethacin Oxytocin receptor antagonists |
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Of the following, which has the highest PPV for dx preterm labor? NPV?
- Cervix >1cm, Contractions >8hrs, cervical length, fibronectin. |
PPV: Cervical length just slightly better than fibronectin.
Fibronectin has best NPV, but very close to CL. USE BOTH, typically. |
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What can help to tx respiratory dx syndx post- partum in infants?
Howabout help prevent recurrent PTD? |
corticosteroids.
17-alpha-hydroxyprogesterone caproate. |