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24 Cards in this Set

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What are the four stages of uterine activity during pregnancy?
quiescence --> activations--> stimulation --> involution
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.
What does oxytocin do? Re: PG production from amnion/decidua?
stim uterine contractions and ^^ PG production from amnion/decidua.
Regular uterine contractions
(duration 30-60 seconds, every 5 minutes)
and
Progressive cervical dilatation

... this defines what?
Labor.
What are the three "P's" of labor?
Powers (uterine actv), passage, passenger.
What is considered "adequate" montevedeo units for labor power?
>200-250 MVU
What are the cardinal movements of labor?
DFIEEE

Descent
Flexion
Internal rotation
Extension
External rotation
Expulsion
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.
What is the most common way to assess fetal health during labor?
external monitoring.. can also use internal monitoring w/ catheter. Both give us fetal HR monitor strip & contraction monitor.
Typical fetal HR strips have _____ variability?
moderate (5-25bpm). [Marked is classed as over 25bpm)
What are the periodic changes seen in the fetal HR during labor?
accelerations (10-15 bpm over baseline normal, depending on wks of gestation)

decelerations
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.
Which decelerations mirror the uterine contractions? Cause?
Early decelerations. Vagal reflex due to cervical compression on fetal head --> mirror the uterine contractions.
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
Which of the 3 types of decelerations usually req intervention? What do we do?
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
@ what lvl do we get uterine pain? Delivery pain? Cesarian pain?
T10-12
S2-4
T4
Most common analgesia in labor?
regional anesthetic --> epidural, spinal, or local/pudendal.
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
CNS/Cardiac dz in mom, NR fetal status, Malpresentation, HSV, arrest of labor, abruption... all are indications for what?
C-section.
What is the risk of VBAC?
uterine rupture.
does 1st trimester bleeding put the pt at risk for preterm birth?
yes.
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
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.
What can help to tx respiratory dx syndx post- partum in infants?

Howabout help prevent recurrent PTD?
corticosteroids.

17-alpha-hydroxyprogesterone caproate.