Ip

Front 1

Station v/s Engagement

Back 1

0 Station- the presenting part is at the level of the ischial spines.

Hint 1

Engagement is when the biparietal diameter/largest transverse diameter has passed through the inlet or is at the level of the ischial spines.

Front 2

True pelvis defines the birth canal

Back 2

Inlet- level of sacral promonotory, linea terminalis and upper margins of pubic bones.
Mid plane - level of ischial tuberosities/tip of coccyx.
Outlet - Anterior Surfaces of the sacrum and coccyx.

Front 3

Hynotics
Sedatives
Narcotics

Back 3

Avoid within 1 hr of birth due to potential fetal respiratory depression.

Front 4

What are the different types of rupture of membranes?

Back 4

Rupture of membranes
Premature - at least 1 hr prior to onset of labour
Prolonged premature - > 18 hours elapse between rupture of membranes and onset of labour
preterm - ROM occurring before 37 weeks gestation
Preterm premature - ROM before 37 weeks AND prior to onset of labour

Front 5

Friedman's First Stage

Back 5

Latent Labor (labor onset to 4cm)
Nullip: <20 hours
Multip: < 14 hours

Hint 5

Active Labor (4 to10 cm):
Nullip:1.2 cm/hr; >1 cm descent
Multip: 1.5 cm/hr, >2cm descent

Front 6

What investigations should be done to confirm rupture of membranes?

Back 6

Sterile speculum exam - pooling of fluid in the posterior fornix, may observe fluid leaking out of cervix on cough
Amniotic fluid turns nitrazine paper blue (alkaline; vaginal - acidic)
ferning (high salt in amniotic fluid evaporates, looks like ferns under microscope)
US to rule out fetal abnormalities - oligohydramnios is indicative of ROM

Front 7

Friedman's Second Stage

Back 7

Nullip: <2 hrs
Multip: <50 min
add 1 hour if epidural.

Front 8

Describe the 1st stage of labour?

Back 8

1
Latent:
- uterine contrasctions typically infrequent and irregular
- slow cervix dilation (usually 3-4cm) and effacement
- usually ROM at end of latent phase
Active phase
- rapid cervical dilation to full dilatation
- should increase by 0.5-1cm/hr for nulliparous woman
- painful, regular contractions, q2min, lasting 45-60 secs
- contractions strongest at fundus, weakest at lower segment
- unwise to push at this stage even if pt feels like it

Front 9

1st degree Lacerations

Back 9

Vaginal Mucosa
Posterior Forchette
Perineal Skin

Front 10

2nd degree Lacerations

Back 10

Vaginal Mucosa, Posterior Forchette, Perineal Skin, AND
Perineal Muscle

Front 11

3rd degree Lacerations

Back 11

Vaginal Mucosa, Posterior Forchette, Perineal Skin
Perineal Muscle, AND Rectal Sphincter

Front 12

4th degree Lacerations

Back 12

Vaginal Mucosa, Posterior Forchette, Perineal Skin
Perineal Muscle, Rectal Sphincter, AND Anterior Rectal Wall

Front 13

Oxytocics

Back 13

1st Line Drug. Can be given IM or IV. Onset is immediate.
Causes intermittent uterine contractions.

Hint 13

20 units in 1000cc of IV fluid OR
10 Units IM

Front 14

Methylergonovine "Methergine"

Back 14

Can be given IV or PO. Onset is in 2-5 minutes,duration 3hrs. Causes sustained uterine contractions.

Hint 14

IM 0.2 mg IM
0.2 mg PO q 4 hrs x's6 doses.
Contraindicated in HTN, PIH cause seizures & vasoconstriction

Front 15

Carboprost "Hemabate"

Back 15

Can be given IM.
250 mcg IM or intramyometrial.
Can repeat in 15 to 90 min.

Hint 15

Contraindicated in Asthma -

Front 16

Battledore Placenta

Back 16

Cord anomaly insertion at the margins of placenta, peripheral cord insertion.

Front 17

Succenturiate Lobe

Back 17

Most common! Accessory placental lobe within the fetal sac which had continuous vascular connections with main placenta.

Hint 17

Suspect if torn blood vessels are at the margin of the maternal surface. Causes Retained parts or hemorrhage.

Front 18

Velamentous Cord Insertion

Back 18

Cord insertion into the fetal sac, (away from placenta) not directly in placental bed.

Hint 18

More common in multiple gestation. Can cause shearing of blood vessels in L&D -causing hemorrhage.

Front 19

Circumvallate Placenta

Back 19

Opaque/white ring of fibrous appearing tissue on fetal side of placenta. Caused by double layer of chorion and amnion.

Hint 19

Ring of chorion and amnion doubles back on themselves. Appears as if central part of placenta is depressed.

Front 20

Vasa Previa

Back 20

Suspect if pulsation is felt ahead of presenting part and if bleeding occurs with ROM.

Hint 20

Unprotected cord blood vessels with amnion only present at the cervical os. a/w velamentous cord.

Front 21

APGAR

Back 21

Activity
Pulse
Grimace,
Appearance & Respirations

Hint 21

< 7 at 5 min Need Pediatric involvement and Cord Blood Gases. A/W neurological at 1 yr and survival.

Front 22

When should foetal scalp blood sampling be used?

Back 22

Indicated when non-reassuring fetal hear rate is suggested by clinical parameters inc. heavy meconium, mod to severe abnormal FHR patterns

Front 23

MgSO4 action in Pre Term Labor

Back 23

Acts on vascular smooth muscles causing vasodilation.

Front 24

Only MA can deliver!!

Back 24

If MA- encourage patient to push as effective as possible.

Front 25

What is a normal fetal pH
Which pH indicates fetal acidosis

Back 25

> 7.25
< 7.2 - acidosis - delivery indicated

Front 26

MP contraindicated for vaginal birth.

Back 26

If MP, fetus is unable to pass under the pubis symphysis.

Front 27

Describe the different types of pain relief used in childbirth?

Back 27

Nitrous oxide and oxygen (50:50); Give in an Entonox machine; Enhances GABA-A receptors, induces dopamine and antagonises NMDA receptors
Epidural (fentanyl and LA); most effective way of relieving pain; L3/L4 space; SE: dizziness, shivering, may increase duration of 2nd stage and increase operative deliveries, severe headache (dural tap)
Pudendal block - gives perineal anaesthesia - commonly used in forceps and vacuum delivery
Spinal - similar to epidural - bolus, one time dose - more common in c/s - SE: decreased sysetmic resistance --> hypotension --> decreased placental perfusion --> fetal bradycardia - can get maternal resp depression if drug affects diaphragm
GA - used in emergency C/S - risk of maternal aspiration, hypoxia to fetus and mother

Front 28

Risk Factors for Retained Placenta

Back 28

Placenta Previa, Prior Cesarean Section, Premature Delivery, Chorioamnionitis, Grand Multip
(PPPCG)

Front 29

Placenta Accreta

Back 29

Placenta adherance to myometrium due to partial or total absence of decidua.

Hint 29

to the myometrium

Front 30

Placenta Increta

Back 30

further extends into the myometrium and penetrates the uterine wall.

Hint 30

to the uterine wall

Front 31

Placenta Percreta

Back 31

Further extends through the uterine wall to the serosa layer.

Hint 31

to the serosa layer

Front 32

What are the components of the bishop score

Back 32

Position (posterior, mid, anterior)
Consistency (firm, medium soft)
Effacement (0-80)
Dilatation
Station of the fetal head

Front 33

Retained Placenta MGMT

Back 33

Baby to breastfeed.
Squatting position
Empty maternal bladder
Oxytocin 10 Units IV

Hint 33

Call MD if >30 minutes and prepare pt for manual removal. Monitor for bleeding or shock, Ensure mom has IV, Notify anesthesia

Front 34

Negative psychological responses to labor pain

Back 34

Hyperventilation - causes
decreased oxygenation.
Stress - Causes increased
cortisol and decreased
placental perfusion.

Hint 34

Hypoxia of uterine muscle cells during action of contractions can cause pain along with various other physiological & psychological factors.

Front 35

Vitals signs

Back 35

Temperature will increase slightly up until 24 hours PP. Will not be >100.0. The highest time is preceding and immediately following birth.

Hint 35

Pulse - inversely proportional to the action of contractions. Increases during increment (most intense) and deceases during acme (strongest).

Front 36

FHR - Parasympathetic nervous system

Back 36

responsible for the beat to beat variability

Front 37

FHR Sympathetic nervous system

Back 37

Responsible for the baseline FHR.

Front 38

Baroreceptors

Back 38

Increased pressures can cause vagal response in the fetus

Front 39

Chemoreceptors

Back 39

Sensitive to changes in the fetal pH, O2, CO2 levels and respond by increasing fetal blood pressure and heart rate.

Front 40

Physiology of FHR regulation

Back 40

r/t: Parasympathetic nervous system, Sympathetic nervous system, Baroreceptors, & Chemoreceptors

Front 41

FHR

Back 41

normal 120-160 bpm,
can be 110-120 at term with good variability,

Front 42

Bradycardia

Back 42

<120bpm for 10 or more minutes

Hint 42

vagal stimulation, cord compression, placental insufficiency, rapid descent, medications, anesthesia, fetal cardiac anomolies, terminal condition of fetus.

Front 43

Tachycardia

Back 43

>160bpm for 10 or more minutes

Hint 43

fetal hypoxia or compensation for hypoxic event, prematurity, Maternal fever, infection, excessive fetal movement, meds-sympathomimetics.

Front 44

Variability

Back 44

Combination of influences between the sympathetic and parasympathetic nervous systems.

Front 45

Variable Deceleration

Back 45

r/t cord compression

Hint 45

Position change,
IV fluid bolus
O2
Pelvic exam to r/o cord prolapse and provide scalp stimulation.
Contact MD
Consider Amnioinfusion

Front 46

Early Decelerations

Back 46

r/t head compression, vagal stimulation.

Hint 46

MGMT - Position change and surveillance

Front 47

Late Decelerations

Back 47

r/t placental insufficiency, hypoxia, uterine hyperstimulation, decreased placental blood flow, maternal hypotension, medications, Abruption

Hint 47

Left lateral position
IV fluid bolus
O2 at 10L
Attempt to correct underlying case, Contact MD

Front 48

Fetal Scalp Sampling

Back 48

normal is >7.25

Hint 48

Results must be repeated q20-30 minutes in indication of distress persist. Cannot be done during deceleration or bradycardia. Must wait for FHR recovery!

Front 49

Fetal Cord blood pH

Back 49

normal is >7.20
Vein Artery
7.32 7.26

Hint 49

remember vein carries oxygenated blood