Ob/gyn Blueprints Ch. 4 Normal Labor & Delivery

Front 1

What 4 things does the Obstetric examination contain beyond the standard physical examination?

Back 1

1. Maternal abdominal examination for contractions & the fetus (Leopold maneuvers)
2. Cervical examination
3. Fetal heart tones
4. sterile speculum examination if rupture of membranes is suspected

Front 2

This procedure determines the position of a fetus in a pregnant woman

Back 2

Leopold maneuver

Front 3

Explain how to do a Leopold maneuver

Back 3

1. Palpate first at the fundus of the uterus in the maternal upper abdominal quadrant
2. Palpate on either side of the uterus
3. Palpate just above the pubic symphysis

Front 4

What does the Leopold maneuver determine?

Back 4

Fetal lie = whether the infant is longitudinal or transverse within the uterus

Front 5

Define Fetal Presentation

Back 5

either breech or vertex positioning of the fetus

Front 6

Define Premature Rupture of Membranes (PROM)

Define Prolonged Premature Rupture of Membranes
-what does it put the mother & infant at increased risk for?

Back 6

1. fetus rupture of membranes at least 1 hour prior to the onset of labor

2. When PROM occurs more than 18 hours before labor
-INFECTION

Front 7

What is PPROM?

Back 7

Preterm, Premature Rupture of Membranes
-before 37 wks gestational age

Front 8

What makes one suspect a diagnosis of Rupture of Membranes?

Back 8

history of a gush or leaking of fluid from the vagina

Front 9

How does one confirm a diagnosis of ROM?

Back 9

Pool test = + if there is a collection of fluid in the vagina
-can be augmented by asking the patient to cough or bear down

Nitrazine = amniotic fluid is basic & turns nitrazine paper blue as opposed to the acidic vaginal secretions

Fern test = estrogens in the amniotic fluid cause crystallization of the salts in the amniotic fluid when it dries

Front 10

What may cause a false positive in the Fern test?

Back 10

taking a sample directly from the cervix b/c cervical mucus also ferns

Also blood, semen, & vaginitis

Front 11

What examination allows the obstetrician to determine whether a patient is in labor, the phase of labor & how labor is progressing?

Back 11

Cervical examination

Front 12

What are the 5 components of the Cervical Examination? What do these 5 components comprise?

Back 12

1. Dilation
2. Effacement
3. Station
4. Cervical position
5. Consistency of Cervix

Bishop Score
**DESC-P

Front 13

A Bishop Score greater than what is consistent with a cervix favorable for both spontaneous & induced labor?

Back 13

8

Front 14

How is Dilation assessed in Bishop Scoring?

Back 14

by using either one or two fingers of the examining hand to determine how open the cervix is at the level of the INTERNAL OS
-Closed = 0 cm
-1 score = 1-2 cm
-2 score = 3-4 cm
-3 score = < 5 cm

Front 15

What centimeter dilation on average is necessary to accomodate the term infant's biparietal diameter?

Back 15

10 cm

Front 16

Describe Effacement

Back 16

is a subjective measurement made by the examiner & determines how thinned out the cervix is

Eg. the typical cervix is 3-5 cm in length; thus, if the cervix feels like it is about 2 cm from external to internal os = 50% effaced

Complete or 100% effacement occurs when the cervix is as thin as the adjoining lower uterine segment

Front 17

Define Station in the Bishop Scoring system

Back 17

relation of the head to the Ischial Spines of the female pelvis

-level of Ischial Spines = 0
-head higher than Ischial Spines = negative #
-head below level of ischial spine = positive #

Front 18

Describe Cervical Constitency in the Bishop Scoring system

Back 18

Firm = 0
Medium = 1
Soft = 2

Front 19

Describe the Cervical Position in the Bishop Scoring system

Back 19

Posterior = 0
Midposition = 1
Anterior = 2

Front 20

List the 3 types of Fetal Position

Back 20

1. Vertex = head down

2. Breech = buttocks down

3. Transverse = neither down

Front 21

How is Fetal Position in the vertex presentation determined?

Back 21

by palpation of the sutures & fontanelles

Front 22

How does one identify the Anterior Fontanelle?

How does one identify the Posterior Fontanelle?

Back 22

Larger & diamond-shaped
-jxn b/w the 2 frontal bones & 2 parietal bones

Smaller & more triangular-shaped
-jxn b/w the 2 Parietal bones & Occipital bone

Front 23

Vertex presentations

Back 23

-

Front 24

In the setting of extensive molding of the fetal skull (Asnclitism), where the sagital suture is not midline within the maternal pelvis, palpation of what can be used to determine position?

Back 24

Fetal Ear

Front 25

With face presentations, what is used as the reference point?

Back 25

Fetal chin or mentum

Front 26

What is the reference point for Breech presentations?

Back 26

Fetal Sacrum

Front 27

What is the strict definition of labor?

Back 27

regular uterine contractions that cause cervical change

Front 28

Describe the difference b/w Induction of labor & Augmentation of labor

Back 28

Induction = the attemp to bein labor in a NON-laboring patient

Augmentation = intervening to increase the already present contractions

Front 29

What 4 general things can labor be induced by?

Back 29

1. Prostaglandins

2. Oxytocic agents

3. mechanical dilation of the cervix

4. Artificial rupture of membranes

Front 30

List 5 indications for induction of labor

Back 30

1. Postterm pregnancy
2. Preeclampsia
3. Premature ROM
4. Nonreassuring fetal testing
5. Intrauterine growth restriction

Front 31

What are 2 maternal contraindications for use of Prostaglandins?

Back 31

1. Glaucoma

2. Asthma

Front 32

What are 2 Obstetric contraindications for Prostaglandin use?

Back 32

1. having had more than one prior C-section

2. nonreassuring fetal testing

Front 33

Induction is usually done pharmacologically with ______

How is it administered?

Back 33

Pitocin = synthetic but identical version of the octapeptide Oxytocin normally released from the Posterior Pituitary

IV since it is rapidly metabolized

Front 34

Other than Pitocin, what else can be done to induce labor? What is this? What are the precautions?

Back 34

Amniotomy

Performed with an Amnio hook to tear the Amniotic sac around the fetus & release some of the Amniotic fluid

After Amniotomy is performed, examination should be performed to ensure that prolapse of the umbilical cord has not occurred
-when doing Amniotomy, it is important not to lift the fetal head b/c cord prolapse may occur

Front 35

What is the normal range for the fetal heart rate?

What should be suspected if the rate is above this range? (3)

Any bradycardia of greater than what length of time & HR are of great concern?

Back 35

Normal = 110 - 160

1. Infection
2. Hypoxia
3. Anemia

> 2 min & HR < 90

Front 36

What are External Tocometers most useful for measuring?

Back 36

FREQUENCY of contractions & comparing the fetal heart rate tracing to determine the type of decelerations occurring

Front 37

What 4 things are considered when determining if FHT's are reassuring?

Back 37

1. Baseline (normal = 110-160 bpm)
2. Variations from the baseline
3. there should be atleast 3-5 cycles per minute of the HR around the baseline
4. 2 ACCELERATIONS OF ATLEAST 15 BPM over the baseline that last for 15 SECONDS within 20 minutes

Front 38

Describe an Early Deceleration

What do they result from?

Back 38

begin & end at approximately the same time as contractions

Head compression

Front 39

Describe Variable Decelerations

What do they result from?

Back 39

occur at any time & tend to drop more precipitously than either early or late decels

Umbilical cord compression during contractions

Front 40

Describe Late Decelerations

What are they the result of?
What may they degrade into?

Back 40

Begin at the peak of contractions & slowly return to baseline after the contraction has finished

Uteroplacental insufficiency = most worrisome type

Bradycardias as labor progresses, particularly with stronger contractions