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Q4 Women's Health > Exam 2 Labor/Delivery, Peurperium > Flashcards

Exam 2 Labor/Delivery, Peurperium Flashcards

1
Q

True Labor characteristics? (5)

A 
Regular intervals, gradual ↑ frequencies
↑ intensity
Cervical dilation
Back and abd discomfort
No relief from sedation
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2
Q

Labor and Delivery eval should include? (6)

A 
Review hx/physicals
Take brief hx
Vitals
Cervical
Membrane status
Fetal monitoring
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3
Q

Amniotic Fluid status: Signs of rupture? (5)

A 
Use sterile speculum to examine
Pooling in vagina
Visible fluid leak thru cervix
Nitrazine test
Fern test
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4
Q

Nitrazine Test is?

A

Test of fluid’s pH
pH of 5 - 6 = intact membrane
pH of 6.5 - 8 = ruptured membrane

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5
Q

Fern Test is?

A

Amniotic fluid appears in “fern” pattern on slide

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6
Q

1st stage of labor is?

Phases based on?

A

Onset to full cervical dilation

Rate of cervical dilation

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7
Q

1st stage of labor:

Latent phase?

Active phase?

A

Latent: First regular contraction thru 4cm dilation
Dilation is slow, <0.5cm/hr

Active: from 4cm to full dilation
Dilation is fast, 1cm/hr

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8
Q

2nd stage of labor is?

A

Complete dilation to delivery of baby (pushing phase)

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9
Q

3rd stage of labor is?

A

Delivery of baby to delivery of placenta (U w/i 30 min)

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10
Q

Progress of labor: Power is?

Strength/frequency controlled by?

A

uterine contractions

prostaglandin E2 and F2-α ->
↑ uterine sensitivity to oxytocin

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11
Q

Adequate labor is what?

A

3 to 5 contractions/10 min

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12
Q

Tocodynamometry measures what?

A

Contractions

External = freq/duration
Internal = freq/duration/intensity
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13
Q

Progress of labor: Passenger

Size?

A

> 4500 gm = macrosomic infant

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14
Q

Progress of labor: Passenger

Presentation options? (5)

A 
Vertex (crown of head)
Face/brow
Breech (frank, complete, footling)
Transverse lie
Compound (2 body parts)
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15
Q

Progress of labor: Passenger

Position is?

A

Relation of presenting part to R or L of mom’s pelvis

```
Occiput Anterior (OA) is normal
face down
~~~

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16
Q

Progress of labor: Passage is?

A

Pelvis size/shape

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17
Q

Cardinal mvmts of labor are?

A

Changes in fetus position as passes thru birth canal

18
Q

Cardinal mvmts of labor: Engagement is?

A

Passage of presenting part’s widest diameter to below pelvic inlet

19
Q

Cardinal mvmts of labor: Flexion is?

A

Complete flexion of head presents smallest head diameter

20
Q

Cardinal mvmts of labor: Descent is fastest when?

A

stage 2 of labor

21
Q

Cardinal mvmts of labor: Internal rotation is?

A

Rotation of presenting to anteroposterior as it passes thru pelvis

22
Q

Cardinal mvmts of labor: Extention is?

A

Once below introitus, head extends beneath pubic symphysis and delivers

23
Q

Cardinal mvmts of labor: External rotation is?

A

Head rotates 45°, line up w/ shoulders

24
Q

3rd stage of labor: Signs of placental separation? (4)

A

Uterus ↓ in size
Uterus rises in abdomen
Globular configuration
Gush of blood/Lengthening of umbilical cord

25
Q

Fetal monitoring should include? (3)

A

Intermittent auscultation
US transducer on abdomen
Internal scalp ECG

26
Q

Fetal monitoring: Heart rate?

A

120 - 160 = N
> 180 = severe tachy
< 100 = severe brady

27
Q

Fetal monitoring: Heart rate variations? (4)

A

Short term: beat-to-beat amp ∆s
Long term: wave pattern ∆s Q 4-6 cycles/min
Acceleration: ↑ 15bmp above baseline for 15 sec
Deceleration (see next card)

28
Q

Fetal monitoring: Heart rate deceleration caused by

Early?

Variable?

Late?

A

Early:
from head compression during contractions

Variable:
from cord compression during contractions

Late:
from hypoxia, insuff placenta, or mom hypoTN

29
Q

Labor pain relief options? (3)

A

Psychoprophylaxis: Lamaze

Meds:
Sedatives (Vistaril)
Narcotics (Demerol, Stadol, Nubain)
Dissociative (Ketamine)

Blocks:
Paracervical
Pudendal
Epidural

30
Q

Perineal lacerations: 1°?

A

vag mucosa or perineal skin

but not underlying tissue

31
Q

Perineal lacerations: 2°?

A

underlying SQ tissue

but not rectum

32
Q

Perineal lacerations: 3°?

A

thru rectal sphincter

but not rectal mucosa

33
Q

Perineal lacerations: 4°?

A

thru rectal mucosa

34
Q

Induction of labor: Highest likelihood of success if? (5)

A 
Dilation 5+ cm
Effaced >80%
Station +1
Soft cervix
Anteriorly-positioned cervix
35
Q

Methods of inducing labor? (5)

A 
Membrane stripping (finger in os)
Amniotomy
Prostaglandin gel
Oxytocin
Misoprostol/Cytotec (abortion pill)
36
Q

Complications of Oxytocin? (3)

A

Hyperstim to >5 contractions/10min
Fetal distress
Water intoxication

37
Q

Puerperium is?

A

Post baby/placenta delivery thru 6 wks post

38
Q

Puerperium anatomic resolution includes? (4)

A

Uterus from 1000gm to 50gm

Cervix loses vascularity, gland hypertrophy, hyperplasia

No ovulation via prolactin 3+ months if lactating

Vagina shrinks but walls stay thin/inelastic/dry until ovulation returns

39
Q

Puerperium management?

A

Hospital 1-2 days vaginal, 2-4 days CSec

Post exam 4-6wks

40
Q

Postpartum Blues vs Depression?

A

Blues should resolve w/i 2 wks

Q4 Women's Health (20 decks)

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