L&D

Question 1

1. What stimulates uterine contractions in labor?
2. What else does this do?
3. Inaddition to this change what else increases?

Answer 1

1. increased synthesis of prostaglandins
2. soften the cervix independant of uterine activity
3. myometrial oxytocin receptors

Question 2

1. First step in delivery?
2. Second step?
3. 3rd step?

Answer 2

1. determine the presenting part. cephaic preferably
2. digitial exam of the vagina/cervix
3. Fetal station

Question 3

What are we looking for on the digital exam? 3

Answer 3

1. Consistency- hard vs soft
2. Effacement: shortening of the cervical canal from 2cm to paper thin
3. Dilation- cervix opens from close to 10 cm (fully dilated)

Question 4

What is the fetal station and what are the measurement?

Answer 4

postion of the fetal head in the birth canal in realtion to the ischial spines

-5cm to +5cm

Question 5

What is the first stage of labor?

Answer 5

from the onset of labor/contractions to full cervical dilation and effacement

Question 6

What are the two phases in the first stage of labor?

Answer 6

1. Latent phase- cervical effacement and early dilation, 20 to 14 hours
2. from about 6cm dilated with more rapid dilation and effacement

Regardless if youve had a delivery before or not

Question 7

What is the second stage of labor?

Answer 7

from complete cervical dilation to delivery of the baby

Question 8

What is the third stage of labor?

Answer 8

delivery of the baby to delivery of the placenta
- 30 min. diagnose a retained placenta and have to go get it out.

• active or passive
• active- start pitocin and massage uterus (creday)

Ferguson relfex- postive feedbacl loop, striping = release of prostagladin = uterine contraction

Estrogen = causes contractions 
Progesterone = opposite, can give to to pts with history of PTL 16-36. injections.

Question 9

What is the fourth stage in labor?

Answer 9

delivery of the placenta to two hours after.

Question 10

1. How often?
2. How long?
3. How intense are contractions in ealry labor?

Answer 10

1. 5- 10 min
2. 30-45 seconds
3. 20-30 mmHg

Question 11

1. HOw often?
2. How long?
3. How intense for later labor?

Answer 11

1. 2-3 min
2. lasting 60-70 sec
3. 40-60 mmHg

Question 12

Managament of first stage of labor:
1. if head is engaged and intermittant fetal monitoring is done what can we do?

2. If laying down what position should they be in and why?
3. They may bathe or shower if what?
4. Hydration?
5. Food?

Answer 12

1. Ambulate
2. supine left lateral potion to avoid supine hypotension
3. Membranes are intact
4. IV fluids
5. NPO except for ice chips

Question 13

What are warning signs in fetal heart rate monitoring?

4

Answer 13

1. late decelerations
2. bradycardia
3. decreased variability
4. Sinusoidal pattern- severe anemia

110-160
moderate variablet 5-25
Cat 1 tracing

Cat2
-anything that doesnt match cat 1 or 3

Cat 3
flatline
recurrent late or not variably decelerations
absent var with brady
sinusious

Tickle babies head if head rate goes up then its at least a pH of 7.2

Question 14

1. Where does pain come from in the first stage of labor?

2. When the fetal head descends?

Answer 14

1. uterine contactions and dilation of the cervix

2. distension of the lower birth canal and perineum

Question 15

Methods of anesthesia or analgesia?

Answer 15

1. Systemic narcotics—early in labor
2. Spinal anesthesia—single injection of anesthetic
3. Epidural block—infusion of local anesthetics or narcotics through a catheter into the epidural space***
4. Local block of the of anesthetic into the vagina or perineum- peudendal nerve block blocks everything on the vulva. takes away pressure or tear in the skin
5. General anesthetic- stat C sections

Question 16

1. Begins with complete dilatation of the cervix and ends with delivery of the baby- mother has urge to push. How long does this stage last?

Answer 16

1. 30 min to 2 hours
2. 5-30 min multigravida

after 5 hours must be careful must get baby out for classic vaginal delivery.

Question 17

What are the cardinal movements in labor?

7

Answer 17

1. Engagement
2. Flexion
3. Descent
4. Internal rotation
5. Extension
6. External rotation aka restitution then deliver posterior shoulder
7. Expulsion

Question 18

What is engagament?

Where can the presenting part of the baby be palpated?

Answer 18

the biparietal diameter has passed the plane of the pelvic inlet

below the level of the ischial spine

Question 19

What is flexion?

Answer 19

As forces cause decent of the fetus though the pelvis, soft and bony resistance is encountered. this allows the smaller diameter of the fetal head to present to the maternal pelvis

Question 20

What is descent?

Answer 20

successful passage of the presenting part though the birth canal

Question 21

When does the greatest rate of descent occur?

Answer 21

during the latter portions of the first stage of labor and during the second stage of labor

Question 22

What is internal rotation?

Answer 22

most commonly from transverse to anterior or posterior

-facilitates optimal diameters of the fetal head to the bony pelvis

Question 23

what is extension?

Answer 23

after further decent the fetal head reaches the introitus

To accomodate the upward curve of the birth canal the flexed head now extends

Question 24

1. What is external rotation?
2. When does it occur?
3. then there is what?

Answer 24

1. the head rotatoes face forward relative to the shoulders (aka restitution)
2. after the delivery of the head occurs
3. expulsion or rapid delivery of the baby

Question 25

After the head delivery what do we need to manage? 5

Answer 25

1. check for nuchal umbilical cord 2. Deliver shoulders, trunk and legs 3. Clamp and cut cord within 15-20 seconds 4. place infant on mothers chest if not in distress then to warmer

Question 26

What should you do in the 3rd stage for management? | 4

Answer 26

1. obtain the cord blood while waiting 2. check for lacerations while waiting for cord to deliver 3. light tension on the cord when placenta separates 4. Usually give oxytocin IV after the delivery of the placenta

Question 27

Causes of postpartum hemorrhage? | 3

Answer 27

1. Urine atony- massaging, pitocin helps, cytotech rectally, IM methergen (cannot use on some with preeclampsia), hemobate- causes a lot of diarrhea, and can't give to patients with asthma balloon- fill with saline, acts as a turnaquette, slowly decrease the volume in the balloon. 2. Retained fragments of the placenta 3. cervical or vaginal lacerations

Question 28

Apgar score?

Answer 28

1. Appearance/Color? 2. Pulse? 3. Grimace/Relfex? 4. Activity/Tone? 5. Respirations?

Question 29

Apgar levels? 1. Appearance/Color? 2. Pulse? 3. Grimace/Relfex? 4. Activity/Tone? 5. Respirations?

Answer 29

1. blue. blue body pink but extremities blue, pink 2. 0, under 100, over 100 3. no response to stimuli, grimaces feebly, cries or pulls away 4. none, some flexion, felxes arm and legs resist extension 5. absent, weak irregular, strong cry

Question 30

How can we induce cervical ripening?

Answer 30

1. misoprostol and prostaglandin E 2. Laminaria- mechanical dilation of the cervix - mostly used for UIFD, or second term miscarriages. 3. Cytotech for cervical ripening.4

Question 31

Augment

Answer 31

1. Pitocin 2. AROM 3. Bishop score** starts out posterior and moves anterior