Principles 1 Flashcards by Iseoluwa Ojo

Labor: is the process whereby the ____________ is _________ via the
______ after ______________ and characterized by ________, ________, __________ uterine contraction leading to progressive _________ and ______________ , descent of the
presenting part and eventual delivery of the _______ and _______

whole content of the uterus

expelled; birth canal

the age of viability

Palpable ; rhythmic ; painful

cervical dilatation ; effacement

fetus ; placenta

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Caesarean section: delivery of the product of conception by ________________ (before or after?)
age of viability

incising the uterus

After

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Abortion: _________ or __________ of the product of conception via the _________ (before or after?) age of viability

expulsion or extraction

birth canal

Before

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Hysterotomy: _________ of the product of conception by ______________ (before or after?) age of viability

extraction

incising the uterus

Before

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Preterm labor: ___-_____weeks

Term labor:______ completed weeks - ________

28 - 37

41weeks + 6 days

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Characteristics of true labor

________,_______,________ (>___ in _____ min) uterine contraction
Progressive cervical _________ and _________
_________ of the presenting part
Passage of ________
_________ of membranes

Painful, progressive, periodic

1; 10

effacement and dilatation

Descent; show; Rupture

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Show is a ?

blood-tinged cervical mucus

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True labor can be abolished by analgesia

T/F

It can not

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Characteristic of false labor
- Characteristics of true labor are not fulfilled
- Can be abolished with analgesia (e.g. 100 mg of pethidine IM)

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Characteristic of false labor
- Characteristics of _________ are not fulfilled

true labor

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False labor Can be abolished with analgesia

T/F

E.g. 100 mg of pethidine IM

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There are ______ stages of labor

Four

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Stages of labor : First Stage

During which cervix dilates from ____ -____ cm
Has two phases:
• ________ phase
• ________ phase

0-10

Latent

Active

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Stage 1: Latent phase

From zero concept of cervical dilatation to ___-___ cm irrespective of gravidity

____________ of the cervix will be complete by the end of this phase
Duration: ___________

Prolonged latent phase: latent phase >________ (to a maximum of ___________)

False labor: latent phase > _________ (may be contractile or non-contractile)

3-4

Effacement

3-8 hours; 8 hours

24 hours ; 24 hours

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stage 1: Active phase

Cervical dilatation from 3-4 cm to _____ cm (full cervical dilatation)

Duration:________ (_____ hours maximum)

2-6 hours; 12

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In labour

Dilatation typically occurs at ____cm/hour; considered abnormal if < ___cm/2 hours

1cm/hour;

1cm/2 hours

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Prolonged labor:_______ phase >________

active

12 hours

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Second Stage of labour

Begins with ______________ and ends with _______________

lasts about ________ in primigravida and ________ in multigravida

Has two phases:
Phase I (_______ or _________ phase)
• Phase Il (________ or _______ phase)

full cervical dilatation

delivery of the fetus (es)

2 hours; 1 hour

propulsive or passive

expulsive or active

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• Stage 2: Phase I
From full cervical dilatation till the _____________ reaches the __________
- lasts ________ in primigravida and multigravida (may be prolonged by recent epidural top-up)

leading part of the fetus

pelvic floor

1 hour

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• Stage 2 : Phase II
From when the fetal presenting part reaches the pelvic floor till the ___________
Here, mother experiences ______________________________________

P r o l o n g e d 2nd stage: 2nd stage >2 hours (or >3 hours in women with epidural a n e s t h e s i a )

baby is delivered

an irresistible urge to “bear down” and push

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Third stage of labour
Involves ___________ from the ___________ , descent to the lower uterus and expulsion with the membranes
- Lasts about ________ (maximum of _______)

placental separation

uterine wall

10 min; 30 min

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Retained placenta: after _________ of delivery of the fetus, the placenta is yet to be out

30 min

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Signs of placenta separation
- Apparent __________ of the cord
-A small ____________ per vaginam
-Rise of __________ to _____________
- Uterus ________ to become ______ and ____________

lengthening

gush of blood

uterine fundus; above the umbilicus

contract; firm

globular

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Fourth Stage of labour

Here patient _______ are monitored every ________ for the ___________ post-
delivery

____________ is kept to monitor bleeding per vaginam

Blood loss should be ≤_______ mLs

vital signs; 15 mins

first 1 hour

Perineal pad

500

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Mechanism of Labor This is the series of changes in ________ and _________ the fetus undergoes during its passage through the birth canal

position and attitude

Sequence of mechanism of labour

(EDFIERE): Engagement, Descent, Flexion, Internal rotation, Extension, Restitution, External rotation

Episiotomy: is a _________________________ made on the _________ to _________ the _________ of _________ to assist child birth

deliberate surgical incision perineum ; widen diameter ; vulva outlet

indications of Episiotomy - Imminent ________ -________ perineum -________ delivery -________ vaginal delivery -Preterm labor -_____________ - __________________ repair

perineal tear Rigid; Breech Instrumental; Shoulder dystocia Vesico-vaginal fistula

Instrumental vaginal delivery can be an indication to do an episiotomy all _________ not all __________

forceps vacuum

Types of Episiotomy • Midline: incision is made in __________________ separating the bulbospongiosus, superficial and deep transverse perineal muscle. -(Easier or Harder?) to repair, heals (well or poorly ?) - (more or less?) painful -bleeds (more or less?) - dyspareunia is (more or less?) common.

the centre of the perineum Easier ; well; less ;less; less

Types of Episiotomy • Mediolateral: -incision is made at ______________ . -(More or Less?) difficult to repair -healing takes (shorter or longer?) and may be faulty, bleeds (more or less?) - may be followed by _________ as the __________________ may be damaged. However, it rarely extends to the ____________

45° to the midline More; longer; more dyspareunia; Bartholin's gland (for lubrication) anal sphincter

commonest Type of Episiotomy is??

Mediolateral

In midline episiotomy , ___________________ is a major draw back

extension through the anal sphincter

Types of episiotomy • J-shaped: made _________ to the top of the anus i.e. a _______ which is then extended _________

tangential midline; laterally

Instrument used in episiotomy is ____________ Incision: made during ___________________ in the _______ stage at _________

episiotomy scissors uterine contraction; second; crowning

Episiorrhaphy: done with Vicryl 2/0 suture under good analgesia

Yeah

Maternal Complications of episiotomy • Early _________ __________ _________ Late ___________ Psychosexual problem e.g. ________ ___________(rare) _________

Hematoma ; dehiscence ; infection Dyspareunia; vaginismus Endometriosis; fistulas

Fetal Complications of episiotomy _____ laceration Risk of _______ of ____________ _________ to local anesthesia

Lip transmission of HIV or hepatitis Hypersensitivity

Grading of perineal tear 1st degree: laceration of the _________________ • 2nd degree: laceration of the ________________ and _______________; • 3d degree: 2nd degree with involvement of ______________________ 4th degree: 3rd degree with _______________________________ extending into the ___________

skin/vaginal epithelium skin/vaginal epithelium and perineal muscles any part of the anal sphincter complex injury to the anal sphincter complex rectal mucosa

episiotomies are _____ grade perineal tears

2nd

Diagnosis of pre gestational diabetes Symptoms of diabetes plus random plasma glucose concentration >______ mmol/L - Fasting plasma glucose ≥____ mmol/L) - Two-hours plasma glucose level ≥_______ mmol/L during an oral glucose tolerance test (OGTT) - HbA1c ≥______% using a standardized assay

11.1 7 11.1; 6.5

fasting is defined as no caloric intake for at least ______

8 hours

Treatment of Pregestational Diabetes Preconceptional care - Complete history and physical examination: all teratogenic medications e.g. ______________ are discontinued and prenatal vitamins, containing minimum of ____mg of folic acid, are prescribed - Assessment of glycemic control: medications, diet and exercise are adjusted. HBA1c <____ % is the target - Eye examination for _________ with careful follow-up or treatment (if needed) Assessment of _____ function: E, U and Cr as well as 24hour urine for albuminuria Assessment of _______ function: particularly in type 1 diabetics

angiotensin converting enzyme (ACE) inhibitors 0.4 mg; 7; retinopathy; renal; thyroid

Treatment of Pregestational Diabetes **_________- care Achievement of __________ level before pregnancy Frequent (_____ times/day) home glucose monitoring Adjustment of _____ Regular ________ (non-weight bearing)

Preconception normal HbA1c 6; diet ; exercises

Medications in pregestational diabetes : should be changed to _______ (0.7 IU/kg in first trimester and progressively to 1IU/kg later in the gestation) ________ and glyburide may be continued

insulin metformin

Care of the patient with pre gestational diabetes during antenatal period 1st trimester:_________ is done to document ________ of pregnancy, other routine antenatal laboratory investigations are done and medications are given.________ culture is also indicated, due to increased risk of urinary tract infection in them 2nd trimester:______________ scan is done around _______ weeks as well as _____________ , to screen for congenital heart diseases 3rd trimester: ultrasound is done to assess ___________. Fetal surveillance is Kicked between ______ wks (________ test twice weekly and mother keeps ___________ daily)

ultrasound ; viability; Urine fetal anomaly ultrasound; 18-22 fetal echocardiography; fetal growth 32-34 ; non-stress; fetal kick chart

Delivery in a patient with pre gestational diabetes In the absence of clear indication for delivery e.g. preeclampsia, induction of labor is done at ______ weeks; however, If estimated fetal weight is > _______g, ____________ should be performed

39 4000 caesarean section

GESTATIONAL DIABETES MELLITUS (GDM) • GDM: is any degree of glucose intolerance with onset or first recognition during _________________ - The hall mark of GDM is _______________ , and as such is etiologically related to type ____ D M

pregnancy insulin resistance 2

Risk Factors of GDM - Age > 35-40 years -______ (non-pregnant BMI > 30 kg/mª) -_____________ of GDM -Heavy _______ (> ___ on dipstick) -History of unexplained _______ -Polycystic ovarian syndrome -Strong family history of _________

Obesity Previous history glycosuria; 2* still birth; diabetes

Preeclampsia: is an idiopathic _________ _____________ disorder characterized by ________________ on at least ______ occasions _______ apart, and _________________ arising de novo after ________ week of gestation and resolving completely within ________ weeks after delivery

progressive multi-systemic elevated blood pressure of ≥ 140/90 mmHg two; 4–6 hours ; significant proteinuria 20th; 6-12

Significant proteinuria: >_____ mg of protein in a 24 hour urine collection >____ of protein on dipstick on at least 2 occasions - Urinary protein to creatinine ratio >_____

300; 2+ 0.3

Moderate risk factors Age ≤ 18 or ≥ 35 yrs _________ of preeclampsia ________ New paternity Interpregnancy interval of >_______ _________ gestation BMI of _____ or more _______ race

Family history Primigravidity 10 yrs; Multiple 35; white

High risk factors of pre-eclampsia ___________ Hyperplacentosis Hydrops fetalis ____________ ____________ of preeclampsia ____________ Pre-existing ________ Hydatidiform mole ____________

Chronic hypertension Antiphospholipid syndrome Previous history Systemic lupus erythematosus renal disease; Diabetes mellitus

Mild pre-eclampsia Blood pressure between ≥______mmHg - <______mmHg on at least 2 occasions, 4-6 hours apart while patient is on ______

140/90 160/110 bed rest

Severe preeclampsia Blood pressure ≥_______ mmHg on at least 2 occasions, 4- 6 hours apart while patient is on bed rest or blood pressure >_______ mmHg on one occasion - Proteinuria of ____ g in 24 hour urine sample or ≥____ on two random urine samples collected 4 hours apart

160/110 180/120 25; 3+

Imminent eclampsia is the correct diagnosis if severe preeclampsia is associated with the following: ________ _________ of _______ ________ and ________ ________ pain Right hypochondriac pain - Hyperreflexia -______________ or cyanosis Fetal growth restriction - Cerebral disturbances

Headache Blurring of vision Nausea and vomiting Epigastric Pulmonary edema

Indications for delivery in a pre-eclampsia patient before term: ________ blood pressure non-reassuring _________________ ________________ __________________

uncontrolled fetal cardiotocography oligohydramnios; eclampsia

Pritchard’s regimen Loading dose:_____ g of ______ given as: ____ g (diluted as 20% slowly ____ over _______ min and _____g is then given _____ into each buttock

14; MgS04; IV 4; 15-20 5 ; IM

Pritchard’s Regimen Maintenance dose: ___g of ______ is given ____ into alternate buttock ____ hrly Should continue for at least _________ after ________ or ____________

5; MgS04; IM 4 24hrs delivery or last convulsion

Complications of Pre-eclampsia Abruptio placentae Cerebral hemorrhage Pulmonary edema Renal failure Heart failure Liver failure HELLP syndrome Intrauterine growth restriction Intrauterine fetal death Preterm labour Coagulation failure Eclampsia Blindness Death

Everything huh

Eclampsia: is the onset of ________________________ in a pregnant woman, with signs and symptoms of ______________ or pregnancy-induced hypertension during pregnancy, in labor or within _________ after delivery, with no medical, organic or neurological cause of the convulsion

generalized tonic-clonic convulsion preeclampsia; 7-10 days

• Etiology of eclampsia : is unknown; presumed to be due to ______________

cerebral vasospasm

Antidote to MgSO, toxicity: 10mL of ________________ given slowly IV

10% calcium gluconate

Signs of MgS0, toxicity Loss of ___________ reflexes Respiratory rate <____ cpm Oliguria < 25 mL/hour _____ speech ___________

deep tendon 12; Slurred Cardiac arrest

Principles 1 Flashcards

(64 cards)