[09.21] Labor & Delivery V2

Estimated Date of Delivery (EDD)

What does EDD stand for?

Transvaginal ultrasound (TVS)

What tool is used for patients with irregular menstrual cycles to compute for EDD?

Crown-rump length (CRL)

What is measured during a transvaginal ultrasound?

Longitudinal, Transverse, Oblique

What are the three types of fetal lie?

Relationship of the long axis of the fetus to the mother

What does fetal lie refer to?

Cephalic and Breech

A baby in a longitudinal lie can be delivered vaginally if what presentations are viable?

Cesarean Section (CS)

If the baby is in a transverse lie, what kind of delivery is needed?

Vertex, Sinciput, Brow, Face

What are the different types of cephalic presentation?

Vertex

What is the most common and ideal cephalic presentation?

Occiput

In a cephalic presentation, what is palpated during an internal examination (IE)?

Frank, Complete, Incomplete footling, Stargazing, Shoulder

What are the different types of breech presentation?

Ovoid

What fetal attitude describes a flexed head, convex back, and flexed thighs?

Mother’s right, Mother’s left, Mother’s posterior, Mother’s anterior

What are the four quadrants when determining fetal position?

Occiput

What is the marker for fetal position in a cephalic presentation?

Sacrum

What is the marker for fetal position in a breech presentation?

Fetal back

If the fetal position is occiput transverse, where are the heart tones heard?

Determine fetal heart tones, Determine if cephalic, breech, or transverse

What are the goals of Leopold’s Maneuver?

Fundal grip

What is the first step in Leopold’s Maneuver?

Fetal lie and presentation

What does the fundal grip determine?

Umbilical grip

What is the second step in Leopold’s Maneuver?

Fetal position

What does the umbilical grip determine?

Pawlick’s grip

What is the third step in Leopold’s Maneuver?

Confirm presentation and determine if the head is engaged or floating

What does Pawlick's grip determine?

Pelvic grip

What is the fourth step in Leopold’s Maneuver?

Descent and attitude

What does the pelvic grip determine?

Superior border of the symphysis pubis

Where is the 0 mark placed when measuring fundal height?

20th-34th week of pregnancy

During what period of pregnancy does fundal height in centimeters correspond to AOG?

Twins, Polyhydramnios, Fetal macrosomia, Myoma, Ovarian tumor

Name some of the possibilities if fundal height exceeds AOG.

Uterine contractions, Cervical effacement & dilation, Ruptured bag of waters

What are the criteria for a strict definition of labor?

Uterine contractions every 5 mins in 1 hour

How often should uterine contractions occur to identify labor?

Nitrazine, Ferning, Actim PROM (IGFBP-1)

What tests can be performed to confirm ruptured membranes?

pH >6.5

What pH level does the Nitrazine test need to be at to determine a positive result?

Fern-like pattern

What pattern is indicative of amniotic fluid presence in the Ferning test?

Uterus should be contracting, Intensity of uterine contractions should be 200 Montevideo Units (200 MVU), Bring about demonstrable cervical effacement and dilation

What are the basic requirements for labor?

Fetal tones and contractions of the mother

What does a fetal monitor register?

Internal Examination (IE)

Besides uterine activity, what else is crucial in diagnosing labor?

Multigravid

Is a parous cervix a sign of multigravid or primigravid?

Cervix is closed, ≤ 2 cm and Cervix is uneffaced (thick)

What are the cervical findings for a patient NOT in labor?

Cervix is open, ≥ 6 cm and Cervix is effaced (thin)

What are the cervical findings for a patient in labor?

Partograph

What tool is used to plot the dilation of the mother during labor?

Cervical ripening

What occurs during the Preparatory Division of labor?

Cervix is still closed or ≤ 2 cm and Slight contractions

What are the signs of cervical findings during the Preparatory Division of labor?

Active phase of labor

What occurs during the Dilatational Division of labor?

Cervix is dilated at 6 cm

What are the cervical findings during the Dilatational Division of labor?

Cervix is dilated at 8 cm

What are the cervical findings during the Pelvic Division of labor?

Nulligravid: dilation of 1.2 cm/hour and Multigravid: dilation of 1.5 cm/hour

What is the expected rate of cervical dilation per hour for nulligravid and multigravid patients?

6 cm

According to new nomenclature, what dilation marks the end of the latent phase and the start of the active phase?

From 0 cm (dilated) to 10 cm (fully dilated)

What is the range of cervical dilation in the first stage of labor?

Cervical dilation measures from 0 cm to 6 cm

What is the range of cervical dilation in the latent phase?

Cervical dilation measures from 6 cm to 10 cm

What is the range of cervical dilation in the active phase?

Acceleration phase, Phase of maximum slope, Deceleration phase

What are the subdivisions of the active phase?

From 10 cm to delivery of the baby

What defines the second stage of labor?

Arrest of Descent and Failure of Descent

What are the two types of descent abnormalities in the second stage of labor?

From baby out to delivery of the placenta

What defines the third stage of labor?

From delivery of placenta to first 2-3 hours postpartum recovery

What defines the fourth stage of labor?

Uterine atony

What is a potential complication during the fourth stage of labor?

Ischial spine

When performing an internal examination, what is palpated to determine the station of the fetal head?

Station 0

What station is it when the fetal head is at the ischial spine?

Station +4

What station is it when the head is seen at the introitus separating the labia?

Graph of labor parameters of time and dilation with alert and action lines

What is a partograph?

Patient Date and Obstetrical Diagnosis (OB Score and AOG), Fetal Heart Rate (FHR), Cervical Dilatation and Fetal Descent, Intensity and frequency of Uterine Contractions, Medications of mother, Maternal vital signs

What are the components of a partograph?

Engagement, Descent, Flexion, Internal rotation, Extension, External rotation, Expulsion

What are the 7 cardinal movements of labor?

Engagement

Which cardinal movement involves the greatest transverse diameter of the fetal head passing through the pelvic inlet?

Pressure of amniotic fluid, Direct pressure of the fundus on the breech, Contraction of abdominal muscles, Extension and straightening of the fetal body

What forces bring about descent?

Flexion

Which cardinal movement involves the fetal head meeting resistance from the cervix, pelvic floor, or pelvic walls?

Internal Rotation

Which cardinal movement involves the occiput gradually moving anteriorly toward the symphysis?

Extension

Which cardinal movement occurs because the vulvar outlet is directed upward and forward?

External Rotation (Restitution)

Which cardinal movement corresponds to the rotation of the fetal body?

Anterior shoulder appears under the symphysis pubis

What occurs during expulsion?

Uterine contractions every 5 minutes in 1 hour

Labor can be identified when there are uterine contractions every how many minutes in an hour?

Engagement

What cardinal movement involves the greatest transverse diameter of the fetal head passing through the pelvic inlet?

1 cm to 10 cm

What range defines the first stage of labor in terms of cervical dilation?

Full cervical dilation to fetal expulsion

What range defines the second stage of labor?

Fetal expulsion to placental separation and expulsion

What range defines the third stage of labor?

Hour after delivery

What defines the fourth stage of labor?

Membrane rupture without labor

What is Premature Rupture of Membrane (PROM)?

Chorioamnionitis (placental infection)

What can failure to deliver the baby within 12 hours of PROM lead to?

Emergency CS

What can anhydramnios lead to if not dealt with promptly?

Nonreassuring Fetal Status

What fetal status calls for the induction of labor?

Postterm Pregnancy (42 weeks)

What gestational period calls for the induction of labor?

Abnormal placental implantation (e.g., placenta previa), Prior uterine incision with high rupture risk (e.g., classical CS, myomectomy), Genital herpes infection, Contracted or distorted pelvic anatomy, Cervical cancer

What are some maternal contraindications for induction?

Macrosomia, Hydrocephalus, Malpresentation, Non-reassuring fetal status

What are some fetal contraindications for induction?

Prostaglandin E2 (e.g., Dinoprostone gel), Transcervical foley catheter, Extraaminionic saline infusion (EASI), Hygroscopic cervical dilators (e.g., laminaria tent)

What are some pre-induction methods?

Oxytocin

After the cervix is ripened, what pharmaceutical method can be used to induce labor?

Amniotomy

What is the process of rupturing the bag of water with a stick called?

Meconium staining

What does amniotomy help determine with regards to the amniotic fluid?

Membrane stripping

What procedure involves stripping the amniotic bag from membranes, releasing prostaglandins?

Auscultate after contraction or CTG assessment

How should intrapartum fetal monitoring be done?

Every 30 minutes

How often should low-risk patients be monitored during intrapartum?

Every 15 minutes

How often should high-risk patients be monitored during intrapartum?

Every 4 hours

How often are maternal vitals taken?

Frequency, duration & intensity

What aspects of contractions are monitored?

Lateral recumbency or sitting

What maternal positions are recommended during labor?

Cord prolapse

What is the risk of asking the patient to walk if the bag of water is already ruptured?

Relaxation techniques

What non-pharmaceutical techniques can help with pain management?

Water, clear tea, black coffee, carbonated beverages, popsicles, pulp-free juices

What clear liquids can a mother consume during labor?

Encouraged to void

Should a laboring patient be encouraged to void or not encouraged to void?

Aortocaval compression

Why should a laboring patient avoid supine positions?

Distention of bladder

What may hinder fetal descent?

Active Management of the Third Stage of Labor (AMSTL)

What does AMSTL stand for?