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Flashcards in normal labor and delivery Deck (18)
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1
Q

What is a normal nonstress test of the fetus? What should you do if you get an nonreactive test?

A

normal: two or more 15 bpm accelerations of fetal heart rate lasting at least 15 s, each within 20 minutes
if nonreactive, go on to get a biopysical profile

2
Q

What is done as part of a biophysic profile?

A

repeat nonstress test

do an ultrasound to measure amniotic fluid index, fetal breathing rate, fetal movement, and fetal tone

3
Q

How is the biophysic profile graded?

A
  1. reactive NST gets 2 pts
  2. amniotic fluid index 5-23 gets 2 pts
  3. 1 or mor rhythmic breathing episode lasting 20 s within 30 min period= 2 pts
  4. 2 or mor episodes of fetal movement in 30 min = 2pts
  5. 1 or more episode of spine and limb extension with return to flexion = 2 pts
4
Q

What is considered a reassuring biophysic profile?

A

score of 8-10. lower suggests fetal distress

5
Q

What is a contraction stress test?

A

fetal heart rate is recorded with external fetal monitor or fetal scalp electrote
-assess beat to beat variability of 5 bpm, long term heart rate variability and heart rate accelerations (2 or more 15 beat changes for at least 15 s within 20 min period) is reassuring

6
Q

What is an early decceleration and what is its significance?

A

decel begins and ends with uterine contraction

signifies head compression and is considered benign

7
Q

What is a late decceleration and what does it signify?

A

begins after initiation of contraction and ends after contraction has ended
suggests uteroplacental insufficiency (most common)
could also be due to maternal hypotension, venous compression, placental abruption, fetal hypoxia

8
Q

What is a variable decceleration and what does it signify?

A

inconsistent onset, duration, and degree

suggests umbilical cord compression

9
Q

What are the 4 stages of labor?

A
  1. latent and active phases
  2. full dilation until delivery of baby
  3. end of baby delivery to end of placenta delivery
  4. 1 hr post-partum
10
Q

What is the difference between the latent and active phases of labor?

A
  1. latent: start of contractions until 4 cm dilated and completely effaced
  2. active: dilation for 4 to 10 cm
    deceleration phase is the transition from active phase to stage 2
11
Q

How fast is normal for the active phase of labor?

A

first baby: 1.2 cm/hr
multip: 1.5 cm/ hr
in total should be

12
Q

What is the normal duration of the second stage of labor?

A

first baby:

13
Q

What factors are associated with greater likelihood of success for induction of labor?

A

more dilation, more effaced, station, cervical consistency, cervical position

14
Q

What are the 3 kinds of breech positioning?

A

frank breech: most common; thighs flexed and knees extended
complete breech: thighs and knees flexed
footling: one or both legs extended

15
Q

At what point in a pregnancy would you consider external cephalic versions?

A

37 wks gestation

16
Q

What are the complications of breech presentation?

A

C-section, cord prolapse, head entrapment, fetal hypoxia, placental abruption, birth trauma

17
Q

What are the indications for a vertical c-section?

A

few- low transverse is preferred
do vertical if fetus lies in transverse position, adhesions/fibroids prevent low transverse, cervical cancer is present, or post-mortem delivery of living fetus from dead mother
note that there is no VBAC or TOLAC for pts who have had a vertical c-section

18
Q

What are the indications for a c-section?

A

Mom: eclampsia (sometimes, though vaginal delivery usually preferred if possible), prior uterine surgery/prior C-section, cardiac disease of mom, obstruction of birth canal, maternal death, cervical cancer, active genital herpes,

baby: acute fetal distress, malpresentation, cord prolapse, macrosomia
both: failure to progress, placenta previa, placental abruption, cephalopelvic disproportion