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General Questions

10 indications for ultrasound dating, bleeding, missed abortion, anatomy, placental location, multiple gestations, fluid level, fetal well-being, r/o placental abruption, detect IUGR, fetal position
Components of a BPP Fetal Movement, Muscle Tone, Reactive FHR, Breathing Movements, Amniotic fluid volume
Components of a Quad Screen Alpha Fetoprotein, Human chorionic gonadrotropin hormone, unconjugated Estridiol, Inhibin A
CBC Components White Blood Cell, Neutrophil, Lymphocyte, Monocyte, Eosinophil, Basophil, Red Blood Cell, Hemoglobin, Hematocrit, Mean Corpuscular Volume, Mean Corpuscular Hemoglobin, Mean Corpuscular Hemoglobin Concentration, Platelets
Normal FHR 120-160 BPM
Fetal Bradycardia Below 120 BPM
Fetal Tachycardia Above 160 BPM
When to offer RhoGAM 28 weeks, <3 days PP, with bleeding, abdominal trauma, miscarriage, amniocentisis, chorionic villus sampling
Listeria Food-Borne Illness, causes miscarriage and stillbirth, can cause menengitis in neonates, blood tests/referral if suspected, high risk if confirmed
CMV (Cytomegalovirus) Spread by infected blood, saliva, urine, and breast milk. Routine testing not indicated, usually detected by ultrasound showing typical abnormalities in fetus
Fifth's Disease (blank)
Risk Factors for GDM Obesity, Hx of abnormal glucose tolerance, hx of GDM, Diabetes in first degree relative, previous infant over 4000 grams (8# 12 oz), hx of poor obstetrical outcomes, hispanic, african, native american, south and east asina, pacific islanders
Diagnosis of GDM 3 hr GTT, 100 gram glucose drink after overnight fast, 2 high values diagnoses GDM
Screening for GDM 50 grams glucose after >2 hr fast, any high number - 100 gram test is indicated
3 hour glucose test values Fasting 95, One hour 180, two hour 155, three hour 140
Risks of GDM Increased UTI, PIH, subsequent Type 2 DM, macrosomia, shoulder dystocia, neonatal hypoglycemia
Antiphospholipid Syndrome 3-15% of women with recurrent pregnancy loss have this syndrome
Risk factors for ectopic pregnancy PID, IUD, DES, prior ectopic, prior tubal ligation,
Symptoms of ectopic pregnancy Most common: Abdominal pain (sharp, stabbing, tearing) and irregular bleeding. Possible: painful pelvic exam, posterior or lateral pelvic mass, neck or shoulder pain (likely already ruptured), diarrhea, low hcg, and more
Cervial Insufficiency Usual: hx of early 2nd trimester loss with painless dilation
Gestational trophoblastic disease symptoms irregular vaginal bleeding, uneven uterine enlargement, elevated hbg, pain, hyperemesis, size greater than dates, no fht's, shortness of breath
Thalassemia inherited anemia - suspect is CBC shows low hemotocrit/hemoglobin with low MCV and MCH
Consequences of anemia Weakness, fatigue, increased risk of pp bleeding, longer pp recovery, only severe anemia is likely to affect fetus
Sickle Cell Disease/Trait Recessive disorder (disease = two copies, trait = one), more common in women of african, mediterranean, caribbean, or middle eastern descent. Asymptomatic UTI more common. Women with sickle cell disease need careful management. Trait = test FOB
Chronic Hypertension >140 and/or >90 persistently, diagnosed prior to pg, before 20 weeks, or after 6 weeks pp
PIH >140 and/or >90, no proteinuria, previously not hypertensive
Pre-eclampsia >140 and/or >90, proteinuria (>30 mg/dL or +1), previously not hypertensive
Severe pre-eclampsia >160, >110, proteinuria (>2 g in 24 hours), increased serum creatinine, decreased platelet count, elevated hepatic enzyme activity, neurologic symptoms, epigastric pain
Eclampsia Any pre-e symptom + seizure
Risk factors for pre-eclampsia nulliparity, trophoblastic disease, multiple gestation, preexisting hypertension, renal disease, DM, family hx, personal hx, afrian or asian ethnicity
Symptoms of Pre-term Labor Uterine contractions or feelings of tightness, Menstrual like cramps, waves, or fluttering, Low, dull backache, rhythmic or constant, not relieved by change of position, Pelvic Pressure, Intestinal cramps, Changes in vaginal discharge, ROM
Know the anatomical locations and functions of uterine pacemakers There are two pacemakers sites found near the fallopian tubes that produce the rhythmic coordinated contractions of labor.
Describe the anatomical and activity changes of the uterine segments during labor Contractions usually begin in the cells near the fundus and spread like a wave downward
What is Uterine Tonus? Tonus is the lowest intrauterine pressure between contractions
Describe the mechanisms of effacement Prostaglandins activate enzymes in the cervix that digest the collagen fibers of the cervix. Effacement is the thinning of the cervix that takes place when the longitudinal muscle fibers shorten taking it from the shape of a cylinder to that of a funnel.
What is the mechanism of Dilation? Dilation is the actual opening of the external os caused by the retraction of the upper part of the cervix. It is both structural changes and the force of contractions that brings about dilation and effacement.
First Stage of Labor The first stage of labor is from the onset of labor to full dilation of the cervix. Encompasses Latent and Active Labor
Latent Phase Latent phase is a variable period after labor begins when contractions are becoming coordinated, stronger and more efficient. It may appear that little is happening during latent phase, but the cervix is working to become soft and pliable
Active Phase Active phase is when the cervix has reached 3-4 cm dilation. The contraction pattern may not appear that different, yet dilation usually proceeds more quickly in this stage.
Second Stage of Labor The second stage begins when dilation is complete (to 10 cm.) to the birth of the baby.
Third Stage of Labor Third stage is from the birth of the baby to the birth of the placenta.
Friedman Average Upper Normal * Average Upper Normal Latent Phase 8.6 hrs. 20 hrs. * 5.3 hrs. 14hrs. Active Phase 5.8 hrs 12 hrs * 2.5 hrs. 6hrs. 1st Stage of Labor 13.3 hrs. 28.5 hrs. * 7.5 hrs. 20 hrs. 2nd Stage of Labor 57 minutes 2.5 hrs. * 18 minutes 50
List different influences which affect a women's perception of labour pain. • Location of the stimuli • Intensity of the stimuli • Culture • Mood • Personality type
Analgesia Absence of normal sense of pain
Anesthesia Partial or complete loss of sensation with or without loss of consciousness.
Regional analgesia or anesthesia Nerve or field blocking causing insensibility or absence of pain over a particular area
gives these clinical indications as the start of second stage 1. increase in bloody show (may or may not happen), 2. the woman wants to bear down with each contraction (a likely indication), 3. she feels pressure on her rectum accompanied by the desire to defecate (also likely), 4. nausea and retching occur frequent
Describe common emotional/behavioral changes exhibited by woman as they progress through second stage of labor Woman can experience intense feelings of panic, a lack of control, or confusion. This can be due to the quick dilation and the urge to push. Woman may need caregivers to help them focus and try to explain pushing feelings to ease their fears. Woman may in
Gynecoid pelvis considered the “perfect female” pelvis, it is deep and broad. All diameters of this pelvis are adequate for labour and birth. Approx. 50% of woman have a gynecoid pelvis. (ischial spines are widely spaced and not prominent, pubic arch 90 or more
Anthropoid pelvis narrow from side to side, but deep from back to front and is usually adequate for birth. Approx. 25% of women. Ischia spines prominent but not restrictive
Android pelvis has more of a “male” shape and about 20% of women have this pelvic structure. The structure is short and narrow. The Android is often not adequate for vaginal birth.
Platypelloid pelvis this pelvis is flat from back to front and wide from side to side and often inadequate for vaginal birth. Approx. only 5% of women have this pelvis. (wide pubic arch)
Sutures the membrane – occupied spaces between the fetal skull bones. The are used to allow the overlap or molding of the fetal skull during birth and as land marks during vaginal exams to identify fetal position
Fontanelles the area on the fetal skull where the sutures intersect. There are two membrane filled fontanelles, the larger anterior (diamond-shaped) and smaller posterior (triangular). These are also landmarks used to assess fetal position during a va
Occiput the back of the head or the occipital bone
Sinciput the fetal brow and again is used to determine presentation
Bregma another name for the anterior fontenelle.
Vertex the area between the two fontenelles. It is the top of the skull
Biparietal diameter is the distance between the two parietal bosses.
Bitemporal diameter is the distance between the two extremities of the coronal suture
Vertex or “flexion” is the best fit. (presents at the pelvic inlet with the suboccipitobregmatic diameter, which is the smallest diameter of the fetal head about 9.5 cm)
Brow Presentation is very rare at about 1% and creates a 13.5cm presenting part. Vaginal birth is rare. (veriticomental diameter)
Face presentation the baby enters the pelvis chin first if well flexed with a diameter of about 9.5cm. (Presents with the submentobregmatic diameter which can be the same or slightly larger than the suboccipitobregmatic diameter.) Incidence <1%
synclitism the sagittal suture is midway between the symphysis pubis and the sacral promontory. This position gives the most room for the fetus to engage into the transverse position of decent.
asynclitism the sagittal suture is tilted to either the symphysis pubis or to the sacral promontory. This gives the fetus a tighter space to descend through. The position can cause failure to progress if not corrected with position change or manual rotation
molding – is the fetal head changing shape(since the bones of the fetal skull are not fused, they are able to overlap to fit a smaller space when needed) to maneuver the maternal pelvis.
caput – is a localized swelling of the scalp. Pressure from the cervix causes decreased venus return, creating edema. Caput is usually indentable on exam and the swelling can cross suture lines. It is evident at birth and usually resolves in a day.
cephalohematoma – is a hemorrhage under the periosteum of one or more bones of the skull. Cephalohematoma is caused by trauma to the skull from foceps, manual rotation, precipitate birth, or prolonged labour (and sometimes it just happens). Cephalohemato
Station refers to the relationship between the presenting part (usually the head) and the ischial spines of the woman’s pelvis.
Internal rotation baby’s head must turn from the transverse or slightly turned position to align the shape of the head with the anteroposterior (front to back) oval of the pelvic outlet. Both are achieved through the baby twisting his/her neck to navig
Extension opposite of flexion – the baby’s head moves chin away from chest. This occurs in order for the head to be born (in a OA birth). The occiput crowns, then the head extends to bring out forehead, face and chin.
Crowning when the largest transverse diameter of the head (biparietal) comes through the vulva.
Restitution once head is born, the baby untwists his/her neck and realigns with the shoulders (which, remember, have remained in an oblique relationship to the pelvic inlet..the head twisted in internal rotation, but the shoulders didn’t), usually OA to LOA or ROA
External rotation movement of head as shoulders turn to navigate the pelvis, usually ROA/LOA to ROT/LOT (yes, you determine that internal rotation of the shoulders has occurred by seeing the external rotation of the head.)
OA- Occiput Anterior
LOA- Left Occiput Anterior
LOT- Left Occiput Transverse
Created by: Jane_P