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LB&IPP
Labor, Birth, and the Immediate Postpartum
Question | Answer |
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Movements of Labor for LOA Descent and flexion: Internal rotation: Extension: Restitution: External rotation: | Descent and flexion: LOA Internal rotation: LOA to OA, 45 degrees Extension: OA Restitution: OA to LOA, 45 degrees External rotation: LOA to LOT, 45 degrees |
T/F: In LOA, the sinciput has a greater distance to travel through the birth canal than the occiput. | True |
Explain what the (dirty) Duncan method of placenta expulsion is. | The lower edge of the placenta comes out first, with the maternal and fetal surfaces appear together, and the rest of the organ slides down |
Explain what the (shiny) Schultze method of placenta expulsion is. | When the placenta comes out like an inverted umbrella, with the (shiny) fetal side appear first and the rest of the organ coming behind it. |
LEFT OCCIPUT TRANSVERSE, LOT. Lie: Presentation: Presenting part: Attitude: Denominator: Presenting diameter: | Lie: Longitudinal Presentation: cephalic Presenting part: vertex Attitude: flexion Denominator: occiput Presenting diameter: suboccipitobregmatic diameter, 9.5cm |
LOT Abdominal Examination. Lie: Head: Back: Small parts: Breech: Cephalic prominence: FHT: | Lie: Longitudinal Head: At or in the pelvis Back: left Small parts: right, clearly felt Breech: fundus Cephalic prominence: forehead on right FHT: LLQ |
Movements of Labor for LOT Descent and flexion: Internal rotation: Extension: Restitution: External rotation: | Descent and flexion: LOT Internal rotation: LOT to LOA to OA, 90 degrees Extension: OA Restitution: OA to LOA, 45 degrees External Rotation: LOA to LOT, 45 degrees |
LOT Vaginal Examination. Sagittal suture: Posterior fontanelle: Bregma: Flexion: | Sagittal suture: transverse diameter of the pelvis Posterior fontanelle: left, 3 o'clock Bregma: maternal right, 9 o'clock Flexion: occiput lower than the brow |
T or F The most common position at the onset of labor is LOT | True |
What is transverse arrest? | When there is no rotation from the transverse position - the head is arrested with the sagittal suture in the transverse diameter of the pelvis, too wide to fit through. |
RIGHT OCCIPUT POSTERIOR, ROP. Lie: Presentation: Presenting part: Attitude: Denominator: Presenting diameter: | Lie: longitudinal Presentation: cephalic/vertex Presenting part: middle or anterior area of let parietal bone Attitude: deflexed, long arc Denominator: occiput Presenting diameter: occipitofrontal diameter, 11.5cm |
ROP Abdominal Examination. Lie: Head: Back: Small parts: Breech: Cephalic prominence: FHT: | Lie: vertical Head: at or in the pelvis Back: right maternal flank, not easily felt Small parts: anteriorly on the left side Breech: fundus Cephalic prominence: left, not easily felt FHT: Right maternal flank or LLQ |
ROP Vaginal Examination. Sagittal suture: Posterior fontanelle: Bregma: Flexion: | Sagittal suture: right oblique diameter of pelvis Posterior fontanelle: right posterior segment of pelvis Bregma: anterior and left of the symphysis pubis Flexion: close to same level as pelvis |
Movements of Labor for ROP - long arc Descent and flexion: Internal rotation: Extension: Restitution: External rotation: | Descent and flexion: ROP Internal rotation: ROP to ROT to ROA to OA, 135 degrees Extension: OA Restitution: OA to ROA, 45 degrees External Rotation: ROA to ROT, 45 degrees |
Movements of Labor for ROP - short arc Descent and flexion: Internal rotation: Extension: Restitution: External rotation: | Descent and flexion: ROP Internal rotation: ROP to OP, 45 degrees Birth by flexion: OP Head falls back to extension: OP Restitution: OP to ROP, 45 degrees External Rotation: ROP to ROT, 45 degrees |
LEFT MENTUM ANTERIOR, LMA. Lie: Presentation: Presenting part: Attitude: Denominator: Presenting diameter: | Lie: longitudinal Presentation: cephalic/face Presenting part: face (left malar bone - Myles) Attitude: complete extension Denominator: Mentum/chin Presenting diameter: submentobregmatic diameter, 9.5 cm |
LMA, Abdominal Examination. Lie: Head: Back: Small parts: Breech: Cephalic prominence: FHT: | Lie: longitudinal Head: at the pelvis Back: right side of mother's abdomen Small parts: left and anterior Breech: fundus Cephalic prominence: right, same side as back FHT: LLQ |
LMA, Vaginal Examination Vertex: Long axis of face: Chin: Forehead: Flexion: | Vertex: not easily palpated Long axis of face: right oblique diameter of the pelvis Chin: left anterior quadrant of maternal pelvis Forehead: right posterior quadrant Flexion: Full extension |
Movements of Labor: LMA. Extension and descent: Internal rotation: Flexion: Restitution: External Rotation: | Extension and descent: LMA Internal rotation: LMA to MA, 45 degrees Flexion: MA - birth by flexion Restitution: MA to LMA, 45 degrees External Rotation: LMA to LMT, 45 degrees |
LEFT MENTUM TRANSVERSE, LMT, Abdominal Examination. Lie: Head: Back: Small parts: Breech: Cephalic prominence: FHT: | Lie: longitudinal Head: at the pelvis Back: to the right Small parts: left side Breech: fundus Cephalic prominence: right, same side as back FHT: LLQ |
Describe Movements of Labor: LMT. Extension and descent: Internal rotation: Flexion: Restitution: External Rotation: | Extension and descent: LMT Internal rotation: LMT to LMA to MT, 90 degrees Flexion: MT - birth by flexion Restitution: MA to LMA External Rotation: LMA to LMT |
LEFT MENTUM POSTERIOR, LMP, Abdominal Examination. Lie: Head: Back: Small parts: Breech: Cephalic prominence: FHT: | Lie: longitudinal Head: at the pelvis Back: anterior and to the right Small parts: left and posterior Breech: fundus Cephalic prominence: right and anterior, same as back FHT: LLQ |
If flexion takes place LMA goes to ________ and RMA goes to ______ . | ROP; LOP |
LEFT FRONTUM ANTERIOR, LFrA. Lie: Presentation: Presenting part: Attitude: Denominator: Presenting diameter: | Lie: longitudinal Presentation: frontum Presenting part: area between the orbital ridges and the bregma Attitude: partial extension Denominator: frontum Presenting diameter: verticomental, 13.5 cm |
LFrA, Abdominal Examination. Lie: Head: Back: Small parts: Breech: Cephalic prominence: FHT: | Lie: longitudinal Head: at the pelvis, not engaged Back: maternal right and posterior Small parts: left and anterior Breech: fundus Cephalic prominence: right, same side as back FHT: LLQ |
LFrA, Vaginal Examination Anteroposterior diameter: Brow: Vertex: Bregma: Frontal suture: Sagittal suture: Flexion: | Diameter: right oblique diameter of the pelvis Brow: left anterior quadrant of the pelvis Vertex: right posterior quadrant Bregma: easily palpated Frontal suture: can be felt Sagittal suture: not easily palpated Flexion: partial extension |
Movements of Labor: LFrA. Extension and descent: Internal rotation: Flexion: Extension: Restitution: External Rotation: | Extension and descent: LFrA Internal rotation: LFrA to FrA, 45 degrees Flexion: FrA - birth by flexion Extension: FrA Restitution: FrA to LFrA, 45 degrees External Rotation: LFrA to LFrT, 45 degrees |
Median Vertex Presentation: Military Attitude. Lie: Presentation: Presenting part: Attitude: Denominator: Presenting diameter: | Lie: longitudinal Presentation: cephalic Presenting part: Vertex Attitude: neither flexion or extension Denominator: occiput Presenting diameter: occipitofrontal, 11 cm |
Military, Abdominal Examination. Lie: Head: Back: Small parts: Breech: Cephalic prominence: FHT: | Lie: longitudinal Head: at or in the pelvic inlet Back: either left or right flank Small parts: opposite the back Breech: fundus Cephalic prominence: no marker cephalic prominence FHT: LQ |
Military, Vaginal Examination. Sagittal suture: Posterior fontanelle: Bregma: | Sagittal suture: felt in the transverse diameter of the pelvis, as LOT or ROT Posterior fontanelle: easy to palpate and identify - at the same level as the anterior fontanelle Bregma: able to palpate and identify, same level as the occiput |
In the breech presentation, what are the 3 mechanisms of labor? | Descent & flexion, internal rotation of breech, birth of buttocks by lateral flexion |
Position: RSA. Lie: Head: Back: Small Parts: Breech: Cephalic prominence: FHT: | Lie: longitudinal Head: at the fundus Back: on the right near the midline Small Parts: on the left, away from midline, and posterior Breech: over or in the pelvis Cephalic prominence: none, and the breech is not ballotable FHT: above umbilicus, RUQ |
Describe Diagnosis of Position RSA Vaginal Examination | Sacrum: Smooth, regular, hard head is absent. presenting part is soft and irregular, and the anal orifice and ischial tuberosities are in a straight line. In frank breeches the sacrum is pulled down and felt by the examining finger |
Mechanisms of Labor, Buttocks and Lower Limbs: RSA. Descent and flexion: Internal rotation: Lateral flexion: | Descent and flexion: RSA Internal rotation: RSA to RST Lateral flexion: RST |
Mechanisms of Labor, Shoulders and Arms: RSA. Engagement: Internal rotation of shoulders: Lateral flexion: | Engagement: RST to RSA Internal rotation of shoulders: RSA to RST Lateral flexion: RST |
Position: Transverse Lie Lie: Presenting part: Denominator: | Lie: horizontal or oblique Presenting part: shoulder, back, abdomen, ribs, or flank Denominator: scapula |
Transverse Lie: Abdominal Examination Lie: Fundus: Upper and lower poles: Head: Buttocks: FHT: | Lie: Transverse Fundus: lower than expected Upper and lower poles: reveals never head nor breech Head: in either maternal flank Buttocks: opposite the head FHT: Below the umbilicus |
Diagnosis of Position Transverse Lie: Vaginal Examination Head: Breech: Presenting part: | Head: not able to be felt Breech: not able to be felt Presenting part: high - may be shoulder, hand, rib cage, or back Note: Binding the mother’s belly and giving the mother homeopathic pulsatilla can be helpful |
most frequent combination of compound presentations? | The head and the hand |
List the combinations of presentation of breech in descending order of frequency | Two vertex; Vertex and breech; Two breeches; Vertex and transverse lie; breech and transverse lie; two transverse lie |