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LB&IPP

Labor, Birth, and the Immediate Postpartum

QuestionAnswer
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
Created by: elisaself