Labor, Birth, and the Immediate Postpartum
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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
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T/F: In LOA, the sinciput has a greater distance to travel through the birth canal than the occiput. | True
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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
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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.
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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
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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
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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
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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
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T or F The most common position at the onset of labor is LOT | True
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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.
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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If flexion takes place LMA goes to ________ and RMA goes to ______ . | ROP; LOP
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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
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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
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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
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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
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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
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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
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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
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In the breech presentation, what are the 3 mechanisms of labor? | Descent & flexion, internal rotation of breech, birth of buttocks by lateral flexion
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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
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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
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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
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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
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Position: Transverse Lie Lie: Presenting part: Denominator: | Lie: horizontal or oblique
Presenting part: shoulder, back, abdomen, ribs, or flank
Denominator: scapula
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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
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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
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most frequent combination of compound presentations? | The head and the hand
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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
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