Duke PA Labor
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| Physiologic process by which a fetus is expelled from the uterus | Labor
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| Defined as an increase in myometrial contractility resulting in effacement and dilation of the uterine cervix | Labor
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| What are the two major functions of contractions during labor | To dilate the cervix, to push the fetus through the birth canal
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| What are the three mechanical variables during delivery known as the three P’s | the powers, the passenger, and the passage
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| One of the three P’s it is the force generated by uterine musculature | Powers
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| What does an external tocodynamometer measure | Number of contractions in an average 10 minute window, intensity, and duration of contractions
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| What is the most precise method of measuring contractions | Intrauterine pressure monitoring via internal pressure transducers (IUPC)
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| What is classically considered to be adequate labor | 3-5 contractions in 10 minutes, however there is no consensus for criteria
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| Macrosomia is considered to be an infant over __ | 4,500 g
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| What is the lie of the fetus | The longitudinal axis of the fetus to the uterus
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| What are the different presentations of the fetus | vertex, breech, shoulder, compound
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| What does the station of the fetus mean | A measurement of descent through the birth canal
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| How often are breech presentations found in term pregnancies | 3-4%
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| External cephalic version is routinely done after __ weeks | 36
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| What landmarks designate 0 station for the fetus | Ischial spines
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| Cardinal movements of labor: passage of widest diameter of presenting part to below the plane of the pelvis | Engagement
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| Cardinal movements of labor: downward passage of presenting part through the pelvis | Descent
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| Cardinal movements of labor: passive flexion of fetal head as it descends due to resistance related to body pelvis | Flexion
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| Cardinal movements of labor: rotation of presenting part (usually from transverse to anterior-posterior) | Internal rotation
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| Cardinal movements of labor: brings base of occiput in contact with the inferior margin of the pubic symphysis, head is delivered by extension | Extension
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| Cardinal movements of labor: rotation to the correct anatomic position in relation to the fetal torso | External rotation (restitution)
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| Cardinal movements of labor: delivery of body of fetus | Expulsion
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| What are the Cardinal movements of labor | Engagement, descent, flexion, internal rotation, extension, external rotation (restitution), expulsion
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| What is the first stage of labor | Onset of labor to full dilation
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| What is the second stage of labor | Interval between full dilation (10cm) and delivery
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| What is the third stage of labor | Time from delivery to expulsion of placenta
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| What are the risks of parenteral pain management in labor (fentanyl PCA) | Maternal risk for aspiration and respiratory depression, fetal risk for respiratory depression (common need for Narcan at delivery)
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| An epidural may slow down labor, however it does not increase the risk of __ | C-section
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| __ is characterized by the slow, abnormal progression of labor | Dystocia of labor
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| What is the leading indication of primary c-section | Dystocia of labor
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| What is the rate of c-section in the US | 1 in every 10 births
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| 60% of all c-sections in the US are attributable to the diagnosis of __ | Dystocia of labor
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| What terms should we never use when talking about dystocia of labor | Failure to progress, or CPD (cephalopelvic disproportion)
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| What are acceptable terms to use when referring to dystocia of labor | Labor slower than normal (protraction disorder), complete cessation of progress (arrest disorder)
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| What are the risk factors for prolonged labor | Older, medical (DM, HTN, obesity), macrosomia, prolonge rupture of membranes and or chorioamnionitis, short maternal stature, high station at complete dilation, occiput posterior position, pelvic abnormalities
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| What are the intervention options for arrest of descend | Forceps, vacuum, c-section
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| What is AROM | Artificial rupture of membranes
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| What are the contraindications of labor induction | Prior classical c-section, active genital herpes, placenta or vasa previa, umbilical cord prolapse, transverse lie
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| What is the best tool to predict the likelihood of successful labor induction (resulting in vaginal delivery) | Bishop score
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| A bishop score of __ or greater is favorable for induction of labor | 6
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| What are cervical ripening agents | Prostaglandins such as misoprostol
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| List the methods of labor induction | Cervical ripening agents (misoprostol), membrane stripping, oxytocin, mechanical dilation, amniotomy (artificial rupture of membranes)
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| What is the mechanism by which membrane stripping works to induce labor | Increases prostaglandin release
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| Delivery that requires additional maneuvers following failure of gently downward traction on the fetal head to effect delivery of the shoulders | Shoulder dystocia
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| What is the rate of shoulder dystocia | .06-1.4% of deliveries
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| What are the risk factors for shoulder dystocia | Maternal obesity, diabetes, hx of macrosomic infant, current macrosomia, hx of shoulder dystocia
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| Warning signs of shoulder dystocia | Prolonged 2nd stage, recoil of head on perineum (turtle sign), lack of spontaneous restitution
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| Fetal complications of shoulder dystocia | Brachial plexus injury, clavicle/humerus fx, asphyxia
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| Treatment for shoulder dystocia | McRoberts maneuver, episiotomy, suprapubic pressure, Rubin’s screw, Wood’s screw, delivery of posterior shoulder (humerus fx), Zavanelli
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| What is McRoberts maneuver | Dorsiflexion of hips against the abdomen to ease birth of fetus with shoulder dystocia.
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| What is the most common cause of postterm pregnancy | Error in dating
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| With postterm pregnancy what are the risks to the fetus | Stillbirth, meconium aspiration, intrauterine infection, uteroplacental insufficiency
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| With postterm pregnancy what are the risks to the mother | Increased labor dystocia, perineal injury related to macrosomia, and c-section rate
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| What are the leading causes of preterm deliveries | Preterm labor (PTL) and preterm premature rupture of membranes (PPROM)
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| Preterm delivery is before __ weeks | 37
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| Major determinant of infant mortality in developed countries | Preterm delivery
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| Preterm delivery is particularly acute among what group | African Americans
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| Leading cause of developmental disability in children | Preterm delivery
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| What are the key risk factors for preterm delivery | Smoking, African American, maternal age (young and old), social factors (poverty, poor housing, crime)
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| The fetal fibronectin test has a high __ value in predicting delivery within the next 14 days | Negative predictive
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| What is the best tool we have right now to determine patients not at risk for imminent delivery | Fetal fibronectin and cervical length
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| What is the purpose for prolonging pregnancy when the patient goes into preterm labor | To allow administration of steroids for fetal lung maturity and maternal transport to a facility with a NICU
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| What doesn’t work in preventing preterm labor | Bedrest, hydration, pelvic rest, antibiotics
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| What are the tocolytic agents used in the management of pre term labor | Beta-mimetic (terbutaline), magnesium sulfate, calcium channel blockers (Procardia), prostaglandin synthetase inhibitors (indomethacin)
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| What should be given to women at risk for preterm delivery between 24-34 weeks to reduce the risk of respiratory distress syndrome, mortality, and intraventricular hemorrhage | Antenatal steroids (betamethasone, dexamethasone)
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| What are the risk factors for PPROM | Intraamniotic infection, prior hx, lower SES/teens, smokers, hx of STD, hx of cervical cerclage, uterine overdistention
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| What do you do if the mother goes in to labor any time after 34 weeks | Proceed with delivery, GBS prophylaxis
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| What do you do if the mother goes in to labor between 24/23 -31 weeks | Expectant management, GBS prophylaxis, steroids recommended, tocolysis, antibiotics
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| What do you do if the mother goes in to labor before 24/23 weeks | Patient counseling about poor outcome, expectant management, no steroids, no GBS prophylaxis or antibiotics
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