! What is parturition?
labor, or the process of giving birth
! ____ is the physiologic process by which sufficiently frequent and strong uterine contractions cause thinning & dilation of the cervix
labor (also called parturition)
! What are the 4 pelvic window types?
Which is best suited for childbirth?
-Gynecoid (best suited for childbirth)
(don't worry about knowing what each shape is)
! Name the fontanelles (x4)
What is the suture that runs across the top of the skull?
-anterior (frontal) fontanel
-posterior (occipital) fontanel
! Name the bones of the neonatal skull (x3)
! Describe a fetus in zero station
head (biparietal diameter or widest part) is at the ischial spines (narrowest part of pelvic window)
! where is the narrowest part of the pelvis?
transverse diameter between ischial spines
! nulliparous vs primiparous vs multiparous vs grand multiparous
nulliparous: never given birth
primiparous: has given birth 1 time
multiparous: has given birth 2 or more times
grand multiparous: has given birth 5 or more times
! ___ refers to the number of times a woman has given birth
! Term birth are those occurring at ___ weeks or beyond. (preterm is before this)
*! Viability is generally considered at ___ weeks
! P 1-0-1-1 indicates:
1 term birth
0 preterm births
1 abortion (miscarriage)
1 living child
! P 3-1-1-3 indicates:
3 term birth
1 preterm births
1 abortion (miscarriage)
3 living child
! ____ is when a woman's cervix fails to dilate at the appropriate rate during the active phase of labor (cervical dilation "falls off the curve")
primary dysfunctional labor
! ____ is when cervical dilation ceases during a 2-hour period in the active phase of labor
secondary arrest of dilation
! A term for an abnormal progress of labor
! Which 2 intrapartum antibioticsre used to prevent chorioamnionitis?
(combat B streptococcus & E. coli which are important neonatal pathogens)
3 components of labor & delivery that determine the success or failure of the process
Top vs bottom portion of the uterus
top: active contractor
Early vs Late labor frequency, duration, pressure generated of contractions
____ is when a fetus' head is too large to fit through the mothers pelvis
cephalopelvic disproportion (CPD)
___ weeks is considered late post date delivery
___ describes how the position of the fetus relates to the long axis of the mother.
__ is good __ is bad
longitudinal is good
transverse is bad
___ position indicates head is the presenting portion overlying the pelvic inlet (occurs 95% of the time)
Cephalic (vertex, brow, face)
Identify the vertex presentations (picture)
Which are missing from the picture? (x3)
L occiput transverse (LOT)
L occiput anterior (LOA)
Occiput anterior (OA)
R occiput anterior (ROA)
R occiput transverse (ROT)
R occiput posterior (ROP)
L occiput posterior (LOP)
Occiput posterior (OP)
5 cardinal movements of labor
-engagement (station of BPD through pelvic inlet)
-descent (artificial term)
-flexion (more of occiput presents d/t axial pressures)
-internal rotation (to OA usually as transverse diameter meets narrowest part [ischial spines])
-extension (head rotates back after fetal head delivered)
Station is associated with which of the 5 cardinal movements of labor?
Why is descent an artificial term?
occurs throughout the birth process unless arrested descent
Preferred vertex presentation for gynecoid pelvis
occiput anterior (OA)
What is the system for describing parity
abortion (spontaneous or induced)
The ___ curve describes the ____ phase (preparatory phase when cervix softens) & the ____ phase (cervical dilation phase) of the 1st stage of labor.
What does it mean if a woman has "fallen off the curve"
cervical dilation is not dilating at the appropriate rate (primary dysfunctional labor or secondary arrest of dilation)
The maximum duration for 2nd stage of labor allowed is:
multiparous: ___ without epidural ___ with
nulliparous: ___ without epidural ___ with
multiparous: 1 hour without epidural 2 hours with
nulliparous: 2 hours without epidural 3 hours with
Why might anesthesia be asked to give NTG after the 2nd stage of labor?
it is a smooth muscle relaxant used to help with uterine inversion or to help get placental tissue out
____ is when the placenta embeds in the uterus
How is this managed?
placenta acreta (like concrete)
3 uterotonic agents & doses
oxytocin 10-20 units in 1L bag
methergonovine 0.2 mg IM
hemabate 0.5 mg IM [15-methylprostaglandin F(2-alpha)]
Hemabate can cause ____ & should be avoided in susceptible pts
Risk for giving oxytocin too quickly
What is the 4th stage of labor
60 minutes after delivery of the placenta (mom must be watched closely for bleeding)
Oxytocin has a ____ effect
Risks for PROM (x2 + x3 in 2nd trimester)
-chorioamnionitis (24 hr window)
How long from rupture of membranes at term before risk for amnionitis? How long will the OB wait if ROM occurs & labor has not yet commenced? What will he do?
12 hours without labor OB will start oxytocin
___ weeks gestation before elective induction of labor
Forceps delivery & vacuum extraction are considered ___ vaginal deliveries
Describe shoulder dystocia
What are the complications from shoulder dystocia? (x2)
-after head delivered it seems to get sucked back into the perineum because the anterior shoulder is getting trapped under the pubic symphasis
-cord compression (asphyxia) & Erb's palsy d/t traction on the brachial plexus