Back to the Basics! Fetal Heart Tracing Anesthesia Stages of Labor Labor Augmentation
100
FIRST!!
She states she has been having regular contractions every 5 minutes and some blood tinged mucous. In the office last week she was 2 cm. You check her cervix and she is now 4 cm, 50%, soft, anterior, -2 station.
What stage is she in?
100
110-160
minimum of 2 minutes in any 10 min segment
What is defined as a normal fetal heart rate?
How is baseline determined on EFM?
100
parental agents, epidural, spinal, general, pudendal blocks
Types of anesthesia available
100
Onset of labor (regular painful ctx q3-5min) to complete dilation. Latent phase - up to 4cm - Active phase - 4cm to complete.
Define the first stage of labor?
What are the 2 phases?
100
E1, 25mcg PV q 4hrs (ususally ~6doses), onset of 30 minutes, no no in VBAC!
MISOPROSTOL
What type of prostaglandin is it?
What is the dosing?
How fast does it work?
200
5 or less
A Bishops score of ____ suggests that labor is unlikely to start without an induction.
200
absent: undetectable
minimal:5 or less
moderate: 6-25
marked: >25
Define Absent/Minimal/Moderate/Marked variability
200
Demerol 25-50mg IV q1-2hr
Demerol 50-100mg IM q2-4hr
Morphine 2-5mg IV or 10mg IM q4hr
Phenergan 25mg IV
parental agents for labor pain
200
nulliparous = >20hrs
multip = >14hrs
What is considered a PROLONGED latent phase?
200
E2, 10mg, usually ~12hrs, per manufacturer: not to start Pit for 6hrs after removal
CERVIDIL
What type of prostaglandin is it?
What is the dosing?
How long does it stay in?
300
RESUSITATE! position change, oxygen to increase maternal-fetal O2 gradient, IVF bolus to corrent hypotension, discontinue PIT, SVE
You review a pts strip and notice late decelerations, what do you do?
300
early: head compression, mirrors ctx and onset to nadir >/=30sec, common in active labor 4-7cm
late: gradual decrease with onset to nadir >/=30sec, nadir after peak of ctx
variable: abrupt decrease, drop 15bts for 15sec but no more than 2 minutes
Define early, late, variable deceleration
300
epidural routine if plt >100,000
contraindicated if less than 50,000
anesthesia and thrombocytopenia
300
1.2cm/hr for nulliparous
1.5 cm/hr for multiparous
PROTRACTION DISORDER
What is the rate of cervical dilation in the active phase of labor for nullip vs multip?
What is the diagnosis if cervical change is less?
300
E2
PREPIDIL
400
Engagement, descent, flexion, internal rotation, extension, external rotation, expulsion
What are the Cardinal movements?
400
baseline110-160
variability: moderate
late/variables: absent
early: present or absent
define a Cat 1 tracing
400
therapeutic Lovenox stop >24hrs
prophylactic Lovenox stop >12hrs
heparin :6hrs
anesthesia and anticoagulation
400
complete dilation to delivery of infant
nullip: <3hr with epidural, <2hr
multip: <2hr with epidural, <1hr without
Define the 2nd stage of labor? How long should it take for nullip vs multip with and without an epidural?
400
Cook catheter, laminaria
Options for mechanical dilation
500
1500
In what year was the first successful cesarean section (with mother and baby both surviving)
500
absent variability in the setting of recurrent lates, variables or bradycardia OR sinusoidal pattern
define a Cat 3 tracing
500
post-dural puncture headache - IVF, caffeine, blood pathch (inject 20-30cc of the pts own blood into the epidural space)
what is the most common pp complaint following epidural anesthesia
500
delivery of placenta, <30minutes
cord lengthening, gush of blood, fundal rebound
Define the 3rd stage of labor?
Signs of cord separation?






Abnormal and Normal Labor

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