Midwifery boards- Intrapartum Study
Quide Questions and Answers.
adolescent- factors in pregnancy/ IP -
\Prone to late entry to care and poor compliance with AP schedule
Increased risk for LBW and PTL; HTN disorders in pregnancy; PTL and PTB, IUGR,
infant mortality
Advanced maternal age (older than 35 years) -
\Higher incidence of infertility and 1st-trimester SAB and ectopic pregnancy
Proportional increase in rates of genetic abnormalities with advancing age
increased rates of complications including:
HTN disorders of pregnancy
PTB
Gestational DM
Dysfunctional labor leading to c-section
Relationship to underlying dz processes
placenta previa and abruption
Race / ethnicity and pregnancy -
\Increased rate of LBW babies to AA
Certain genetic disorders are increased within specific ethnic groups
Nullipara on average have _____ labors -
\longer
Multpara on average have ______ labors -
\shorter
Grand multiparous women (greater than 5) can have ______ -
\prolonged dysfunctional labors
Increased parity is associated with -
\abruption placenta; placenta previa; multifetal pregnancy; PPH
Grand multiparty can contribute to abnormal presentation including transverse lie
Naegele's rule -
\add 7 days to 1st day of LMP and subtract 3 months
US dating is most accurate -
\if done in 1st trimester
,Gravidity -
\total number of pregnancies
Parity -
\outcome of previous pregnancies
T- term
P- preterm
A- abortions
L- living
Indications for sterile speculum exam during IP -
\Before digital exam if ROM is suspected, frank bleeding is present, or inspection for
herpetic lesions is necessary
Digital exam -
\Dilation
Effacement
Station- 0= presenting part in level with ischial spines
-3, -2, -1= number of centimeter above ischial spines
+1, +2, +3= number of centimeter below ischial spines
Presenting part
position- relationship between the denominator of the presenting part and the maternal
pelvic
1) cephalic presentation0 tje denominator is the occiput
2) breech presentation- the denominator is the sacrum
3) shoulder presentation- the denominator is the scapula
4) face presentation- the denominator is the mentum
Status of membranes
clinical pelvimetry -
\Determination of adequacy of bony pelvis
Pelvis is made up of 4 bones... -
\Two innominate
Sacrum
Coccyx
Symphysis paving joins the two -
\innominate (pubic) bones anteriorly
True pelvis defines the birth canal -
, \inlet boundaries are at the level of the sacral promontory ( posteriorly)m the line
terminals (laterally), and the upper margins of the pubic bones (anteriorly)
Midplane of the pelvis is known as the "plane of least dimensions" and the boundaries
are the sacrum at the junction of the fourth and fifth sacral vertebrae (posteriorly), the
ischial spines (laterally), and the inferior border of the symphysis pubis (anteriorly).
Outlet boundaries are the saccrococcygeal joint (posteriorly), the inner surface of the
ischial tuberosities (laterally), and the lower border of the symphysis pubis anteriorly
Gynecoid pelvis -
\Round shaped pelvis
transverse diameter only slightly longer than anteroposterior
incidence- 505% white women
Excellent prognosis for vaginal birth
Android pelvis -
\typical male pelvis
Heart- shaped or triangular-shaped pelvis
posterior pelvis wider than anterior
poor prognosis for vaginal birth requiring operative delivery or c-section
Anthropoid pelvis -
\Oval-shaped pelvis
anteroposterior diameter is longer than transverse diameter
incidence 40.5% of nonwhite
good prognosis for vaginal birth - favors OP presentation
Platypelloid pelvis -
\flattened gynecoid shape
wide transverse diameter with short AP diameter
Poor prognosis for vaginal birth
Continuous FHR assessment - external -
\determination of FHR
assessment of variability
determine presence or absence of periodic changes, including decelerations,
tachycardia, or bradycardia
Continuous FHR assessment- internal -
\Measures the actual R to R interval of the fetal QRS complex; more accurate
surveillance
increased risk of infx with internal monitoring; most frequently used if unable to obtain
clear tracing with external monitor
Quide Questions and Answers.
adolescent- factors in pregnancy/ IP -
\Prone to late entry to care and poor compliance with AP schedule
Increased risk for LBW and PTL; HTN disorders in pregnancy; PTL and PTB, IUGR,
infant mortality
Advanced maternal age (older than 35 years) -
\Higher incidence of infertility and 1st-trimester SAB and ectopic pregnancy
Proportional increase in rates of genetic abnormalities with advancing age
increased rates of complications including:
HTN disorders of pregnancy
PTB
Gestational DM
Dysfunctional labor leading to c-section
Relationship to underlying dz processes
placenta previa and abruption
Race / ethnicity and pregnancy -
\Increased rate of LBW babies to AA
Certain genetic disorders are increased within specific ethnic groups
Nullipara on average have _____ labors -
\longer
Multpara on average have ______ labors -
\shorter
Grand multiparous women (greater than 5) can have ______ -
\prolonged dysfunctional labors
Increased parity is associated with -
\abruption placenta; placenta previa; multifetal pregnancy; PPH
Grand multiparty can contribute to abnormal presentation including transverse lie
Naegele's rule -
\add 7 days to 1st day of LMP and subtract 3 months
US dating is most accurate -
\if done in 1st trimester
,Gravidity -
\total number of pregnancies
Parity -
\outcome of previous pregnancies
T- term
P- preterm
A- abortions
L- living
Indications for sterile speculum exam during IP -
\Before digital exam if ROM is suspected, frank bleeding is present, or inspection for
herpetic lesions is necessary
Digital exam -
\Dilation
Effacement
Station- 0= presenting part in level with ischial spines
-3, -2, -1= number of centimeter above ischial spines
+1, +2, +3= number of centimeter below ischial spines
Presenting part
position- relationship between the denominator of the presenting part and the maternal
pelvic
1) cephalic presentation0 tje denominator is the occiput
2) breech presentation- the denominator is the sacrum
3) shoulder presentation- the denominator is the scapula
4) face presentation- the denominator is the mentum
Status of membranes
clinical pelvimetry -
\Determination of adequacy of bony pelvis
Pelvis is made up of 4 bones... -
\Two innominate
Sacrum
Coccyx
Symphysis paving joins the two -
\innominate (pubic) bones anteriorly
True pelvis defines the birth canal -
, \inlet boundaries are at the level of the sacral promontory ( posteriorly)m the line
terminals (laterally), and the upper margins of the pubic bones (anteriorly)
Midplane of the pelvis is known as the "plane of least dimensions" and the boundaries
are the sacrum at the junction of the fourth and fifth sacral vertebrae (posteriorly), the
ischial spines (laterally), and the inferior border of the symphysis pubis (anteriorly).
Outlet boundaries are the saccrococcygeal joint (posteriorly), the inner surface of the
ischial tuberosities (laterally), and the lower border of the symphysis pubis anteriorly
Gynecoid pelvis -
\Round shaped pelvis
transverse diameter only slightly longer than anteroposterior
incidence- 505% white women
Excellent prognosis for vaginal birth
Android pelvis -
\typical male pelvis
Heart- shaped or triangular-shaped pelvis
posterior pelvis wider than anterior
poor prognosis for vaginal birth requiring operative delivery or c-section
Anthropoid pelvis -
\Oval-shaped pelvis
anteroposterior diameter is longer than transverse diameter
incidence 40.5% of nonwhite
good prognosis for vaginal birth - favors OP presentation
Platypelloid pelvis -
\flattened gynecoid shape
wide transverse diameter with short AP diameter
Poor prognosis for vaginal birth
Continuous FHR assessment - external -
\determination of FHR
assessment of variability
determine presence or absence of periodic changes, including decelerations,
tachycardia, or bradycardia
Continuous FHR assessment- internal -
\Measures the actual R to R interval of the fetal QRS complex; more accurate
surveillance
increased risk of infx with internal monitoring; most frequently used if unable to obtain
clear tracing with external monitor
