Recall third long:

INTRAPARTUM ASSESSMENT:

1. used for fetal heart monitoring: except

- stethoscope
- internal fetal heart rate monitoring
-external fetal heart rate monitoring

2. Rate
a. Decreases with fetal maturation; corresponds to the maturation of the parasympathetic (vagal
heart control)
b. Approximate mean rate rounded to increments of 5 bpm during a 10 minute tracing segment
110 to 160 bpm
3. Causes of Bradycardia:

1. Head compression
2. Congenital heart block
3. Serious compromise
4. Maternal hypothermia under general anesthesia
4. Causes of tachycardia:
1. Maternal fever from amnionitis and other sources
2. Fetal compromise
3. Cardiac arrythmia
4. Maternal administration of parasympathetic (atropine) or sympathomimetic (terbutaline) drugs
5. If associated with fetal compromise with deceleration
5. Short term variability
Reflects the instantaneous change in the fetal heart rate from one beat (or R wave) to the
next
A measure of the time interval between cardiac systoles
6. Long term variability
Used to decribe the oscillatory changes that occur during the course of 1 minute which
results in the waviness of the baseline

7. Physiological and pathological process that may affect or interfere with beat to beat variability:

i. Fetal breathing
ii. Fetal body movements
iii. Sleep cycles
iv. Advancing gestation - after 30 weeks, diminished baseline variability
v. Fetal acidemia (with decelerations) - >/= 5 bpm
vi. Maternal acidemia
vii. Analgesic drugs given during labor
viii. Magnesium sulfate
8. Most common cause of arrhythmia?
Complete heart block

9. sinusoidal pattern:
a. Regular oscillation of baseline longterm variability with absent short term variability
 b. May be observed in serious fetal anemia

10. Early deceleration-

1. A gradual decrease and return to baseline associated with a contraction

2. Probable cause: head compression vagal nerve activated due to dural stimulation

3. Smooth and rounded in configuration and are the mirror image of the contraction. The degree of
deceleration is generally proportioned to the contraction strength and rarely falls below 100 to 110 bpm,
or 20 to 30 bpm below baseline

11. Not appreciated in Early deceleration:

- fetal hypoxia
- acidemia
- low apgar scores

12. Late deceleration:

- A smooth, gradual symmetrical decrease in fetal heart rate beginning at or after the peak of the
contraction and returning to baseline after the contraction has ended.

13. signs of non reassuring fetal status:

Fetal tachycardia
Fetal bradycardia
Saltatory variability
Variable decelerations associated with a non reassuring pattern
Late decelerations with preserved beat to beat variability

14. test used to identify fetal heart rate pattern: (Except ata tanong)
- fetal scalp blood sampling
- scalp stimulation
- vibroacoustic stimulation

DELIVERY TECHNIQUE IN BREECH

15. Why preterm fetuses are common to breech presentation: because the largest part of the body
occupies the largest part of the uterus which is the fundus

16. sacrum in relation to the maternal pelvis

Ans. Right sacrum anterior

17. recommendation for CS delivery:

Large fetus
Contracted pelvis
Hyperextended head
Absence of labor
Uterine dysfunction
Incomplete/footling breech
Healthy and viable preterm
Severe fetal growth restriction
Req for sterilization
Lack of an experienced operator

18. drawing of vaginal breech delivery

Partial

19. preterm breech is at risk for

-cord prolapsed

20. mauriceau-smellie-veit maneuver

Drawing

21. complete/ total breech delivery

- 2 fingers are carried up along one extremity to the knee to push it away fr the midline

22. Pipers forcepts

Delivery of the aftercoming head

23. Prague manuever

24. Duhrssen incision reason ata ang question:

- less blood loss?
- to deliver the head

25. etiology of transverse lie

-Unusual relaxation of the abdominal wall resulting from great multiparity
-prematurity
-placenta previa
-contacted pelvis
-abnormal uterine anatomy
-excessive amniotic fluid

26. Diagnosis of shoulder presentation

-acromion process is palpable

27. Management of shoulder dystocia

-Mc Roberts
-Woods-corkscrew maneuver
-Delivery of posterior shoulder

Mechanism of Labor:

Fetal lie- relationship of long axis to fetus to that of mother, answer: transverse lie(description ang given)

Leopolds manuever- abdominal palpation to identify the presenting part

Latent phase- preparatory division- less than or equal to 4cm with irregular contraction
Prolonged latent phase if:
More than 20 hours in nullipara
More than 14 in multipara

Active labor: rate of cervical dilatation:

Nullipara 1.2 to 6.8 cm per hour
Multipara 1.5 cm/hr

Cardinal mo0vements of labor or mechanism of labor?-descent, flexion, internal rotation, extension,

external rotation

Flexion- fetal head touches the fetal chest

Internal rotation- occiput rotates anteriorly and fetal head assumes oblique orientation

External rotation- the shoulder rotate into an oblique or frankly anterior- posterior orientation with further
descent encourage fetal head to return to its transverse position

95% of fetus are in occiput or vertex presentation during labor

Delivery of anterior shoulder, then delivery of posterior shoulder

Crowning- encirclement of the larger head diameter by the vulvar ring

Fourth stage of labor- first hour after delivery

Type of episiotomy- mediolateral or midline?

Occipitomental- longest diameter of the head

Episiotomy is necessary for:

-All vaginal deliveries

ABNORMAL LABOR:

Dystocia- difficult labor

Malposition of fetal head- asynclitism

Prolonged second stage of labor

Nulliparas 2 to 3 hours
Multiparas 1 to 2 hours

Pathologic Retraction Ring caused by obstructed labor; sign of impending uterine rupture

Decrease pelvic capacity- creates dystocia

Pelvic contraction- diagnosis: malpresentation

Sacral promontory: 11.5 cm

Normal synclitism sagittal suture remains parallel to the transverse axis of the pelvic inlet. Midaway
between the symphysis pubis and sacral promontory

Anterior asynclitism/naegeles obliquity - the sagittal suture is laterally deflected

towards the sacral promontory and the anterior parietal bone present to the examining fingers during
internal examination

Posterior asynclitism/ - the sagittal suture close to the symphysis, more of the posterior parietal bone will
present on internal examination