ࡱ> `b_b +jbjb $P%.......lm)NNNNNNNN(((((((,*R?-).NNNNN)r$..NN')r$r$r$N.N.N(r$BD,....N(r$r$&..@'B %H#* '@'=)0m)', .r$ .@'r$.vDvModule 1 Terminology: Juliana Leyda Intrapartum: during labor and delivery (vs ante partum and post partum) [partus meaning childbirth] Amnioinfusion: a fix for cord prolapse caused by a dry-ish birth: injection of warmed saline into the uterus through the cervix, serving as a cushion. 3-4% of women at teaching hosps in 1995 recvd this tx. Apgar Score: our 1-10 scale of how good the baby is doing for basic survival at time of birth. Performed at 1 minute and 5 minutes after delivery, named for Dr. Apgar. Also acronym for: A. activity and muscle tone P. pulse (heart rate) G. grimace response (medically known as "reflex irritability") A. appearance (skin coloration) R. respiration (breathing rate and effort) Apgar Sign 210Heart Rate(pulse) Normal (above 100 beats per minute) Below 100 beats per minute AbsentBreathing(rate and effort) Normal rate and effort, good cry Slow or irregular breathing, weak cry Absent (no breathing)Grimace (responsiveness or "reflex irritability") Pulls away, sneezes, or coughs with stimulation Facial movement only (grimace) with stimulation Absent (no response to stimulation)Activity(muscle tone)Active, spontaneous movement Arms and legs flexed with little movement No movement, "floppy" toneAppearance(skin coloration)Normal color all over (hands and feet are pink) Normal color (but hands and feet are bluish) Bluish-gray or pale all over Bloody show: rupture of the mucus plug at the cervix, usually in prelabor or early labor Breech (Br, b.p.): baby coming out in a not so good way: Complete: presentation of butt, legs and feet: so that the baby is sitting crosslegged, with feet beside the bottom. Footling/Incomplete: just a foot or both feetmore common in preemies. Frank: presentation of just a butt with the feet at the head. 65-70% of breech babies. Kneeling Breech: knees down, feet and head up: this is a very rare presentation Crowning: holy crap theres a headvisible and stretching the vulva Dilatation (dil): occurs during labor, the cervical os opens in response to contractions. Dystocia: meaning difficult childbirthnot that they arent usually difficult. Your textbook birth would be eutocia. Effacement (Eff): ripening, shortening, thinning of the cervix. Engagement: may or may not have happened before the pregnancy, or the point when the presenting part [hopefully the head] has entered the pelvis [or superior pelvic straight] and will now continue down the pelvic canal. Episiotomy: epis: a cut to the perineum to enlarge the passageway and allegedly to prevent tearingthe widespread practice has decreased in the US but we are still way behind Europe. Can be on the midline [ML epis] or mediolateral right or left [RML epis or LML epis. Midline epis are usually less painful and heal more rapidly, are most common but do result in greater tearing. Expulsion: popping something out of a body partmost of us do this a few times a day through various body parts. This is the 7th cardinal mechanism of labor: meaning the part when the baby pops out via expulsion. The placenta is also technically expelled. Induction: starting up labor artificially, usually with pitocin or amniotomy [snag the bag.] 2/3rds of US inductions are elective, and induction rate has doubled in the last decade. Many herbal and folk remedies are also used. Laceration (Lac): a severing of tissue: in this case the perineum, vulva, cervix, etc. Primary cause of PPH [postpartum hemorrhage.] Usually worst in primip moms, and most common in the perineum. Lie: the spine of the babe vs the spine of the mother. Most babies lie longitudinally or in line with the mothers spine [whether breech or not], some babies lie transverse. Molding: squishing of the infant head into a more convenient form: usually aided by the overlapping of incomplete skull bones and fontanelles. Occiput (anterior or posterior): the difference between ow and a whole lot more ow, occiput anterior being far less painful than the back labor caused by an occiput posterior orientation. This is considered the orientation. Parturient: woman popping out a baby [to bring forth] Full term - 37 to 42 weeks gestational age from LMP - Last Menstrual Period Posterm: A baby thats a little overcooked [past 42 weeks] Presentation: which baby part is lowest in the pelvic inlet: head, feet, butt, etc: breech presentation versus cephalic presentation. Prolapse (cord): cord pushed outside the uterus, often along with the amniotic fluid. More likely to happen after the bag of water breaks and is no longer present to cushionthis is bad because the cord is needed to provide oxygen to the baby. Station: how far down is the babybased on an imaginary line between the two ischial spines, which demarks 0. Normally the ischial spines are the narrowest part of the pelvis. Measurements of -1 to -3 would be 1, 2 or 3 cm above the zero point, and +1-+3 being closer to the outside world. Transition: the crazy part where aliens take over moms body: the cervix dilates from 8 to 10 cm. These contractions are big and crazy with short rest periods, and sweating, vomiting, and generalized freakout are common symptoms. Vacuum: eek, sucks out a baby or a fetus, depending on whos getting it. Sticks onto a babys head in order to pull out the baby, or used in early abortions. Vertex: baby with a cephalic presentation: vertex also means the top of the head, so again, the head is presenting. Postpartum (PP): period of time after the birth/delivery Afterpains/Afterbirth pains: when you hurt afterwards, usually contractions of the uterus returning to normal size. Can last 2-3 days after. Boggy uterus: when your uterus becomes humid, muddy, and grows vines, and alligators are at risk for taking up residence. This condition is usually accompanied by a retroflexed or anteroflexed uterus, A soft, boggy uterus signifies atony, and uterine massage will stimulate uterine contractions and frequently stops uterine hemorrhage. Subinvolution: Should really be called the baggy uterus: a uterus that does not return to normal size after delivery. Endometritis: Inflammation of the innermost lining of the uterus: infection of the uterus, usually after delivery and at the former site of the placental implantation. Engorgement: swelling with blood, especially in erectile tissues [nipples, penis, vulva]usually refers to the breast for the 3-5 days after birth Fundus: topmost section of the uterus Involution: uterus involutes after delivery: it shrinks back down to size and shape. Lochia (name the 3 colors): vaginal discharge after birth [during puerperium], name all three! Lochia Rubra: thick red bloody flow that comes first Lochia Serosa: serous, pink to brown, flows for a week after birth Lochia Alba: thin, yellowish whiteish, lasts several weeks after the bloody stuff clears up. Mastitis: inflammation/infection of the breast [usually one milk duct] that hurts and makes mom feel flu-ish Puerperium (postnatal): period from placental delivery through the first few weeks Newborn: neonate! You get to be a newborn until you are 1 month old Acrocyanosis: benign bluish skin on hands and feet in newborns up to 10 days Fontanel: squishy section of the infant skull that is filled in by skullbones within their first two years. Lanugo: soft downy baby hair, found all over the baby except for the scalp, palms and soles Meconium: first infant stools, sticky gooey dark green to black, free of bacteria or food content and odorless. Maybe witnessed during the intrapartum period due to stool passed in utero during a period of stress, which the fetus hopefully does not aspirate. Vernix: the goo thats all over the neonate when they pop outprotective fatty coat. Midwives sometimes think its good for wrinkles. Sutures: stitchesput them wherever they are needed, please. Also the types of joints between skull bones when they finally form. Then: Write a 3 sentence paragraph with as many of the abbreviations (from week one) and terms as you can pack into the scenario: 38 yo primip pt with FOB and doula arriving to triage more than 48 hrs post SROM w/o UC. US confirms ROM. GBS neg. VS stable, FHR-R. Start IV antibiotics and Pit for Ind. Fetus is OA and Vtx. Dil to FT per SVE after 14 hours of Pit, pt requested LEP. Balloon Catheter placed, dil Cx to 5cm, no further dil. FHR-R. Pt VS WNL, SOB when sleeping: O2 per N/C applied. No dil past 5cm. IFM placed, mec observed. Pt refused FSE. Pt requested C/S at 2300, FOB to NBN with infant. [38 year old primipara with father-of-baby and doula to triageafter spontaneous rupture of membranes without uterine contractions. Ultrasound confirms rupture of membranes. Group B Strep culture is negative. Vitals stable, Fetal Heart Rate reassuring. Start antibiotics and pitocin for induction of labor. Fetus is occiput anterior and vertex. Dilated to finger tip per sterile vaginal exam after 14 hours of pitocin, patient requested Lumbar Epidural anesthesia. Balloon catheter dilated cervix to 5cm, and no futher. Fetal heart rate still reassuring. Patients vitals within normal limits, shortness of breath when sleeping: Oxygen via nasal cannula administered. No dilation past 5 cm, Intrauterine fetal monitor placed, meconium observed. Patient refused Fetal Scalp Monitor. 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