HIGH YIELD FACTS Intrapartum effacement

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					                                                          History of allergies
                                                          How long ago did patient consume food or liquids and how much
                                                          Use of medications
                                                          Risk status assignment (high or low)


                                                    Vaginal Exam (VE)
                                                    A sterile speculum exam if:
                                                          Suspect rupture of membranes
                                                          Preterm labor
                                                          Signs of placenta previa
                                                    Otherwise, a digital VE may be performed
                                                    The following must be assessed:
                    What can cause a false-
                                                    STATUS OF AMNIOTIC FLUID AND MEMBRANES
                    positive nitrazine test?
 HIGH-YIELD FACTS




                      Vaginal infections with       A sterile speculum is used to look for fluid in the posterior vaginal fornix
                      Trichomonas vaginalis         (pool test), which determines if ROM has occurred.
                      Blood                         Fluid may be collected on a swab for further study if the source of fluid is un-
                      Semen                         clear:
                                                           Ferning test (high estrogen content of amniotic fluid causes fern pat-
                                                           tern on slide when allowed to air dry):
                                                             Crystallization/arborization is due to interaction of amniotic fluid
                                                             proteins and salts.
                                                             Confirms ROM in 85 to 98% of cases
                                                           Nitrazine test—nitrazine paper is pH sensitive and turns blue in pres-
                                                           ence of amniotic fluid:
                                                             Amniotic fluid (pH = 7.15) is more alkaline than vaginal secretions.
                    Vernix: The fatty                        90 to 98% accurate
                    substance consisting of
                    desquamated epithelial cells    Fluid should also be examined for vernix or meconium.
Intrapartum




                    and sebaceous matter that              The presence of meconium in the amniotic fluid may indicate fetal
                    covers the skin of the fetus.          stress.
                    Meconium: A dark green                 Meconium staining is more common in term and postterm pregnancies
                    fecal material that                    than in preterm pregnancies.
                    accumulates in the fetal               Meconium aspiration syndrome (MAS) can occur → infant tachypnea,
                                                           costal retractions, cyanosis, coarse breath sounds, etc.
                    intestines and is discharged
                                                           Prevent MAS via amnioinfusion intrapartum and DeLee suction post-
                    at or near the time of birth.          partum


                                                     CERVICAL EXAM


                                                    There are four parameters of the cervix that are examined: effacement, consis-
                                                    tency, dilation, and position.

                                                    EFFACEMENT
                                                    Effacement describes the length of the cervix. With labor, the cervix thins
                                                    out and softens, and the length is reduced. The normal length is 3 to 4 cm.
                    Know this cervical exam               Terminology: When the cervical length shrinks by 50% (to around 2
                    stuff cold for the wards!!            cm), it is said to be 50% effaced. When the cervix becomes as thin as
                                                          the adjacent as the lower uterine segment it is 100% effaced.


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Description: HIGH YIELD FACTS Intrapartum effacement