1st and 2nd stage of labor Flashcards
How is prolonged latent labor calculated?
Still with Friedmans number not many new studies of latent labor.
Why perform an episiotomy?
Primarily due to FHR tracing indicating acidemia. Occasionally for shoulder dysotcia of with forceps/vaccuum.
Describe mid-line episotomy, and its advantages/disadvantages
mid-line from posterior forchette through perineal muscle no int anal sphincter: equivalent to 2nd degree laceration. Less painful, possible increase in 4th degree tears
Describe mediolateral episotomy, and its advantages/disadvantages
From posterior forschette lateral away from rectum. More nerves, may hurt more. Better for anyone with impaired healing, less likely to breakdown.
What are strategies the midwife can actively do to promote intact perineum (5)?
- warm compresses
- perineal massage with lubricant ok, but not sustained or vigorous .
- No lateral abduction of thighs and legs
- Delivery fetus slowly between contractions, controlling extension
- if blanching occurs encourage breathing and not pushing to slow birth of fetal head.
What positions support the perineum. What is the worst?
semi-upright and lateral position are good. Lithotomy the worst because of abduction. Squatting increased 2nd decreased 3rd and 4th degree.
Describe 1st degree laceration
only involves perineal skin
Describe 2nd degree laceration.
Involves skin, vaginal mucosa, and posterior fourchette, in perineal musculature but not anal sphincter. Includes transverse and bulbocavernornosus muscles.
Describe a 3rd degree laceration, and categories within
like 2nd degree plus anal sphincter.
3a less thant 50% of anal sphincter
3b more than 50% of anal sphincter
3c complete rupture of anal sphincter plus tear to internal anal sphincter.
Describe a 4th degree laceration
3c laceration plus anterior rectal mucosa
What is a sulcus tear
side of vagina incstead of middle inferior part
Where are cervical lacerations most common?
on lateral aspects (3 and 9 o’clock) but can be anywhere
