3-Normal Labor Flashcards
What is a labor?
Regular contractions causing progressive dilation of the cervix and subsequent expulsion of the fetus
What is a false labor?
Irregular, brief contractions
Pain located in the groin or lower abdomen
No cervical change
Contractions stop when patient lie down
When do you admit a pregnant women to the hospital ?
When uterus is contracting every 3-5 minutes for at least 40 seconds
When cervix is dilated to approximately 3 cm or 50% effaced
When there is ruptured membranes
What are the stages of labor?
Stage 1- cervical effacement & dilation
Stage 2-expulsion of fetus
Stage 3- placental separation & expulsion
Stage 4-2 hours after delivery of placenta
What are the characteristics of stage 1 of labor?
Begins with frequent intense uterine contractions to cause cervical dilation and effacement
Ends with fully dilated cervix (10cm) to allow passage of fetal head
Consists of 2 phases: latent and active
What are the characteristics of the lat nt phase of stage 1 of labor?
Precedes active labor by several hours Contractions are uncomfortable and regular Slow cervical effacement and dilation Typically ends at 3-5cm Is a retrospective diagnostic
What are the characteristics of the active phase of stage 1 of labor?
Starts at 3- 5cm after the latent phase
Contractions are more intense and more rapid with consistent cervical dilation
What is the purpose of monitoring labor?
Periodic cervical exams every 2 hours should check dilation, effacement and fetal station
Assess frequency and surations of contractions
Assess fetal tolerance of labor
What are the different fetal stations?
Station 0 is when fetal vertex is at the level of the ischial spines
Negative number means the fetal vertex is higher
Positive number means the fetal vertex is lower
The fetus can be engaged or not engaged
When do we monitor fetal heart tone?
First stage- every 30 mins after a contraction fo low risk, every 15 mins for high risk
Second stage- every 15 mins after contraction for low risk, every 5 mins for high risk
What are the cardinal movements of labor?
Required movements the fetal head must undergo to negotiate the maternal pelvis
Do not necessarily happen sequentially
What are the sequences of the cardinal movements?
Engagement- biparietal diameter Flexion- smallest portion enter pelvis Descent Internal rotation- similar to flexion Extension External rotation Expulsion
What is the genesis of early pain during labor?
Sensory fibers of uterus and cervix transmitted to T11 and T12 via Frankenhauser ganglion to internal iliac plexus
What is the genesis of pain as labor progresses?
Pain arises from pudendal nerve providing sensation to the lower genital tract
Pudendal fibers originate in the ventral branches of S2 to S4
What are the modalities of pain control?
Non pharmacologic- psychological support, birth classes
Parenteral agents- narcotics, fentanyl
Regional anesthetics- epidural, pudendal block
What are the characteristics of the stage 2 of labor?
Begins with complete cervical dilation
Ends with delivery of infant
Pushing earlier can cause maternal exhaustion and cervical edema
What is episiotomy?
Surgical incision of the perineum to aid in the delivery of the fetus
Consider archaic technique
What are the characteristics of the stage 3 of labor?
Begins with delivery of infant
Ends with delivery of placenta and fetal membrane
What are the signs of placental separation?
Uterus rises in the abdomen and becomes globular
Umbilical cord lengthens
Gush of blood
What is prolonged third stage of labor?
When more than 30 mins of time has elapsed between the time of the delivery of the fetus and the time of the delivery of the placenta
Associated with increased risk of postpartum hemorrhage
What follow the delivery of the placenta?
Systemic inspection of the genital tract and cervix for evidence of obstetric laceration
Examination of the placenta to ensure that is intact and also anatomy(ie 3 vessel cords)
What is a first degree obstetric laceration?
Involves vaginal epithelium and/or perineal skin but no muscle tissue
What is a second degree obstetric laceration?
First degree laceration plus underlying subcutaneous and muscle tissue but not extending into the anal sphincter or rectal mucosa
What is a third degree obstetric laceration ?
Second degree laceration plus external anal sphincter
