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OB > 4. Labor > Flashcards

4. Labor Flashcards

1
Q

Definition of Labor: Physiologcal

A

The process of moving the fetus, placenta and membranes out of the uterus and through the birth canal

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2
Q

Definition of Labor: Clinical

A

Progressive contractions resulting in progressive cervical change

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3
Q

Contractions without change is ____, change (cervical) without contractions is ______.

A

• Contractions without change is false labor • Change (cervical) without contractions is nothing.

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4
Q

Factors affecting Labor (5)

A

o Passenger (the baby)

o Passageway (the birth canal)

o Powers (contractions)

o Position (Mom’s position)

o Psychological Response (Mom’s psych response)

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5
Q

Fetal lie (def):

A

Relationship between the long axes of the fetal and maternal spines

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6
Q

3 categories of fetal lie

A
  • Longitudinal
  • Transverse
  • Oblique
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7
Q

Fetal presentation (def)

A

Refers to the part of the fetus that would / will enter the pelvis first

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8
Q

3 Presentations

A
  • Cephalic
  • Breech
  • Shoulder
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9
Q

Presenting Part (def)

A

First aspect of the fetus felt on the (vaginal) exam

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10
Q

How can you feel if the presenting part is the head?

A

Anterior part of skull has THREE lines. If you reach in to feel the head and feel 3 lines, the baby is face down.

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11
Q

Fetal Position (def)

A

Relationship of the denominator of the presenting part to the mother’s pelvis. Listed as a 3 letter abbreviation

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12
Q

Position: What does the 3-letter abbreviation mean?

A

1) Right / Left
2) Assigned denominator (Presenting Part)
3) Anterior / Posterior / Transverse

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13
Q

What does “Anterior” mean in terms of positioning?

A

It means the baby’s BACK is facing forward

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14
Q

What does “Posterior” mean in terms of positioning?

A

It means the baby’s BACK is facing the mom’s BACK

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15
Q

What does “transverse” mean in terms of positioning?

A

It means the baby’s BACK is to the side

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16
Q

Fetal Station (def)

A

The relationship of the presenting part of the baby to the ischeal spines of maternal pelvis

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17
Q

How is fetal station measured?

A

Measured in cm above (-) or cm below (+) the ischeal spines

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18
Q

3 / 30 / -1 : MEANING

A

3 cm dilation

30% effacement

-1 station (just above the ischeal spine)

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19
Q

Components of the bony pelvis (7)

A
  • Iliac crest
  • Iliac fossa (flat face)
  • ASIS (tubercle)
  • Ala
  • Sacrum
  • SI joint
  • Pubis
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20
Q

Basic female pelvis types (4)

A
  • Gynecoid - Android - Anthropoid - Platypelloid
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21
Q

Gynecoid Pelvis - Incidence - Shape - Prognosis

A
  • 50% of women - Best for childbearing - Circular. “Female shaped pelvis”
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22
Q

Android Pelvis

  • Incidence
  • Shape
  • Prognosis
A
  • 23% of women
  • Not ideal for birth
  • Male shaped pelvis (gave your heart to a man)
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23
Q

Anthropoid pelvis

  • Incidence
  • Shape
  • Prognosis
A
  • 24% of women
  • 2nd best for childbirth
  • Vertical oval
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24
Q

Platypelloid Pelvis

  • Incidence
  • Shape
  • Prognosis
A
  • 3% of women
  • WORST for childbearing
  • Horizontal oval
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25
Q

What maternal position is good for back labor?

A

Kneeling and leaning forward with support

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26
Q

8 positive positions for labor

A
  • Walking
  • Sitting / leaning
  • Tailor sitting
  • Semirecumbant
  • Hands and knees
  • Standing
  • Squatting
  • Kneeling, leaning forward with support
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27
Q

4 positions for pushing /birth

A
  • Lithotomy
  • Semirecumbant
  • Lateral recumbant
  • Squatting
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28
Q

What are primary powers?

A

Uterine contractions causing cervical change. Involuntary

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29
Q

Primary powers cause:

A

CERVICAL CHANGE. Effacement and dilation

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30
Q

Effacement:

  • Def:
  • How measured
  • Non-effaced cervix is ____
A
  • Elongation and thinning of the cervix
  • Measured as a percentage
  • Non effaced cervix: 2cm
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31
Q

Dilation

  • Def:
  • How measured
A
  • Def: Opening of the cervis
  • Measured in cm (0-10cm)
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32
Q

What are secondary powers?

A

Expulsive (involuntary) uterine contractions in conjunction with voluntary maternal pushing efforts

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33
Q

False Labor vs. True Labor: Ctx Quality

A

FALSE: Inconsistent in frequency, duration and intensity TRUE: Longer, stronger and closer together

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34
Q

False Labor vs. True Labor: How ctx change with activity

A

FALSE:Slow with movement TRUE: Progress with movement

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35
Q

False Labor vs. True Labor: Location of ctx

A

FALSE: Felt in the abdomen and groin

TRUE: Begin in lower back and gradually sweep around to the abdomen

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36
Q

False Labor vs. True Labor: Discomfort

A

FALSE:May be more annoying than truly painful

TRUE: Sometimes persists as back pain; often resembles menstrual cramps during early labor.

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37
Q

False Labor vs. True Labor: Cervix

A

FALSE: Does not significantly change in effacement or dilation

TRUE: Includes progressive effacement and dilation.

38
Q

What is the most important factor that differentiates true labor from false labor?

A

Cervix undergoes progressive effacement and dilation

39
Q

Six Sxs of impending labor

A
  • Light(e)ning
  • Stronger Braxton Hicks
  • Mucus Plug
  • Bloody Show
  • SROM
  • GI upset
40
Q

Sxs of impending labor: Lightening

A

1) “Lightening”: Mom’s “load” is lightened: Baby drops, mom can breathe again.
2) “Lightning”: Electrical, shooting pain is another sign

41
Q

Sxs of impending labor: Braxton Hicks

A

Braxton Hicks: Painless Contractions. Uterus is “warming up.”

42
Q

Sxs of impending labor: Mucus plug

A

Drop of plug

43
Q

Sxs of impending labor: Bloody show

A

Might come along with the mucus plug

44
Q

Sxs of impending labor: SROM

A

Trickle or gush. Positive firning

45
Q

Sxs of impending labor: GI upset

A

Vomiting, diarrhea. Body moves bowels to get things moving.

46
Q

How does the mucus plug form?

A

Excess hormones (esp estrogen) causes excess discharge (Lukarrhea): Forms mucus plug (wine cork)

47
Q

How do you know if substance is amniotic fluid? (Lab)

A

“Positive firning:” means substance is positive for amniotic fluid.

(Why? Because under a microscope, the fluid looks like little fir trees.)

48
Q

Four stages of labor (summary):

A

1) 0-10 cm
2) Pushing and birth
3) Placental separation and expulsion
4) Initial PP period

49
Q

Four stages of labor (duration):

A

1) 14 - 20h
2) 10m - 3 h
3) 5m - 1h
4) 1 - 2h

50
Q

1st stage of labor: Multiparous v Primiparous

A
  • Multiparous = multitasks. Several steps can happen at the same time.
  • Primiparous = takes longer.
51
Q

1st stage of labor:

  • Onset:
  • Conclusion:
A

Onset: Regular uterine contractions

Conclusion: Full dilation

52
Q

3 phases of 1st stage of labor (list)

A
  • Latent -

Active

  • Transition
53
Q

Latent stage of labor:

  • cm dilated
  • CTX Intensity
  • CTX duration
A
  • 0-3 cm dilated
  • CTX mild to moderate in Intensity
  • CTX last for 30-60 seconds
54
Q

Active stage of labor

  • cm dilated
  • CTX Intensity
  • CTX duration
A
  • 4-7 cm dilated
  • CTX moderate to strong in Intensity
  • CTX last 60 seconds
55
Q

Transition

  • cm dilated
  • CTX Intensity
  • CTX duration
A
  • 8-10 cm dilated
  • CTX INTENSE. Stronger, longer, closer together.
  • CTX last 60-90 seconds
56
Q

2nd stage of labor:

Onset:

Conclusion:

A
  • Onset: Full dilation
  • Conclusion: Birth of the fetus
57
Q

CARDINAL (8)

A
  • Engagement
  • Descent
  • Flexion
  • Internal Rotation
  • Extension
  • Restitution
  • External Rotation
  • Lateral Flexion
58
Q

Describe ENGAGEMENT

A

Presenting part / widest diameter is at the ischeal spines: 0 station. You’re committed!

59
Q

Describe FLEXION

A

Flexion of the fetal head, allowing the smallest head diameter to align with the smaller diameters of the mid-pelvis as the fetus descends

60
Q

Describe INTERNAL ROTATION

A

Allows hte largest fetal head diameters to align with the largest maternal pelvic diameters

61
Q

Describe EXTENSION

A

Extension of the fetal head as the neck pivots on the inner margin of the symphysis pubis, allowing the head to align with the curves of the pelvic outlet

62
Q

Describe RESTITUTION

A

The shoulders of the fetus enter the pelvis obliquely, and remain like that when the head rotates to the AP diameter through internal rotation

63
Q

Describe EXTERNAL ROTATION

A

As the shoulders rotate to the AP diameter, the head is turned further to one side. Allows head to align with curves of the pelvic outlet.

64
Q

Describe LATERAL FLEXION

A
  • Baby bends at waist
65
Q

3rd stage of labor

  • Onset:
  • Conclusion:
A
  • Onset: Birth of newborn
  • Conclusion: Birth of placenta
66
Q

When will a HCP do a manual removal of the placenta?

A

Usually after 1 hour

67
Q

Signs of placental separation (4)

A
  • Change in shape – uterus becomes lobular
  • Sudden gush of blood
  • Lengthening of cord (appears to lengthen)
  • Change in position of uterus
68
Q

Placenta

  • Name of maternal side
  • Name of fetal side
A
  • Maternal: DUNKIN
  • Fetal: SCHULTZ
69
Q

How would a smoker’s placenta differ from a non-smoker?

A

Smokers have larger placentas because it has to grow larger to get enough oxygenation (due to vasoconstriction)

70
Q

What covers the umbilical cord?

A

WHARTON’S JELLY

71
Q

What happens during the 4th stage of labor?

A
  • Maternal stabilization and homeostasis
72
Q

System Analgesics: Types (4)

A

* Opioids

* Atarctics

* Barbituates

* Benzos

73
Q

System Analgesics: Risks (3)

A

* Fetal Depression

* Prolonged Labor

* N / V

74
Q

Opiate antagonist

A

Narcan

75
Q

What are Atarctics?

A

Analgesics Potentiators

76
Q

Nerve Block (Neuraxial) Analgesia / Anesthesia: Types (5)

A

* Local infiltration

* Pudendal block

* Spinal anesthesia

* Epidural block

* General anesthesia

77
Q

Pudendal Block: Indication

A

Used for sewing up

78
Q

Nerve Block (Neuraxial) Analgesia / Anesthesia: Risks (3)

A

* Maternal Hypotension

* Fetal bradycardia

* Prolonged labor / 2nd stage

79
Q

What is the difference between analgesia and anesthesia?

A
  • Analgesia: Relief of pain without the total loss of feeling or muscle movement. Lessening of pain.
  • Anesthesia: Blockage of all feeling, including pain
80
Q

What are Leopold’s Maneuvers?

A

Vaginal exam to determine presentation and position of fetus and to aid in location of fetal heart sounds

81
Q

What labs would you do on admission for L&D?

A

Dip urine for glucose, protein, ketones

82
Q

What is the name for an artificial rupture of membranes?

A

Amniotomy

83
Q

What do you note for the ROM?

A
  • Time
  • Color
  • Odor
  • Amount
84
Q

What do you do if there is meconium in the amniotic fluid?

A

PREPARE SUCTION FOR BIRTH

85
Q

First stage of labor management (5)

A
  • FHR & CTX check Q14-30 m
  • BP Q 1-2 h
  • T Q4 if membranes intact, Q1-2 if ruptured
  • Void Q2h
  • Frequent position changes
86
Q

Second stage of labor management (5)

A
  • FHR Q5 minutes or between CTX
  • BP Q 5-15 min
  • Support and encourage position changes / optimize position
  • Room prep
  • Document
87
Q

Third stage management (4)

A
  • Vitals Q15
  • Palpate fundus til firm
  • Pitocin
  • Document
88
Q

Perineal Lacerations (4 levels)

A

1) Perineal skin / vag mucosa
2) Superficial muscles
3) Deep muscle to anal capsule
4) Rectal sphincter

89
Q

Other laceration locations (3):

A
  • Labial
  • Urethral
  • Cervical
90
Q

Episiotomies (3)

A
  • Midline (MLE)
  • Mediolateral (RML, LML)

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