4. Labor Flashcards
Definition of Labor: Physiologcal
The process of moving the fetus, placenta and membranes out of the uterus and through the birth canal
Definition of Labor: Clinical
Progressive contractions resulting in progressive cervical change
Contractions without change is ____, change (cervical) without contractions is ______.
• Contractions without change is false labor • Change (cervical) without contractions is nothing.
Factors affecting Labor (5)
o Passenger (the baby)
o Passageway (the birth canal)
o Powers (contractions)
o Position (Mom’s position)
o Psychological Response (Mom’s psych response)
Fetal lie (def):
Relationship between the long axes of the fetal and maternal spines
3 categories of fetal lie
- Longitudinal
- Transverse
- Oblique
Fetal presentation (def)
Refers to the part of the fetus that would / will enter the pelvis first
3 Presentations
- Cephalic
- Breech
- Shoulder
Presenting Part (def)
First aspect of the fetus felt on the (vaginal) exam
How can you feel if the presenting part is the head?
Anterior part of skull has THREE lines. If you reach in to feel the head and feel 3 lines, the baby is face down.
Fetal Position (def)
Relationship of the denominator of the presenting part to the mother’s pelvis. Listed as a 3 letter abbreviation
Position: What does the 3-letter abbreviation mean?
1) Right / Left
2) Assigned denominator (Presenting Part)
3) Anterior / Posterior / Transverse
What does “Anterior” mean in terms of positioning?
It means the baby’s BACK is facing forward
What does “Posterior” mean in terms of positioning?
It means the baby’s BACK is facing the mom’s BACK
What does “transverse” mean in terms of positioning?
It means the baby’s BACK is to the side
Fetal Station (def)
The relationship of the presenting part of the baby to the ischeal spines of maternal pelvis
How is fetal station measured?
Measured in cm above (-) or cm below (+) the ischeal spines
3 / 30 / -1 : MEANING
3 cm dilation
30% effacement
-1 station (just above the ischeal spine)
Components of the bony pelvis (7)
- Iliac crest
- Iliac fossa (flat face)
- ASIS (tubercle)
- Ala
- Sacrum
- SI joint
- Pubis
Basic female pelvis types (4)
- Gynecoid - Android - Anthropoid - Platypelloid
Gynecoid Pelvis - Incidence - Shape - Prognosis
- 50% of women - Best for childbearing - Circular. “Female shaped pelvis”
Android Pelvis
- Incidence
- Shape
- Prognosis
- 23% of women
- Not ideal for birth
- Male shaped pelvis (gave your heart to a man)
Anthropoid pelvis
- Incidence
- Shape
- Prognosis
- 24% of women
- 2nd best for childbirth
- Vertical oval
Platypelloid Pelvis
- Incidence
- Shape
- Prognosis
- 3% of women
- WORST for childbearing
- Horizontal oval
What maternal position is good for back labor?
Kneeling and leaning forward with support
8 positive positions for labor
- Walking
- Sitting / leaning
- Tailor sitting
- Semirecumbant
- Hands and knees
- Standing
- Squatting
- Kneeling, leaning forward with support
4 positions for pushing /birth
- Lithotomy
- Semirecumbant
- Lateral recumbant
- Squatting
What are primary powers?
Uterine contractions causing cervical change. Involuntary
Primary powers cause:
CERVICAL CHANGE. Effacement and dilation
Effacement:
- Def:
- How measured
- Non-effaced cervix is ____
- Elongation and thinning of the cervix
- Measured as a percentage
- Non effaced cervix: 2cm
Dilation
- Def:
- How measured
- Def: Opening of the cervis
- Measured in cm (0-10cm)
What are secondary powers?
Expulsive (involuntary) uterine contractions in conjunction with voluntary maternal pushing efforts
False Labor vs. True Labor: Ctx Quality
FALSE: Inconsistent in frequency, duration and intensity TRUE: Longer, stronger and closer together
False Labor vs. True Labor: How ctx change with activity
FALSE:Slow with movement TRUE: Progress with movement
False Labor vs. True Labor: Location of ctx
FALSE: Felt in the abdomen and groin
TRUE: Begin in lower back and gradually sweep around to the abdomen
False Labor vs. True Labor: Discomfort
FALSE:May be more annoying than truly painful
TRUE: Sometimes persists as back pain; often resembles menstrual cramps during early labor.
False Labor vs. True Labor: Cervix
FALSE: Does not significantly change in effacement or dilation
TRUE: Includes progressive effacement and dilation.
What is the most important factor that differentiates true labor from false labor?
Cervix undergoes progressive effacement and dilation
Six Sxs of impending labor
- Light(e)ning
- Stronger Braxton Hicks
- Mucus Plug
- Bloody Show
- SROM
- GI upset
Sxs of impending labor: Lightening
1) “Lightening”: Mom’s “load” is lightened: Baby drops, mom can breathe again.
2) “Lightning”: Electrical, shooting pain is another sign
Sxs of impending labor: Braxton Hicks
Braxton Hicks: Painless Contractions. Uterus is “warming up.”
Sxs of impending labor: Mucus plug
Drop of plug
Sxs of impending labor: Bloody show
Might come along with the mucus plug
Sxs of impending labor: SROM
Trickle or gush. Positive firning
Sxs of impending labor: GI upset
Vomiting, diarrhea. Body moves bowels to get things moving.
How does the mucus plug form?
Excess hormones (esp estrogen) causes excess discharge (Lukarrhea): Forms mucus plug (wine cork)
How do you know if substance is amniotic fluid? (Lab)
“Positive firning:” means substance is positive for amniotic fluid.
(Why? Because under a microscope, the fluid looks like little fir trees.)
Four stages of labor (summary):
1) 0-10 cm
2) Pushing and birth
3) Placental separation and expulsion
4) Initial PP period
Four stages of labor (duration):
1) 14 - 20h
2) 10m - 3 h
3) 5m - 1h
4) 1 - 2h
1st stage of labor: Multiparous v Primiparous
- Multiparous = multitasks. Several steps can happen at the same time.
- Primiparous = takes longer.
1st stage of labor:
- Onset:
- Conclusion:
Onset: Regular uterine contractions
Conclusion: Full dilation
3 phases of 1st stage of labor (list)
- Latent -
Active
- Transition
Latent stage of labor:
- cm dilated
- CTX Intensity
- CTX duration
- 0-3 cm dilated
- CTX mild to moderate in Intensity
- CTX last for 30-60 seconds
Active stage of labor
- cm dilated
- CTX Intensity
- CTX duration
- 4-7 cm dilated
- CTX moderate to strong in Intensity
- CTX last 60 seconds
Transition
- cm dilated
- CTX Intensity
- CTX duration
- 8-10 cm dilated
- CTX INTENSE. Stronger, longer, closer together.
- CTX last 60-90 seconds
2nd stage of labor:
Onset:
Conclusion:
- Onset: Full dilation
- Conclusion: Birth of the fetus
CARDINAL (8)
- Engagement
- Descent
- Flexion
- Internal Rotation
- Extension
- Restitution
- External Rotation
- Lateral Flexion
Describe ENGAGEMENT
Presenting part / widest diameter is at the ischeal spines: 0 station. You’re committed!
Describe FLEXION
Flexion of the fetal head, allowing the smallest head diameter to align with the smaller diameters of the mid-pelvis as the fetus descends
Describe INTERNAL ROTATION
Allows hte largest fetal head diameters to align with the largest maternal pelvic diameters
Describe EXTENSION
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
Describe RESTITUTION
The shoulders of the fetus enter the pelvis obliquely, and remain like that when the head rotates to the AP diameter through internal rotation
Describe EXTERNAL ROTATION
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.
Describe LATERAL FLEXION
- Baby bends at waist
3rd stage of labor
- Onset:
- Conclusion:
- Onset: Birth of newborn
- Conclusion: Birth of placenta
When will a HCP do a manual removal of the placenta?
Usually after 1 hour
Signs of placental separation (4)
- Change in shape – uterus becomes lobular
- Sudden gush of blood
- Lengthening of cord (appears to lengthen)
- Change in position of uterus
Placenta
- Name of maternal side
- Name of fetal side
- Maternal: DUNKIN
- Fetal: SCHULTZ
How would a smoker’s placenta differ from a non-smoker?
Smokers have larger placentas because it has to grow larger to get enough oxygenation (due to vasoconstriction)
What covers the umbilical cord?
WHARTON’S JELLY
What happens during the 4th stage of labor?
- Maternal stabilization and homeostasis
System Analgesics: Types (4)
* Opioids
* Atarctics
* Barbituates
* Benzos
System Analgesics: Risks (3)
* Fetal Depression
* Prolonged Labor
* N / V
Opiate antagonist
Narcan
What are Atarctics?
Analgesics Potentiators
Nerve Block (Neuraxial) Analgesia / Anesthesia: Types (5)
* Local infiltration
* Pudendal block
* Spinal anesthesia
* Epidural block
* General anesthesia
Pudendal Block: Indication
Used for sewing up
Nerve Block (Neuraxial) Analgesia / Anesthesia: Risks (3)
* Maternal Hypotension
* Fetal bradycardia
* Prolonged labor / 2nd stage
What is the difference between analgesia and anesthesia?
- Analgesia: Relief of pain without the total loss of feeling or muscle movement. Lessening of pain.
- Anesthesia: Blockage of all feeling, including pain
What are Leopold’s Maneuvers?
Vaginal exam to determine presentation and position of fetus and to aid in location of fetal heart sounds
What labs would you do on admission for L&D?
Dip urine for glucose, protein, ketones
What is the name for an artificial rupture of membranes?
Amniotomy
What do you note for the ROM?
- Time
- Color
- Odor
- Amount
What do you do if there is meconium in the amniotic fluid?
PREPARE SUCTION FOR BIRTH
First stage of labor management (5)
- 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
Second stage of labor management (5)
- FHR Q5 minutes or between CTX
- BP Q 5-15 min
- Support and encourage position changes / optimize position
- Room prep
- Document
Third stage management (4)
- Vitals Q15
- Palpate fundus til firm
- Pitocin
- Document
Perineal Lacerations (4 levels)
1) Perineal skin / vag mucosa
2) Superficial muscles
3) Deep muscle to anal capsule
4) Rectal sphincter
Other laceration locations (3):
- Labial
- Urethral
- Cervical
Episiotomies (3)
- Midline (MLE)
- Mediolateral (RML, LML)
