406 4 Flashcards
latent phase is from the beginning of true labor until
3 to 4 cm dilation
active phase is from 4 cm to __ cm
7
transition phase is from _ to _ cm
8 to 10 cm
active phase: contraction frequency and duration
every 2 or 3 minutes for 30 to 60 seconds
Intrapartum Description:
Begins with true labor and consists of four stages
Intrapartum stage: From the beginning of regular contractions or ROM to 10 cm of dilatation and 100% effacement
1st
Intrapartum stage: 10 cm to delivery of the fetus
2nd
Intrapartum stage: Delivery of the fetus to delivery of the placenta
3rd
Intrapartum stage: Arbitrarily lasts about 2 hours after delivery of the placenta (recovery)
4th
True or false labor: pain in lower back that radiates to abd
true
True or false labor: pain plus regular rhythmic contractions
true
True or false labor: contractions that intensify with ambulation
true
True or false labor: progressive cervical dilation and effacement
true
True or false labor: discomfort localized in abd
false
True or false labor: no lower back pain
false
True or false labor: contractions decrease with ambulation
false
Lightening
fetus drops into true pelvis
“practice contractions”
Braxton Hicks contractions
Prodromal labor signs include: burst of
energy
FHR best heard over the fetus’
back
Location of presenting part of the fetus in relation to midpelvis or ischial spines
fetal station
Fetal station 0
Fetus is “engaged”
Fetal station is expressed in terms of cm below the
ischial spines
Fetal presentation: The part of the fetus that presents to the inlet: Vertex presentation is
head
Fetal presentation: The part of the fetus that presents to the inlet: Vertex acromion is
shoulder
Fetal presentation: The part of the fetus that presents to the inlet: Vertex breech is
buttocks
The relationship of the point of reference
(occiput, sacrum, acromion) on the fetal presenting part (vertex, breech, shoulder) to the mother’s pelvis.
Fetal position
most common Fetal position is
LOA (left occiput anterior)
Relationship of the fetal parts to one another
Fetal attitude
Fetal attitude: ____ is desirable so that the smallest diameters of the presenting part move through the pelvis.
Flexion
normal FHR during labor:
110 to 160
normal maternal BP during labor
140/90
normal maternal pulse during labor
less than 100
normal maternal temp during labor
less than 100.4
when should you take BP (relative to contractions)
between
during labor, take BP in what position
side-lying
if infant’s head is floating, watch for
cord prolapse
assess the strength of a contraction according to
how indentable the fundus is
if membranes/water broke, vaginal fluid ___s under microscope
ferns
Woman should be allowed to ambulate during labor only if the
FHR is within a normal range and if the fetus is engaged (zero station)
If mother ambulates during labor when the fetus is not yet engaged, there is an increased risk for
prolapsed cord
Prolonged latent phase lasts over ___ hours in primigravida
20
Prolonged latent phase lasts over __ hours in multipara
14
___-stained fluid is yellow-green-gold and may indicate distress
meconium
intrapartum: Allow sips of clear fluid if
no general anesthesia is anticipated
Offer anesthesia or analgesia in ___ phase of labor.
midactive
If given too late, narcotics increase the risk of
neonatal respiratory depression
Heralded by the involuntary need to push, 10 centimeters of cervical dilatation, rapid fetal descent, and birth
Second Stage of Labor
if you start pushing to early, the cervix can get
edema and never fully dilate
At crowning, put gentle ____ against the
perineum
counterpressure
Third Stage of Labor
From complete expulsion of the baby to complete expulsion of the placenta (so basically the placenta coming out)
Give oxytocin ___ the placenta is delivered
AFTER (if you give it before the placenta might get stuck in there)
Estimation of blood loss after delivery
done by the doctor
after delivery, dry and __ the infant
suction
during the episiotomy, the baby is held by
father
Fourth Stage of Labor
first 1 to 4 hours after delivery of placenta
withhold oxytocin if BP is
greater than 140/90
methergine is not given to clients with
HTN
never give methergine or hembate to a client while
in labor or before passing the placenta
vaginal discharge after giving birth
lochia
after delivery, fundus should be firm and
at or below umbilicus
one of the most common reasons for uterine atony or hemorrhage in the first 24 h after delivery
full bladder
After delivery: if the fundus is soft/boggy
massage the fundus, then have the client void.
Re-check fundus periodically
after delivery: If the uterus does not become firm from the massage
escalate
after delivery: if the 2nd perineal pad is soaked in only 15 min
escalate
safety regarding analgesics
she should stay in the bed
after delivery: to minimize edema of the perineum, apply
ice pack
after delivery, Apply witch hazel compresses to perineum for
comfort
after delivery, Provide a warm, darkened environment so newborn will
open eyes
newborn: suction mouth and nose with ___ syringe
bulb syringe
newborn: position head
slightly lower than body
newborn: Expiratory grunt can indicate
breathing problem
Do not ____ the newborn neck at any time
hyperextend
a “good” apgar score is
7 to 10
___ prophylaxis is mandatory in the U.S.
eye
in addition to erythromycin, another med that may be used for the newborn’s eyes is
silver nitrate
Moro
startle
If parents desire an open-eye bonding period, may
delay eye prophylaxis for up to
1 hour
Regional blocks (epidural, caudal, and subarachnoid) cause a temporary interruption of nerve impulses (especially pain) but also cause
vasodilation
pain meds during labor cannot be given via
PO
pain meds during labor: between IV and IM
IV is preferred because it only takes 20 min for it to work
pain meds during labor: give the IV push at the beginning of a
contraction (so that less meds go to the fetus)
pain meds during labor: explain the purpose of the drug but
don’t promise results
If baby delivers during peak drug absorption time,
tell provider you might need narcan for the baby
___ anesthesia is rarely used in today’s obstetric units.
General
the first sign that a block (medication) is working is
warmth or tingling in the foot
block (medication): if hypotension occurs, position
on left side
block (medication): begin oxygen face mask at
10 L/min
block (medication): have ___ ready at the bedside
ephedrine
stop block medication infusion at the end of ___ _ or during ____
stage 1 or during transition
stop block medication infusion at the end of stage 1 or during transition to
increase effectiveness of pushing
____ rotation is harder to achieve when the pelvis is relaxed by anesthesia
internal rotation
the cardinal sign of persistent posterior fetal position
maternal back pain
regional blocks commonly result in
assisted delivery (forceps or vacuum) because you can’t push effectively
