class 5 - labour Flashcards
Start of true labour to complete effacement and dilation
Includes latent/early phase & active phase
Longest stage
1st stage
From complete effacement & dilation
Ends with birth of newborn
2nd stage
3rd stage:
from birth of newborn to placenta delivery
when does the early/latent phase of 1st stage end?
when at 3cm for nulliparous, and 0-4cm for multips
how effaced do you have to be to be in active phase of labour?
100%
5 componants of the birth passageway
Bony pelvis
Soft tissues of the cervix of the birther (may be affected by fibroids or tumors)
Pelvic floor
Vagina
Introitus: external opening of the vagina
2nd P is for _________
passenger
what are the 5 ps?
passageway
passenger
powers
position (birther)
psychological
what are the components of “passenger”?
presentation, position, station, lie, attitude
definition of “fetal attitude””:
relationship of fetal body parts to each other
what landmarks station 0 for fetal station?
ischial spine
“engagement” usually corresponds to ______ station
0
what are the “powers” of labor?
primary: involuntary uterine contractions
secondary: birther’s bearing down efforts (only in second stage
how many cardinal movements are there? what is the first? when is flexion? what happens after flexion?
- first is engagement. flexion happens at movement 3, after that is internal rotation
what is the “golden rule” for dilation?
1cm per hour
what is the definition of “dystocia”?
greater than 4 hours of less than 0.5 cm per hour of cervical dilation in active labour OR greater than 1 hour of active pushing with no descent
when do we usually see hypertonic contractions?
early phase of first stage
what is cephalopelvic disproportion?
head is too big to fit
what is the difference between PROM and PPROM?
PROM is premature rupture of membranes BEFORE LABOUR, and PPROM is if rupture happens before 37 weeks
describe the interprofessional care if we see meconium stained fluid?
call NICU resus team to be on standby at delivery
how do we treat GBS
-IV abx prophyylaxis for GBS + status or GBS unknown
-Loading dose: Penicillin G 5 million units IV
-Maintenance dose: Penicillin G 2.5 million units IV
-Frequency: q4h until birth
risks associated with forceps delivery
mmom: laceration, hematoma, injury to urethra/bladder
PPH
baby: facial marks, bruising, lacerations, shoulder dystocia
rare: facial nerve palsies, ocular trauma, skull fractures, intracranial hemorrhage
risks for vacuum delivery
mom: laceration, injury
baby: caput (swelling of head), cephalohematoma, jaundice (d/t rbc breakdown from giant hickey)
what to document for vacuum delivery:
when placed, number of pop-offs and timing, number of pulling and timing, max amount of suction used (ask ob)
