class 5 - labour

Question 1

Start of true labour to complete effacement and dilation
Includes latent/early phase & active phase
Longest stage

Answer 1

1st stage

Question 2

From complete effacement & dilation
Ends with birth of newborn

Answer 2

2nd stage

Question 3

3rd stage:

Answer 3

from birth of newborn to placenta delivery

Question 4

when does the early/latent phase of 1st stage end?

Answer 4

when at 3cm for nulliparous, and 0-4cm for multips

Question 5

how effaced do you have to be to be in active phase of labour?

Answer 5

100%

Question 6

5 componants of the birth passageway

Answer 6

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

Question 7

2nd P is for _________

Answer 7

passenger

Question 8

what are the 5 ps?

Answer 8

passageway
passenger
powers
position (birther)
psychological

Question 9

what are the components of “passenger”?

Answer 9

presentation, position, station, lie, attitude

Question 10

definition of “fetal attitude””:

Answer 10

relationship of fetal body parts to each other

Question 11

what landmarks station 0 for fetal station?

Answer 11

ischial spine

Question 12

“engagement” usually corresponds to ______ station

Answer 12

0

Question 13

what are the “powers” of labor?

Answer 13

primary: involuntary uterine contractions
secondary: birther’s bearing down efforts (only in second stage

Question 14

how many cardinal movements are there? what is the first? when is flexion? what happens after flexion?

Answer 14

7. first is engagement. flexion happens at movement 3, after that is internal rotation

Question 15

what is the “golden rule” for dilation?

Answer 15

1cm per hour

Question 16

what is the definition of “dystocia”?

Answer 16

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

Question 17

when do we usually see hypertonic contractions?

Answer 17

early phase of first stage

Question 18

what is cephalopelvic disproportion?

Answer 18

head is too big to fit

Question 19

what is the difference between PROM and PPROM?

Answer 19

PROM is premature rupture of membranes BEFORE LABOUR, and PPROM is if rupture happens before 37 weeks

Question 20

describe the interprofessional care if we see meconium stained fluid?

Answer 20

call NICU resus team to be on standby at delivery

Question 21

how do we treat GBS

Answer 21

-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

Question 22

risks associated with forceps delivery

Answer 22

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

Question 23

risks for vacuum delivery

Answer 23

mom: laceration, injury
baby: caput (swelling of head), cephalohematoma, jaundice (d/t rbc breakdown from giant hickey)

Question 24

what to document for vacuum delivery:

Answer 24

when placed, number of pop-offs and timing, number of pulling and timing, max amount of suction used (ask ob)

Question 25

what to document for forceps delivery

Answer 25

when placed, number of pulls and timing