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Reproduction > Clinical 1 Normal Labor and Delivery > Flashcards

Clinical 1 Normal Labor and Delivery Flashcards

1
Q

Def of labor

A

Progressive Cervical Effacement, Dilatation or both
due to regular uterine contractions
(occur every 5 mins & last 30-60 secs)

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2
Q

Cervical Effacement

A

“Thinning of the cervix” as it is taken up into the lower uterine segment.
Usually begins prior to labor.
Usually results in the “Bloody Show” where the mucous plug from the cervix mixes with blood.

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3
Q

Caput

A

Localized, edematous swelling of the fetal scalp. Is caused by pressure of the cervix on the presenting portion of the fetal head.

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4
Q

First stage of labor

A

From the onset of true labor to complete cervical dilatation.

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5
Q

2nd stage of labor

A

From complete cervical dilatation to birth of the baby.
Pt is fully dilated. Usually has urge to push.

Duration
Primigravids 30 min to 3 hrs. Median 50 minutes.
Multigravids 5 to 30 minutes. Median 20 minutes.
Completed when baby is born.

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6
Q

3rd stage

A

From birth of the baby to delivery of the placenta.

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7
Q

4th stage

A

From delivery of the placenta to stabilization of the patient. (Usually 6 hrs post partum. or 1 hr post partum).

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8
Q

LATENT PHASE-

A

consists of cervical effacement and early dilatation. Considered completed at 3cm dilatation.

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9
Q

ACTIVE PHASE

A
  • Begins when cervix is 2-4 cm dilated in the presence of regular contractions. Consists of an acceleration, max slope & a theoretical deceleration component.
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10
Q

Know slide 29

A

KNOW IT

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11
Q

Management of 1st stage

A

May Ambulate with intermittent monitoring
I.V. Fluids Only (emergencies and pitocin)
Labs (CBC, Type and Rh, Urine for glucose and protein.
Vitals q 1-2 hours.
Analgesia ( Epidural, I.V. Morphine etc..) usually not during latent phase.
FETAL MONITORING (low risk)
every 30 minutes in active phase of Stage 1.
every 15 minutes in 2nd Stage.
With Some Obstetrical risk factors
q 15 minutes in active phase
q 5 minutes in 2nd stage.
HIGH RISK - NECESSITATES CONTINUOUS MONITORING.
If patient is on Pitocin for induction or augmentation, she should be monitored extensively.
Vaginal Exams q 2 hours in active phase or more often as warranted. (Beware the risk of chorioamnionitis if membranes are ruptured.)
Amniotomy -artificially breaking the bag of water. (when labor is advanced) Good for assessing fluid. May speed up labor.

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12
Q

6 cardinal movements

A 
DESCENT
FLEXION
INTERNAL ROTATION
EXTENSION
EXTERNAL ROTATION
EXPULSION
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13
Q

Descent

A

Results from the forces of the uterine contractions

is continuous until delivery of the fetus

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14
Q

Flexion

A

Natural muscle tone of the fetus

resistance from cervix, walls of the pelvis and pelvic floor

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15
Q

Internal rotation

A

when the fetal head turns anteriorly towards the symphysis pubis from the transverse or oblique diamter.
occurs at the pelvic floor when the head meets the muscular sling of the pelvic floor

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16
Q

Extension

A

During descent, the fetal head will extend as it meets the vaginal outlet whic his directed upward and forward
“crowning” the bulding of the perineum which indicates that the largest diameter of the fetal head is encircled by the vulvar ring

17
Q

External rotation

A

The rotation of the fetal head back to it’s original position at the time of engagement to realign itself with it’s back and shoulders.

18
Q

expulsion

A

Usually Anterior shoulder under pubic symphysis
Posterior Shoulder
Rest of fetus in rapid succession.

19
Q

Management of the second stage

A

Position- Comfortable as long as fetus can be monitored and mother is able to push.
Monitoring- Continuous is preferred but intermittent may be allowed.( Decelerations may be noted.)
Vaginal Exams- q 30 minutes (more frequent as warranted).
Delivery of the Fetus
Ritgen’s Maneuver- controls delivery of the head. Fingers of one hand press posterior to the rectum extending the fetal head. Counterpressure is applied to the occiput.
Episiotomy- provides greater room to facilitate delivery. 2 types
Midline
Mediolateral
Delivery of the Fetus -continued
After delivery of the head- suction mouth then nares.
Check for Nuchal Cord, Downward traction, Upward traction, traction on shoulders until delivery is completed.
Clamp and Cut Cord.

20
Q

3rd stage of labor

A

Delivery of the Placenta - 0 to 30 minutes.
Separation usually occurs at 2 to 10 minutes.
Signs include; Fresh show of blood from vagina, lengthening of umbilical cord, elevation of fundus, uterus becomes firm and globular.

21
Q

3rd stage management

A

Inspection of cervix and vagina for lacerations.
Do not pull on cord (Inversion of uterus)
Bleeding Control
Massage
Pitocin, Methergine and Prostaglandin F2 Alpha.
Manual Extraction, D&C
Repair of Episiotomy and or Lacerations.
Laceration Types
1st degree- vaginal epithelium or perineal skin.
2nd degree- extends into subepithelial tissues of vagina or perineum. w/wo perineal body.
3rd degree- anal sphincter
4th degree- rectal mucosa.
Absorbable Sutures

22
Q

4th stage of labor

A

1-6 hours after delivery.
1st hour is most important
watch for bleeding, hematoma (pelvic or rectal pain).
increased pulse rate out of proportion to decreased blood pressure.

23
Q

Indications for induction

A

Maternal: Preeclampsia, diabetes, heart disease

24
Q

Indications for augmentation

A 
Abnormal labor (in the presence of inadequate contractions)
prolonged latent or active phase
25
Q

Indications of induction/augmentation of labor: Fetoplacental

A 
Prolonged Pregnancy
IUGR
Abnormal Fetal Testing
RH  Incompatibility
Fetal Abnormality
PROM
Chorioamnionitis
26
Q

Maternal CI for Induction/Augmentation of labor Absolute

A

Contracted pelvis

27
Q

Maternal CI for Induction/Augmentation of labor-relative

A

Prior Uterine Surgery
Classic C-Section (Low Transverse is OK)
Complete transection of uterus (myomectomy, reconstruction) Most common reason.
Overdistended Uterus (severe polyhydramnios etc.)

28
Q

Fetoplacental CI for Induction/Augmentation

A

Preterm fetus without lung maturity
Acute fetal Distress
Abnormal presentation

29
Q

Induction Points

A

Induction before term (37 weeks) is indicated only if continuation of the pregnancy represents a risk to mom or baby.
If no medical indication, you must make sure you have fetal lung maturity.
ACOG guidelines indicate you must have documented fetal lung maturity prior to 39 weeks gestation.
L/S ratio PG ratio? Amniocentesis.
Prior to Induction may need to ripen cervix.
Prostaglandin gel; PGE 2 gel, cervidil and prepidil.
Osmotic dilators- Laminaria
Corticosteroid Use? Accelerates Pulmonary Maturity.
BISHOP SCORE Prior to cervical ripening.

30
Q

Bishop score significance

A 
High score (9 to 13) equals high likelihood of vaginal delivery.
Low score ( <5 equals) decreased liklihood of success (65% to 80%).
31
Q

Oxytocin infusion

A

Dilute Solution (piggyback to main I.V.)
I.V. ( for quick discontinuation) 1/2 life 3-5 min.
Induction should not exceed 72 hours.
If membranes ruptured and no progress after 12 hours may do c- section.
Don’t worry about dosing chart on page 164 for test.

32
Q

Oxytocin infusion Complications

A 
Hyperstimulation
Rupture of Uterus
Antidiuretic Effect can lead to (water intoxication, convulsions and coma especially if over 24hours.)
Muscle Fatigue
Postpartum Uterine Atony
33
Q

Define: Puerperium

A

period following delivery to approx 6 weeks postpartum

34
Q

Anatomic and Physiologic Changes (not important)

A

Involution of Uterus
Tissue catabolism (1000 grams to 100-200 grams in 3 weeks).
Discharge
Lochia rubra- erythrocytes first 3-4 days
Lochia serosa-paler 3-10 days
Lochia alba- white or yellow/white
Foul Smelling- may be indicative of endometritis.
Cervix- becomes firm.
Cardiovascular- increase in peripheral vascular resistance, cardiac output and plasma volume return to normal over 2 weeks.
Marked Weight Loss

Psychosocial Changes
“Postpartum Blues”
Return of Menstruation and Ovulation
Usually 6-8 weeks. This is Variable.

35
Q

Breast feeding

A 
Immunologic Advantages
Secretory IgA/Colostrum
Lactation Initiation
Drop in Placental Estrogen
Suckling Stimulation
Lactation Suppression
Tight bra, ice packs, (Bromocriptine no longer on market).
36
Q

Breast Milk composition

A

proteins, lactose, water and fat

37
Q

Proteins in breast milk but not in cow’s milk

A

casein
lactalbumin
b-lactoglobin

38
Q

Breast feeding complications

A

Cracked nipples
Mastitis
Drug passage to newborns

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