Clinical Approach To Labor Flashcards
Latent labor
Is the first part of the 1st stage of labor where the cervix is 0-6cm dilated
Can show “false labor/Braxton-hicks” contractions = regular and irregular painful contractions with no change to the cervix
95th percentile time for null = 30hrs
95th percentile for multi = 24.5 hrs
Treat if prolonged and minimal to no cervical change
- therapeutic rest
- oxytocin IM
- no intervention of just keep the labor going
- *if the fetus or mother are unstable = immergent delviery**
Leopoldo maneuvers
Used to position baby in better position and lie
more difficult if obese, polyhydramnios, multiple gestation or an anterior placenta are present
Position of the fetus
Is the orientation fo the body part in relation to the maternal pelvis (pubic symphysis)
Membrane status
Use a sterile speculum and look for vaginal pooling
- *if you suspect ruptured membranes, always do a sterile speculum exam before digital exam**
- if the patient starts leaking fluid or fluid is noticeable on speculum exam after lying semi-recumbent for 45 minutes, test with Nitrazene
- *however if there is any pooling of fluids it pretty much suggests rupture of membranes
Contraction evaluation
Measure the amount per minute, a outside of contractions and length of contractions
Normal length = 60-90 seocnds
<2 contractions/10 minutes = not able to actually induce birth
> 5 contractions/10 minutes = may be harmful for fetus if not inducing labor right then
Nitrazine paper
Helps confirmation of ROM
Take and pooled fluid and swab it with a stick and then touch the paper
- if it turns blue = (+) ROM
Ferning
Used to confirm ROM
Place fluid on slide and allow it to try and check for low power microscopy
(+) ROM = crystallized sodium chloride is seen
When to do an exam for a patient admitted for labor
On admission
Every 2-4hrs in first stage of labor
Prior to administration of anesthesia
Every 1-2 hrs in second stage of labor
When to he patient feels the urge to push
When any FHR abnormalities present
Types of ROM
SROM = spontaneous
AROM = artificial
PROM = premature (prior to onset of labor
PPROM = preterm premature (prior to onset of labor and before 37 weeks)
Admission labs to acquire for labor
CBC
Type and screen
Urinalysis
If they are preeclampsia
- CMP
- Uric acid
- Fibrinogen
- protein:creatine ratio
If gestational diabetes mellitus
- POCT blood sugar reading
Normal length of the second stage of labor
Without epidural
- null = 0.6 hrs
- multi = 0.2 hrs
With epidural
- null = 1.1 hrs
- multi = 0.4 hrs
Normal labor characteristics
Regular
Painful contractions
Progressive dilation and effacement of the cervix occurs with each contraction
Descent and expulsion for the fetus occurs during labor
Arrest and protraction risk factors of the second stage of labor
Think “POWER, PASSENGER, PASSAGE”
Power
- uterine aTony = most common
Passenger
- non occiput anterior and spontaneous rotation to the OA is most common
- macrosomia is present
Passage
- maternal obesity
- maternal pelvis abnormal shape
Protractive active phase of labor treatment
if dilating < 1cm/hr over 2hrs minimum = administer oxytocin and proceed with amniotomy at same time
Also consider the station of the head also
- if it is high and not well applied to the cervic = can use oxytocin alone for 4-6hrs and then consider amniotomy afterwards
- *risk factors**
- cord prolapse
- bradycardia
- emergent C-section
Arrested active phase treatment
C-section is needed
Null = allow up to 4hrs total before diagnosing
Multi = allow up to 3 hrs total before diagnosing
dont put off too long though
