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exam 2 Flashcards

1
Q

5 Ps that could affect L&D

A

Passenger (fetus and placenta)
passageway (birth canal)
powers (contractions)
position of mother
psychological response

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2
Q

what determines how the fetus moves through passageway

A

size of head
fetal presentation
fetal lie
fetal altitude
fetal position

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3
Q

anterior fontanel

A

In front of head
diamond shape

what we want to feel when baby is engaging

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4
Q

posterior fontanel

A

in back of head
triangular shape

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5
Q

fetal presentation

A

how baby is facing

Cephalic/vertex- baby is head down

Breech- baby bottom is towards the canal

Shoulder- baby’s shoulder is towards canal

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6
Q

why can’t you deliver a baby if its face first

A

it can cause nerve damage and facial bruising is likely

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7
Q

fetal lie

A

the relation of the long axis of the fetus to the long axis (spine) of the mother

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8
Q

3 types of lies

A

longitudinal- baby back parallel with moms

oblique- baby is crooked

transverse- baby back is perpendicular to moms

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9
Q

what can be performed if breech or transverse

A

version

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10
Q

fetal attitude

A

the relation of the fetal body parts to one another

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11
Q

flexion fetal attitude

A

fetal head is flexed to chest

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12
Q

military fetal attitude

A

head isn’t really flexed or extended

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13
Q

extension fetal attitude

A

baby head is extended. not good

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14
Q

how to determine the 3 level abbreviation for fetal position

A

First letter will be what side baby is laying on in moms abdomen - R or L

Middle letter will be the presenting part - occiput, sacrum, mentum, sinciput

Last letter will be if its anterior or posterior fontanel. Could also be transverse meaning we don’t really have a position.

Ideally we want to feel the anterior fontanel , baby be in occipital presenting part, and the side doesn’t matter

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15
Q

station

A

measurement of fetal descent

-5 is the highest up in the body. baby is not engaged in birth canal

station 0 is at level with ischial spine

+5 is the lowest point, baby is about to be birthes

We expect to see -2 when mom is at full term, but not in labor process
We expect to see +2 when mom is ready to start pushing and is fully dilated

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16
Q

what is passageway composed with

A

mothers rigid bony pelvis, soft tissues of cervix, pelvic floor, the vagina, and the introitus

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17
Q

external vs internal os

A

External os- outer opening of cervix
Internal os- inner opening of cervix

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18
Q

effacement

A

gradual thinning, shortening, and drawing up of the cervix measured in percentages from 0-100%

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19
Q

primary powers

A

involuntary contractions- frequency, duration, intensity

responsible for effacement and dilation

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20
Q

secondary powers

A

voluntary contractions. mom is pushing

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21
Q

signs preceding labor

A

lighting or dropping
return of urinary frequency
backache
braxton hicks
increased discharge
cervical ripening
possible rupture of membranes
weight loss possible from fluid loss
cervical change!!!!

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22
Q

4 stages of labor

A
  1. cervix dilating and thinning
  2. pushing. Baby born
  3. delivery of placenta
    4.After placenta delivery and thru period of recovery. About 2 hours
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23
Q

7 cardinal movements of labor

A

engagement
descent
flexion
internal rotation
extension
external rotation
birth by expulsion

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24
Q

what happens in internal rotation

A

head is under symphysis pubis

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25
what has head reached in the extension cardinal movement of labor
perineum
26
what 2 cardinal movements occur together
restitution and external rotation. baby automatically rotates
27
what happens in the expulsion movement of labor
baby is out
28
how much does cardiac output decrease by in first hour after delivery
50%
29
factors influencing pain
physiologic factors culture anxiety previous experience comfort/support enviroment
30
non pharmacological pain management
relaxation and breathing techniques counter pressure massage heat/cold hydrotherapy aromatherapy hypnosis music
31
can you give opioids when mom is almost fully dilated
No- could cause resp depression in baby
32
types of anesthesia
spinal epidural local perineal anesthesia- for repairs nitrous oxide general-For emergent cases that cant get a epidural. Could cause resp depression in baby. Mom will wake up in a lot of pain
33
what is a epidural and what are side effects
regional anesthesia that blocks pain in a particular region of the body hypotension, N/V, itching, increase in body temp serious: spinal nerve damage, convulsions, breathing difficulties
34
spinal anesthesia block
anesthetic solution inserted into L3, L4 or L5 into the subarachnoid cavity where it mixes with CSF - most commonly used for C section takes affect in 1-2 mins, last 1-3 hours
35
advantages of spinal anesthetic
no fetal hypoxia if BP is fine mom remains conscious excellent muscle relaxation minimal blood loss no feeling from chest down
36
disadvantages of spinal anesthetic
hypotension decreased RR leakage of CSF
37
why would baby develop late decelerations after epidural
low BP fix it with IV vasopressor
38
what is needed for amnionfusion
IUPC
39
variable deceleration interventions
*reposition, notify physician, amnioinfusion, discontinue oxytocin, o2, consider vaginal exam
40
three phases of labor
latent active transition
41
true labor
contractions are regular and increase in intensity. Walking causes intensified contractions as well. Cervix changes from posterior to anterior. Fetus is descending into pelvis
42
false labor
contractions are temporary. Stop when mom starts walking. Cervix may start to soften but it is not thinning out or dilating, baby isn't engaged
43
early laboring mom comfort measure that can be done at home (water hasn't broke yet but will within few days)
warm shower, repositioning, encourage to walk, distraction methods
44
latent phase
not dilates yet to 5 cm relatively calm phase with passive descent of baby through birth canal
45
active phase
6cm dilated and above active pushing and urges to bear down
46
emergency medical treatment and active labor act (EMTALA)
federal regulation that all pregnant woman that come in must be assessed before getting sent home
47
TOLAC
trial of labor after c section
47
what is the most important history we want to know about mom
previous pregnancies & complications, blood type, medications, GBS status, any discharge
48
VBAC
vaginal birth after c section
49
how many nurses must be in laboring room
2 1 for baby 1 for mom
50
Contraction assessment
frequency, duration, intensity, resting tone, strength use TOCA palpate for strength of contraction
51
what needs done in the first stage of labor assessment
head to toe with focused OB vitals- need accurate BP assessment of fetal HR assessment of uterine contractions vaginal exam
52
what does L&D vaginal exam tell us
Tells us if ruptured, dilation, how much time we have
53
what labs to look for in a laboring mom
hgb, hct, wbc, plt, UA, AST, CMP, GBS
53
what needs documented with a rupture of membranes
time odor color amount
54
what test tells us if patient ruptured membranes
fern test
54
what to monitor for with amnioninfusion
for fluid to come back out
55
ferguson reflex
mom has natural urge to push
56
what is needed as soon as baby is born
immediate assessment
57
OA position vs OP position of baby
Baby looking down - OA position - desired Baby looking up- OP position
58
1st degree laceration
laceration confined to skin. Repair usually isn't needed
59
2nd degree laceration
laceration extends through perineal muscles
60
3rd degree laceration
Laceration that involves injury to the external anal sphincter muscle
61
4th degree laceration
Laceration that extends completely through the anal sphincter and the rectal mucosa May need to go to OR after and will cause issues with BM. Usually has significant hemorrhage
62
when is QBL counted
after placenta is out
63
what to worry about if placenta didn't deliver
placenta being embedded in uterine wall
64
precipitous labor
last less than 3 hours from onset of contraction to birth
65
preterm labor
regular labor contractions along with a change in effacement and/or dilation week 20 to week 36 and 6 days
66
why would a preterm birth be indicated
medical issue
67
difference between preterm birth and low birth weight
preterm is more dangerous no matter the size of the baby because it had less time in utero
68
risk factors for preterm births
previous preterm, multifetal, infection, smoking, drug use, high stress, congenital or medical issues.
69
fetal fibronectin test
picks up protein due to separation of amnion and chorion. If detected early on may mean preterm. Has high false positive rate, but if its negative its negative
70
if preterm is suspected what do we do
restrict sexual activity bed rest aside from things such as bathroom admission if needed
71
what do tocolytics do
arrest labor ex- nifedipine, indocin
72
magnesium sulfate for preterm labor
can be given to relax uterus and to onboard steroids
73
antenatal glucocorticoid
painful, slow injection given in the buttocks to accelerate fetal lung maturity by stimulating fetal surfactant production given 24 hours apart ex- betamethasone
74
PROM
premature rupture of membranes- happens after labor starts
75
PPROM
Preterm premature rupture of membranes. happens between 20-37 weeks may be caused by UTI, weekend amniotic membrane
76
chorioamnionitis
bacterial infection in the abdominal cavity most often occurs after membranes rupture or labor begins risk factors- long labor, PROM, multiple vaginal exams, use of internal monitors s/s- fever, increased HR
77
post term weeks and risks
42 weeks or more risks: fetal Macrosomia, amniotic fluid decreases- cord compression, placenta function decreases, meconium aspiration
78
dystocia
lack of progress in labor
79
dysfunctional labor
labor that is long, abnormal, or difficult
80
latent phase disorders of labor
ineffective contractions
81
active phase disorders of labor
Arrest of dilation, abnormal labor patterns, mom exhausted to keep bearing down
82
induction of labor- cervix ripening
medication (cervidil) put in cervix to help thin out
83
amniotomy
procedure to break the water to induct labor
84
oxytocin
High alert med with a lot of risks. Synthetic form of oxytocin. Can be used for labor process for contractions and after if mom is at risk for hemorrhage. can be used for labor induction
85
types of operative vaginal delivery
forceps assisted vacuum assisted
86
why may someone get a C section
Malpresentation, non reassuring fetal HR, herpes, failure to progress, placental abruption, they want it
87
why is meconium stained amniotic fluid a OB emergency
aspiration risk for baby
88
shoulder dystocia
baby shoulder gets stuck in vaginal delivery life threatening injuries may occur- brachial plexus palsy, death, asphyxia, broken clavicle
89
amniotic fluid embolism
amniotic fluid gets into maternal circulation causing cardiovascular collapse. high mortality rate sudden onset of hypoxia, hypotension and hemorrhage unsure why it happens and is not preventable
90
OB emergencies
meconium stained amniotic fluid shoulder dystocia prolapse of umbilical cord uterine rupture amniotic fluid embolism
91
risk for developing shoulder dystocia
The greatest risk factor is a previous shoulder dystocia, as well as diabetes because of the risk for macrosomia, but we do not always know why a woman develops this problem in delivery. Women have had shoulder dystocia with smaller babies.
92
two maneuvers for shoulder dystocia
McRoberts Maneuver (pulling moms legs back as far as you can) and the application of Suprapubic pressure.
93
what can cause a prolapse of umbilical cord and how to fix
water breakage before baby is engaged try to keep baby off cord C section delivery keep mom in trendelenburg position provider try to keep pressure by doing a vaginal exam to physically keep pressure off the cord
94
uterine rupture
separation of the layers of the uterus or previous scar high risk if mom has had many c sections s/s- abnormal fetal heart patterns, sharp abdominal pain, bright red bleeding, hypovolemic shock
95
late decel intervention
Reposition-turn on side, oxygen, stop Pitocin, administer fluid bolus, notify physician, administer terbutaline. We may need to prepare for C section.
96
variable decel interventions
Reposition mom, which will hopefully reposition the baby. We may need to oxygenate mom, do a vaginal exam, discontinue oxytocin, or do amnioinfusion. When this happens, we should also notify the provider.

maternity (4 decks)

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