Exam 3 Flashcards
anticipatory signs of labor
Lightening: ability to breathe easier
loss of mucous plug
ROM
Nesting: burst of energy
effacement: thinning of cervix
dilation: opening of cervix
abor Contractions Have the Following Characteristics:
They are regular
They follow a predictable pattern (such as every eight minutes)
They become progressively closer
They last progressively longer
They become progressively stronger
Each contraction is felt first in the lower back and then radiates around to the front or vice versa
A change in activity or body position will not slow down or stop contractions
Your mucus plug may appear
Membranes might rupture
Your health care provider will notice cervical changes, such as effacement (thinning) or dilation
Powers
Purpose: Dilate the cervix + aid in the expulsion of the fetus.
Contractions originate in the fundus and radiate out
Measured by: Frequency: how often are they occurring from start of 1 contraction to the start of the next.
Duration: how long 1 contraction lasts - from start to end of 1
Intensity:
Mild - fundus is able to be pushed feels like the noseo
Moderate: chin
Strong: can’t push in like forehead
Can measure by
IUPC
Mild = <40mmhg
Mod = 40-70mmhg
Strong = >70mmhg
Passageway
Route the fetus must travel
- maternal pelvis
- cervix
Types of Pelvis
Gynecoid: true female - 50% , round, shallow, open
Android: male resemblance, more heart shape - c/s
Anthropoid: narrow + deep
Platypelloid: flat, least common, wide, shallow - egg/oval
Passageway
Route the fetus must travel
- maternal pelvis
- cervix; needs to be ripe –> BISHOP SCORE
- effacement
- dilation
Types of Pelvis
Gynecoid: true female - 50% , round, shallow, open
Android: male resemblance, more heart shape - c/s
Anthropoid: narrow + deep - could do vaginal but it could be a long labor
Platypelloid: flat, least common, wide, shallow - egg/oval c/s
Cardinal Movement of Fetus
- engagement with cervix, flexion, descent
- further descent, internal rotation
- complete rotation, extension
- complete the extension
- restitution - external rotation
- delivery of anterior shoulder
- delivery of posterior shoulder
Passanger
Fetal Attitude: general flexion
Mentum: face presentation, loosely flexed legs. back arched - 13.5cm
Brow: brown at the cervix, sitting like a genie
Sinciput: head is up and not flexed on the chest 10 cm
Vertex/Occiput: fully flexed head to chest, legs flexed up; optimal position - 95% - 9.5cm
Fetal Lie: how the fetus is positioned in the womb
longitudinal: fetus spine running the same direction parallel as mother’s spine; can also be breech
transverse: positioned horizontally - CANNOT HAVE VAGINAL BIRTH
oblique: the head is against the mother’s hip, above the birth canal no parts are against the cervix
Fetal Presentation: the fetus body part that is closest to the cervix; which is presenting first
Frank: buttocks first, legs up
Full: buttocks first but less flexed
Footling: feet first and not flexed
Occiput: head first
Positon
Fetal Position: how the fetus is positioned in the womb and what part of the baby emerges first
1st letter: which way is facing
L: left
R: right
2nd Letter: what part of the body is presenting
O: occiput
S: sacrum
T: transverse
3rd: direction the fetus is facing in relation to mother
A: anterior: facing forward
P: posterior: facing backward
LOA – left, occiput, anterior = fetus is head first, angled to the left of mom’s pelvis and facing mom’s anterior
LOP: sunny side up; back pain –> counter pressure
LOT:occiput isn’t anterior or posterior
Station: relation of the presenting part in relation to the maternal pelvis
0 = engaged at the ishial spines
-5 = higher on the ishial spines
+5 = lower towards cervix
Leopold Maneuvers
To feel the fetal presentation and maneuvers
1. feels the top of the fundus
2. side of the uterus
3. suprapublic
4. only if in cephalic presentation feel for fetal attitude and extension
True Labor
contractions: strong, regular, long and close together, more intense with walking
felt in the lower back and doesn’t stop with comfort measures PAIN RADIATES
Cervix: changes - softening, effacement, dilution
Fetus: presenting parts engage the cervix, easier to breathe (lightening)
show is present
False Labor
Contractions: irregular, stops while walking or comfort measures, felt in the back or above umbilicus; only in groin + lower abdomen
Cervix: may be soft but no significant changes, no bloody show, posterior position - posterior position
Fetus: not engaging cervix
Fetal Heart Tones
Early Dec
VEAL CHOP
Variable Decelerations –> Cord Compression
Early Decelerations –> head Compressio
Accelerations –> ok
Late Decelerations –> placental insufficiency
Accelerations: want to see 2 accelerations >15 bpm for 15s
Early decels: pressure on skull; nothing can be done
Late: hypoxia, need to promote perfusion to fetus. STOP OXY and change position
Variable: change position, fetal or Trendelenburg to relieve pressure.; STIOP INFUSION, O2, amniofusion
Maternal Assessment Before birth
Materal hx: allergies, medications, hx of preg, maternal testing (blood type, Rh, hct/hg, GBS, Hepatitis B, nonstress)
Vital signs
uterine activity
Bladder I&O
Membrane status –> nitrazine (pH strip), amnisure, fern test
Response to labor
discomfort
cultural needs
Fetal Assessment before birth
Fetal presentation and station
HR
Internal: on scalp of baby
External: on top of fundus + on the baby’s spine on the outside
Looking for baseline FHR, variability, accelerations, decelerations
gestational growth + age
Fetal Heart Rate
Goal is to interpret + assess fetal oxygenation
Auscultation use of fetoscope + doppler, internal, external monitoring
Baseline: 110 - 160
Tachy
Mild: 161-180
Severe: >180
Causes: infection, increase metab, hyperthyroid, dehydration, anxiety, stress, fetal hypoxia, corchioamniotesis
Brady
Mild: 100 - 109
Moderate: 70-99
Severe <70
Cause: increase vagal tone, beta blockers, supine hypo, cardiac defects, cord prolapse, CHP
Variability = status of CNS
normal –> 6-25 bpm
Decrease = decrease CNS, alcohol, heroin, hypoxia; if sustained then fetus may need to be immediately delivered
Psyche
The way a woman handles the labor process
influenced by:
Parity
age
culture
coping mechanisms
emotional factors
length + intensity of labor
maternal + fetal position
Pain caused by dilation, pressure on cervix + tissue anorexia
THE SIX CARE PRACTICES THAT SUPPORT NORMAL BIRTH
- labor begins on it’s own
- freedom of movement
- continuous labor support
- minimize intervention
- spontaneous pushing in non supine positions
- no separation of mother and baby
Categories of FHT
Category I: normal; no intervention
2: indeterminate; requires eval + continued monitoring
3: predictive of abnormal fetus acid base, requires prompt eval and interventions
Methods of pain management
Non pharm: moving freely, position change, support system, massage, heat, water immersion, relaxation, aromatherapy, acupuncture, counter pressure, walking, sensory - aroma therapy, breathing, cognitive: hypnosis
Pharm:
Analgeis: partial + full relief from pain: opiates, morphine, stadol, nubain
Anesthesia: loss of sensation
Epidural: blocking neurotransmission —> give bolus for hyptoT
Nitrous oxide
Spinal block
Administration:
Systemic: IV, IM +inhalation; opiates can slow progression + affect fetus
Regional: epidural, spinal - risk of spinal headache, combo
Local block: pupendal + para cervical nerve block
First Stage
True labor contractions –> full dilation of cervix
- Early/Latent Phase: 0-3 cm; irregular contractions 20-40s, 10-30 min apart
woman is excited!
Actions: review plan, reinforce breathing techniques, lab tests per orders - Active: 4-7 cm; intense contractions, every 2-5 min, 45-60 s each, discomfort increases
Actions: monitor FHR, assess pain/admin analgesia, oral fluids - Transition: 8-10cm; shortest but most intense, 1-2 min 60-90 s N/V, diaphoresis
Actions: assess FHR + contractiosn Q15 min, assist with toileting, comfort + support
Second Stage
complete cervical dilation –> birth
INTENSE CONTRACTIONS Q2 min 60-90 s
URGE TO BEAR DOWN (ferguson’s reflex); don’t push until completely effaced and dilated
Actions: instruct when to bear down, monitor FHR Q5-15 / after each contraction, comfort
Third Stage
Birth –> placenta
Uterus contracts until placenta is out ~ 30 mins
You’ll know it’s coming when the uterus gets smaller and there’s a gush of blood.
Actions: assess vitals q15, utertonics as prescribed
Fourth Stage
postpartum –> 4hrs
Chills, pain fatigue,
newborn skin - skin
ASSESS FOR HEMORRHAGE