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NURS787 Exam 1 > First Stage of Labor > Flashcards

First Stage of Labor Flashcards

1
Q

Define labor

A

regular, painful contractions that promote cervical change

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2
Q

Phase 1

A

quiescence = prelude to parturition.

Contractile unresponsiveness; cervical softening

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3
Q

What inhibits uterine contractions?

A

1) progesterone
2) prostacyclin
3) relaxin
4) nitric oxide
5) parathyroid hormone-related peptide
6) corticotropin-releasing placental lactogen

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4
Q

Phase 2

A

activation = preparation for labor

uterine preparedness for labor; cervical ripening

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5
Q

Define uterotropins

A

1) estrogen
2) prostaglandins

  • stimulate upregulation of myometrial receptors for oxytocin and prostaglandins
  • activate gap junctions b/w myometrial cells
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6
Q

Phase 3

A

stimulation = processes of labor

uterine contraction; cervical dilation; fetal and placental expulsion

includes 3 stages of labor

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7
Q

Define uterotonins

A

promote labor progression

1) prostaglandins
2) oxytocin

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8
Q

Phase 4

A

involution = parturient recovery

uterine involution; cervical repair; breastfeeding

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9
Q

What promotes involution?

A

1) oxytocin
2) thrombin
3) prostaglandin

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10
Q

1st clinical stage of labor

A

begins w/ true labor contractions –> ends with full dilation; comprised of 2 phases

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11
Q

What are the 2 phases of the first stage of clinical labor?

A

1) latent: contractions become more regular, painful, and frequent BUT little cervical dilation w/ little to no fetal descent
2) active: cervical dilation to completion

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12
Q

Describe receptor changes that stimulate labor

A
  • progesterone binds more readily to PR-A (vs PR-B) –> quiescence ceases
  • estrogen stimulates expression of prostaglandin and oxytocin receptors
  • myometrial cells develop gap junctions that facilitate direct communication b/w muscle fibers

–> uterine contractions

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13
Q

Goodell’s sign

A

cervical softening ~4wks after LMP

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14
Q

Chadwick’s sign

A

increased cervical vascularity ~6wks after LMP (cervix and vaginal walls appear blue)

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15
Q

cervical ripening

A

rearrangement of collagen prior to and during labor –> become less dense

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16
Q

What are the 4 phases of cervical remodeling?

A

1) softening
2) ripening
3) dilation
4) postpartum repair

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17
Q

effacement

A

lengthening of muscle fibers at internal os –> stretches endocervix upward into lower uterine segment

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18
Q

dilation

A

widening of external os

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19
Q

What promotes dilation?

A

1) force of contractions
2) hydrostatic action of amniotic fluid
3) pressure of presenting part if ROM

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20
Q

What does passing of mucuos plug indicate?

A

likely labor w/in 48h

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21
Q

Describe internal rotation

A

OT/LOA/ROA –> direct OA

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22
Q

How long is the latent phase of the 1st clinical stage of labor?

A

<20h

23
Q

What is considered prolonged latent phase?

A

nullips: >20h
multips: >14h

24
Q

How dilated are people at the beginning of the active phase?

A

nullip: ~4cm
multip: ~5cm

25
Q

How long does the active phase last?

A

nullip: ~4.4-4.9h w/ 1.2cm dilation/h
multip: ~2.2-2.4h w/ 1.5cm dilation/h

26
Q

What are the 3 subphases of the active phase?

A

1) acceleration: little progress in dilation
2) maximum slope: 3.0cm/h (nullip); 5.7cm/h (multip)
3) deceleration: occurs b/w 8-10cm

27
Q

How else may labor progression be identified beyond a cervical exam?

A
  • fetal station and position
  • maternal behavior
  • contraction pattern
  • s/sx of transition into second stage of labor
  • change of location of back pain
  • change in location of maximum intensity of FHT
  • change in position of FHT
28
Q

Define transition

A

change from first to second stage of labor; occurs typically b/w 8-10cm dilation

29
Q

s/sx of transition

A
  • lull in frequency/intensity of contractions
  • presenting part induces maternal urge to bear down
  • FHT progressively lower on maternal abdomen
  • rectal/perineal bulging
  • progressive visibility of fetal head at introitus
  • increase in bloody show
30
Q

premature rupture of membranes (PROM)

A

occurs >1h before onset of labor

31
Q

preterm premature rupture of membranes (PPROM)

A

PROM before 37wks GA

32
Q

artificial rupture of membranes (AROM)

A

AKA amniotomy

provider induced ROM

33
Q

What is criteria for AROM?

A

1) cephalic presentation

2) engagement in pelvis (0 or +1 station)

34
Q

What are risks associated w/ AROM?

A
  • cord compression –> FHT deceleration
  • cord prolapse
  • maternal discomfort
  • increased risk infection
  • rupture of fetal vessels (RARE)
35
Q

What is ACOG criteria for labor dystocia?

A

1) active labor (>/= 6cm)
2) adequate contractions (>/=200 Montevideo units)
3) ROM for at least 4h

36
Q

What is the effect of labor on gastric emptying time?

A

prolonged, especially after administration of analgesics

37
Q

When is fasting recommended?

A

6-8h before elective C/S or puerperal tubal ligation

38
Q

How is the risk of gastric content aspiration mitigated?

A
  • clear fluids b/w normal pushing; no solids
  • antacids given routinely
  • prepped for intubation w/ cricoid pressure
  • employ regional anesthesia (vs general) when possible
39
Q

When are antacids indicated during labor?

A

before general anesthesia (w/in 1h - give second dose if >1h and anesthesia not yet induced)

40
Q

What is an example dose of antacids?

A

Bicitra (sodium citrate + citric acid) 30mL PO

others: nonparticulate antacid; H2-receptor antagonist; metoclopramide

41
Q

What are indications for IVs during labor?

A
  • potential or actual risk factors
  • cannot tolerate PO fluids
  • administration of rx (eg abx prophylaxis, analgesics, oxytocin) prior to epidural
42
Q

What is a recommended IV administration?

A

isotonic fluids 125-250mL/h

43
Q

What are indications for measuring I/Os?

A
  • IV fluid administration
  • pre-eclampsia/on magnesium = STRICT I/Os!
  • concern for pt hydration status (eg dehydration, hyperemesis)
  • post-C/S
  • during active labor
44
Q

How often should pt empty bladder during active labor?

A

q2h

45
Q

What effect does a distended bladder have on first stage of labor?

A
  • blocks fetal head from descending

- increases lower abdominal pain

46
Q

What effect does a distended bladder have on second stage of labor?

A

inhibits contractility of uterine contractions

47
Q

What effect does a distended bladder have on postpartum state?

A
  • can increase PPH d/t uterine atony

- bladder hypotonicity, stasis, infection risk

48
Q

What is the effect of labor on WBC count?

A

peaks –> 20x10^3/mm^3

49
Q

What is the effect of labor on BP?

A

increases during contractions; returns to baseline in b/w

50
Q

What is the effect of labor on cardiac output?

A
  • increases by 10-15% in first stage

- increases up to 50% during second stage d/t increased stroke volume

51
Q

How often should vitals be checked during labor?

A

BP, HR, RR: q1h

T: q2-4h w/ membranes intact; q1-2h if abnormal T or ROM

52
Q

hypotonic uterus

A
  • slow/stalled labor progress d/t acute stress (eg fatigue, pain)
  • R/O malpresentation and CPD
53
Q

hypertonic uterus

A
  • series of contractions each lasting >2mins

OR

  • contraction frequency of 5 or more in 10 mins

NURS787 Exam 1 (6 decks)

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