Intrapartum Flashcards
What factors combined cause the onset of labor
Oxytocin, estrogen, progesterone, prostiglandins, CRH, and relaxin Progesterone withdrawal (increase in E1)
What changes happen in they myometrium to bring on adequate ctrx
Myomentirum (smooth muscle) is usually electromagnetical with increasing intracellular Ca through changes in membrane potential or receptor mediated
Neurotransmitted innervations of the uterus
sympathetic = alpha adrenergic
parasympathetic = beta adrenergic
all receptors are subject to influences of agonists or antagonists
Alpha adrenergic agonist used to stimulate contractions (3)
used to stimulate contractions
Oxytocin/Pitocin
Ergots
Prostiglandins
Beta adrenergic agonists (7)
tocolytics; decrease uterine contractions Inhibits myosin/actin and moves Ca out of the cell causing smooth muscle relaxation ETOH Mag SO4 Prostaglandin synthesis inhibitors Beta 2 Adrenergic Drugs (Terbutaline) Calcium Channel Blockers Aminophylline
ABCs of Labor Assessment
Amniotic Fluid leakage Bleeding Vaginally Contractions Dysuria Evidence of Preeclampsia Fetal movement
Vital signs during labor (4)
Temp: slight elevation throughout labor, highest during and after childbirth (rule out infection)
BP: During contx an increase systolic= 15; diastolic = 5-10 mmHg
Pulse and respirations slightly increased
Intermittent monitoring recommendations (8)
30 minutes in first/active stage of labor 5 minutes in 2nd stage Additional assessment needed for the following ROM sudden change in contx pattern before/after vag exams before ambulation any indication of complications. (listen through contrx)
3 main types of fetal presentation
Cephalic (vertex), breech, shoulder (transverse)
Longitudinal lies
cephalic (vertex, brow, face)
Breech
Complete=flexion at hips and knees butt presents
Frank = flexion at hips extension at knees; butt presents
Footling = extension at hips and knees; one or both feet presents
Kneeling = extension at hips, flexed knees; knees presents
Transverse/oblique; shoulder presents
Diagnosis of ROM (2)
Sterile Spec exam
visualizing pooling in the posterior fornix (most definitive diagnosis)
Nitrazine paper test (pH of amniotic fluid = 7.0-7.5; pH of vagina 4.5-5.5)
Monitoring contractions (manual)
Palpation (contx start in fundus and move down toward cervix)
Frequency (begininning of 1 contrx to the beginning of the next)
Intensity (mild, moderate, firm)
Monitoring contractions (electronic)
Intensity (in early labor) approx 25mmHg increasing to 50mmHg by the end of labor
IUPC
provides only electronic method of mearuing uterine resting tone, intensity/strength of ctrx
in MVU
Contraindicated in HIV
Clinical Labor
80-120 MVU, 3 contrx in 10 min, each approx 40 mmHg in intensity
Uterine activity normal/abnormal
normal = 5 or less contx in 10 mins, over 30 min abnormal = 6 or more in 10 min, over 30 min (tachysystole)
Purpose of EFM
to determine if the fetus is well oxygenated
EFM Baseline:
Baseline: rounded to increments of 5bpm during 10 min segment
Normal: 110 to 160 bpm
Brady: < 110bpm
Tachy: >160 bpm
EFM Variability
fluctuation in FHR baseline hat are irregular in amplitude and frequency Absent: Undetectable Minimal: = to or < 5 bpm Moderate: 6- 25 bpm Marked: > 25 bpm
EFM Accelerations
an abrupt increase of at least 15 bpm above baseline
Onset to peak < 30 secs and duration is = to or > 15 secs and < 2 mins from onset to baseline
Accelerations that are 10 mins or more are considered baseline changes.
EFM Decelerations
Late: Onset to nadir is = to or > 30 secs. The nadir of decels usually occurs after peak of contraction
Early: Onset to nadir is = to ro > 30 secs and usually occurs at same time of peak of contrx
Variable: an abrupt decrease below the baseline which may or may not be associated with UCs
Prolonged: decreased FHR > 15 bpm lasting at least 2 min but < 10 min. If sustained for 10 min or more is a baseline change.
Indications for internal EFM
Inability to monitor externally Fetal distress High Risk pregnancy meconium stained fluid Contraindicated in HIV
Fetal Tachy and causes
FHR >/= 160 bpm x 10 min Mild: 161-180 bpm Severe: >180 bpm Causes: 1. fever 2. infection 3. medications (beta adenergics) 4. chronic fetal hypoxia 5. cardiac prob
Fetal brady and causes
FHR < 110 bpm x 10 min Mild: 100-109 bpm (mostly positional) Moderate: 80 - 100 Severe: < 80 bpm for 3 min or greater Causes: 1. anestesia 2. head compressions with posterior positions 3. cord compressions 4. placental insufficiency 5. medications (beta blockers) 6. cardiac probs 7 terminal fetal condition
