Intrapartum Flashcards
what are the 5 P’s for labor and birth
passage
passenger
position
power
psyche
what is passage
- size and type of maternal pelvis
- ability of cervix to dilate and efface
- ability of vaginal canal and external opening of vagina to distend
what are the various shapes of pelvic canal
- gynecoid: most common
- android: larger sacrum
- anthropoid: narrow and longer
- platypelloid: flat like a pancake, want baby in transverse lye
what is the passenger
the fetus characteristics
- head
- attitude
- lie
- presentation
what characteristics does a fetal head have
6 bones connected by membraneous sutures, where sutures intersect we call fontanelles
- helps skull to be flexible during birth
- allows for brain development and growth
what is fetal attitude
how the baby is positioning itself (relation of fetal parts to one another)
- rounded back, chin tucked to chest, legs pulled into chest, arms crossed over chest
what is fetal lie
fetus relation to how its lying in mother
- longitudinal: cephalic, breech
- transverse: horizontal (shoulder position)
types of cephalic presentation
suboccipitobregmatic: want
occipitofrontal diameter: chin not flexed
occipitomental diameter: brow delivered frist
submentobregmtaic: face first (bruised and edema)
types of breech presentation
- frank: butt presents, knees extended
- complete: butt presents, hips and knees flexed
- footling: feet present, hips and legs extended
what is position
- station (+/-)
- engagement (ischial spine)
- fetal position (presenting part)
what is station
relation of presenting part to the ischial spines
- above are negative, below are positive
what is ballotable
floating or not engaged
what is engagement
when presenting fetal part reaches zero station
what is fetal position
in relation to mother’s pelvis
- right, left
- anterior, posterior, transverse
- occiput, mentum, sacrum, acromion process
- head, chin, butt, scapula
what is powers
- primary: uterine muscular contractions until complete dilation (body controls)
- secondary: abdominal muscles used when pushing down (patient controls)
what is in/decrement of contraction
- the build up and decline of contraction
what is acme
the strongest point of contraction
what is resting
the time between the contractions where the resting tone is relaxed
what is intensity
how strong the contraction is
- mild, moderate, intense
what is duration
start of contraction to end of contraction
what is the frequency
on contraction until the start of contraction and next
what happens during the valsalva maneuver
occurs with secondary forces when you are pushing
- reduces blood flow to baby and mom
what is psyche
- fear and anxiety of labor
- excitement
- exhaustion
- level of social support
abnormalities of the five P’s that cause problems in labor
- passageway to small
- fetus is in malpresentation
- position is posterior
- powers are inadequate
- psychological factors like fear, anxiety, poor support system, exhaustion
impending sigs of labor
- lightening (movement into pelvis)
- braxton hicks
- cervical changes
- blood show/expulsion of mucus plug
- ROM
- sudden burst of energy (nesting)
- wt loss
- GI upset
facts about true labors
- contractions are regular, gradually shorten, and increase in duration and intensity
- cervical dilation and effacement progress
- contractions do not get better with warm
facts about false labor
- contractions are irregular
- discomfort usually in abdomen
- no cervical change
- warm baths help
stages of labor
first: onset until finally dilated
second: full dilation until birth
third: birth until birth of placenta
fourth: 4 hours after birth
what are the stages of first stage of labor
latent: 0-3 cm, contractions q 10-30 mins for 30 secs, mild to moderate
active: 4-7 cm, contractions q 2-5 mins lasting 4-60 secs, moderate to strong
transition: 8-10 cm, contractions q 1.5-2 mins lasting for 60-90 secs
what happens in the second stage of labor
the pushing stage that ends with birth
- urge to push, crowning
- contractions q 1.5 mins to 2 mins, lasting 60-90 sec, strong by palpation
woman has inc sense of control bc she can be actively involved now
what are the mechanisms of labor
engagement
descent
flexion
internal rotation
extension
external rotation
expulsion
descend down the hill, flex on them with your time, internally rotate to slow down, extend your hands in the air, externally rotate ur hands and wave to your fans
what are the benefits of kangaroo care
- inc bonding
- inc oxytocin release
- stimulates milk production
- stabilizes HR, temp
what is the third stage of labor
birth until delivery of placenta
- no longer than 30 mins
- pitocin IV bolus to dec blood loss
- fundal massage
signs of placental separation
- globular uterus rises in abdomen
- gush or trickle of blood
- inc protrusion of umbilical cord
what are the characteristics of placenta
dirty duncan –> uterus, mom
shiny schultze –> fetal membrane (chorion, amnion)
what is oxytocin given for
induce labor
dec postpartum bleeding
what happens during the fourth stage of labor
4 hours after birth
- ensure blood loss of 250-500 mls (vaginal) or > 1000 ml (c/s)
ensuring hemodynamic stability
- returning sensation
- O2 sat
- fundus, perineum
- temp
- bladder fullness
common physiological readjustments in the 4th stage
- thirst and hunger
- shaking (CNS response)
- bladder is often hypotonic
- uterus should remain hard and in midline of abdomen and between symphysis pubis and umbilicus
sve score
dilation/effacement/staging
admission assessments for labor
- term or preterm
- HTN?, bleeding disorders?
- DOPE (DM, obese, previously large infant, excessive wt gain)
- ambulation or bed rest?
- continuous or intermittent?
- birth plan?
admission labs
- blood type and screen
- CBC
- GBS
- rubella
external fetal monitoring
- toco: monitors contractions, place on fundus
- FHR monitor: place on fetal shoulders/back
external fetal monitoring advantages (US)
- continuous
- established baseline
- noninvasive
- no ROM
- nurse can place
external fetal monitoring disadvantage
- susceptible interference from movement
- may be weak signal
- may be sketchy and difficult to interpret
fetal scalp electrode
continuous HR monitor without adjustment by placing electrode on baby head (not fontanelles)
- better tracings but inc risk of infection and requires ruptured membrane and cervical dilatation
intrauterine contraction monitoring
inserted by the HCP when the toco monitor is not doing the job
- monitors frequency, duration, intensity, resting tone to determine if you have adequate labor
- add up values (want greater than 200 in 10 mins but dont want greater than 300)
- needs membrane ruptured, inc risk of uterine infection or ruptured, no low lying placenta
nitrazine tape
tests for amniotic fluid (aka ROM)
- negative: yellow color (more acidic)
- positive: deep blue color (more alkaline)
ferning test
tests for amniotic fluid (aka ROM)
- positive: crystalized under microscope
amnisure
tests for amniotic fluid (aka ROM)
- swab vaginal discharge and then wait for basically covid results to come back
- two lines is positive
what are episodic FHR with contractions
FHR changes that are not associated with contractions
what are periodic FHR with contractions
FHR changes that are associated with contractions
FHR baseline range
110-160 bpm for 10 mins
what are accelerations
32 wks: + 15 beats for 15+ secs
31 wks: +10 beats for 10+ secs
early decels are
head compression
late decels are
uteroplacental insufficiency
variable decels are
umbilical cord compression
early decels
HR dec when contraction happens (mirror)
- longer than 30 secs
- SVE
late decels
caused by a perfusion problem (HTN, HypoTN, bleeding)
- HR dec around end of contraction
- position change
variable decels
caused by cord compression which can happen with out without a contraction
- ABRUPT dec in HR
- position change
veal chop
variable cord compression
early head compression
acceleration is okay
late placental perfusion
UNCOIL
Undo what is happening
Change position
Oxygen on or oxytocin off
IV fluid bolus
Lower HOB
prolonged decel
decel that lasts longer than 2 mins
* if it lasts longer than 10 mins it is a change in baseline*
sinusoidal pattern
baby is acidotic and needs to be delivered now
- HCP alerted immediately
what does FHR variability indicate
fetal oxygenation
types of variability
absent: baby in distress, no changes flat lines
minimal: less than 5 change
moderate: 6-25 change
marked: 25+
goal variability
moderate
FHR bradycardia
less than 110 bpm
- prolapsed cord
- placental abruption
- lots of bleeding
- occurs for at least 10 mins
FHR tachycardia
greater than 160 bpm
- check mom’s temp bc could be infection so that needs to be ruled out
- could be caused by medications
nursing interventions for non reassuring patterns
- change position
- slow or turn off pit
- inc IV fluid (bolus)
- oxygen
- notify HCP and document
- tocolytics
- prepare for delivery
coat
assesses amniotic fluid
- color
- odor
- amount
- time
effleurage
massaging cervix/vagina with circular motion using palms of hands
indications of imminent birth
bulging of the perineum
uncontrollable urge to bear down
inc bloody show
BUBBLELE
breasts
uterus
bowel
bladder
lochia
emotional status
laceration
immediate dangers post birth
hypotenstion
tachycardia
uterine atony
excessive bleeding
hematoma
