Intrapartum Flashcards
What is effacement
Thinning and shortening of the cervix
What are the 4 Ps of the birthing process
Power
Passage
Passenger
Psyche
What are the two parts of the power
uterine contractions
Maternal pushing efforts
What is the Ferguson reflex
The fetus distends on the vaginal and puts pressure on the rectum- women feels the need to push
What is the two parts of the passage
The hard tissue- bone (pelvis)
The soft tissue- cervix and vagina
What hormone helps the birthing process with the pelvic
Relaxin- softens the joint in the pelvis
Which pelvis is good for labor
Gynecoid
Android
Anthropoid
Platypelliod
Yes
NO
yes
NO
What is Fetal Lie
The orientation of the long axis of the baby
What are these fetal lie
Longitudinal lie
Transverse lie
Oblique lie
cephalic or breech ( head or feet first)
Perpendicular ( back first)
Slanted
What is the fetal attitude
The relation of the fetal neck
What are these fetal attitudes
Flexion
Extension
Neck is flexed ( most desirable for labor)
Neck is extended
What are the different cephalic presentations?
Vertex
Military
Brow
Face
The top of the head is first out
The head is slightly raised from vertex
The brow bone is first out
The face is first out
What are the three different breech presentations?
Frank Breech- presentation with head and feet up
Complete Breech- presentation with head and feet down
Footling- foot comes up first with labor
What is the first letter in the positioning indicate
Presenting part to mom’s left or right side
Right
Or
Left
What is the second letter in positioning
What part is coming out first
Occiput (O)
Sacrum (S)
What is the 3rd letter in the positioning mean?
the presenting part pointing towards front of mom
Anterior (A)
Posterior (P)
Transverse (T)
What can anxiety cause to the baby
Releases catecholamins- inhibit uterine contractility and placental blood flow-slows labor
What are some signs of true labor
Contractions are consistently increasing in frequency, duration, and intensity
Increases with walking
Discomfort increasing and pain
Cervix progresses in effacement and dilation (Most important)
What is some signs of false labor
Contractions are inconsistent in frequency, duration, and intensity.
Decreasing with walking
Discomfort in more annoying than painful
Cervix has no significant change
When should a mom go to the hospital
Contractions,
Nullipara-
Multipara-
Membranes
Vaginal bleeding-
Fetal movement
Concerns
NP- reg CTXs - 5 mins,
MP- reg CTXs- 10 mins
Ruptured membranes
Bleeding should be evaluated
DFM
Concerns- severe pain, vision changes, HA, epigastric pain
What is the engagement
What is great engagement
The descent of the fetal presenting part throught the true pelvis
0 station
What is the movement of the baby through labor (cardinal movement )
Flexion
Internal rotation
Extension
External rotation
Expulsion
What is the first stage of labor?
Cervial dilation and effacement
Begins with the onset of true labor and ends with complete dilation of the cervix
What is the characteristics of the latent phase on the first stage
Dilation
Contractions
1-3 cm
Mild crontractions- 5 min apart
What are some characteristics of the active phase of the first stage of labor
Dilation
Contractions
4-7 cms
Moderate CTXs 2-5 mins apart
What are some characteristics of the transition phase of the first stage of labor
Dilation
Contractions
8-10
Very strong contractions 1 1/2-2 mins apart
What is the second stage of labor?
Begins with complete dilation (10cm) and 100% effacement and ends with birth of baby
What is an episiotomy
An incision in the perineum made to provide more space for labor
What are the two types of episiotomy incisions?
Median/midline- at midline
Mediolateral- cut at a 45 degree angle to right or left
What are some indications of episiotomy
(5)
Shoulder dytocia
Face presentation
Breech delivery
Macrosmic fetus
Vacuum or forceps- assisted birth
What are these types of perineal lacerations
1st-
2nd-
3rd-
4th-
Tear of perineal skin and vaginal membrane
Tear of skin, vaginal membrane, and fascia of the perineal body
Tear of skin, vaginal membrane, perineal muscle, and rectal sphincter
Tear of vaginal membrane to lumen of rectum
What is the 3rd stage of labor
Begin with birth of baby and ends with expulsion of placenta
What can be done to prevent uterine hemorrhages (2)
Massage the fundus
Administer uterotonic medication
What are some examples of uterotonic medications
Oxytocin
Methylergonovine
Carboprost tromethamine
Misoprostol
What is contraindicated for methlergonovine
Hypertensive patients
What is contraindicated for carboprost tromethamine
Asthma patients
What is the fourth stage of labor
Begins with delivery of placenta - focuses on post partum care
What is the initial nursing assessment for the labor admission? (9)
GPTALM
Gestational age
FHR and VS
UA
Vaginal exam and membrane
UA (dip stick)
Obtain consent
IV access and labs
Delivery prep
What can be assessed with Sterile Vaginal Exams
(4)
Assess for ruptured/bulging membranes
Assess for dilation effacement, position
Assess for fetal station, presentation, and position
Determine labor progression
What nursing intervention need to be done after a rupture of membranes (3)
Assess FHR/UA
Assess amniotic Fluid
Take temperature q2
What is polydramnios
What is Oligohydramnios
And
What do this indicate
Excessive Amniotic fluid- GI issues
Small quantity of amniotic fluidd- placental insufficiency or urinary tract abnormalities
What is normal amniotic fluid look like
Clear with white flecks (vernix) with musty odor
What does dark stained fluid indicate
What does yellow and could smelling fluid indicate
Meconium stained fluid- fetal compromise
Yellow stained fluid- chorioamnionitis
When is the rupture of membranes considered PPROM?
Between 37 weeks
What some amniotic fluid test
Nitrazine paper- positive if paper turns deep blue
Fern Test-
Amnisure ROM test
What are is a risk of ROM
Prolapse of the umbilical cord
When do you take FHR during labor
Latent
Active
Transition
L- q30 mins
A-q15-30 min
T-q5-15 mins
When do you take temps for a laboring patient
Q4 hrs
ROM - Q1hrs
During the second stage of labor when should you get FHR
After each contraction
What are some nursing interventions during the 3rd stage of labor (5)
Observe the blood loss when the placenta separates
Administer oxytocin as ordered
Palpate the fundus
Clean perineal area, assist provider with episiotomy/ laceration repair
Remove both legs together
What are some side effects of analgesics during labor
It slow the labor process
It can cause neonatal depression
What is a common side effect of epidurals
Maternal hypotension
What are some nursing interventions to help with the hypotension
Left lateral position
Fluid bolus
Medication- ephedrine
What does Misoprostol used for
It’s used to help induce labor
When use Misoprostol to induce labor, when can you give Oxyocin?
Until 4 hours after last dose
What must be done before giving oxytocin to a patient?
Obtain a baseline FHR for 20 minutes
What type of route is oxytocin given?
IVPB on secondary pump
If tachsystole or abnormal FHR pattern what is the nursing intervention?
Turn off oxytocin
Bolus fluids
O2 with mask
What is version
The physician turns the fetus from breech to cephalic
Can you do version on patient who have had membranes have ruptured or a previous C section
Neither
When would you do a C section over a natural birth (5)
High risk patient
STI
Prolapsed umbilical cored
Placenta abruption
Previous uterine incisions
What is the safest incision for C sections
Low transverse
What is some nursing interventions post op of a C section
Observe for hemorrhage
Post op vitals
Assess bladder/fundus
Postoperative care
What type of delivery will a patient who is a failed TOLAC previous
A C sections
What is a contradiction for Misoprostol >
Never use with a mom who has previous uterine scar
