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OB Theory > Intrapartum > Flashcards

Intrapartum Flashcards

1
Q

series of processes by which the fetus and other products of conception are expelled from the mother’s body

A

Labor

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2
Q

regular rhythmic tightening of uterine muscle. Has increment, acme, and decrement

A

Contraction

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3
Q

–thinning and shortening of the cervix, measured by percentage

A

Effacement

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4
Q

enlargement of the diameter of cervix, measured in centimeters

A

Dilation

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5
Q

descent of present part, measured in +/- numbers
- = baby is higher
+ = baby is below ischial spine

A

station

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6
Q

The 5 P’s in labor

A
  1. Power
  2. Passenger
  3. Passage
  4. Placenta
  5. Psyche
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7
Q
  • uterine contractions (needs oxytocin)

* maternal pushing

A

Power

1st P

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8
Q

how fetus is oriented to mother’s spine •longitudinal–most common, parallel •transverse–at right angles to mother •oblique–somewhere in between

A

Lie

Passenger - 2nd P

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9
Q

fontanels allow for…

A

molding

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10
Q

how is the fetus flexed.

•Prefer chin on chest, arms and legs flexed toward body

A

Attitude

Passenger - 2nd P

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11
Q

fetal part that enters the pelvis first
•cephalic/vertex–head first
•breech – butt/feet first
•transverse–shoulder or side

A

Presentation

Passenger - 2nd P

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12
Q

buttocks with feet at shoulders

Can deliver this way

A

Frank Breech

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13
Q

buttocks with legs flexed upon abdomen

A

Complete breech

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14
Q

foot or feet presenting part

A

Footling

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15
Q

Breech causes placenta to be planted in lower uterus or it doesn’t perfuse well so…

A

Baby is not ready

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16
Q

how a reference point on presenting part is oriented within pelvis
•cephalic/vertex use occiput
•breech use sacrum

A

Position

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17
Q

ROA

A

Right Occiput Anterior

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18
Q

LSA

A

Left Sacrum Anterior

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19
Q
  • Mother’s bony pelvis

* Soft tissue–cervix, vagina, perineum

A

Passage

3rd P

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20
Q 
•Placement 
•Ability to sustain fetus during labor 
•At 40+ weeks it is 
wearing out and breaking down 
Towards end it doesn't produce much progesterone
Should be in upper Posterior
A

Placenta

4th P

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21
Q
  • Mother’s psychological response to labor process
  • Coping skills
  • Support system
  • Expectations for labor
  • Knowledge base
A

Psyche

5th P

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22
Q
  • Braxton-Hicks contractions–occur throughout pregnancy but do not affect dilation of the cervix
  • no progressive cervical dilation
  • amniotic membranes usually intact
A

False Labor

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23
Q

After 4 cm you see ….

A

1 cm per hour

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24
Q

•Progressive dilation and effacement of cervix
•membranes may or may not be ruptured
•bloody show may be present (“mucous plug” from cervix that falls out when it gets bigger)
•uterine contractions are regular with intervals between shortening
and intensity increasing

A

Signs of True Labor

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25
Q

•Physical activity intensifies
•Mild sedation does not affect strength or pattern
•Pain/discomfort in abdomen and back
•Nausea and vomiting may occur in true labor
Morphine doesn’t work in true labor

A

What Effects Uterine Contractions in True Labor

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26
Q

•Bloody show–thick mucus mixed with pink or dark brown blood, may occur several days before labor begins
•Spontaneous rupture of membranes
•SROM
•must go to hospital even if no other signs of labor!
Infection can occur when it breaks

A

Signs of approaching Labor

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27
Q
  • Risk for infection
  • open pathway for microorganisms into uterus
  • prophylactic IV antibiotics during labor if prolonged time of rupture
  • Risk for prolapsed umbilical cord
  • emergency C-section
  • position mother to relieve pressure
A

SROM

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28
Q

settling of presenting part into pelvis

can breath easier since baby is dropping

A

Lightening

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29
Q
  • Ruptured membranes
  • Contractions strong and regular q 5-7 min for 1-2 hours for primips, q 10 min for 1 hour for multips
  • Bleeding greater than bloody show
  • Decreased fetal movement–no movement felt for > 2-3 hours
A

when to go to hospital

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30
Q
  • Admission charting
  • Fetal monitoring to check FHR and variability (FIRST THING - makes sure baby is stress free)
  • Maternal Vital signs
  • Vaginal exam–dilation, effacement, position. Nitrazine tape (will be blue if ruptured) for SROM•Review prenatal record
  • Routine UA (look for nitrates, albumin)
  • Complete blood count
  • Blood type and antibody screen
  • IV site established, IV fluids per orders
A

Do upon admission

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31
Q
  • Descent–station
  • Engagement
  • Flexion
  • Internal rotation
  • Extension
  • External rotation •Expulsion
A

Labor process

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32
Q
  • “Stage of Dilation”
  • onset of labor to full dilation
  • Primiparas 8-10 hours •Multiparas 6-8 hours
A

First stage of labor

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33
Q

Latent phase

A

0-3 cm - lasts the longest

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34
Q

Active phase

A

4-7 cm - more rapid

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35
Q

transition phase

A

8-10 - short intense pain - must to be complete to push

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36
Q
  • “Stage of expulsion”
  • Complete dilation until birth of babe through vagina
  • Primiparas 1 1/2 - 3 hours
  • Multiparas 20-45 minutes
  • Strong urge to push, may need guidance to push effectively
  • Fetal head molds to pass through pelvis/vagina
  • Crowning–head visible at perineum
A

Second Stage of Birth

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37
Q

•From the birth of the baby to expulsion of the placenta
•Approximately 5 -30 minutes
•Usually “shiny Schultze” (fetal side) side presents
•Manual exam with forceps by examiner to check for retained
placenta or tissue
•May give Oxytocin IV or IM to contract uterus, fundal massage or breastfeed

A

Third Stage of Labor

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38
Q
  • Period of stabilization and recovery from birth process– 1-4 hours
  • Uterus firm, grapefruit sized, at midline
  • Chilling, involuntary shaking
  • Perineal discomfort
  • Important time for breastfeeding and bonding
A

Fourth stage of labor

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39
Q
  • Monitor the fetal oxygen status - do kick counts
  • Promote adequate fetal oxygen - if mom BP is low the uterus doesn’t perfuse well - turn to left side
  • Take corrective action as needed
  • Notify MD of fetal oxygenation problems
  • Document
A

Nurse responsibilities for fetal monitoring

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40
Q

beginning of one contraction to the beginning of next

measuring the start of hills

A

frequency

41
Q

beginning of end of one contraction to other

how long It lasts

A

duration

42
Q

how strong contraction is, internal tocotransducer is the most accurate
•mild–uterus easily indented (tip of nose)
•moderate-uterus firm, indent slightly, (chin)
•strong- very firm, can’t indent, (forehead)

A

Intensity

43
Q
  • period of relaxation between contractions
  • External – Palpation - soft •Document: Present or Absent
  • IUPC – 5-25 mmHg
  • Pressure of uterus should be
A

Resting Tone

44
Q

4 things to look for contractions

A
  1. Frequency
  2. Duration
  3. Intensity
  4. Resting tone
45
Q
  • Need to evaluate in conjunction with contractions to determine pattern
  • Baseline–rate between contractions, 110-160 bpm at full term
  • Determine mean and round 0-5
A

Fetal heart patterns

46
Q

Most effective labor pattern that allows baby to perfuse….

A

2-3 minutes apart
60-90 seconds duration
strong intensity with positive resting tones

47
Q 
irregular fluctuations in the baseline
•Minimum 0-5 bpm (baby sleeping)
 •Moderate 6-25 bpm 
•Marked >25 bpm (mom had burst of energy and went to baby)
want this so we know the baby has energy
A

Variability

48
Q

rate increases 15 bpm for at least 15 seconds in a 10 min strip–Reassuring sign

A

Accelerations

bible verse 2

49
Q

rate decreases from baseline
•early - need interventions
•variable - nursing judgment if ok
•late - never good

A

decelerations

50
Q

rate decrease during contraction that returns to baseline by the end of contraction. Normal sign *caused by compression of head
head is being compressed
towards transition and when she’s pushing

A

early decels of decelerations

51
Q

rate change begins and ends abruptly. V, W, or U shaped. Not always in conjunction with contraction. Indicates cord compression
vary in size, shape and frequency
*cause is cord compression

A

Variable decels of decelerations

52
Q

resemble early but don’t return to baseline until after contraction ends
•Indicates not enough O2 to infant by placenta–uteroplacental insufficiency

A

late decels of decelerations

53
Q
  • Reposition mother to left side
  • O2 per face mask
  • Increase IV fluids
A

Intervention for fetal distress

bible verse 3

54
Q
  • Turn off Pitocin (if applicable)
  • Notify the provider
  • Document
A

intervention for fetal distress

bible verse 4

55
Q
  • Nitrazine paper - cobalt blue
  • Ferning
  • Pooling
A

SROM

56
Q

artificial rupture of membranes (AROM) using sterile disposable Amnihook.
•Assess FHT
•Note time and condition of fluid

A

AROM

57
Q
  • Record color, odor, and amount of fluid
  • green–meconium. Note if thick or watery (babies 1st stool)
  • yellow, cloudy, foul odor–infection
  • large quantity of fluid–at risk for prolapsed cord.
  • Monitor FHR at least 10 minutes after ROM to detect prolapsed cord or compression
A

Amniotic fluid

58
Q

take temp every 2 hours if elevated or ROM

Pulse, BP and respiration every 1 hour

A

fetal monitoring

59
Q
  • Vaginal exams check:
  • effacement, dilation, station of fetus
  • Check when contractions increase in frequency, intensity, woman’s behavior changes
  • Always use sterile technique
A

Monitor labor progress

60
Q

initiation of labor before it begins naturally

last longer

A

induction

61
Q

stimulation of contractions after they have begun naturally (ROM, Pitocin)

A

augmentation

62
Q
  • Prostaglandin gel (Cervidil) or misoprostil (Cytotec) inserted vaginally to soften cervix.
  • May induce labor by itself or be used with oxytocin
A

cervical ripening

63
Q
  • “Pit induction”–artificial stimulation of uterine contractions with IV oxytocin (Pitocin)
  • Oxytocin diluted in IV solution and piggybacked into mainline IV. Always regulated with infusion pump
  • Slowly increased until desired contraction pattern established
  • Continuous EFM
A

types of oxytocin and augmentation

64
Q
  • Drugs are avoided during latent phase of labor–slow or stop labor
  • Meds can cross placental barrier (if 8 cm, opioids cross placenta)
  • Goal of pain meds is to reduce pain to tolerable level (doesn’t take away all pain)
  • IV most frequent route
A

Pain meds - Analgesics

65
Q
  • Most commonly used
  • Do not give if delivery in 1 hour or less
  • Butorphanol (Stadol) - 1-2 hours, slows baby heartrate
  • Fentanyl (Sublimaze) - 1 hour, respiratory depression
  • Naloxone (Narcan) –antagonist
A

Narcotics in pregnancy

66
Q
  • Promethazine (Phenergan)–reduces N/V - makes fentanyl work better - cause drowsiness
  • Diphenhydramine (Benadryl)–reduces itching
A

Adjunct Medications

67
Q

numb specific area, but still feel pressure
Any meds that end in -caine
Local infiltration: injection of perineal area for epistomy before delivery or for repair
injection of pudendal nerves 10-20 mins before delivery, nubs lower 2/3 of vagina (saddle part that’s numb)
•Epidural block
– injection into epidural
space
• Blocks transmission of pain impulses to
brain
•No sedation of mother/fetus
•May affect ability to push

A

Regional Anesthetics

68
Q 
•Catheter and infusion pump to deliver 
continuous dose
•may be used for c-section
•Single dose of epidural opioids administered prior to removal of catheter 
can last 24 hours
A

Epidural

69
Q 
•Spinal Block
--injection through lumbar 
interspace into subarachnoid space
•Used for C
-sections
•Level of anesthesia from nipples to the 
feet
A

Regional Anesthetics (2)

70
Q

•Not used for vaginal births
•Used for emergency C
-sections
C-section when epidural or intrathecal contraindicated or refused by woman
Use when you have 3 minutes to get baby out

A

General Anesthetic

71
Q
  • Does not harm mother and fetus
  • Does not slow labor
  • No risk of allergy or adverse reaction
  • May not provide adequate pain relief when used alone
  • Most methods need to be practiced before labor begins–education
A

Non-pharmacological pain management

72
Q 
•Relaxation - 1 job is to provide smooth environment 
•Skin stimulation
a) effleurage - gate control theory 
b) sacral pressure 
c) thermal stimulation
•Positioning
•Mental stimulation
A) focal point 
B) imagery 
C) music 
D) Meditation 
E) TV
A

Techniques for labor

73
Q 
perineal incision to enlarge 
vaginal opening
•midline 
•mediolateral 
•lateral
A

episiotomy

74
Q

tearing of perineal tissue
•Classified by how far it extend from the
vagina to the anus
1. 1st degree
—through the skin
2. 2nddegree–through the muscle
3. 3rd degree–extends into the rectal sphincter
4. 4th degree-extends through rectal sphincter

A

Laceration

75
Q

instruments with curved blades that fit around the fetal head
•Pull on infant as mother pushes
•Use if woman is exhausted, pushing ineffectively
•Use if fetus in distress at end of labor
•May injure tissue

A

Forceps

76
Q

used suction
applied to fetal scalp to pull as mother pushes
• Does not enter pelvic cavity like forceps
• Causes circular edema to infant’s scalp that subsides after birth

A

Vacuum extraction

77
Q 
surgical birth of fetus 
through incisions in the mother’s 
abdomen and uterus
•32.2% of all deliveries
(2014 CDC)
A

C-section

78
Q
  • Abnormal labor
  • Cephalopelvic disproportion (CPD)– baby doesn’t fit
  • PIH
  • Previous c-section or uterine surgery
  • Fetal compromise
  • Placenta previa (its implanted in cervical opening or lower uterine segment) or abruptio placentae (pulling away so not good perfusion)
A

C-section indications

79
Q

Types of C-Section

A
  1. planned (breech, repeat)
  2. Unplanned
  3. Emergency
80
Q
  • Low transverse or Pfannensteil–preferred, less chance of uterine rupture in next pregnancy
  • Low vertical–allows delivery of larger fetus
  • Classic– vertical, rarely used, higher incidence of rupture in subsequent pregnancy
A

Types of c-section incisions

81
Q

•Emotional support– disappointment, guilt, anger,
anxiety
•Post-op vital signs
•Assess fundus and lochia - healing and not bleeding
•I & O –IV and Foley until next a.m.
•Dressing changes, assess incision
•Pain management – epidural or PCA
• Teach CDB cough and deep breath
•Encourage ambulation

A

Nursing care for c-section

82
Q

•Meconium in amniotic fluid
•Fetal Heart Rate (FHR) decreasing below 110 bpm
between
contractions
•Large amount of bleeding from vagina more than 1 TBSP – Placental
shearing
•Maternal HR > 100bpm (sign of infection)
•increased temperature
•cardiac decompensation, circulatory alterations
•Maternal BP 20 mmHg above baseline
•Cord presents at or near vaginal outlet
•Contractions are > 90 seconds duration, > 2 minutes in frequency
•Irregular fetal or maternal heartrate
•Elevated maternal temperature
•Extreme maternal headache
– increased risk for seizures or stroke
•Failure to dilate in 24 hours

A

Danger signs in labor

83
Q

•Difficult labor r/t fetus, uterine contractions, birth canal, maternal position during labor, placenta and
psychological responses of the mother

A

Dystocias of Labor

84
Q

head delivered but shoulders stuck above

symphysis pubis – fractures

A

Shoulder dystocia

problems with fetus (passenger)

85
Q 
•Fetal anomalies -- hydrocephalus (too much fluid = big head)
• Abnormal Presentation
•breech 
•face or brow (emergency c) 
•Abnormal Positions
•LOP or ROP -- face up, back labor
•repositioning mother on hands/knees may 
rotate to OA
•Multifetal pregnancy
•Overdistention of uterus and ineffective 
contractions
•Abnormal presentation of one or more 
fetuses
Often delivered by C-section
A

passenger

86
Q
  • Contractions too weak

* usually diminish during active phase

A

Hypotonic labor dysfunction

87
Q 
•contractions are frequent, cramplike with 
poor coordination, very painful
•occur during latent phase
•Administer mild sedation to 
promote rest
•Tocolytics
reduce contractions -- Terbutaline
(Brethine)
•Hydrate
A

Hypertonic labor dysfunction

88
Q

Causes increase in heartrate

If mom’s heart rate is high you cannot give it

A

Terbutaline (Brethine)

89
Q

•Ineffective maternal pushing
•Weak abdominal wall
•allows uterus to rotate forward and
prevent fetus from aligning with birth canal
•put mother in upright position, abdominal
pressure

A

Power

90
Q
  • Contractures of the pelvic diameters
  • congenital anomalies
  • maternal malnutrition
  • neoplasms - benign tumors
  • lower spinal disorders
  • young maternal age
A

Problems with birth canal (passage)

91
Q
  • Soft tissue dystocia
  • Full bladder or rectum
  • Placenta Previa (grows in lower uterus)
  • Uterine fibroids
  • Ovarian tumors
  • Edematous cervix
A

Passage

92
Q
  • Abruption/Previa
  • Infarcts - dead tissue=poor perfusion from smoking/drugs
  • Postdate - older placenta
A

Problems with placenta

93
Q
  • Diabetes
  • Hypertensive disorders
  • Smoking
  • Taking cocaine or other drugs
  • Malnutrition
  • Maternal age
  • Multiple births
  • Blood clotting disorders
  • Trauma
  • Prior placenta issue
A

conditions that cause Add to dictionary insufficiency

94
Q
  • Fetal Kick Count - 10 kicks per hour
  • Fetal Movement
  • Fetal Monitoring - look for contractions, baseline, variability
  • Ultrasound - 20 weeks to check for amniotic fluid if it’s too much or little
  • Post delivery assessment
A

placenta assessments

95
Q 
•Prolonged labor
--> 24 hours
•Can result in maternal and/or fetal infections
•Exhaustion 
•Postpartum hemorrhage
A

abnormal labor

96
Q 
completed in less 
than 3 hours
•Abrupt onset, quickly intensifies, frequent and intense contractions
•Higher risk for injury to mother and 
fetus
A

Precipitous labor

97
Q
  • Occurs after 20 weeks and before 37 6/7 weeks
  • Signs:
  • contractions or cramping
  • constant backache
  • pelvic pressure
  • change in vaginal discharge
  • general ill feeling
A

duration of pre-term labor

98
Q
  • Bed-rest
  • Hydration
  • Tocolytics–Brethine, MgSO4 - muscle relaxant, only give in hospital so you can monitor because it causes respiratory labor and stops contractions
  • Treat UTI if present
  • Steroids given IM to mature fetal lungs
  • betamethasone - cause production of surfactant- give to mom to give to baby
  • dexamethasone
A

preterm labor treatment

OB Theory (16 decks)

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