Intrapartum Care Flashcards
first stage of labor is divided into what 3 stages (in order!)
latent
active
transition
stage of labor characterized by
‣ Irregular, Mild, Moderate ‣ Contractions: 5-30 Minutes ‣ Duration 30-45 seconds ‣ dilation (.95) ‣ talkative, eager
latent phase of first stage
which stage of labor is characterized by
‣ Regular, Moderate, Strong
‣ Contractions: 3-5 minutes
‣ duration 40-70 seconds
‣ rapid dilation and effacement
‣ increased anxiety and helplessness
active phase of first stage
stage of labor characterized by ‣ Strong to very strong ‣ Frequency every 2-3 minutes ‣ Duration 45-90 seconds ‣ Completely dilated
transition phase of first stage of labor
during what stage of labor is the is the infant born unto the world a goopy slimey potato bean?
second stage
what happens during the third stage of labor?
the placenta is expelled
what happens during the 4th stage of labor?
recovery
there are 3 main fluids that are coming out of the vagina before the baby can slip out. What are they
• mucus plug- can happen a couple weeks before labor
• blood showy- happens in labor
• water breaking/ amniotic fluid / ROM
◦ water can break after labor starts or before
◦ water can break before or after bloody show
re: Physiological changes preceding labor
fetal head descends into true pelvis 14 days before labor, feeling the uterus has dropped =
lightening
re: Physiological changes preceding labor
irregular, get better with hydration and rest, practice contractions , will not cause true labor =
braxton hicks contractions
definition of true contractions
happen at uterus and CAUSE DILATION and EFFACEMENT
physiological changes preceding labor- list some!
• Lightening: fetal head descends into true pelvis 14 days before labor, feeling the uterus has dropped
• Braxton-Hicks contractions: irregular, get better with hydration and rest, practice contractions , will not cause true labor
◦ True Contractions happen at uterus and cause dilation and effacement
• Cervical ripening
• Nesting
• Bloody show : brownish or blood tinged mucus plug resulting from onset of cervical dilation and effacement
• Backache
• Weight loss
what is a brownish or blood tinged mucus plug that is expelled resulting from onset of cervical dilation and effacement ?
bloody show
labor usually occurs within ____ hours of ROM
24
what is Chorioamnionitis- what can cause it?
inner lining gets infected, s/s of pain and tenderness, increased fetal HR , can occur with prolonged rupture of membrane
what do we want to assess for after ruputre of membranes (think baby #1 vital sign)
fetal decels
Vital sign to be checking every 2 hours for preggo after ROM?
temp!
infection
Normal color for amniotic fluid?
straw
what does it mean if the amniotic fluid is brownish or green? What’s the big deal?
meconium stained fluid
◦ concerned if that is expelled in utero if post term birth or baby is distressed
◦ concern about respiratory distress for baby, let NICU know
What is nitrazine paper used for?
test amniotic fluid (turns blue – alkaline)
five p’s of intrapartum care
Passenger (Fetus and Placenta) Passageway (Birth Canal / Maternal Pelvis) Powers (Contractions) Position (mom's) Psychological response
Primary and secondary forces that bring fetus into vaginal canal?
primary mary = uterine contractions
secondary berry= maternal pushing efforts
3 characteristic of uterine contractions
◦ Increment- rising of contraction
◦ Acme - peak of contraction
◦ Decrement - fall of contraction
wtf is ACME?
peak of contraction
which part of the uterus is contracting to get that damn baby out?
upper myometrium (muscle)
opening of cervix =
VS
thinning of cervix =
opening = dilation thinning = effacement
we want to assess what 3 main things with cotnractions
frequency, duration, intensity
how am I going to determine the intensity of a contraction manually? (think about touching your face)
• Intensity = strength of contraction at its peak
‣ you have to feel the fundus when client is having a contraction at peak
◦ Mild =tip of nose, slightly tense
◦ Moderate = finger to chin, firm
◦ Strong = finger forehead, rigid
what does an intrauterine pressure catheter measure?
strength/intensity of contractions
2 main risks we are watching for with contractions
- Watch for prolonged contractions
* Watch for too frequent
> _____ contractions in a 10 minute period does not allow time to restore resting tone!
5
if contractinos are coming to fast/strong what meds are we going to admin/stop
stop pitocin
give tocolytic like terbutaline if other interventions don’t work
fully dilated = ____ cm
10
how do we measure effacement- what increment? how long/thick is cervix before labor?
◦ Before labor, cervix is 2 –3 cm long and approximately 1 cm thick
◦ Effacement is in % and goes from 0 to 100%
cheese and crackers- there are 4 types of pelvises and I pracy to god we don’t need to memorize these words but what are they:
- Gynecoid: most common; 50% of women
- Android: heart shaped
- Anthropoid: oval brim and a slightly narrow pelvic cavity
- Platypelloid: flat oval; least common; 3% of women
most common pelvis shape
gynecoid
heart shaped pelvis
android
A(my hearts her fold up android phone)
oval brim and a slightly narrow pelvic cavity pelvis shape
Anthropoid
trending girl wearing oval brim hat from anthropologie
re pelvic shape: flat oval; least common; 3% of women
Platypelloid
platypus is least common
Station ____ is the narrowest diameter the fetus must pass through = ischial spine
0
- station =
baby is high up
+ station =
baby is lower, moving towards delivery
re: passenger, fetal position:
relationship of fetal body parts to one another=
fetal attitude
posture
flexion vs extension fetal attitiude (posture) - what are they and which one is best for delivery
◦ Flexion (chin to chest, extremities flexed in) - what we want
◦ Extension (chin and extremities extended)
3 types of fetal presentations
cephalic
breech
shoulder
what does “breech frank” presentation mean
legs extended toward shoulders , butt first
what is complete breech mean?
legs flexed, but first
what is a breech footling ? what is the risk?
One or both feet present first into maternal pelvis
risk:Cord prolapse, cord compression, prolonged labor
this presentation occurs when the fetus is in a transverse lie
shoulder
3 types of cephalic presentations
brow, vertex, face
i have no idea what this means
position abbreviateios
- Vertex: Occiput ( ___)
- Face: Chin (or mentum) (___)
- Breech: Sacrum (___)
- Shoulder: acromion process (___)
- Vertex: Occiput (O)
- Face: Chin (or mentum) (M)
- Breech: Sacrum (S)
- Shoulder: acromion process (A)
example: ROA- what is the first letter?
First letter – the side of the maternal pelvis that the presenting part of the fetus is located
Right
example: ROA- what is the second letter?
Second letter – the part of the fetus that is closest to the cervix
Occiput
example ROA: what is the third letter?
Third letter – where the fetal part is located in the maternal pelvis – anterior, posterior, or transverse
Characteristics of true labor vs falce labor
TRUE:
- regular intervals
- increase in frequency, duration, intensity
- cause changes in cervical dilation and effacement
FALSE:
- irregular intervals
- little or no cervical change
During stage 1 of labor there are three phases: latent, active, and transition. What is the cervical dilation for these phases?
◦ Latent phase: 0 – 3 cm
◦ Active phase: 4 – 7 cm
◦ Transition: 8 – 10 cm
cardinal movements of birth
- Engagement
- Descent
- Flexion
- Internal Rotation
- Extension
- Restitution / External rotation
- Expulsion
what is leopolds maneuver
External palpations of uterus through abdominal wall to determine:
Number of fetuses.
Presenting part, lie, attitude.
Degree of descent of presenting part into pelvis.
Expected location of PMI.
Preparation for birth signs in stage 2 of labor
- Bulging of perineum and rectum
- Flattening and thinning of the perineum
- Increased bloody show
- Labia begin to separate
signs of imminent birth
- Crowning
- Burning sensation
- Intense pressure in rectum
- Episiotomy - treat as wound and assess frequently
during stage 3 of labor there is a gush of ____ from the vagina
blood
remember this is when the palcenta is delivered
how often do we want to check for firmness of uterus during stage 4 of labor?
every 15 minutes
a boggy uterus feels like
a bag of iv fluids
