Intrapartum Care Flashcards by Kol Giessel

first stage of labor is divided into what 3 stages (in order!)

latent
active
transition

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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

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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

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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

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during what stage of labor is the is the infant born unto the world a goopy slimey potato bean?

second stage

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what happens during the third stage of labor?

the placenta is expelled

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what happens during the 4th stage of labor?

recovery

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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

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re: Physiological changes preceding labor

fetal head descends into true pelvis 14 days before labor, feeling the uterus has dropped =

lightening

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re: Physiological changes preceding labor

irregular, get better with hydration and rest, practice contractions , will not cause true labor =

braxton hicks contractions

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definition of true contractions

happen at uterus and CAUSE DILATION and EFFACEMENT

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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

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what is a brownish or blood tinged mucus plug that is expelled resulting from onset of cervical dilation and effacement ?

bloody show

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labor usually occurs within ____ hours of ROM

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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

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what do we want to assess for after ruputre of membranes (think baby #1 vital sign)

fetal decels

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Vital sign to be checking every 2 hours for preggo after ROM?

temp!

infection

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Normal color for amniotic fluid?

straw

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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

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What is nitrazine paper used for?

test amniotic fluid (turns blue – alkaline)

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five p’s of intrapartum care

Passenger (Fetus and Placenta)
Passageway (Birth Canal / Maternal Pelvis)
Powers (Contractions)
Position (mom's)
Psychological response

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Primary and secondary forces that bring fetus into vaginal canal?

primary mary = uterine contractions

secondary berry= maternal pushing efforts

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3 characteristic of uterine contractions

◦ Increment- rising of contraction
◦ Acme - peak of contraction
◦ Decrement - fall of contraction

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wtf is ACME?

peak of contraction

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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!

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

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:

1. Gynecoid: most common; 50% of women 2. Android: heart shaped 3. Anthropoid: oval brim and a slightly narrow pelvic cavity 4. 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

- 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