Intrapartum Care Flashcards
1
Q
Labor
A
Physiologic process in which a fetus is expelled from the uterus
2
Q
T/F: a woman is not in labor until the contractions bring about demonstrable effacement and dilation of the cervix
A
True
3
Q
Dilation
A
How open the internal os is
4
Q
Complete dilation
A
10 cm
5
Q
Effacement
A
Difference between the internal and external os
Thinning of the cervix
6
Q
Station
A
Degree of descent of the presenting part of the fetus measured in cm from the ischial spines
7
Q
Amount of station
A
-4: 4 cm above the ischial spine
0: at the level of the ischial spine
+4: 4 cm below the ischial spine
8
Q
In order to diagnose labor, there must be __
A
Cervical change
9
Q
Braxton Hicks contractions
A
Contractions without cervical change
10
Q
Ways to diagnose labor
A
Ferning
pH measurement of fluid (nitrazine test)
Presence of amniotic pooling in the vagina
US to measure amniotic fluid index
11
Q
Spontaneous rupture of membranes
A
Rupture of membranes during labor
12
Q
Premature rupture of membranes
A
Rupture of membranes before the onset of labor
13
Q
When are women screened for group B strep?
A
35 weeks
14
Q
If the group B strep swab is positive?
A
PCN
If PCN allergy, give vanc
15
Q
When should a woman be treated even if her group B strep swab comes back negative?
A
Group B strep has been colonized in a urine culture
Previous OB hx of group B strep or neonatal sepsis
16
Q
Stages of labor
A
Stage 1: from onset of labor to complete cervical dilation
Stage 2: from complete cervical dilation to expulsion of fetus
Stage 3: from delivery of infant to delivery of placenta
Stage 4: from delivery of placenta to 1 hour postpartum
17
Q
Friedman’s labor curve
A
Good guideline for expected progression in labor but is not used as frequently anymore
18
Q
Duration of labor for nulliparous vs multiparous
A
Nulli: 10-12 hours
Multi: 6-8 hours
19
Q
Latent phase of first stage of labor
A
From onset of labor with slow cervical dilation to 4 cm
20
Q
Active phase of first stage of labor
A
From 4 cm to complete dilation
21
Q
Protracted dilation
A
Taking longer to dilate
22
Q
Arrest of descent
A
Baby is not coming down into the pelvis
23
Q
Factors affecting stages of active labor
A
Power: uterine contractions are poor or uncontrolled
Passenger: fetus’s head and its ability to pass through the birth canal
Pelvis: mom’s pelvis is too small for the fetus to pass
24
Q
Breech
A
Baby’s head is up and not in the pelvis where it should be
25
A c-section is recommended for all babies over ___, or ___ if the mother is diabetic
5000 g; 4500 g
26
Fetal variables that can affect labor
Fetal presentation
Degree of flexion or extension of the neck
Relationship between the fetal presenting part to the right or left side of the birth canal
Number of fetuses
Presence of fetal anomalies
27
Fetal presentation
What part of the baby is entering the pelvis first
28
In vertex position, ___ is the reference point, and in breech position, ___ is the reference point
Occiput; sacrum
29
Diagnosis of fetal presentation and position
Leopold maneuvers
Vaginal exam
US
30
Leopold maneuvers
Abdominal palpation to determine fetal lie, weight estimate, position, and presentation
31
T/F: any position other than vertex usually results in a c-section
True
32
A ___ pelvic outlet is an indication for c-section
Small
33
Cephalopelvic disproportion
Passenger is too large for the pelvis
34
How can activity be assessed?
Observation
Palpation of the fundus
External tocodynamometry
IUPC (intrauterine pressure catheter)
35
What is considered adequate labor?
3-5 contractions in a 10 minute period
36
If labor is not progressing...
Insert IUPC to adequately monitor contraction
If under 200 MVU in 10 minutes, then start Pitocin
37
How to intervene to increase the force of already present contractions
Pitocin
Artificial rupture of membranes
38
Induction of labor
Attempt to begin labor in a non-laboring patient
39
Ideal time to deliver baby
39 weeks (ARRIVE trial)
40
Indications to induce labor
Multiple gestation
Maternal HTN, DM, HIV
H/O fetal demise or PROM
41
CI to induce labor
Placenta previa and vasa previa
Transverse fetal lie
Umbilical cord prolapse
Prior c-section
Active herpes lesion
Prior myomectomy
42
Bishop score
6 or less: unfavorable outcomes
Over 8: probable success
43
Methods to induce labor
Cervidil
Cytotec
44
Characteristics of Cervidil
Removable device
12 hours
Expensive
45
Characteristics of Cytotec
Tablet
4 hours
Cheap
46
T/F prostaglandins used for cervical ripening increase the likelihood of delivery within 24 hours
True
47
Balloon catheter (Cook)
Gently helps cervix ripen w/o causing overstimulation
48
Pitocin
Identical version of oxytocin leading to uterine contractions
49
SE of Pitocin
Tachysystole
Uterine rupture
Hypotension
50
Tachysystole
Over 5 contractions in 10 minutes
51
Why is tachysystole a problem?
Force of contractions can take blood supply away from the baby, so baby's HR can go down if contractions are too fast
52
Pros and cons of amnihook
Pros: if you do it after labor, it can make labor shorter
Cons: increased risk of infection and poor outcomes if water is broken before they are in labor
53
Characteristics of epidural anesthesia
Epidural catheter placed in L3-L4
Initial bolus of anesthetic given then a continuous infusion started
54
Complications of epidural
Maternal hypotension
Spinal HA
Maternal respiratory depression
55
CI of epidural
Bleeding disorder
Patient refusal
56
Characteristics of spinal anesthesia
One time dose placed directly into the spinal canal
Used for c-section
57
Pudendal block
Provides perineal anesthesia for pelvic floor pressure pain
58
When can general anesthesia be used?
Used for c-section in emergent or urgent settings
59
Complications of general anesthesia in labor
Maternal aspiration
Risk of hypoxia to mother and fetus
60
How long do you have to get the baby off after blood flow is cut off?
4 minutes
61
Normal FHR baseline
110-160 bpm
62
What criteria is needed to set a baseline?
Must last for 2 minutes
63
T/F: fluctuations in the baseline FHR is regular in its amplitude and frequency
False - it is irregular
64
Variability in FHR
Absent: amplitude range is undetectable
Minimal: range is detectable but 5 bpm or fewer
Moderate (normal): range 6-25 bpm
Marked: range greater than 25 bpm
65
Acceleration of FHR
Visually apparent abrupt increase in the FHR
66
Acceleration peak before and after 32 weeks gestation
Before 32 weeks: acceleration has a peak of 10 bpm above baseline with a duration of 10 seconds
After 32 weeks: acceleration has a peak of 15 bpm above baseline with a duration of 15 seconds
67
Prolonged acceleration
Lasts 2 minutes or more but less than 10 minutes in duration
68
If an acceleration lasts ___, it's a change in baseline
10 minutes or more
69
Deceleration
Visually apparent usually symmetrical gradual decrease and return of the FHR associated with a uterine contraction
70
Early vs late deceleration
Early: the nadir of the deceleration occurs at the same time as the peak of the contraction
Late: the deceleration is delayed in timing, with the nadir of the deceleration occurring after the peak of the contraction
71
If the deceleration lasts more than ___, it is a change in baseline
10 minutes
72
T/F: sinusoidal pattern is extremely dangerous and insinuates anemia
True
73
What usually causes early decelerations?
Head compression
74
Late decelerations are the result of ___
Uteroplacental insufficiency
75
Interventions for late decelerations
Position change
Stop Pitocin
Check cervix
Consider c-section
76
What causes variable decelerations?
Cord compression
77
Intervention for variable deceleration
Amnioinfusion: infusion of saline into amniotic sac
78
Category 1 FHR
Baseline rate 110-160
Variability: moderate
Decelerations: none
79
Outcome of category 1 FHR
Baby will typically be fine
80
Category 2 FHR
Characterized by intermediate FHR patterns of tachy or bradycardia, minimal or absent baseline variability not accompanied by recurrent decelerations, marked baseline variability, no accelerations, and periodic or episodic decelerations
81
Category 3 FHR
Recurring late decelerations
Recurrent variable decelerations
Bradycardia
Sinusoid pattern
82
Outcome of category 3 FHR
Baby needs to come out via c-section right away
83
Contraction stress test
Evaluates the fetal response to a transient reduction in fetal oxygen delivery during uterine contractions
84
For the contraction stress test, use ___ to achieve ___ in ___
Pitocin; 3; 10 minutes
85
Indications for contraction stress test
Growth restricted baby
86
Cardinal movements of labor
Changes in the fetal head position during its passage through the canal
87
Engagement
Passage of the widest diameter fetal presenting part below the place of the pelvic inlet
88
Descent
Downward passage of the presenting part through the body pelvis
89
Flexion
Complete flexion allows the fetal head's smallest diameter to fit through the pelvis
90
Internal rotation
Rotation of the fetal head from occiput transverse to occiput anterior or posterior position
91
Extension
Occurs when the occiput is just past the level of the symphysis
92
External rotation/restitution
As the head is delivered, it rotates back to its original position prior to internal rotation
93
Expulsion
Delivery of the fetus
94
Delivery of the shoulders
Downward traction allows release of the anterior shoulder and the fetus is delivered
Then posterior shoulder is delivered
95
Indications of second stage
Pelvic/rectal pressure
96
Molding
Alteration of the fetal cranial bones in relation to each other as a result of compressive forces of the maternal bony pelvis
97
Caput
Localized edematous area on the fetal scalp caused by pressure on the scalp by the cervix
98
Perineal lacerations
1st degree: extends through the vagina and perineal skin
2nd degree: extends into soft tissue of perineum (perineal body)
3rd degree: through anal sphincter
4th degree: through rectal mucosa
99
Episiotomy
Surgical incision of female perineum
100
Complications of episiotomy
Vaginal bleeding
Pain
Sexual dysfunction
Infection
101
Midline vs mediolateral episiotomy
Midline: straight through the perineum
Mediolateral: through the side
102
Indications for use of forceps or vacuum in operative vaginal delivery
Prolonged second stage of labor
Maternal exhaustion
Hasten delivery for fetal compromise
103
How much time is usually between fetal and placental delivery?
Usually 30 minutes
104
3 signs of placental separation
Lengthening of umbilical cord
Gush of blood
Fundus becomes more globular and more anteverted against abdominal hand
105
What must be closely monitored in the 4th stage?
BP
Uterine blood loss
Pulse rate
106
What can cause uterine inversion?
Aggressive removal of the placenta
107
Repair of uterine inversion
Give med to relax uterus
Place fist in uterus to fix the shape
Give them Pitocin to contract the uterus into position
108
Shoulder dystocia
Difficulty in delivery of the anterior shoulder due to impaction of the anterior shoulder on the pubic symphysis
109
Complications of shoulder dystocia
Fracture of clavicle
Brachial plexus injury
Hypoxic brain injury
Death
110
Management of shoulder dystocia
Call for help
Episiotomy
McRoberts maneuver
Suprapubic pressure
Delivery of posterior arm
111
McRoberts position
Sharp flexion of maternal hips to open symphysis more horizontally
112
Umbilical cord prolapse
Prolapse of umbilical cord in front of fetal head
113
Why is an umbilical cord prolapse dangerous?
Cut off bloodflow to fetus
114
T/F: umbilical cord prolapse is an indication for a c-section
True
115
MCC for postpartum hemorrhage
Uterine atony (receptors get flooded and uterus doesn't react to oxytocin anymore)
116
Treatment of postpartum hemorrhage
Removal of placental fragments or repair lacerations
IV access
Type and cross match for blood
Medications for uterine atony
117
Meds for uterine atony
Pitocin
Methergine
Cytotec
Hemabate
118
CI for uterine atony drugs
Pitocin: hypotension
Methergine: hypertension
Hemabate: can't use in asthmatics
