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Undeleted > Intrapartum care, abnormal labor + emergencies > Flashcards

Intrapartum care, abnormal labor + emergencies Flashcards

1
Q

2 things that define labor

A
  1. contractions

2. cervical changes

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2
Q

what happens to cervix

A

dilatation and effacement

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3
Q

def. presentation

A

portion of body closest to the birth canal

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4
Q

4 types of presentaiton

A
  1. cephalic
  2. breech
  3. transverse
  4. compound
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5
Q

def. lie

A

orientation of the long axis of the fetus to the long axis of the uterus

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6
Q

def. positon

A

relation of presenting part of the fetus to maternal pevis

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7
Q

3 types of poitions

A
  1. occiput
  2. sacrum
  3. mentum
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8
Q

def. station

A

level of presenting part in relation to the ischial spines

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9
Q

4 stages of labor defs

A
  1. active and latent
  2. full dilatation to delviery
  3. delivery to placenta
  4. immediate post partum
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10
Q

defs and times of 1st stage

A

latent

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11
Q

time for second stage

A

around 2 hours

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12
Q

7 cardinal movements of labor

A
  1. engagement - head to side
  2. descent - of presenting part
  3. flexion
  4. internal rotation - towards back
  5. extension then crowning
  6. external rotation or restitiution
  7. expulsion and delivery
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13
Q

time for 3rd stage

A

under 30 minutes

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14
Q

** 3 signs of placental separtaiont

A
  1. uterus becomes more globular and rises up
  2. gush of blood
  3. lengthening of umbilical cord
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15
Q

time for 4th stage

A

time from placenta to when patient is stable - 6hours

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16
Q

3 parts of inital assessment

A
  1. vitals
  2. Hx
  3. physical
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17
Q

5 things to assess of physical

A
  1. strength and timeing of contractions
  2. status of membranes and fluid
  3. lie and presentation of fetus
  4. maybe speculum exam
  5. vagina examination
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18
Q

3 signs membranes have rubtures

A
  1. clear odorless fluid
  2. ferning - from E
  3. pH high
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19
Q

what is warning sign and what to do

A

green amniotic fluid - mecinium - monitor beb

20
Q

what is goal of fetal surveillance

A

detect fetal decom and provide support

21
Q

2 types of fetal heart rate monitoring

A
  1. intermittent ausculations

2. continuous electronic monitoring

22
Q

monitoring guides for each stage

A
  1. 15-30 minutes

2. q 5 minutes

23
Q

2 things to assess for on auscultation

A
  1. baseline fetal heart rate

2. heart rate chnages

24
Q

2 times to use cont.

A
  1. concerns from auscultaiton

2. high risk

25
Q

2 methods of continuous

A
  1. extenal

2. internal

26
Q

4 steps to assess on continuous

A
  1. uretine contraction activity
  2. baseline FHR
  3. assess baseline variability + acceleations
  4. assess FHR decelerations
27
Q

3 types of decelerations

A
  1. variable - abrupt complicated and uncomplicated
  2. late - visually apparent - ominous- hypoxia
  3. early - gradual decrease followed by return to baseline - mirroring - generally benign
28
Q

3 goals to intrauterine resuscitaiton

A
  1. imprive uterine blood flow
  2. umbilical circulation
  3. maternal O2 sat
29
Q

intial mgmt of abnormal tracing (6)

A
  1. stop ocytocin
  2. reposition
  3. hydration with IV bolus
  4. vaginal exam to relieve pressure on cord
  5. O2 by mask
  6. scalp electrode and sampling
30
Q

6 option for analgesia

A
  1. non-pharm - relax etc
  2. NO
  3. Narcotics
  4. nerve blocks
  5. perineal infiltration
  6. regional anasthesia
31
Q

what is freidman’s curve

A

dilatation vs. time

32
Q

def. dystocia

A

abnormal labor or childbirth

active > of 1hr with no descent

33
Q

4 Ps of inadequate progress

A
  1. power - should be strong, last 45s and q2-3min
  2. passenger - position can be altered
  3. passage - maternal soft tissues and pelvic shape
  4. psyche
34
Q

aspects to passage

A
  1. vagina
  2. episiotomy - midline ro mediolateral
  3. tears - degree
35
Q

4 aspects to psyche

A
  1. comfort
  2. support
  3. energy
  4. analgesia
36
Q

prevention of dystocia

A
  1. education
  2. diagnosis
  3. companion
  4. nursing
  5. hydration
37
Q

indications for assisst

A 
fetal - compromise
maternal
- exhaustion
- cardiac conditions
- conditions contrindicate pushing
- effort
38
Q

2 types of assists

A
  1. forceps

2. vacuum

39
Q

5 contra. to assists

A
  1. non-cephalic
  2. face/brow
  3. unengaged head
  4. incompletely dilated cervix
  5. low ptob of success
40
Q

4 risks to assists

A
  1. maternal soft tissue
  2. fetal scalp trauma
  3. intraventricular hemorhhage
  4. hemorrgae with vac.
41
Q

classification of CSec

A

based on uretine incision

  1. lower segment - preferable
  2. classical
42
Q

risks of Csection

A
  1. infeciton
  2. hemmorgae
  3. atelctasis
  4. injure surrouding stuctures
  5. DVT
  6. recovery time
43
Q

risk after CS

A

risk of uterine rupture after

44
Q

contra to VBAC

A
  1. previus classical
  2. previous rupture
  3. placenta previa
  4. previous surgeon opinion
  5. 1 layer closure
45
Q

6 indications for induction of labor

A
  1. pre-eclampsia>37weeks
  2. maternal disease
  3. hemmoprage
  4. chorioamnioitis
  5. fetal compromise
  6. preterm ROM
46
Q

2 types of IOL

A
  1. artificial rupture of membranes if cervix favorable

2 if not - need PGE2 or mechanical to dilate cervix

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