Intrapartum care, abnormal labor + emergencies

Question 1

2 things that define labor

Answer 1

1. contractions

2. cervical changes

Question 2

what happens to cervix

Answer 2

dilatation and effacement

Question 3

def. presentation

Answer 3

portion of body closest to the birth canal

Question 4

4 types of presentaiton

Answer 4

1. cephalic
2. breech
3. transverse
4. compound

Question 5

def. lie

Answer 5

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

Question 6

def. positon

Answer 6

relation of presenting part of the fetus to maternal pevis

Question 7

3 types of poitions

Answer 7

1. occiput
2. sacrum
3. mentum

Question 8

def. station

Answer 8

level of presenting part in relation to the ischial spines

Question 9

4 stages of labor defs

Answer 9

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

Question 10

defs and times of 1st stage

Answer 10

latent

Question 11

time for second stage

Answer 11

around 2 hours

Question 12

7 cardinal movements of labor

Answer 12

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

Question 13

time for 3rd stage

Answer 13

under 30 minutes

Question 14

** 3 signs of placental separtaiont

Answer 14

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

Question 15

time for 4th stage

Answer 15

time from placenta to when patient is stable - 6hours

Question 16

3 parts of inital assessment

Answer 16

1. vitals
2. Hx
3. physical

Question 17

5 things to assess of physical

Answer 17

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

Question 18

3 signs membranes have rubtures

Answer 18

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

Question 19

what is warning sign and what to do

Answer 19

green amniotic fluid - mecinium - monitor beb

Question 20

what is goal of fetal surveillance

Answer 20

detect fetal decom and provide support

Question 21

2 types of fetal heart rate monitoring

Answer 21

1. intermittent ausculations

2. continuous electronic monitoring

Question 22

monitoring guides for each stage

Answer 22

1. 15-30 minutes

2. q 5 minutes

Question 23

2 things to assess for on auscultation

Answer 23

1. baseline fetal heart rate

2. heart rate chnages

Question 24

2 times to use cont.

Answer 24

1. concerns from auscultaiton

2. high risk

Question 25

2 methods of continuous

Answer 25

1. extenal | 2. internal

Question 26

4 steps to assess on continuous

Answer 26

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

Question 27

3 types of decelerations

Answer 27

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

Question 28

3 goals to intrauterine resuscitaiton

Answer 28

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

Question 29

intial mgmt of abnormal tracing (6)

Answer 29

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

Question 30

6 option for analgesia

Answer 30

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

Question 31

what is freidman's curve

Answer 31

dilatation vs. time

Question 32

def. dystocia

Answer 32

abnormal labor or childbirth | active > of 1hr with no descent

Question 33

4 Ps of inadequate progress

Answer 33

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

Question 34

aspects to passage

Answer 34

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

Question 35

4 aspects to psyche

Answer 35

1. comfort 2. support 3. energy 4. analgesia

Question 36

prevention of dystocia

Answer 36

1. education 2. diagnosis 3. companion 4. nursing 5. hydration

Question 37

indications for assisst

Answer 37

``` fetal - compromise maternal - exhaustion - cardiac conditions - conditions contrindicate pushing - effort ```

Question 38

2 types of assists

Answer 38

1. forceps | 2. vacuum

Question 39

5 contra. to assists

Answer 39

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

Question 40

4 risks to assists

Answer 40

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

Question 41

classification of CSec

Answer 41

based on uretine incision 1. lower segment - preferable 2. classical

Question 42

risks of Csection

Answer 42

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

Question 43

risk after CS

Answer 43

risk of uterine rupture after

Question 44

contra to VBAC

Answer 44

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

Question 45

6 indications for induction of labor

Answer 45

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

Question 46

2 types of IOL

Answer 46

1. artificial rupture of membranes if cervix favorable | 2 if not - need PGE2 or mechanical to dilate cervix