Intrapartum care, abnormal labor + emergencies Flashcards
2 things that define labor
- contractions
2. cervical changes
what happens to cervix
dilatation and effacement
def. presentation
portion of body closest to the birth canal
4 types of presentaiton
- cephalic
- breech
- transverse
- compound
def. lie
orientation of the long axis of the fetus to the long axis of the uterus
def. positon
relation of presenting part of the fetus to maternal pevis
3 types of poitions
- occiput
- sacrum
- mentum
def. station
level of presenting part in relation to the ischial spines
4 stages of labor defs
- active and latent
- full dilatation to delviery
- delivery to placenta
- immediate post partum
defs and times of 1st stage
latent
time for second stage
around 2 hours
7 cardinal movements of labor
- engagement - head to side
- descent - of presenting part
- flexion
- internal rotation - towards back
- extension then crowning
- external rotation or restitiution
- expulsion and delivery
time for 3rd stage
under 30 minutes
** 3 signs of placental separtaiont
- uterus becomes more globular and rises up
- gush of blood
- lengthening of umbilical cord
time for 4th stage
time from placenta to when patient is stable - 6hours
3 parts of inital assessment
- vitals
- Hx
- physical
5 things to assess of physical
- strength and timeing of contractions
- status of membranes and fluid
- lie and presentation of fetus
- maybe speculum exam
- vagina examination
3 signs membranes have rubtures
- clear odorless fluid
- ferning - from E
- pH high
what is warning sign and what to do
green amniotic fluid - mecinium - monitor beb
what is goal of fetal surveillance
detect fetal decom and provide support
2 types of fetal heart rate monitoring
- intermittent ausculations
2. continuous electronic monitoring
monitoring guides for each stage
- 15-30 minutes
2. q 5 minutes
2 things to assess for on auscultation
- baseline fetal heart rate
2. heart rate chnages
2 times to use cont.
- concerns from auscultaiton
2. high risk
2 methods of continuous
- extenal
2. internal
4 steps to assess on continuous
- uretine contraction activity
- baseline FHR
- assess baseline variability + acceleations
- assess FHR decelerations
3 types of decelerations
- variable - abrupt complicated and uncomplicated
- late - visually apparent - ominous- hypoxia
- early - gradual decrease followed by return to baseline - mirroring - generally benign
3 goals to intrauterine resuscitaiton
- imprive uterine blood flow
- umbilical circulation
- maternal O2 sat
intial mgmt of abnormal tracing (6)
- stop ocytocin
- reposition
- hydration with IV bolus
- vaginal exam to relieve pressure on cord
- O2 by mask
- scalp electrode and sampling
6 option for analgesia
- non-pharm - relax etc
- NO
- Narcotics
- nerve blocks
- perineal infiltration
- regional anasthesia
what is freidman’s curve
dilatation vs. time
def. dystocia
abnormal labor or childbirth
active > of 1hr with no descent
4 Ps of inadequate progress
- power - should be strong, last 45s and q2-3min
- passenger - position can be altered
- passage - maternal soft tissues and pelvic shape
- psyche
aspects to passage
- vagina
- episiotomy - midline ro mediolateral
- tears - degree
4 aspects to psyche
- comfort
- support
- energy
- analgesia
prevention of dystocia
- education
- diagnosis
- companion
- nursing
- hydration
indications for assisst
fetal - compromise maternal - exhaustion - cardiac conditions - conditions contrindicate pushing - effort
2 types of assists
- forceps
2. vacuum
5 contra. to assists
- non-cephalic
- face/brow
- unengaged head
- incompletely dilated cervix
- low ptob of success
4 risks to assists
- maternal soft tissue
- fetal scalp trauma
- intraventricular hemorhhage
- hemorrgae with vac.
classification of CSec
based on uretine incision
- lower segment - preferable
- classical
risks of Csection
- infeciton
- hemmorgae
- atelctasis
- injure surrouding stuctures
- DVT
- recovery time
risk after CS
risk of uterine rupture after
contra to VBAC
- previus classical
- previous rupture
- placenta previa
- previous surgeon opinion
- 1 layer closure
6 indications for induction of labor
- pre-eclampsia>37weeks
- maternal disease
- hemmoprage
- chorioamnioitis
- fetal compromise
- preterm ROM
2 types of IOL
- artificial rupture of membranes if cervix favorable
2 if not - need PGE2 or mechanical to dilate cervix
