intrapartum care, abnormal labor obstet emerg, Flashcards
what is labor
contractions and cervical dilation effacement
fetal presentation
part of fetal body closest to birth canal
Lie
orientation of long axis of fetus relative to long axis of uterus
position
relation of presenting part (head or bottom) relative to maternal pelvis
vertex presentation position can be
occiput - anterior/posterior
Breech presentation often position
sacraum
Face presentation positive is
Mentum (chin)
Station is the level of presenting part relative to ischial spines
-3–1 is ABOVE - spine
positive below
first stage of labor can be
latent or active
The latent phase of labor (1st)
0-3 cm
The active phase of labor
3-10cm
Second stage of labor
Full dilatation and delivery
Third stage
Delivery of fetus and delivery of placenta
fourth stage
Placenta -> immediate post partum
Check rupture of membranes
Ferning - due to estrogen
what is the Ph when membranes have ruptured
7-7.5 turns nitraxine paper yellow to dark blue
two ways to monitor fetal heart rate
1) intermittent auscultation
2) continuous electronic fetal monitoring
Normal fetal hrt rate
110-160 bpm
FHR accelerations are
> = 15 bpm x >15s
EFM assessment
doesnt tell you how strong contractions are
tells you frequency and duration
What is a variable deceleration?
abrupt decrease in FHR
> 15 bpm below baseline > 15s
response to cord compression
Complicated variable decelerations are
< 70bpm > 60s, loss variability, slow return to baseline, tachy/bradycardia
late decelerations
Gradual decrease and return to baseline
Uteroplacental insufficiency and some degree of hypoxia
late decelerations occur when relative contractions?
after BEGINNING, peak, and end of contraction
If decelerations coincide with beginning, peak and end of contraction they are
EARLY decelerations, associated with fetal head compression, benign and inconsequential
Initial management of atypical tracing:
intrauterine resuscitation
improve uterine blood flow
umbilical circularion and
maternal O2 saturation
What do you do in initial management of atypical tracing
STOP oxytocin
REPOSITION To left or right lateral
Delivery is indicated when fetal scalp sample Ph is
< 7.2
Dystocia
abnormal labor/difficult childbirth
Active stage- > 4 hrs of < 0.5cm/hr cervical dilatation
2nd stage: > 1 hr with no fetal descent durin active pushing
4 Ps of inadequate progress
Power
passenger
passage
psyche
POWER
contractions moderate-strong
45 seconds
2-3 mins
(consider artificial rupture or oxytocin)
Placenta previa
PAINLESS vag bleeding
AVOID digital exam
Risk for PPH
placental abruption
PAINFUL bleed
LARGELY clinical diagnosis
vasa previa
vilamentous cord insertion
vessels insert into membrane before reaching placental body
FETAL vessels
bleed due to FETAL blood
Vasa previa associated with what type of pattern on FHR?
sinusoidal pattern
Unique features of uterine rupture
Profound fetal bradycardia severe constant abdominal pain PGE contraindicated (dont want to increase contractions)
To avoid uterine inversion MUST NOT
put pressure on fundus to deliver placenta
Contraindications for assisted vaginal delivery
Baby is non-cephalic face/brow delivery Unengaged head incomplete cerivcal dilatation Low success rate
Contraindications specific to vaccum
premature babies -
bleeding disorder -
Indications for C-sections
Dystocia maternal disease previous uterine surgery fetal distress, malpresentation previa, abruption
classical c-SECTION has a risk of
greater blood loss
higher risk of rupture in future
Risk of C-sections
Infection hemorrhage atelectasis injury to surrounding structures DVT/PE longer recovery
what is NOT a contraindication to VBAC?
Multiple gestation !
Mode of induction of labor
- prostaglandins
- Mechanical foley catheter
Most common presenting signs of AFE?
profound systemic hypotension
Hemorrhage DIC
cyanosis, dyspnea or respiratory arrest
Three directives for managing AFE
1) rapid initiation of oxygenation
2) circulatory support
3) correction of coagulopathy
CPR immediately if cardiac arrest
