Intrapartum- EXAM 1 Flashcards by El S

In what times is the mother instructed to call the doctor

Rupture membranes
regular, frequent uterine contractions
any vaginal bleeding
decreased fetal movement

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4 P’s

Powers: Uterine contractions
Passage: bony pelvis, soft tissue of the cervix, pelvic floor, vagina and Introits
Passenger: fetus, membranes and placenta
Psyche:Womans emotional status

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Lightening

Sign of labor
when fetus begins to settle into the pelvic inlet
Breathing better, leg cramps, increased pelvic pressure, urinary frequency, vaginal secretions, venous stasis and edema

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Braxton Hicks contractions

Sign of labor
Irregular, intermittent contractions
“False” labor, can disturb mother without affecting cervical change if strong enough

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What is ripening

A cervical change sign of labor
The softening of the cervix to stretch and dilate, allowing for the passage of the fetus

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What is bloody show

Sign of labor
Pink-tinged secretion with mucous plug
Labor begins within 24-48 hours

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What are the ruptures of membranes

PROM, SROM, AROM, PPROM

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PROM

Premature rupture of membranes: 20,25,30 weeks
Occurs before onset of labor
Must be evaluated

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SROM

Spontaneous rupture of membranes
Occurs at height of intense contractions

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AROM

Artificial rupture of membranes
40-42 weeks and has had no rupture yet, so membranes are ruptures with amino hook

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PPROM

Preterm premature rupture of membranes
Rupture before 37 weeks of gestation
Risk for infection

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Signs of labor extras

Sudden burst of energy 24-48 hours before labor
weight loss, diarrhea, indigestion, nausea or vomiting

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False labor

Irregular contractions
No change in effacement or dilation of cervix, no bloody show
Walking relieves these contractions

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True labor

Contractions of regular pattern become stronger
Bloody show present and effacement and dilation

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Inspection of the Amniotic fluid

color: normal clear fluid
green= meconium was passed
Should not smell
Trickle to a litter amount

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6 Lamaze Institute basic

Labor should begin on its own
No routine interventions should be performed
Woman should have freedom to move
Have a birth support person
Be in non supine positions
Not be separated from infant

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Birth passage & factors that may effect it

True bony pelvis consists of inlet, pelvic cavity and outlet
Size and type of maternal pelvis, ability to dilate and efface

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Largest part of the fetus

Head

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Fetal attitude

The way the fetus will flex, attitude must be compressible to be able to turn in any direction

Fetal lie

Has to be in head to toe direction, longitude

Complete breech

Sitting criss crossed, head to toe but in wrong direction, butt at vaginal opening, umbilical wrapped on legs
Will need to be C-sected

Frank breech

Feet are touching his head, looks squished

Single footling breech

leg is out vaginal opening

What is engagement

When the largest diameter reaches or passes through the pelvis, aka the head

Describe the station

When the presenting part is between the ischial spine of the pelvis @ ischeal=0. Goes from -5 to +5 The lower down the head goes, it reaches positive numbers

Occiput baby position

vertex presentation

Mentum baby position

face presentation

Sacrum baby position

breech presentation

Acromion process baby position

shoulder presentation

Theories to why labor occurs

Changes in estrogen prostaglandin secretion increased secretion of oxygen Fetal role, wants to cone out Stretching, pressure and irritation of the uterus

First stage of labor

Onset of true labor Has 3 stages: Latent,Active-4-6cm,Transition-6-10cm May be anxious, feel out of control and tired Strong contractions every 1.5-2 min for 60-90 seconds Increased rectal pressure and amount of bloody show Rupture of membranes

Second stage of labor

Mom is fully dilated Crowning, the fetus changes positions as it goes through the birth passage Ends with delivery of baby

Third stage of labor

Begins at delivery of newborn, ends with delivery of the placenta 20-30 min after birth, the placenta will separate from the uterine wall Women will have to bear down to aid or gentle traction will be applied to help Placenta will need to be inspected!

Life span considerations for women over 35

Higher rate of miscarriage, stillbirth, preterm birth, low birth rate, perinatal morbidity and mortality

Maternal assessment

Assess contractions:frequent, duration and intensity Cervical assessment: check for dilation, 10cm is the most

Baseline Fetal heart rate

Normal range of 110-160 BPM

Fetal compromise conditions

High fetal heart rate Meconium stained amniotic fluid Cloudy, yellowish or foul odor to amniotic fluid Excessive frequency or duration of contractions Incomplete uterine relaxation Maternal hypotension or hypertension Maternal fever of 100.4 or higher

Fetal bradychardia

Less then 110 BPM

Fetal tachycardia

More then 160 BPM

VEAL CHOP

Fetal heart rate V:Variable C:Cord compression E:Early. H:Head compression A:Acceleration O:Okay! L:Late P:Placental Insufficiency

Breathing techniques and If hyperventilation

Slow, deep breathing Shallow or modified paced breathing Pant-blow Hyperventilating: encourage slow breathing, shallow breaths

How do you assess with nuchal cord after baby is born

suction mouth and then nose with the bulb syringe

Assessing the fundus

Displaced=caused by full bladder or blood in uterus Blood and clots can be expelled by grasping uterus and squeezing DO NOT message uterus unless it is "boggy" or not firm

APGAR

7-10=normal 4-6=moderetly depressed but can improve 0-3=needs resucution

Analyzing umbilical cord after birth

Make sure it has: 2 umbilical veins, one artery one vein Any deviation has to be analyzed Fluid is checked to see acidosis