Intrapartum- EXAM 1 Flashcards
In what times is the mother instructed to call the doctor
Rupture membranes
regular, frequent uterine contractions
any vaginal bleeding
decreased fetal movement
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
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
Braxton Hicks contractions
Sign of labor
Irregular, intermittent contractions
“False” labor, can disturb mother without affecting cervical change if strong enough
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
What is bloody show
Sign of labor
Pink-tinged secretion with mucous plug
Labor begins within 24-48 hours
What are the ruptures of membranes
PROM, SROM, AROM, PPROM
PROM
Premature rupture of membranes: 20,25,30 weeks
Occurs before onset of labor
Must be evaluated
SROM
Spontaneous rupture of membranes
Occurs at height of intense contractions
AROM
Artificial rupture of membranes
40-42 weeks and has had no rupture yet, so membranes are ruptures with amino hook
PPROM
Preterm premature rupture of membranes
Rupture before 37 weeks of gestation
Risk for infection
Signs of labor extras
Sudden burst of energy 24-48 hours before labor
weight loss, diarrhea, indigestion, nausea or vomiting
False labor
Irregular contractions
No change in effacement or dilation of cervix, no bloody show
Walking relieves these contractions
True labor
Contractions of regular pattern become stronger
Bloody show present and effacement and dilation
Inspection of the Amniotic fluid
color: normal clear fluid
green= meconium was passed
Should not smell
Trickle to a litter amount
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
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
Largest part of the fetus
Head
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
