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Intrapartum (First stage of labour) Flashcards

1
Q

What marks the end of the 1st stage of labour?

A

When the patient is fully dilated and effaced

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2
Q

What happens to a patient’s cardiac output during labour?What does it result in?

A

It increases resulting in improved blood flow to the uteroplacental unit and the maternal kidneys

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3
Q

What pulse rate is considered fetal bradycardia?

A

Anything less than 110bpm for more than 10min

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4
Q

How does an upright position (walking, sitting, kneeling, squatting) aid in delivery?

A

Gravity helps!

Stronger but more efficient contractions (helps with dilation and effacement)

Improved cardiac output

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5
Q

What should we do to in terms of helping patient positioning during labour?

A

Encourage to help her find positions that make her comfortable!!!

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6
Q

What occurs during the active phase during the first stage of labour?

A

there is more rapid dilation of the cervix and increased rate of descent of the presenting part.

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7
Q

What happens to fetal respiration during labour? What changes occur?

A

Chemoreceptors are stimulated in the aorta and carotid artery to prepare the fetus for initiating respirations. Changes that occur include:

1.) Fluid is cleared from the air passages as the newborn passes through the birth canal during labour

2.) Fetal oxygen pressure (Po2) decreases

3.) Arterial carbon dioxide pressure (Pco2) increases

4.) Arterial pH decreases

5.) Bicarbonate level decreases

6.) Fetal respiratory movements decrease during labour

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8
Q

What causes FHR late deceleration attributed to?

A

Attributed to uteroplacental insufficiency

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9
Q

What are secondary powers?

A

The labouring patient experience an involuntary urge to push (The patient uses the secondary powers (bearing-down effort) to aid in expulsion of the fetus as they contract their diaphragm and abdominal muscles and pushes

(Secondary powers have no effect on cervical dilation, but they are of considerable importance in the expulsion of the newborn from the uterus and vagina after the cervix is fully dilated)

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10
Q

how many cm is the cervix dialated in the 1st stage of Active labour?

A

4-10cm dilated

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11
Q

What is the first thing we must do if we detect fetal bradycardia?

A

Confirm the maternal pulse to differentiate it from the fetal heart rate as fetal bradycardia Raley occurs

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12
Q

What affects fetal circulation during labour?

A

Affected by maternal position, contractions, BP, and umbilical cord flow

-Uterine contraction during labour tend to decrease circulation through spiral arteriols and subsequent perfusion through the intervillous space

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13
Q

What can fetal bradycardia be caused by?

A

Fetal cardiac problems (Structure defects or heart failure)
Infection
Maternal hypoglycemia
Maternal hypothermia

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14
Q

What respiratory changes occur to the mother during labour?

A

-Increase in respiratory rate and oxygen consumption

(Hyperventilation may cause respiratory alkalosis (an increase in pH), hypoxia, and hypocapnia (decrease in carbon dioxide). In the unmedicated labouring patient in the second stage, oxygen consumption almost doubles)

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15
Q

What occurs during the internal rotation/what is the baby doing (one of the cardinal fetal movements)

A

-Rotation of the head

(4th cardinal movement)

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16
Q

What is fetal bradycardia not specifically related to?

A

Fetal oxygen

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17
Q

What is occurring during the expulsion movement? (cardinal movement)

A

-The baby has completely immerged

(FINAL 7th cardinal movement)

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18
Q

What do we assess for vaginal discharge? (blood show)

A

C: color

O: odor

A: amount

T: time

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19
Q

What pulse rate is considered fetal tachycardia?

A

Anything greater than 160bpm for more than 10min

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20
Q

What changes occur to the mothers Endocrine system during labour?

A

The onset of labour may be triggered by decreasing levels of progesterone and increasing levels of estrogen, prostaglandins, and oxytocin

Metabolism increases, and blood glucose levels may decrease with the work of labour (Patients who are diabetic require close monitoring of glucose levels during labour)

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21
Q

In terms of Ambulation, what should we encourage the mother to do during labour?

A

Encourage and support movement and changing positions :
-walking
-Swaying hips
-Shower
-Bath
-Sitting on exercise balls

(Encourage position change every 30 - 60min if the patient has not changed their position)

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22
Q

What happens the descent during labour? (One of the fetal cardinal movements)

A

Progress of the presenting part

Measured by station

Accelerates in active phase

(This is the second movement that occurs)

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23
Q

What is tachysystole?

A

Greater than 5 contractions in 10min, averaged over a 30min window

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24
Q

What are Late Decelerations of FHR? WHat are they associated with?

A

It is a visually apparent GRADUAL (onset to nadir is greater then or equal to 30 sec) decrease in and return to baseline FHR that’s associated with utermine contractions

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25
What are Accelerations? How are they characterized?
-An apparent, abrupt (onset to peak should be less than 30 seconds) increase in FHR above the baseline -The peak is at least 15bpm above the baseline and the acceleration lasts 15 seconds longer, with the return to baseline in less than 2 min
26
During the 1st stage of labour what education ca we provide to a patient?
-Signs of labour (laten vs. active) -Coping strategies (water (shower), massage, walks, relaxation, distraction, sleep, eating, drinking
27
When are Late Decelerations a concern?Why?
Persistent and repetitive decelerations are a concern when they are uncorrectable as they can lead/cause a disruption in fetal oxygenation and sufficiently result in metabolic acidemia
28
What can the onset of labour be triggered by? (endocrine system wise?
The onset of labour may be triggered by decreasing levels of progesterone and increasing levels of estrogen, prostaglandins, and oxytocin
29
When do FHR decelerations begin/characteristics?
Begins after the contraction has started, and the lowest point of the deccerlation occurs at the peak of the contraction -The deccerlation usually does not return to baseline until after the contraction is over
30
What happens to fetal heart rate during labour? What should the normal rate be?
The rate should be 110-160 with accelerations and slight decelerations with movement and contractions
31
What is happening during the restitution and external rotation movement? (cardinal movement)
Rotation as shoulders immerge (6th cardinal movement)
32
What structures do the "soft tissues" include?
1.) Lower uterine segment 2.) Pelvis floor muscles 3.) Vagina 4.) Introitus (vaginal opening) - Introitus = entrance into a canal or organ
33
What renal changes occur to the mother during labour? What is something that we might see that can be considered normal?
-Spontaneous voiding may be difficult due to: tissue edema caused by pressure from the presenting part, discomfort, analgesia, and embarrassment Proteinuria up to + 1 is a normal finding because it can occur in response to the breakdown of muscle tissue from the physical work of labour
34
What are the steps/how do we conduct a labour admission? (11 steps/things)
*Interview and Physical Assessment* 1.) Time labour started 2.) Frequency of contractions 3.) Where is pain felt and the intensity 4.) Vaginal discharge (bloody show) 5.) Have membranes ruptured? If so when? 6.) Vaginal exam (determine the dilation and if ROM occurred) 7.) Fetal assessment (heart rate and Leopolds manoeuvres) 8.) Notify the care provider 9.) Systems assessment is done after admission 10.) Anrenatal data and birth plan 11.) Pscyhosocial factors (Ex. history of sexual abuse, stress in labour)
35
What are prolonged decelerations
It is a visually apparent decrease (can be gradual or abrupt) of at least 15bpm below the baseline and lasting more than 2min but less than 10min from onset to return to baseline.
36
What is the purpose/goal of electronic fetal monitoring (EMF)?
To detect impending fetal decompensation (hypoxia and metabolic acidosis) during labour and provide timely interventions
37
What changes to the Integumentary system of the mother occur during labour?
Stretching of tissues (vaginal introitus) Despite this ability to stretch, even in the absence of episiotomy or lacerations, minute tears in the skin around the vaginal introitus occur.
38
In terms of elimination, what should we encourage the mother to do during labour?What do we want to avoid?
-Encourage voiding at a minimum of every 2 hours!!!! -We want to avoid a discened bladder because it may impeded the desent of the presenting part, slow or stop uterine contractions, and lead to decreased bladder tone or atony after birth
39
What changes occur to the MSK system of a mother during labour?
The musculoskeletal system is stressed during labour. Diaphoresis, fatigue, proteinuria (+ 1), and possibly an increased temperature accompany the marked increase in muscle activity Backache and joint ache (unrelated to fetal position) occur as a result of increased joint laxity at term. The labour process itself and the patient’s pointing their toes can cause leg cramps.
40
What is recommended during labour when there is a high risk for adverse outcomes?
Electronic fetal monitoring
41
When do early decelerations typically occur?Are interventions required?
-Typically occuring during rhe first stage of labour when the cervix is 4-7cm dilated -NO intervention are required
42
Characteristics of Early Decelerations?
Considered normal (described in relation to a contraction) Can be abnormal or benign Caused by transient fetal head compression during contraction which slows FHR Onset to lowest point is greater or equal 30 sec (gradual) -Sometimes referred to as a "mirror image" of a contraction because they usually correspond with thebegining, peak, and end of the contraction
43
What are some signs of preceding labour?
-Weight loss (0.5 - 1.5kg) -Surge of energy (nesting) -GI Upset (diarrhea, nausea, vomiting) -Increased vaginal discharge (bloody show) -Cervical ripening -Backache -Stronger Braxton hicks contractions
44
What happens during engagement during labour? (One of the fetal cardinal movements)
When the biparietal diameter of the head passes the pelvic inlet Occurs before or during active labour depending on if this is a nulliparous or multiparous woman
45
Effacement vs. Dilation
Effacement = shortening and thinning of the cervix (measured in degrees 0-100%) Dilation = enlargement of the cervix (expands from 1cm to approx. 10cm)
46
What are the main criterias for internal monitoring?
1.) All membranes must be ruptured 2.) Cervix must be sufficiently dilated (2-3cm) 3.) The presenting part low enough to allow placement of the spiral electrode
47
What terms are uterine contractions described in?(4 different ones)
1.) Frequency - measured by determining the number of contractions on a 10-min period average over a 30min window 2.) Intensity - The palpable strength of a contraction at its peak 3.) Duration - The time that elapses between the onset and the ned of a contraction (in seconds) 4.) Resting Tone - The tension in the uterine muscle between contractions;relaxation of the uterus
48
When is the first stage of labour considered to last from?
From the onset of regular uterine contractions to full dilation of the cervix
49
How is normal uterine activity pattern in labour characterized?
-By 5 or less contractions occuring in a 10min window (averaged over a 30min time period); these contractions last less than 90 seconds with a minium of 30 seconds of rest period between contractions
50
What increased hormones levels cause regular and rhythmic uterine contractions?
Increased estrogen, oxytocin, and prostaglandin contribute to uterine distention and intrauterine pressure
51
how many cm is the cervix dialated in the 1st stage of early labour?
0-3cm (lots of effacement occurs - this is the stretching and thinning of the cervix)
52
What does the first stage of labour begin with? What does it end with?
The first stage of labour begins with he onset of regular uterine contractions that result in cervical change and ends with complete cervical effacement and dilation
53
What is considered when deceleration last for more then 10min?
A change in baseline and requires immediate intrauterine resuscitative measures.
54
What is Proteinuria?
Elevated protein in the urine Proteinuria up to + 1 is a normal finding because it can occur in response to the breakdown of muscle tissue from the physical work of labour
55
What is Intermittent Auscultation?
Method that is used for fetal health surveillance in healthy patients who are ta term and are not expected to experience adverse perinatal outcomes Frequency of this depends on what stage of labour the patient is in *Invloves assessing fetal heart rate through palpation and listening to and counting the fetal heart sounds at peropdic intervals in order to assess overall fetal status
56
What occurs/how is the baby moving during extension? (one of the cardinal movements)
The head emerges by extension (5th cardinal movement)
57
What are the 5 P's/factors that affect the process of labour?
1.) Passenger (fetus + placenta) 2.) Passageway (birth canal) 3.) Powers (contractions) 4.) Position of the labouring patient 5.) Psychological response
58
What are the primary powers responsible for?
They are responsible for the effacement and dilation of the cervix and descent of the fetus (Beginning of labour)
59
When do we assess the baby during labour/delivery?
Assess before and after ROM, and medical intervention
60
What occurs during the latent phase of the first stage of labour?
there is more progress in effacement of the cervix and little increase in descent
61
Variable deceleration characteristics?
They are a visually ABRUPT (onset to lowest point is less than 30 sec) decrease in FHR below the basline FHR decreases at least 15bpm below baseline and the deceleration lasts for at least 15 seconds but less than 2 minutes -Can occurring during or between contractions
62
Once effacement and dilation is complete, what can be felt?
Once effacement is complete only a thin ridge can be felt Once dilation is complete the cervix cannot be felt
63
What are Variable decelerations?
They are the most common type of deceleration that us caused by umbilical cord compression which interrupts oxygen transfer to the fetus, thus causing hypoxia
64
What do contractions push the fetus against?
The cervix
65
What structures is the "Passageway" composed of?
1.) The true bony pelvis (portion that is involved in child birth) 2.) The soft tissues (After labour begins the uterine body the bottom portion of the uterus becomes thin and muscular (top is think and muscular)
66
What does the term "engagement" refer to/indicate?
Engagement is the term used to indicate that the largest transverse diameter of the presenting part (usually the biparietal diameter) has passed through the maternal pelvic brim or inlet into the true pelvis and usually corresponds to station 0. (The head is a 0 station)
67
What neurological changes occur to a mother during labour?
Initially, the patient may be euphoric. Euphoria gives way to increased seriousness, to amnesia between contractions during the second stage, and finally to elation or fatigue after giving birth. Endogenous endorphins (morphine-like chemicals produced naturally by the body) raise the pain threshold and produce sedation physiological anaesthesia of perineal tissues, caused by pressure of the presen
68
What is station measuring? how is it measured?
-It is measuring the degree of the presenting part -It is measured in cm and ranges from -5cm to +5cm
69
Causes of prolonged decelerations?
Cause by the causes of late or variable decelerations last for a longer period of time: -Maternal hypotension -Cervical exam -Uterine tachysystole or rupture -Extreme placental insufficient -Cord entanglement -Prolonged cord compression or prolapse
70
What happens during flexation of labour? (One of the fetal cardinal movements)
Flexes so the chin is closer to the chest with resistance from the cervix and pelvic wall (3rd cardinal movement that occurs)
71
What factors affect/determine the movement of the passenger (fetus) through the birth canal?
-Head size -Presentation -Lie -Attitude -Position
72
What cardiovascular changes occur to the mother during labour?
-Cardiac output increases up to 51% above baseline pregnancy values at term and peaks about 10 - 30 min after both vaginal and caesaren birth and returns to its prelabour baseline within the first hour postpartum -Blood pressure increases during contractions and return to baseline levels between contractions
73
When do secondary powers begin/occur?
After the cervix has dilated (this is the "bearing down" feeling
74
What are "repetitive" decelerations defined as?
Greater then 2 decelerations in a row
75
When can fetal Tachycardia occur?
Maternal fever (most common) Maternal or fetal infection Maternal hyperthyroidism Fetal anemia medications
76
What are accelerations an indication of?
Indication of fetal health, they may occur in association with fetal movement or spontaneously * They can also be elicited via fetal scalp stimulation
77
How do we assess uterine contractions? What do we assess?
Done by palpation 1.) Frequency The time (minutes) from the beginning of one contraction to the beginning of the next 2.) Intensity The strength of a contraction at its peak 3.) Duration The time (seconds) of one contraction from start to stop 4.) Resting tone The tension of the uterine muscle between contractions -Mild: slightly tense fundus -Moderate: firm fundus -Strong: Rigid fundus
78
what 4 things does Leopolds Manoeuvers help identify?
1.) The number of fetuses 2.) The presenting part (fetal lie and fetal altitude) 3.) The degree of descent of the presenting part into the pelvis 4.) The expected location of the point of maximal intensity of the fetal heart rate on the patients abdomen
79
What GI changes occur to a mother during labour?
During labour, gastrointestinal motility and absorption of solid foods are decreased, and stomach-emptying time is slowed Nausea and vomiting of undigested food eaten after onset of labour are common. Nausea and belching also occur as a reflex response to full cervical dilation The patient may state that diarrhea accompanied the onset of labour, or the nurse may palpate the presence of hard or impacted stool in the rectum
80
81
When does "Engagement" occur? How can it be determined?
Engagement often occurs in the weeks just before labour begins in nulliparas and may occur before or during labour in multiparas. Engagement can be determined by abdominal or vaginal examination.
82
How long is the segment to determine fluctuations in the FHR baseline?
Fluctuations in the baseline FHR that are determined in a 10 minute segment
83
What are the 7 turns and adjustments that the fetus must make during labour? (Cardinal movements)
1.) Engagement 2.) Descent 3.) Flexion 4.) Internal Rotation 5.) Extension 6.) Restitution and External Rotation 7.) Expulsion
84
What is fetal tachycardia an ealry sign of?
Early sign of hypoxia
85
How often does fetal monitoring occur during labour?
Every 15-30min

NURS 372 (Midterm) (8 decks)

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