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OB > Intrapartum Part 1 > Flashcards

Intrapartum Part 1 Flashcards

1
Q

Intrapartum

A

During labor until a few hrs after delivery

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2
Q

Clinical Pelvimetry

A 
False pelvis (above pelvic brim)
True pelvis represents bony limits of birth canal: most important in childbirth
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3
Q

3 subdivisions of true pelvis

A

Bony limits of birth canal:
pelvic inlet
midpelvis
pelvic outlet

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4
Q

Pelvic types

A

Gynecoid: prognosis good, best pelvic type for delivery
Anthropoid: good prognosis

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5
Q

female bony pelvis

A 
four bones: 
2 innominate (hip bones)
ilium, ischium, pubis
sacrum
coccyx
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6
Q

pelvic floor

A

musculature to overcome force of gravity
pelvic diaphragm
-dilation during pregnancy
-returns after birth

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7
Q

Premonitary signs of labor

A 
braxton hicks
lightening
increased vaginal secretions
bloody show/ mucous plug
energy spurt
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8
Q

phone triaging a pt

A
  1. what is your EDD

2. what time did the membranes rupture

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9
Q

True vs. False labor

A

progressive dilation and effacement

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10
Q

false labor management

A

pain can be relieved by ambulation, changes of position, resting or hot bath or shower

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11
Q

RN responsibilities admission to the birth center

A

therapeutic relationship
imminence of birth
fetal and maternal status
admission assessments

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12
Q

ROM

A

ferning
nitrazine paper turns blue if amniotic fluid is present
vaginal pH < 4.5
amniotic fluid pH 7.0-7.5

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13
Q

uterus changes during birth

A

contractions

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14
Q

Cervical changes during birth

A

effacement

dilation

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15
Q

cardiovascular changes during birth

A

check vitals between contractions

remember about positioning

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16
Q

respiratory changes during birth

A

hyperventilation

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17
Q

GI changes during birth

A

motility decreased

thirst

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18
Q

GU changes during birth

A

reduced sensation of full bladder

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19
Q

hematopoietic system changes during birth

A

SVD 500 ml, C/S 1000 ml
H/H
WBC increased up to 25000/mm3

increased clotting factors
decreased fibrinolysis

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20
Q

psychosocial considerations

A 
readiness
preconceived ideas about birth
birth plan
factors associated w/ positive birth
support system
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21
Q

4 P’s of birth process

A 
powers
passage
passenger
psyche
the 4 P's are interrelated and must all work together
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22
Q

powers

A

physiologic forces of labor- uterine muscular contractions
-frequency & intensity
pushing during second stage of labor

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23
Q

passage

A

size of maternal pelvis
type of maternal pelvise
ability of cervix to dilate, efface
ability of vaginal canal to descend

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24
Q

Passenger

A

fetal head
fetal lie
fetal attitude
fetal presentation

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25
Q

fetal head

A

overlapping bones- molding

sutures- allow for molding

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26
Q

fetal lie

A

longitudinal- vertical

transverse- horizontal

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27
Q

fetal attitude

A

posture of fetus to conform to uterine cavity

normal attitude: head flexed, chin on chest, arms crossed over chest, legs flexed at knee, thighs on abdomen

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28
Q

Fetal presentation

A

b

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29
Q

fetal malpresentation

A 
breech (frank, footling, complete)
transverse lie (shoulder presentation)
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30
Q

Station

A

presenting part vs. imaginary line between the ischial spines
presenting part moves from negative to positive

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31
Q

psyche

A 
culture
individual values
education/ support
birthing experiece
impact of technology
pain, fatigue and fear
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32
Q

Stages of Labor

A
  1. Cervical dilation: 0-10 cm
  2. Birth of baby “pushing”
  3. placental delivery
  4. Recovery
33
Q

1st stage- 1st phase

cervical dilation

A

latent phase:

  • beginning cervical dilation and effacement
  • no evident fetal descent
  • contractions increase, mild-regular intensity
  • excited, talkative, smiling
34
Q

1st stage-2nd phase

cervical dilation

A

active phase

  • dilation 4-7 cm
  • progressive fetal descent
  • contractions increase in freq and intensity
  • increased anxiety
35
Q

1st stage- 3rd phase

cervical dilation

A

transition phase
-dilation 7-10 cm
progressive fetal descent
-contractions increase in freq and intensity
-woman more likely to withdrawal into self

36
Q

second stage

“pushing”

A 
complete dilation 10 cm
ends with birth of baby
spontaneous birth
positional changes of fetus
"urge to push"
37
Q

recommendation time for 2nd stage

A

2 hrs for mulitparous woman w/ anesthesia and 3 hrs for nullipara w/ anesthesia
-after this time period, c-section is recommended

38
Q

open glottis pushing

A

grunt without holding breath and bear down spontaneously

push no more than 8 seconds, no more than 3 times per contraction

39
Q

closed glottis

A

valsalva manuver

no longer recommended

40
Q

3rd stage

“placental”

A

begins with birth of baby, ends with expulsion of placenta

placental separation

  • signs!!
  • delivery
  • retained (placenta breaks in pieces)
  • schultz and duncan mechanisms
41
Q

Uterine Inversion

A

Medical Emergency

placenta doesn’t detach or is ripped from cervix

42
Q

4th stage

“recovery”

A 
begins with delivery of placenta, ends when mother is stable
1-4 hrs after birth
physiologic readjustment
thirsty and hungry
shaking
bladder is hypotonic
uterus remains contracted
43
Q

Amniotomy

A

Sterile procedure- rupture of membranes
Have ready: amnio-hook, sterile gloves and lubricant, clean chux, blankets, washcloth

when the membranes are rupture the mother feels pain, baby’s head is no longer cushioned

44
Q

RN assesments before and after amniotomy

A

assure the presenting part is engaged prior to procedure to prevent cord prolapse
monitor FHR before and after
monitor color, amount and smell of the fluid

45
Q

Prolapsed cord

A

medical emergency

when a cord comes out before the baby

46
Q

Prolapsed cord management

A

priority is to relieve pressure off the cord
birth by stat C/S unless vag birth is imminent
position hips higher than head
with gloved hand, push fetus upward
give O2

47
Q

RN care during labor

A

promote placental functioning
-maternal position, IV fluids, relaxation and pain relief
provide comfort measures
-lighting, temp, mouth care, bladder (empty q 2 h)

48
Q

Pain during labor

A

…

49
Q

Non-pharmacologic pain relief

A 
relaxation techniques
visualization
thermal stimulation
focal point
massage
music
50
Q

Breathing Techniques

A

…

51
Q

Pharmacologic pain management

A

remember any drug taken by the woman is taken by the fetus

….

52
Q

Common drugs used in labor

A
  1. Opioids-
  2. Adjunctive drugs-
  3. Narcotic Antagonists-
53
Q

Labor induction

A

the chemical or mechanical initiation of uterine contractions

  • bishop score is used to assess readiness and predict success of induction augmentation
54
Q

Labor Augmentation

A

improving the quality of uterine contractions once labor has started

  • bishop score is used to assess readiness and predict success of induction augmentation
55
Q

Factors of Bishop Score

A 
cervical dilation
cervical effacement
fetal station
cervical consistency
cervical position

Max score 13

56
Q

cervical ripening

Prostaglandin E2

A

intravaginal insert
left in posterior vagina-slow release
easily removed

57
Q

cervical ripening

Misoprostol

A

…

58
Q

contraindications to cervical ripening

A

…

59
Q

Pitocin

A

used to induce contractions

Assess maternal pelvis and fetal position before starting infusion

60
Q

RN responsibilities during induction or augmentation

A

Observe the uterine response for hyper-stimulation and high resting tone (we don’t want these sxs)
observe the fetal response
pain assessment
documentation

61
Q

Monitoring uterine contractions (UC)

A

palpation
external- tocodynamometer
internal- intrauterine pressure catheter

62
Q

Internal EFM

A 
Fetal scalp electrode (FSE)
cervix must be dilated at least 2 cm
membranes ruptured
electrode attached to presenting part
continuous recording
infection risk
63
Q

FHR patterns

A 
interval between heartbeats (continually monitored)
baseline
variability
accelerations
decelerations
64
Q

baseline FHR

A 
the rate at which the baby stays while at rest between UCs
mean FHR during 10 min period
rounded to 5 bpm
must be observed for 2 mins
FHR decreases w/ gestational age
65
Q

FHR Variability

A

most important indicator of an adequatley oxygenated fetus

moderate 6-25 bpm (normal)

66
Q

episodic changes in FHR

A

not associated w/ uterine contractions

67
Q

periodic changes in FHR

A

associated w/ uterine contractions

68
Q

FHR Accelerations

A

a breif temp increase of at least 15 beast above baseline, lasting 15 seconds

usually associated w/ fetal movement, vaginal exams, contractions, fetal scalp stem, etc.

considered a sign of well being

69
Q

FHR decelerations

A

a periodic decrease in FHR below the baseline

70
Q

FHR early decelerations

A

normally reassuring, the onset and return of deceleration coincide with the start and end of the contraction

71
Q

FHR variable changes

A

variable in duration, intensity and timing, not usually concerning UNLESS:
less than 70 bpm
lasts > 60 seconds
slow return to baseline

72
Q

FHR late decelerations

A 
immediate interventions: 
position change
increase IV fluids
O2 face mask
stop IV Pitocin in infusing
notify MD, CNM
73
Q

Guidelines for management: prolonged decelerations

A

perform vag exam to r/o cord prolapse
maintain maternal position on L side
d/c oxytocin
report findings and document, provide explanation to pt
increase IV fluids
administer tocolytic as ordered
anticipate intervention if FHR previously abnormal, deceleration lasts > 3 min

74
Q

Reassuring FHR patterns

A

Baseline 110-160
moderate variability
accelerations > 15x15
no concerning decelerations

75
Q

Non reassuring FHR patterns

A 
tachycardia
bradycardia
decreased or absent variability
late decelerations
severe variable decelerations 
any prolonged decelerations
76
Q

RN interventions for non reassuring FHR

A
  1. identify the cause
  2. stop or decrease oxytocin infusion per unit policy
  3. increase placental perfusion (L side then increase IV fluids)
  4. increase maternal O2 sat (face mask, 8-10 L/min)
  5. reduce cord compression
  6. Call MD
77
Q

what are factors that might cause minimal variabiliy and lack of accels on a FHR?

A

hypoxia
maternal narcotic admin
magnesium sulfate
CNS abnormalities

78
Q

RN actions for minimal variability and lack of acels on FHR

A

MAXIMIZE PLACENTAL PERFUSION
lateral position
oxygen
maintain BP

79
Q

testinf to determine abnormal FHR significance

A

fetal scalp stimulation
vibroacoustic stimulation
fetal oxygen saturation monitor
fetal scalp blood sampling

OB (3 decks)

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