L & D Flashcards
What is labor
Painful, repetitive uterine contractions causing cervical effacement and dilation
What properties make up ‘true labor’
Regular contractions
interval decreases
walking makes worse
abdomen / back pain
mild sedation has no effect
What properties make up ‘false labor’
irregular contractions
interval remains the same
walking helps
abdominal cramping
mild sedation helps
If group B strep is present and the mom is not allergic, how do you treat them
pen G for at least 2 doses 4hrs apart until delivery
*IV cefazolin if allergic
How do you assess fetal wellbeing
Fetal heart rate
presentation/position/attitude
Size
What is the goal of fetal wellbeing assessments during labor
to maintain optimal oxygenation to the brain
How do you monitor the fetus during labor
external and internal methods
What is an internal method of monitoring the fetus
fetal scalp electrode
What is an external method of monitoring the fetus
Intermitten auscultation
continuous electronic monitoring
What is the purpose of electronic fetal monitoring
to continuously record heartbeat of fetus and contractions of the uterus through labor
how is an internal electric fetal monitoring preformed
an intrauterine pressure catheter
less effected by birthing person/fetal movement
What is the upper tracing on the fetal monitoring screen
Fetal heart rate
What is the lower tracing on fetal monitoring
contractions
What does the fetal heart rate tell us
Whether or not its safe to continue labor if no other problems are present
What things may effect the fetal heart rate during labor
Fetal conditions
tests done during labor
birthing person condition
medication in labor
uterine contractions
pushing
*doesnt mean something is wrong
What are the 5 components of fetal heart rate tracing
baseline
variability
accelerations
deceleration
changes/trends over time
What is a normal fetal heart rate
110-160 bpm
What is a moderate beat to beat variability
amplitude of 6-25 over a 10-20 minute period
What is beat to beat variability a measure of
fetal pH
What are early decelerations associated with
head compression
What are variable decelerations associated with
cord compression
What are accelerations associated with
oxygenation
What are late decelerations associated with
placental insufficiency
What is the most common form of deceleration
Variable (cord compression)
What do the presence of accelerations predict
Absence of metabolic anemia at the time of observation
How are uterine contractions measured
the number of contraction occurring in 10 minutes, averaged over 30 minutes
What is tachysystole contractions
> 5 contractions in 10 minutes over 30 minutes
What is normal uterine activity
<5 contractions in 10 minutes averaged over 30
How is contraction strength measured
by Montevideo units
*the sum of intensity of each contraction in 10 minutes
What indicated accurate uterine activity
a contraction pattern that generates >200MVUs
What are the 3 Ps of labor
passenger
power
passage
What is felt on the first Leopold maneuver
Determines shape and consistency of the fundus and if fetal part is head or butt
What are the descriptors used to describe the passenger
Lie (how are they in relation to mom)
Presenting part (Breech, shoulder, etc)
position
attitude (How high in the birth canal)
What is the second Leopold maneuver
Determines where the back is
What is the third Leopold maneuver used for
identifies presenting part and its mobility
What is the fourth Leopold maneuver
Determines fetal attitude and degree of extension into pelvis
What determines the babies position
Where the back is on mom
What is the normal presenting part in delivery
Facing backwards, head first
What is the cord presentation
umbilical cord falls between present part and crevice with or without membrane rupture
What is a cord prolapse
umbilical cord falls through cervic next to or before presenting part WITH membrane rupture
*STAT C-section
What are the 3 configurations of breech presentations
Frank
complete
footling
What are some risk factors for breech presentations
Gestational age before term
hydramnios
multiple fetuses
hydrocephaly
pelvic tumor
uterine anomalies
placenta previa
what is placenta previa
When the placenta is low in the uterus and blocks some of the cervical opening
What is fetal station
Station refers to how far down fetal head is in pelvis
What is considered the ‘zero station’
Geometric plane that extends through ischial spine up to the pubic bone (mid-pelvis)
What is placenta accreta
When the placenta grows too deeply into the uterine wall and cannot be separated
What properties make up a GOOD contraction
covers entire uterus
all parts reach peak at same time
intrauterine pressure 55-60
frequency every 2-4min
Complete relaxation between
What is cervical effacement
Thinning of cervix
What is cervical dilation
Enlargement of cervical opening
When does effacement occur in first time births
before dilation
When does effacement occur in experienced mothers
After dilation
What is Bishops score used for
Determine favorability / ripening of cervix in vaginal examination
What does it mean is the Bishop score is <6
Cervical ripening is needed before labor induction
How can you ‘ripen’ the cervix
Balloon
Osmotic
amniotomy
prostaglandins
What is cervical ripening
collagen chains fracture, more hydrophilic glycosaminoglycans, increased H2O
What occurs in the first stage of labor
From beginning of labor until full cervical dilation
What occurs in stage 2 of labor
From full dilation ends with delivery of baby
What occurs in stage 3 of labor
from delivery of baby ends with delivery of placenta and membranes
What is the 4th stage of labor
Recovery period after delivery of placenta uterus contracts and regains
What occurs in the prodrome of labor
Passing mucous plug
lightening (dropping into pelvis)
Cervical ripening
What are the cardinal movements of labor
Engagement
Descent
Flexion
Internal rotation
extension
external rotation
expulsion
What are the signs of the third stage of labor
Gush of blood
cord appears to lengthen
uterus is globular
uterus rises anteriorly
What are the 2 methods for managing the 3rd stage of labor
Active: admin oxytocin, apply fundal pressure, controlled umbilical traction
Expectant: Spontaneous placenta expulsion
What is uterine involution
Fundus is about the size of a grapefruit immediately
rises to umbilicus for about 12 hours
drops 1cm each day for 10 days until back in pelvis
When do mothers have their post partum visit
Between 21 and 56 days post delivery
What conditions require Cesarean section or expedited delivery
Fetal distress
birthing person distress
arrest of dilation
arrest of descent
placenta previa
malpresentation
