L & D Flashcards
Stage 1
Onset of labor to 10 cm dilation
- Longest part of labor
- Time spent in contractions
Stage 2
- Full dilation (10 cm) to birth of neonate
- May take hours
- Pushing signals beginning
Stage 3
- Birth to delivery of placenta
Stage 4
First hour of birth when risk of maternal hemorrhage is greatest
Stage 1: Early labor
0-4 cms dilation
- Longer part of stage 1
- Stay at home
- Beginning of contractions
- Eat and drink
Stage 1: Active labor
- 4 - 7 cms
- Active contractions 5 min apart 1 min in length
- shorter period of time
- Time to go to hospital
- Changes in ability- mood
- Anesthesia
Stage 1: Transition
- 8-10 cms dilation
- transition between contractions and pushing
- Stormy, relentless with early peak
- Short time between contractions
Puerperium
Delivery of placenta to 6 wks postpartum
- Involution of uterus
- Changes in lochia (vaginal flow of uterine remnants- rubra, serosa & alba)
- CV changes (diuresis, wt loss, freq urination, sweating)
- Mentration & ovulation
- Psychosocial changes
Leopold manuvers
- Assessment of fetal presentation in early labor
- Palpalte fundus to determine postion
- Palpate sides to determine extremities
- Palpate lower abdomen above symphysis
- Pressure on uterus to determine head flexion
Cardinal movements
Progression of labor in vertex position
- Engagement
- Flexion
- Descent
- Internal rotation
- Extension
- External rotation
Cesarian section
- Major abd surgery
- Requires anesthesia
- Thrombus formation
- Uterine rupture
- Longer post partum recovery: VTE, bowel disruption, pain
- Fetal/ neonatal risks- increased injury & respiratory morbidity
Uterine rupture- Eti
- Complete or incomplete
- Separation through thickness of uterine wall including visceral serious (with to without fetal placental unit) or uterine muscle separation
- Due to trauma, obstruction, congenital anomaly, previous surgery
Uterine rupture- Sx
- Severe FHR deceleration
- Uterine pain
- Sometimes chest pain
- Loss of station
- No external bleeding
Uterine rupture- Risk
- Perinatal death rate high
- Cesarian section (low 3/1000)
- Admin of oxytocin
- Hysterectomy
- Perinatal death
Uterine rupture- Tx
- Immediate c-section
- Tx of shock
Postpartum hemorrhage- Eti
- Excessive blood loss following vaginal delivery
- > 500ml
- Due to uterine atony (most common),
- obstetric lacerations
- retained placental tissue
- coagulation defects.
- 3rd leading cause of maternal death
Postpartum hemorrhage- Sx
- Excessive blood loss immediately or up to 6 weeks postpartum
- Evidence of shock in VS
Postpartum hemorrhage- Tx
- Active management of 3rd stage of labor
- Prevention of know issues
- Fundal massage/ bimanual compression for placental delivery
- Administer uterotonic
- Blood transfusion
Fetal distress- Eti/ sx
- Variable fetal heart rate
- Persistent drop in fetal HR during contractions
Fetal distress- Tx
- Prolonged bradycardia = c-section
- Halt contractions
- Improve maternal hydration & blood flow to fetus
Failure to progress- Eti/ sx
- Lack of cervical dilation or descent
- Prolongation of normal labor progression curve
- Due to power, passenger & pelvis
Failure to progress- Tx
- Assess contractions, strengthen
- Assess passenger- rotate or change delivery position
- Asses pelvis- c-section if needed
Cephalopelvic disproportion- Sx/tx
- Head too large for canal
- C-section
Cord prolapse- Eti
- Descent of umbilical cord into lower uterine segment
- Causes compression compromising fetal circulation
- Cord palpable or visible
Cord prolapse- Tx
- Knee chest position to keep fetus away from cord
- C-section
Abruptio placentae- Eti
- Premature separation of normally implanted placenta
- After 20 wks gestation
- Trauma, HTN, increased parity
Abruptio placentae- Sx
- Bleeding from vagina
- Uterine activity
- Fetal HR abn
- Maternal hemodynamic changes
Abruptio placentae- Tx
- > 37 weeks, induction of labor
- < 34 weeks- corticosteroids x 48 hrs then induction
- Tx hemodynamic status
Placenta previa- Eti
- Leading cause of 3rd trimester bleeding
- Placental implantation adjacent or overlying cervical os
Placenta previa- Sx
- Painless vaginal bleeding
- 3rd trimester
- US findings
Placenta previa- Tx
- Hemodynamic stabilization
- Delivery if fetal distress or >37 wks
- Stabilization & conservative mgmt (hydration, HR monitoring)
- Corticosteroids
Malpresentation- Sx
- Leopold manuvers to dx
- Presentation other than cephalic
- Shoulder, footing, frank (most common)
Malpresentation- Tx
- External cephalic version after 36 wks
- C-section if complicated, sign of fetal distress
- Vaginal delivery very complicated
Precipitous labor- Eti
- L & D < 3 hrs
- Rate of dilation > 5 cm/ hr
Precipitous labor- Tx
- Rarely complications
- Avoid meds that cause additional contractions
- Uterine atony- postpartum hemorrhage
Systemic analgesia
- Opioids to relieve pain sx
- SE: N/V/cough suppression, constipation
- Used during first stage of labor
General anesthesia
- c-section when regional techniques contraindicated
- coagulopathy, infection, hypovolemia
Regional anesthesia
Injection of anesthetic to modulation perception and sensation of pain
- Epidural- establishment of labor
- Caudal block- 2nd stage of labor
Psychological support
- Better pain outcome
- Relaxation, breathing & concentration techniques to coach mom through process
