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HRR 3 > L & D > Flashcards

L & D Flashcards

1
Q

Stage 1

A

Onset of labor to 10 cm dilation

  • Longest part of labor
  • Time spent in contractions
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2
Q

Stage 2

A
  • Full dilation (10 cm) to birth of neonate
  • May take hours
  • Pushing signals beginning
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3
Q

Stage 3

A
  • Birth to delivery of placenta
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4
Q

Stage 4

A

First hour of birth when risk of maternal hemorrhage is greatest

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5
Q

Stage 1: Early labor

A

0-4 cms dilation

  • Longer part of stage 1
  • Stay at home
  • Beginning of contractions
  • Eat and drink
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6
Q

Stage 1: Active labor

A
  • 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
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7
Q

Stage 1: Transition

A
  • 8-10 cms dilation
  • transition between contractions and pushing
  • Stormy, relentless with early peak
  • Short time between contractions
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8
Q

Puerperium

A

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
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9
Q

Leopold manuvers

A
  • 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
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10
Q

Cardinal movements

A

Progression of labor in vertex position

  • Engagement
  • Flexion
  • Descent
  • Internal rotation
  • Extension
  • External rotation
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11
Q

Cesarian section

A
  • Major abd surgery
  • Requires anesthesia
  • Thrombus formation
  • Uterine rupture
  • Longer post partum recovery: VTE, bowel disruption, pain
  • Fetal/ neonatal risks- increased injury & respiratory morbidity
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12
Q

Uterine rupture- Eti

A
  • 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
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13
Q

Uterine rupture- Sx

A
  • Severe FHR deceleration
  • Uterine pain
  • Sometimes chest pain
  • Loss of station
  • No external bleeding
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14
Q

Uterine rupture- Risk

A
  • Perinatal death rate high
  • Cesarian section (low 3/1000)
  • Admin of oxytocin
  • Hysterectomy
  • Perinatal death
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15
Q

Uterine rupture- Tx

A
  • Immediate c-section

- Tx of shock

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16
Q

Postpartum hemorrhage- Eti

A
  • 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
17
Q

Postpartum hemorrhage- Sx

A
  • Excessive blood loss immediately or up to 6 weeks postpartum
  • Evidence of shock in VS
18
Q

Postpartum hemorrhage- Tx

A
  • Active management of 3rd stage of labor
  • Prevention of know issues
  • Fundal massage/ bimanual compression for placental delivery
  • Administer uterotonic
  • Blood transfusion
19
Q

Fetal distress- Eti/ sx

A
  • Variable fetal heart rate

- Persistent drop in fetal HR during contractions

20
Q

Fetal distress- Tx

A
  • Prolonged bradycardia = c-section
  • Halt contractions
  • Improve maternal hydration & blood flow to fetus
21
Q

Failure to progress- Eti/ sx

A
  • Lack of cervical dilation or descent
  • Prolongation of normal labor progression curve
  • Due to power, passenger & pelvis
22
Q

Failure to progress- Tx

A
  • Assess contractions, strengthen
  • Assess passenger- rotate or change delivery position
  • Asses pelvis- c-section if needed
23
Q

Cephalopelvic disproportion- Sx/tx

A
  • Head too large for canal

- C-section

24
Q

Cord prolapse- Eti

A
  • Descent of umbilical cord into lower uterine segment
  • Causes compression compromising fetal circulation
  • Cord palpable or visible
25
Q

Cord prolapse- Tx

A
  • Knee chest position to keep fetus away from cord

- C-section

26
Q

Abruptio placentae- Eti

A
  • Premature separation of normally implanted placenta
  • After 20 wks gestation
  • Trauma, HTN, increased parity
27
Q

Abruptio placentae- Sx

A
  • Bleeding from vagina
  • Uterine activity
  • Fetal HR abn
  • Maternal hemodynamic changes
28
Q

Abruptio placentae- Tx

A
  • > 37 weeks, induction of labor
  • < 34 weeks- corticosteroids x 48 hrs then induction
  • Tx hemodynamic status
29
Q

Placenta previa- Eti

A
  • Leading cause of 3rd trimester bleeding

- Placental implantation adjacent or overlying cervical os

30
Q

Placenta previa- Sx

A
  • Painless vaginal bleeding
  • 3rd trimester
  • US findings
31
Q

Placenta previa- Tx

A
  • Hemodynamic stabilization
  • Delivery if fetal distress or >37 wks
  • Stabilization & conservative mgmt (hydration, HR monitoring)
  • Corticosteroids
32
Q

Malpresentation- Sx

A
  • Leopold manuvers to dx
  • Presentation other than cephalic
  • Shoulder, footing, frank (most common)
33
Q

Malpresentation- Tx

A
  • External cephalic version after 36 wks
  • C-section if complicated, sign of fetal distress
  • Vaginal delivery very complicated
34
Q

Precipitous labor- Eti

A
  • L & D < 3 hrs

- Rate of dilation > 5 cm/ hr

35
Q

Precipitous labor- Tx

A
  • Rarely complications
  • Avoid meds that cause additional contractions
  • Uterine atony- postpartum hemorrhage
36
Q

Systemic analgesia

A
  • Opioids to relieve pain sx
  • SE: N/V/cough suppression, constipation
  • Used during first stage of labor
37
Q

General anesthesia

A
  • c-section when regional techniques contraindicated

- coagulopathy, infection, hypovolemia

38
Q

Regional anesthesia

A

Injection of anesthetic to modulation perception and sensation of pain

  • Epidural- establishment of labor
  • Caudal block- 2nd stage of labor
39
Q

Psychological support

A
  • Better pain outcome

- Relaxation, breathing & concentration techniques to coach mom through process

HRR 3 (12 decks)

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