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Labor and Delivery > L&D > Flashcards

L&D Flashcards

1
Q
  1. What stimulates uterine contractions in labor?
  2. What else does this do?
  3. Inaddition to this change what else increases?
A
  1. increased synthesis of prostaglandins
  2. soften the cervix independant of uterine activity
  3. myometrial oxytocin receptors
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2
Q
  1. First step in delivery?
  2. Second step?
  3. 3rd step?
A
  1. determine the presenting part. cephaic preferably
  2. digitial exam of the vagina/cervix
  3. Fetal station
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3
Q

What are we looking for on the digital exam? 3

A
  1. Consistency- hard vs soft
  2. Effacement: shortening of the cervical canal from 2cm to paper thin
  3. Dilation- cervix opens from close to 10 cm (fully dilated)
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4
Q

What is the fetal station and what are the measurement?

A

postion of the fetal head in the birth canal in realtion to the ischial spines

-5cm to +5cm

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5
Q

What is the first stage of labor?

A

from the onset of labor/contractions to full cervical dilation and effacement

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6
Q

What are the two phases in the first stage of labor?

A
  1. Latent phase- cervical effacement and early dilation, 20 to 14 hours
  2. from about 6cm dilated with more rapid dilation and effacement

Regardless if youve had a delivery before or not

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7
Q

What is the second stage of labor?

A

from complete cervical dilation to delivery of the baby

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8
Q

What is the third stage of labor?

A

delivery of the baby to delivery of the placenta
- 30 min. diagnose a retained placenta and have to go get it out.

  • active or passive
  • active- start pitocin and massage uterus (creday)

Ferguson relfex- postive feedbacl loop, striping = release of prostagladin = uterine contraction

Estrogen = causes contractions 
Progesterone = opposite, can give to to pts with history of PTL 16-36. injections.
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9
Q

What is the fourth stage in labor?

A

delivery of the placenta to two hours after.

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10
Q
  1. How often?
  2. How long?
  3. How intense are contractions in ealry labor?
A
  1. 5- 10 min
  2. 30-45 seconds
  3. 20-30 mmHg
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11
Q
  1. HOw often?
  2. How long?
  3. How intense for later labor?
A
  1. 2-3 min
  2. lasting 60-70 sec
  3. 40-60 mmHg
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12
Q

Managament of first stage of labor:
1. if head is engaged and intermittant fetal monitoring is done what can we do?

  1. If laying down what position should they be in and why?
  2. They may bathe or shower if what?
  3. Hydration?
  4. Food?
A
  1. Ambulate
  2. supine left lateral potion to avoid supine hypotension
  3. Membranes are intact
  4. IV fluids
  5. NPO except for ice chips
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13
Q

What are warning signs in fetal heart rate monitoring?

4

A
  1. late decelerations
  2. bradycardia
  3. decreased variability
  4. Sinusoidal pattern- severe anemia

110-160
moderate variablet 5-25
Cat 1 tracing

Cat2
-anything that doesnt match cat 1 or 3

Cat 3
flatline
recurrent late or not variably decelerations
absent var with brady
sinusious

Tickle babies head if head rate goes up then its at least a pH of 7.2

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14
Q
  1. Where does pain come from in the first stage of labor?

2. When the fetal head descends?

A
  1. uterine contactions and dilation of the cervix

2. distension of the lower birth canal and perineum

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15
Q

Methods of anesthesia or analgesia?

A
  1. Systemic narcotics—early in labor
  2. Spinal anesthesia—single injection of anesthetic
  3. Epidural block—infusion of local anesthetics or narcotics through a catheter into the epidural space***
  4. Local block of the of anesthetic into the vagina or perineum- peudendal nerve block blocks everything on the vulva. takes away pressure or tear in the skin
  5. General anesthetic- stat C sections
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16
Q
  1. Begins with complete dilatation of the cervix and ends with delivery of the baby- mother has urge to push. How long does this stage last?
A
  1. 30 min to 2 hours
  2. 5-30 min multigravida

after 5 hours must be careful must get baby out for classic vaginal delivery.

17
Q

What are the cardinal movements in labor?

7

A
  1. Engagement
  2. Flexion
  3. Descent
  4. Internal rotation
  5. Extension
  6. External rotation aka restitution then deliver posterior shoulder
  7. Expulsion
18
Q

What is engagament?

Where can the presenting part of the baby be palpated?

A

the biparietal diameter has passed the plane of the pelvic inlet

below the level of the ischial spine

19
Q

What is flexion?

A

As forces cause decent of the fetus though the pelvis, soft and bony resistance is encountered. this allows the smaller diameter of the fetal head to present to the maternal pelvis

20
Q

What is descent?

A

successful passage of the presenting part though the birth canal

21
Q

When does the greatest rate of descent occur?

A

during the latter portions of the first stage of labor and during the second stage of labor

22
Q

What is internal rotation?

A

most commonly from transverse to anterior or posterior

-facilitates optimal diameters of the fetal head to the bony pelvis

23
Q

what is extension?

A

after further decent the fetal head reaches the introitus

To accomodate the upward curve of the birth canal the flexed head now extends

24
Q
  1. What is external rotation?
  2. When does it occur?
  3. then there is what?
A
  1. the head rotatoes face forward relative to the shoulders (aka restitution)
  2. after the delivery of the head occurs
  3. expulsion or rapid delivery of the baby
25
Q

After the head delivery what do we need to manage?

5

A
  1. check for nuchal umbilical cord
  2. Deliver shoulders, trunk and legs
  3. Clamp and cut cord within 15-20 seconds
  4. place infant on mothers chest if not in distress then to warmer
26
Q

What should you do in the 3rd stage for management?

4

A
  1. obtain the cord blood while waiting
  2. check for lacerations while waiting for cord to deliver
  3. light tension on the cord when placenta separates
  4. Usually give oxytocin IV after the delivery of the placenta
27
Q

Causes of postpartum hemorrhage?

3

A
  1. Urine atony- massaging, pitocin helps, cytotech rectally, IM methergen (cannot use on some with preeclampsia), hemobate- causes a lot of diarrhea, and can’t give to patients with asthma

balloon- fill with saline, acts as a turnaquette, slowly decrease the volume in the balloon.

  1. Retained fragments of the placenta
  2. cervical or vaginal lacerations
28
Q

Apgar score?

A
  1. Appearance/Color?
  2. Pulse?
  3. Grimace/Relfex?
  4. Activity/Tone?
  5. Respirations?
29
Q

Apgar levels?

  1. Appearance/Color?
  2. Pulse?
  3. Grimace/Relfex?
  4. Activity/Tone?
  5. Respirations?
A
  1. blue. blue body pink but extremities blue, pink
  2. 0, under 100, over 100
  3. no response to stimuli, grimaces feebly, cries or pulls away
  4. none, some flexion, felxes arm and legs resist extension
  5. absent, weak irregular, strong cry
30
Q

How can we induce cervical ripening?

A
  1. misoprostol and prostaglandin E
  2. Laminaria- mechanical dilation of the cervix
    - mostly used for UIFD, or second term miscarriages.
  3. Cytotech for cervical ripening.4
31
Q

Augment

A
  1. Pitocin
  2. AROM
  3. Bishop score**

starts out posterior and moves anterior

Labor and Delivery (1 decks)

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