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L&D, Fetal Monitoring Flashcards

1
Q

what are some critical factors in labor?

A
  • birth passage
  • fetus (passenger)
  • relationship b/w the passage and fetus (proportion)
  • physiologic forces of labor (powers)
  • psychological factors (psyche of mother)
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2
Q

vertex presentation

A

occiput presentation; crown of head is presenting first; fetal head is completely flexed and chin is to chest

most common and this is what we want to see!

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3
Q

cephalic presentation

A

head is partially flexed

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4
Q

brow presentation

A

baby’s head is beginning to lift up and the brow/forehead is the presenting parts

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5
Q

facial presentation

A

fetal head hyperextended, babies can come out w/ very bruised faces

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6
Q

fetal sutures

A

membranous spaces between cranial bones

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7
Q

fetal fontanels

A

intersections of cranial sutures; molding

anterior (diamond shape), posterior (triangle shape)

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8
Q

what is the purpose of sutures and fontanels?

A

during vaginal delivery process, sutures can override themselves to make the head a little smaller for the birthing process

as a developing human child and the brain grows, these allow the skull to grow with it

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9
Q

engagement in presenting part to pelvis

A

largest diameter of the presenting part passes through the pelvic inlet (BPD; biparietal diameter)

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10
Q

station in presenting part to pelvis

A

relationship of the presenting part to the ischial spine

ex: - 5 = high up; + 5 = baby’s ready to come out; 0 = at ischial spine

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11
Q

how do we confirm spontaneous ROM?

A

ferning & nitrazine/amnio indicator

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12
Q

ferning

A

obtain fluid, put on slide, dry, and look at microscope = looks like fern plant

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13
Q

nitrazine/amnio indicator

A

exposed to amniotic fluid = turns dark blue/black color = positive ROM, ruling out urine or other vaginal secretions

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14
Q

what is the key to true labor?

A

progressive dilation and effacement

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15
Q

what is pitocin?

A

chemically manufactured oxytocin which is used to augment or induce labor

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16
Q

what does pitocin do?

A

promotes increased uterine tone following delivery = to prevent some bleeding as well

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17
Q

first stage of labor

A

0-10 cm dilated

3 phases

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18
Q

second stage of labor

A

10 cm dilated –> deliver of baby

  • pushing, counting w/ pushes
  • nullipara: lasts 2 hrs
  • multipara: lasts 15 min
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19
Q

third stage of labor

A

expulsion and delivery of placenta

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20
Q

fourth stage of labor

A

first few hours (1-4 hrs) postpartum

  • prime time for breast feeding and bonding
  • drop in BP, increase in pulse d/t blood loss
  • firm fundus and should be measured
  • hypotonic bladder
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21
Q

phases within the first stage of labor

A
  • early/latent phase
  • active phase
  • transition phase
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22
Q

first stage of labor: early/latent phase

A
  • starts with onset of contractions (mild)
  • able to cope w/ pain
  • excited!
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23
Q

first stage of labor: active phase

A
  • contractions intensify
  • anxiety increases
  • 4-7 cm and fetal decent (coming down)
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24
Q

first stage of labor: transition phase

A
  • increasing force and intensity of contractions
  • significant anxiety
  • dilation slows and decent increases

nullipara: lasts < 3 hrs
multipara: lasts < 1 hr

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25
cardinal movements of labor
1. descent 2. flexion 3. internal rotation 4. extension 5. restitution 6. external rotation 7. expulsion
26
pro of perineal laceration
tissue tears where it's weakest
27
con of perineal laceration
may be difficult to repair if it's jagged, may extend to 4th degree laceration (where tissue b/w vagina and rectal area tears completely), labia, or urethra
28
how can we prevent a perineal laceration?
perineal massage (scooping tissue to stretch it out to allow for deliver)/mineral oil
29
what is an episiotomy?
lengthening the vaginal opening to allow for delivery by cutting the tissue
30
pro of an episiotomy
controlled (don't risk tearing into rectum, urethra, or labia), repair is cleaner may have less chance for infection
31
con of episiotomy
may be unnecessary
32
what is a retained placenta?
placenta that hadn't been delivered within 30 minutes following delivery of baby
33
pain management in labor
- relaxation techniques - narcotics - epidural - spinal
34
how can nurses be supportive in pain management for a woman in labor?
- massage or counter pressure (using tennis balls into back, use of light touch) - breathing - meditation - focal point - sip and chips - hygiene
35
what is the most concerning possible side effect of an epidural?
hypotension monitor every 2-3 min then every 15 during epidural
36
criteria for epidural
- pt PLT count must be at least 100,000 - fluid bolus must be given to decrease change of drop in BP - monitor BP
37
why is hypotension concerning when given an epidural?
this affects the fetus because there's less pressure perfusing to the placenta = fetal HR to bottom out = fetus gets less O2 during this time
38
how do we position a patient with an epidural?
- left lateral tilt, pressure of pregnancy off abdominal aorta - frequent repositioning to avoid pressure --> epidural works w/ gravity - straight cath q2
39
contraindications for epidurals
- PLT < 100,000 - coagulation disorders/hemorrhage - severe spinal abnormalities = makes placement difficult - infection or septic - uncooperative pt
40
common indications of a c-section
- prior c/s - breech presentation - failure to progress - fetal distress - placental complications
41
nursing care following c-section
- encourage mom to breast feed in recovery room w/in 1hr - continue to provide emotional support
42
what orders do we expect following c-seciton?
- pitocin to ensure uterus remains firm - DVT prophylaxis (ambulate 4 hrs post op) - advance diet - pain management
43
external fetal monitor
toco & EFM on monthers abdomen
44
toco
looks for uterine muscle tone, cx strength placed on fundus only tells us duration of cx
45
EFM
place over where baby's heart would be, graphical representation of cardiac movement
46
what is a drawback of external fetal monitoring?
inability to precisely determine how strong cx is if mother moves or baby moves = may not have accurate reading
47
methods of internal fetal monitoring
scalp electrode and IUPC
48
scalp electrode
small spiral placed into layer of skin on baby's scalp reassurance for accurate HR
49
IUPC (internal uterine pressure catheter)
- determine intensity of uterine cx - mmHg muscle tone of uterus is doing - resting tone in b/w cx as well as during cx --> how effective cx's are
50
indications of internal fetal monitoring
- when not getting a good reading w/ external - baby must be vertex
51
what's a major drawback of internal fetal monitoring?
risk for infection
52
what are the risks of using internal fetal monitoring?
- AROM - uterine perforation --> going through uterus - baby may have small mark on scalp
53
how can we accurately determine if a fetus is tachycardic or bradycardic?
HR must last > 10 min
54
what does variability indicate?
fetal wellbeing, it's the interaction b/w sympathetic and parasympathetic
55
nursing interventions for non-reassuring variability
- give mom something to wake baby up - acoustical stimulator (buzzer) --> lil apparatus on belly to startle baby
56
accelerations in FHR
elevation > 15 bpm lasting at least 15 seconds; indicates fetal wellbeing
57
early decelerations in FHR
- "mirror" cx - d/t head compression
58
nursing interventions for early decels
- vaginal exam, check mom - perhaps progressing and moving along - potentially change positions
59
late decelerations in FHR
- start at peak of cx and then resume to baseline - non-reassuring!! - indicates placental insufficiency
60
what are we most concerned about with late decels?
most concerned about the brain, hypoxia
61
nursing interventions for late decels
"5 turns" 1. turn pt on left side 2. turn fluids on 3. turn pitocin off 4. turn O2 on 5. turn call light on (for additional assistance!)
62
variable decelerations in FHR
- can happen whenever - d/t cord compression
63
nursing interventions for variable decels
- sometimes it's positional - move so there's not as much pressure - continue to monitor
64
prolonged decelerations
decel is > 15 bpm and > 2min but < 10 min

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