Labor- 10/16 Flashcards
What is labor? How do you know that you are in labor?
Regular unrelieved contractions with dilation
What are the three stages of labor?
1 = 0-10cm dilation and fetus drops in pelvis 2 = start of pushing @ 10cm to fetal delivery 3 = delivery of baby to delivery of placenta
What is the 4th stage of labor?
1hour after delivery of placenta (postpartum managment and assessment of uterine contraction)
What are the divisions of the 1st stage of labor?
Latent, active, transitional labor
What is latent labor?
- Part of 1st stage
- Cervical dilation 0-3cm
What is active labor?
- Part of 1st stage
- Cervical dilation 4-7cm
What is transitional labor?
- Part of 1st stage
- Cervical dilation 8-10cm
Which stage of labor is the longest?
1st stage
Which part of the 1st stage of labor is the longest (latent, active, or transitional)?
Latent
What assessments are regularly conducted during labor?
- VS
- FHR
How often are maternal VS checked during latent labor?
- BP, RR, HR = Q1hr
- Temp = Q4hr if water not broken, Q2hr if water broken
How often is FHR checked during latent labor?
- Q30min
- If meds (epidural, etc.), high risk pregnancy = more frequent
How often should contractions be palpated during latent labor?
Q30min
How do you palpate contractions?
Throughout the entire course of a contraction (before, during, and after)
How often do you check maternal VS during active labor?
Q15-30min
How often do you check FHR during active labor?
Q30min (Q15 if high risk)
How often do you check maternal VS during transitional labor?
Q15-30min
How often do you check FHR during transition labor?
Q15min
Do uterine contractions reduce oxygen supply to the fetus?
No- they should not
What is a normal FHR?
110-160
What is normal on a FHR?
- Rate within 110-160
- Normal variability
- Accelerations with contractions
- Possible early decelerations
How do you care for a hypotensive patient?
- Change position
- Stop pitocin
- Push fluids
- Possibly administer O2
What should be done if a patient’s water breaks?
- Assess color and content of amniotic fluid
- Note time of rupture
- Volume of rupture
What VS is checked more regularly after a patient’s water breaks?
Temp- shifts from Q4 to Q2hr
What fetal assessment is done after a patient’s water breaks?
FHR monitor (to make sure baby responds appropriately to less room in uterus and less amniotic fluid)
What can be done if a woman has not progressed to active labor?
- Assess baby’s position (engagement, presenting part, etc.)
- If all is normal, send mom home with instructions on when to return
When should a mom that was sent back home return to the hospital?
- Contractions are 2-3min apart and last 60sec
- Water breaks
- Abnormals (excessive bleeding, etc.)
What are the 4Ps that affect labor?
- Passageway
- Passenger
- Physiologic labor
- Psychosocial
What are the ideal pelvis shapes for vaginal delivery?
- Gynecoid
- Anthropoid
What are the 5 considerations of the “passenger” P of labor?
- Attitude
- Lie
- Presentation
- Position
- Engagment
What is fetal attitude?
Relation of fetal body parts to one another (flexed or relaxed)
What is fetal lie?
Lie of the fetus’ spine relative to the mother’s spine
What is fetal presentation?
Which part of the fetus is entering the cervix first (occiput, shoulder, breech)
What is fetal position?
Position of fetus in relation to cervix and mother (ROA = spine towards mom’s R, occiput, anterior (facing diagonal forward), etc.)
What is fetal engagement?
Station of the fetus’ presenting part relative to the pelvis (-4/+4)
What is the physiology of labor?
- Force of contractions (frequency, duration, intensity)
- Maternal muscular force of contraction
What are the phases of a contraction?
- Increment (start)
- Acme (peak)
- Decrement (end)
What is considered in the psychosocial “P” of labor?
Mom’s level of preparedness, previous pregnancies, prenatal care, high-risk dx, etc.
What are 2 major causes of poor labor pregression?
1- CPD (cephalopelvic disproportion)
2- position of fetus
What is CPD?
Cephalopelvic disproportion (baby’s head is too big for pelvis)
What is done if CPD is dx?
- Assisted vaginal delivery (forceps or vacuum)
- C-section
What are the causes of labor pain?
- Muscular stretching (uterus)
- Cervical dilation
- Fear/anxiety
- Pressure from fetus dropping
What are negative effects of early pushing (before 10cm dilation)?
- Causes cervical swelling (from repeated force), can obstruct vaginal delivery
- Maternal fatigue
What would you give for pharmacologic management of a patient that does not want an epidural?
- Anxiety = benzos
- Pain management = NuBain, Stadol, Fentanyl
How long does the 2nd stage of labor last?
Nullipara = 3hrs Multipara = 0-30min
When should a patient begin bearing down?
- Not until 10cm dilated
- Ideally not until fetal pelvic station is engaged
- When mother feels the urge to push (trust body)
What are sensations a mother might feel indicating a need to push?
- Urge to have a BM
- Perineal burning or pain
- Bulging at the labia
What assessments are done during the 2nd stage of labor?
- FHR Q15min
- Mom’s VS (temp, BP, etc.)
- Contraction patterns
- Pain
What factors can prolong the 2nd stage of labor?
- CPD
- Fetal presenting part
- Fetal position (ROA vs. ROP)
- Meds that prevent the mom from feeling the urge to push
- Ineffective pushing
- Fear
How long does the 3rd stage of labor last?
30min
What needs to be assessed to be sure the 3rd stage of labor is complete?
That the entire placenta was delivered
What interventions are performed to support placental delivery?
- Fundal stimulation
- Pitocin
Where should the fundus be when the placenta is delivered?
Midline and at the umbilicus
What should be assessed after placental delivery?
- Entire placenta was delivered
- Freq assessment for bleeding (clots vs. spotting)
What assessments are done during the 4th stage of labor?
VS and fundal assessments Q15min for 1hr
