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Repro exam 2 > Labor- 10/16 > Flashcards

Labor- 10/16 Flashcards

1
Q

What is labor? How do you know that you are in labor?

A

Regular unrelieved contractions with dilation

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2
Q

What are the three stages of labor?

A 
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
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3
Q

What is the 4th stage of labor?

A

1hour after delivery of placenta (postpartum managment and assessment of uterine contraction)

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4
Q

What are the divisions of the 1st stage of labor?

A

Latent, active, transitional labor

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5
Q

What is latent labor?

A
  • Part of 1st stage

- Cervical dilation 0-3cm

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6
Q

What is active labor?

A
  • Part of 1st stage

- Cervical dilation 4-7cm

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7
Q

What is transitional labor?

A
  • Part of 1st stage

- Cervical dilation 8-10cm

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8
Q

Which stage of labor is the longest?

A

1st stage

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9
Q

Which part of the 1st stage of labor is the longest (latent, active, or transitional)?

A

Latent

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10
Q

What assessments are regularly conducted during labor?

A
  • VS

- FHR

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11
Q

How often are maternal VS checked during latent labor?

A
  • BP, RR, HR = Q1hr

- Temp = Q4hr if water not broken, Q2hr if water broken

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12
Q

How often is FHR checked during latent labor?

A
  • Q30min

- If meds (epidural, etc.), high risk pregnancy = more frequent

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13
Q

How often should contractions be palpated during latent labor?

A

Q30min

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14
Q

How do you palpate contractions?

A

Throughout the entire course of a contraction (before, during, and after)

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15
Q

How often do you check maternal VS during active labor?

A

Q15-30min

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16
Q

How often do you check FHR during active labor?

A

Q30min (Q15 if high risk)

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17
Q

How often do you check maternal VS during transitional labor?

A

Q15-30min

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18
Q

How often do you check FHR during transition labor?

A

Q15min

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19
Q

Do uterine contractions reduce oxygen supply to the fetus?

A

No- they should not

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20
Q

What is a normal FHR?

A

110-160

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21
Q

What is normal on a FHR?

A
  • Rate within 110-160
  • Normal variability
  • Accelerations with contractions
  • Possible early decelerations
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22
Q

How do you care for a hypotensive patient?

A
  • Change position
  • Stop pitocin
  • Push fluids
  • Possibly administer O2
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23
Q

What should be done if a patient’s water breaks?

A
  • Assess color and content of amniotic fluid
  • Note time of rupture
  • Volume of rupture
24
Q

What VS is checked more regularly after a patient’s water breaks?

A

Temp- shifts from Q4 to Q2hr

25
Q

What fetal assessment is done after a patient’s water breaks?

A

FHR monitor (to make sure baby responds appropriately to less room in uterus and less amniotic fluid)

26
Q

What can be done if a woman has not progressed to active labor?

A
  • Assess baby’s position (engagement, presenting part, etc.)

- If all is normal, send mom home with instructions on when to return

27
Q

When should a mom that was sent back home return to the hospital?

A
  • Contractions are 2-3min apart and last 60sec
  • Water breaks
  • Abnormals (excessive bleeding, etc.)
28
Q

What are the 4Ps that affect labor?

A
  • Passageway
  • Passenger
  • Physiologic labor
  • Psychosocial
29
Q

What are the ideal pelvis shapes for vaginal delivery?

A
  • Gynecoid

- Anthropoid

30
Q

What are the 5 considerations of the “passenger” P of labor?

A
  • Attitude
  • Lie
  • Presentation
  • Position
  • Engagment
31
Q

What is fetal attitude?

A

Relation of fetal body parts to one another (flexed or relaxed)

32
Q

What is fetal lie?

A

Lie of the fetus’ spine relative to the mother’s spine

33
Q

What is fetal presentation?

A

Which part of the fetus is entering the cervix first (occiput, shoulder, breech)

34
Q

What is fetal position?

A

Position of fetus in relation to cervix and mother (ROA = spine towards mom’s R, occiput, anterior (facing diagonal forward), etc.)

35
Q

What is fetal engagement?

A

Station of the fetus’ presenting part relative to the pelvis (-4/+4)

36
Q

What is the physiology of labor?

A
  • Force of contractions (frequency, duration, intensity)

- Maternal muscular force of contraction

37
Q

What are the phases of a contraction?

A
  • Increment (start)
  • Acme (peak)
  • Decrement (end)
38
Q

What is considered in the psychosocial “P” of labor?

A

Mom’s level of preparedness, previous pregnancies, prenatal care, high-risk dx, etc.

39
Q

What are 2 major causes of poor labor pregression?

A

1- CPD (cephalopelvic disproportion)

2- position of fetus

40
Q

What is CPD?

A

Cephalopelvic disproportion (baby’s head is too big for pelvis)

41
Q

What is done if CPD is dx?

A
  • Assisted vaginal delivery (forceps or vacuum)

- C-section

42
Q

What are the causes of labor pain?

A
  • Muscular stretching (uterus)
  • Cervical dilation
  • Fear/anxiety
  • Pressure from fetus dropping
43
Q

What are negative effects of early pushing (before 10cm dilation)?

A
  • Causes cervical swelling (from repeated force), can obstruct vaginal delivery
  • Maternal fatigue
44
Q

What would you give for pharmacologic management of a patient that does not want an epidural?

A
  • Anxiety = benzos

- Pain management = NuBain, Stadol, Fentanyl

45
Q

How long does the 2nd stage of labor last?

A 
Nullipara = 3hrs
Multipara = 0-30min
46
Q

When should a patient begin bearing down?

A
  • Not until 10cm dilated
  • Ideally not until fetal pelvic station is engaged
  • When mother feels the urge to push (trust body)
47
Q

What are sensations a mother might feel indicating a need to push?

A
  • Urge to have a BM
  • Perineal burning or pain
  • Bulging at the labia
48
Q

What assessments are done during the 2nd stage of labor?

A
  • FHR Q15min
  • Mom’s VS (temp, BP, etc.)
  • Contraction patterns
  • Pain
49
Q

What factors can prolong the 2nd stage of labor?

A
  • CPD
  • Fetal presenting part
  • Fetal position (ROA vs. ROP)
  • Meds that prevent the mom from feeling the urge to push
  • Ineffective pushing
  • Fear
50
Q

How long does the 3rd stage of labor last?

A

30min

51
Q

What needs to be assessed to be sure the 3rd stage of labor is complete?

A

That the entire placenta was delivered

52
Q

What interventions are performed to support placental delivery?

A
  • Fundal stimulation

- Pitocin

53
Q

Where should the fundus be when the placenta is delivered?

A

Midline and at the umbilicus

54
Q

What should be assessed after placental delivery?

A
  • Entire placenta was delivered

- Freq assessment for bleeding (clots vs. spotting)

55
Q

What assessments are done during the 4th stage of labor?

A

VS and fundal assessments Q15min for 1hr

Repro exam 2 (2 decks)

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