Labor Flashcards
During labor, contractions that occur in a ____ pattern and produce ____ change (effacement and dilation)
regular
cervical
True labor is described as….
The contractions come in a regular pattern about __-__ minutes apart; each contraction lasts __-___ seconds.
3-5 min
30-60 sec
During labor…
- Cervix will dilate from __-__ cm
- Cervix will efface (thin) from ___-___% effaced
- Fetal head will move from its original station to +__ and out.
1-10 cm
0-100%
3+
What is involved in effacement?
thinning + softening of cervix
In the first delivery, effacement is completed, followed by ____.
In subsequent pregnancies, ___ has begun prior to labor, ___ usually waits till labor has ensued. which happens faster?
dilation
dilation
effacement
Dilation
Fetal station is defined as where the head is in relation to the _____
Described as -__ to +___
ischial spines
3 (for both)
____ occurs when the widest diameter of the presenting part (usually the head) has passed through the pelvic inlet.
“____” is a perception that often accompanies this
engagement
Lightening
____ is described according to where the occiput of the fetal head is
fetal head position
What are the stages of labor?
1st stage: Dilation/Effacement
2nd stage: Pushing/Delivery
3rd Stage: Placental delivery
What are the 2 phases of the 1st stage of labor?
Latent phase: early effacement and dilation from 0-4 cm
Active phase: rapid effacement, most dilation occurs most painful 6-fully dilated
What is Friedman’s curve?
a graph depicting the progression of labor
** outdated
In the second stage, there is ____ to delivery of the fetus.
The mother experiences ___ and desire to ____
Full dilation
Pressure and desire to bear down
In the second stage, there is ____ to delivery of the fetus. The mother experiences ___ and desire to ____
Full dilation
Pressure and desire to bear down
what happens to the fetal head during the second stage of labor
Molding of the fetal head
Caput-localized swelling of the fetal head
____ are movements of the fetus that enable it to adapt to the pelvis and to move through the pelvis.
6 cardinal movements
what tools can be used in instrumental deliveries
Forceps
Vacuum
what are the indications for instrumental deliveries?
maternal exhaustion
dystocia
non-reassuring fetal status in second stage of labor
what are the benefits and risks of instrumental deliveries?
Benefits: avoid C-section
Risks: fetal + maternal injury
what is an episiotomy
cutting the posterior vaginal opening. done if there is concern for baby fitting or needs to come out quick.
not done much anymore
repair with sutures
how are vaginal lacerations graded?
how are they repaired
what are complications of 3/4th degree tears?
1-4
reabsorbable sutures
urinary/defecation issues
how long does the 3rd stage of labor usually take?
2-10 minutes to deliver the placenta
what are signs of placental separation in the 3rd stage of labor?
gush of blood
lengthening of umbilical cord
fundus rises up
uterus becomes firm
When does the placenta commonly separate?
right after baby is delivered
how long should you wait before considering manual removal of the placenta?
20-30 min
____ is a surgical procedure used to deliver a baby through incisions in the mother’s abdomen and uterus.
Cesarean section
what are common indications for C-section?
too small, too slow, too dangerous
- cephalo-pelvic disproportion
- Fetal malpresentations
- Previous C-section
- Fetal distress
what % of deliveries are via C-section?
32.2%
what are reasons for the high rate of C-sections in the US?
Bigger babies more prior C-section Fewer VBACs Medicolegal concerns Maternal requests
What is an absolute indication for C-section ?
if the uterine incision is above the lower uterine segment.
if a woman has had a prior C-section, there is a ___-___% risk of incision will rupture if the previous incision was above the lower uterine segment during the next labor
1-9%
why would a C-section incision occur above the lower uterine segment?
very premature delivery
Any woman with >___ prior C/S’s should be scheduled for repeat C/S with no option for labor.
2
what is malpresentation?
baby isn’t in optimal position for birth
- breech (most common)
- transverse lie
- shoulder presentation
___% of babies are breeach at 28 weeks at 36 weeks only __% of babies are breech
25%
4%
____ is a procedure in which caregivers attempt to externally manipulate a fetus from breech to vertex
ECV: External Cephalic Version
On who is ECV: External Cephalic Version easiest to perform?
small fetus thin mom posterior placenta plenty of fluid no engaged
___ is the Creation of labor via use of cervical ripening agents or uterine contraction agents prior to natural labor beginning. Can be for fetal or maternal indications.
Induction
What scoring system is used to determine if the cervix is “favorable” for induction
Bishops
what are maternal indications for labor induction?
- fetal demise
- severe HTN dz
- medical issues (DM, Renal, pulm)
- risk of precipitous labor or distance from hosptial
what are fetal indications of labor induction?
- Post-term pregnancy
- Maternal HTN
- DM
- PROM
- Chorioamnionitis
- Oligohydramnios
- IUGR
- Rh sensitization
what are contraindications to labor induction?
- Placenta previa
- Abnormal lie or presentation
- Prior classic incision
- Maternal HIV infection
- Active genital herpes
- Severe Pelvic abnormalities
- Invasive cervical cancer
what are methods of induction?
membrane stripping
amnitomy
Pitocin
Vaginal prostaglandins
____ is inflammation of the fetal membranes (amnion and chorion) due to a bacterial infection.
Chorioamnionitis
Chorioamnionitis typically results from ____ ascending into the uterus from the vagina and is most often associated with ____ labor.
bacteria
prolonged
when should you suspect Chorioamnionitis?
at least 2
- fever
- uterine tenderness
- fetal tachycardia
- Foul smelling amniotic fluid
what risks can occur from a Chorioamnionitis?
- Dysfunctional labor patterns (due to infxn of the contractile tissue)
- Postpartum hemorrhage
- Maternal infxn/sepsis/endometritis
- Neonatal Sepsis and death
what increases the risk of Chorioamnionitis occurring
- Known vaginal infxns/ STD’s
- Water broken >20 hours
- Frequent cervical exams
- Internal monitoring
- PPROM or PTL
how do you tx Chorioamnionitis
IV abx
fetal monitoring
prompt delivery
Normal blood loss is about __-__ ml
300 - 500 ml
Early PPH presents w/ Blood loss >__ ml. in the first __ hours after a vaginal delivery or greater than ____ ml after a cesarean birth
500 ml
24 hr
1000 ml
___ is a hemorrhage that occurs after the first 24 hours
Late PPH:
___ is a hemorrhage that occurs after the first 24 hours
Late PPH
what are causes of early hemorrhage?
- Uterine Atony
- Cervical or Uterine Lacerations
- Retained Placental Fragments
Also (Inversion of the Uterus, Placenta Accreta, Vulvar or Vaginal Hematomas)
what are RF for lacerations during birth?
- Instrumented or Precipitous delivery
- Large or malpresented baby
- Contracted (small) Pelvis
what are S/S of lacerations?
- bright red blood with a steady trickle and the uterus remains firm
- maternal hypovolemia with firm uterus
what should you do if a laceration is suspected?
- type and cross early
- meticulous inspection
- suture bleeders
- vaginal packing
- blood replacement
___ is failure of the myometrium to contract. This happens, the distensible uterus fills with blood because of the lack of pressure on the open vessels of the placental site.
Uterine atony
what are predisposing factors for uterine atony
prolonged labor trauma due to obstetrical procedures overdistention of uterus grand multiparity excessive use of analgesia/anesthesia intrapartum stimulation with pitocin
how do you treat Uterine Atony (EXTRA)
- Bimanual Uterine Massage
- Pitocin and Prostaglandins
- Uterine packing
- Hysterectomy
___ is characterized by the slow, abnormal progression of labor. (EXTRA)
Labor dystocia
labor dystocia is an imbalance of what 3 things (EXTRA)
Power (uterine contractions, maternal pushing efforts)
Passage (birth canal)
Passenger (fetus)
External monitoring can tell you how ___ contractions are.
Internal monitoring can also tell you how ___ contractions are.
EXTRA
frequent
strong
What can cause a power imblance in labor dystocia
EXTRA
IV epidural
What can you do to improve the power imbalance in labor dystocia
(EXTRA)
Pitocin
nipple stimulation
amniotomy
___% of women have atypical pelvic structures (EXTRA)
50%
What are “passage” issues that contribute to labor dystocia? (EXTRA)
Android pelvis
- Ischial spines
- pubic arch
- Sacrum
how do you tx labor dystocia? (EXTRA)
depends on cause
- allow more time
- C-section
- vacuum or forcep delivery
