labor and deliver Flashcards
braxton-Hicks contractions
spontaneous uterine contractions late in prego not associated with cervical dilation
lightening
fetal head descending into the pelvis, causing a change in the abdomens shape and sensation that the baby has become “lighter”
ruptured membranes
sudden gush of liquid or constant leakage of fluid
bloody show
passage of blood-tinged cervical mucus late in prego
*occures when the cervix begins thinning–> effacemnt
true labor
contractions of the uterine fundus with radiation to the lower back and abdomen
*Regular & painful contractions of the uterus causes cervical dilation & fetus expulsion
stage 1 of labor
Onset of labor (true regular contractions) to full dilation of cervix @ 10 cm
what are the two phase of stage 1 labor?
Latent Phase → 1-6 hrs→ Cervix effacement with gradual cervical dilation
Active Phase → 4-6 hrs → Rapid cervical dilation → Usually beginning @ 3-4 cm
stage II of labor
1-2 hrs → Time from full cervical dilation until delivery of the fetus
phases of stage II labor
Passive Phase → Complete cervical dilation to active maternal expulsive efforts
Active Phase → From active maternal expulsive efforts to delivery of the fetus
stage III of labor
Postpartum until delivery of placenta → 0-30 minutes (avg 5)
what are 3 signs of placental separation?
Gush of blood
Lengthening of umbilical cord
Anterior-Cephalad Movement of uterine fundus (becomes globular and firmer) after the placenta detaches
how is the placenta expulsed?
Due to downward pressure of the retroplacental hematoma, uterine contractions
stage IV of labor
eriod 1-2 hours after delivery where mother is assessed for complications is sometimes called the 4th stage
cardinal movements of labor?
engagement Flexion descent internal rotation extension external roation
what is engagement of the fetus?
when the fetal presenting part enters the plevis
what is fetal flexion
flextion of head to allow the smallest diameter to present to the pelvis
what is descent?
passage of the head into the pelvis (lightening”)
what is internal rotation?
Fetal vertex moves from the occiput transverse position to position where the sagittal suture is parallel to the anteroposterior diameter of the pelvis
what is extension?
vertex extends as it passes beneath the pubic symphysis
what is external rotation?
fetus externally rotatesafter the head is delivered so that the shoulder can be delivered
what needs to be monitored during labor?
maternal pulse and BP (every 2-4 hrs)
maternal fluid balance
fetal monitoring (every 30 mins during the first stage, then every 15 during 2cd stage)
uterine contractions (via palpationa, tocodynamometer, or internal pressure catheter
progress of labor (cervis)
monitoring the cervix during labor during latent phase
(especially when the membranes are ruptured) vaginal examinations should be done sparingly to decrease the risk of intrauterine infection
monitoring the cervix during labor during active phase
Cervix should be assessed approximately every 2 hours → The cervical effacement and dilatation and the station and position of the fetal head should be recorded
postpartum monitoring?
maternal blood pressure, pulse rate, and uterine blood loss must be monitored closely first hour after delivery
what is the APGAR score?
A- appearance P-pulse Grimace (reflex irritability) Activity Respiration
Appearance score
0- blue-gray, pale
1-acrocyanosis (body pink but extremities blue)
2- pink baby, no cyanosis
Pulse score
0: 0
1: <100
2: >/= 100
grimace
0: no response to stimulation
1: grimaces feebley
2: pulls away
Activity (
muscle tone
0: none
1: some flexion
2: flexes arms and leges, resists extension
Respiration
0: absent
1: weak, irregular
2: strong, crying (30-60/min)
how often is APGAR scored?
1 & 5 minutes after birth → Repeated at 10 minutes if abnormal
how is apgar scored?
Score from 1-10
> 7 → Normal
4-6 → Fairly Low
< 3 → Critically Low
what is puerperium?
6 wk period after delivery
what does the uterus do after delivery?
At the level of the umbilicus after delivery → Involution (shrinks) after 2 days → Descends into pelvic cavity ~2 wks → Normal size around 6 wks postpartum
what is the lochia serosa?
Pinkish/brown vaginal bleeding especially postpartum days 4-10 → From the decidual tissue → Usually resolves by 3-4 weeks postpartum
breast/menstruation in the puerperium?
Breast milk in postpartum days 3-5 bluish white → If lactating, mothers may remain anovulatory during that time
If not breastfeeding → Menses may return 6-8 weeks postpartum
