Labor and Delivery (1) Flashcards
what is the birth passage?
from uterus through cervix into vagina
what are physiologic forces of labor
contractions
what is cephalic presentation?
head first
what is breech presentation?
butt first
what are the types of cephalic presentation?
vertex!!
cinisput??, brow, facial
what type of presentation is where you can see the face coming out?
occiput posterior
what is the most common/ideal presentation?
right occiput anterior (head to the right of pelvis and forward)
what is frank breech?
butt first (me lol)
what is footling breech?
a foot is coming out, not butt
what is transverse presentation
sideways, shoulder first
is flexed or extended preffered?
flexed inward
what are the 3 major parts of the fetal head?
face, base of skull, vault
describe the fusion of the face, base of skull, and vault
-face: bones well fused
-base of skull: 2 temporal bones well fused
-vault: NOT FUSED, held by sutures
what are the membranous spaces between cranial bones
sutures
what are the intersections of cranial sutures
fontanels
the anterior fontanel is ____ shaped and the posterior is _____ shaped
diamond, triangle
what is the ideal shape of the maternal pelvis?
gynecoid
what is the gradual thinning, shoertening, and drawing up of the cervix measured in percents from 0-100
effacement
what is the gradual opening of the cervix measures in cm from 0-10
dilation
what is dilation caused by?
fetal axis pressure (uterus contracts, pushes fetus down)
what is complete dilation
cerviz is fully dialted (10cm), cant feel cervix
what do 0% and 100% effacement mean?
0 = thick cervix
100 = paper thin
what is when the largest diameter of the presenting part passes through the pelvic inlet (BPD=bi-parietal diameter)
engagement
what is the relationship of the presenting part to the ischeal spines
station
what is zero station
baby is at the presenting part of the ischial spines
what is the strength of contractions called?
intensity
what is the frequency of contractions described as
the start of one contraction to the start of the next
what is duration of a contraction described as
start of one contraction to the relaxation of that same ocntraction
what is lightening
engagement, baby drops and settles
what are premonitory signs of labor?
-lightening
-increased frequenct/duration of cont.
-vaginal bleeding
-cervix ripening (soft/thin)
-back pain
-SROM
-sudden energy burst (nesting)
what is done to confirm rupture of membranes?
ferning test (test amniotic fluid appearance)
nitrazine / amnio indicator (to r/o other secretions)
what are characteristics of true labor
- regular contractions
- inc. frequency, duration, strength
- progressive dilatation and effacement!!!!
- discomfort starts in back and radiates around body
what are characteristics of false labor?
- irregular contraction
- do not increase in frequency, duration, and strength
- do not lead to dilatation and effacement
- “hardening”sensation
what is pitocin, what is it used for, and what does it promote
-chemically manufactured version of oxytocin
-used to augment or induce labor
-promotes increased uterine tone following delivery
what is the cardiovascular response to labor?
- increase in cardiac output
- increased BP during contractions
what are fluid and elec responses to labor?
- diaphoresis
- hyperventilation
- inc. temp from muscle activity
respiratory responses to labor
- increased O2 demand
- mild metabolic acidosis compensated by respiratory alkalosis
renal responses to labor?
- increased renin & angiotensin to control uterine blood flow
- bladder pushed forward and up
GI responses to labor?
- motility reduced
- gastric emptying prolonged
- increased acidity of gastric contents
immune responses to labor?
- increased WBC (25-30,000) due to stress
- decreased blood glucose
what is a birth plan?
plan for the mother and the team for the best outcomes
name and describe the stages of labor/birth?
- 1st stage: 0-10cm dilated
- 2nd stage: 10cm dilated-delivery of the baby
- 3rd stage: delivery of the placenta
- 4th stage: first few hours postpartum
what are the phases within the first stage of labor?
- early/latent phase
- active phase
- transition phase
what phase of the first stage of labor starts with the onset of contractions?
early/latent phase
how are pain/contractions during the early/latent phase
mild contractions, able to cope with pain
what phase of the first stage of labor is where contractions intensify and anxiety increases?
active phase
how far is fetal descent during the active phase?
4-7cm
what is the typical pattern/distance of descent for nullipara and multipara?
nullipara: 1.2cm/hour
multipara: 1.5cm/hour
what phase of the first stage of labor is where dilation slows but descent increases, force and intensity of contractions increase, and there is significant anxiety?
transition phase
how much is dialted during the transition phase?
8-10 cm
how long does the transition phase last for nullipara and multipara?
nullipara: less than 3 hours
multipara: less than an hour
what stage of labor involves pushing with the urge to push?
second stage
how long does the secong stage of labor last for nullipara and multipara?
null: 2 hr
multi: 15 min
what are some tops for coaching the mother through pushing?
- reassurance
- encouragement
- birthing bar
- pulling
- open glottis pushing (don’t hold breath)
what is the sign that birth is imminent
crowning
what are the 7 cardinal movements of labor?
- descent
- flexion
- internel rotation
- extension
- restitution
- external rotation
- expulsion
describe the cardinal movement of descent
head enters the inlet d/t
1. pressure from amniotic fluid
2. pressure from uterus
3. contraction of abd muscles
4. extension of fetus
describe the cardinal movement of flexion
chin flexes downward onto chest d/t resistance from soft tissues in pelvis
describe the cardinal movement of internal rotation
occiput rotates from left to right in order to fit the diameter of the pelvic cavity
describe the cardinal movement of extension
fetal head extends as it passes under the symphysis pubic d/t resistance of the pelvic floor and opening of vulva
describe the cardinal movement of restitution
head emerges and turns to one side and aligns with position of the back (neck became twisted through process of shpuldrs entering pelvis)
describe the cardinal movement of external rotation
head turns farther to one side becasue the shoulders are rotating to the anterior/posterior position in the pelvis
describe the cardinal movement of expulsion
anterior shoulder moves under the symphysis pubis. flexion of the shoulder and head occur
-anterior shoulder born, followed by posterior shoulder and body
what is where the vaginal tissue tears where it is weakest to allow greater opening for delivery?
perineal laceration
what are the pros/cons of perineal laceration
pro: tears where it is weakest
con: may be difficult to repair, may extend to 4th degree, labia, or urethra
how to prevent perineal lacerations
massage/mineral oil
what is lengthening the vaginal opening to allow for delivery by cutting the tissue
episiotomy
what are the pros and cons of episiotomy
pro: controlled, repair is cleaner
con: may be unnecessary
placental separation, delivery of the placenta, and retained placenta happen during what stage of labor?
third stage
why does placental separation begin?
d/t inc. uterine tone and dec. surface area
how is the placenta delivered?
pushing, don’t pull cord
what are the guidelines for a retained placenta
placenta is not delivered within 30 mins following delivery of the baby
what stage of labor/birth is prime time for breastfeeding, mother may be shaking, and has hypotonic baldder
4th stage
the 4th stage of L/D is __-__ hours after delivery
1-4
how should the fundus feel in the 4th stage of L/D
firm and between the umbilicus and symphysis pubis
what do BP and pulse look like during the 4th stage
drop in BP and increase in pulse
what are some pain management techniques used during L/D?
nonpharm: relax techniques, comfort measures, distraction, massage, effleurage (finger mvmt on abd), position
pharm: narcotics, epidural, spinal
what narcotics are used during L/D?
stadol, nubain, demerol, morphine
what is an epidural?
local anesthetic and narcotic into epidural space
what is a spinal
local anesthetic into the spinal fluid in the spinal canal (often for c/s birth)
what are the pros/cons of epidural?
pros:
* fully awake
* can be adjusted
* allows urge to push
cons:
* skilled procedure
* takes 30 mins
* no ctrl of mvmt below waste
* costly
what are possible side effects of epidural?
- HYPOTENSION
- seizures (rare)
- meningitis (rare)
- arrest (rare)
- spinal HA
for a patient wanting an epidural, platelets must be at least ___
100,000 mm3
what should be monitored during an epidural
- BP (might be low)
- position
- effectiveness
- bladder, straight cath q2h
how can a low BP from epidural effect fetus
can cause fetal HR to decrease, less o2
what are contraindications for epidural?
- platelets less than 100,000 mm3
- coag disorder
- spinal abnormality
- infection
- uncooperative
what are indications for c section
- prior c/s
- breech
- failure to progress
- fetal distress
- placental complications
what is the most common c/s incision
low transverse, allows for VBAC too
what is done for prep for c/s
- shaving
- foley
- SCDs
- prep for spinal
what are usual orders during a c/s
- pitocin
- DVT prevention/SCD
- advance diet
- pain management
what does a TOCO measure?
muscle tone or contraction strength on fundus
what does an EFM (external fetal monitor) show?
placed where fetal heartbeat is, shows heartbeat on graph
when should external monitors (TOCO and EFM) be used?
when things are well! only shows duration
what are pros/cons of EFM?
pro: external, not invasive
con: con’t show contraction strength, might not be accurate with movement
what are the internal monitors?
-IFM (scalp electrode)
-IUPC (intra uterine pressure catheter)
what does an IUPC measure?
intensity in cintractions in mg
when are internal monitors used?
when the externals are inaccurate
what are drawbacks of internal monitors?
needs ROM, baby needs to be vertex, infection, perforation
how is frequency of contractions measured?
beginning of one contraction to beginning of the next, OR peak to peak
how is duration of contraction measured
from beginning to end
how does the fundus feel during mild contractions?
like pressing on your nose, easily indented
how does the fundus feel during moderate contractions
like ppressing your chin, difficult to indent
how does the fundus feel during string contractions?
like pressing your forehead, hard
what are contractions recorded in?
MVUs
how to calculate contraction MVUs?
its recorded by measuring each contraction over a 10 min span.
-make sure to measure contraction strength by subtracting the baseline from the reading at the top of the peak, add all contractions within 10 mins together
what is the normal fetal HR
110-160, slows with increased gestational age
what is fetal tachycardia?
greater than 160 (lasting longer than 10 mins)
what is fetal bradycardia
less than 110 (lasting longer than 10 mins)
what is jaggedness of FHR called?
variability
is variability good or bad?
good!!
what does variability represent?
interaction between sympathetic and aprasympathetic NS
what does absent variability mean and what should we do?
potentially nonreassuring, give mom a sugary drink to stimulate, use buzzer to startle baby
what is fetal elevation of greater than 15 bpm lasting at least 15 sec?
accelerations
are accelerations good?
yes!!! reassuring
what is shown with a “flat line” on fetal heart rate tracings?
lack of variability
nursing interventions for lack of variability
reposition, stimulate
what is important to look at for decelertions
where they begin in relation to contraction
what causes early decelerations?
head compression
what are interventions for early decelerations
reposition, vaginal exam!!!!!
what causes late decelerations?
uteroplacental insufficiency, sign of stress and hypoxia
what are nursing interventions for late decelerations?
5 Ps
* turn pt to left side
* turn fluids on
* turn pitocin off
* turn o2 on
* turn call light on
what are variable decelerations like?
abrupt onset and abrupt return to normal, vary in timing of contraction
what causes variable decelerations?
cord compression
what are interventions for variable deceleration?
positioning
what is the time calssification of a prolonged deceleration?
greater than 2 minutes
what are indirect methods of fetal assessment?
-scalp stimulation
-cord blood analysis at birth (bllod gasses, pH)
