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OB > Labor and Delivery (1) > Flashcards

Labor and Delivery (1) Flashcards

1
Q

what is the birth passage?

A

from uterus through cervix into vagina

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2
Q

what are physiologic forces of labor

A

contractions

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3
Q

what is cephalic presentation?

A

head first

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4
Q

what is breech presentation?

A

butt first

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5
Q

what are the types of cephalic presentation?

A

vertex!!
cinisput??, brow, facial

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6
Q

what type of presentation is where you can see the face coming out?

A

occiput posterior

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7
Q

what is the most common/ideal presentation?

A

right occiput anterior (head to the right of pelvis and forward)

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8
Q

what is frank breech?

A

butt first (me lol)

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9
Q

what is footling breech?

A

a foot is coming out, not butt

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10
Q

what is transverse presentation

A

sideways, shoulder first

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11
Q

is flexed or extended preffered?

A

flexed inward

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12
Q

what are the 3 major parts of the fetal head?

A

face, base of skull, vault

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13
Q

describe the fusion of the face, base of skull, and vault

A

-face: bones well fused
-base of skull: 2 temporal bones well fused
-vault: NOT FUSED, held by sutures

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14
Q

what are the membranous spaces between cranial bones

A

sutures

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15
Q

what are the intersections of cranial sutures

A

fontanels

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16
Q

the anterior fontanel is ____ shaped and the posterior is _____ shaped

A

diamond, triangle

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17
Q

what is the ideal shape of the maternal pelvis?

A

gynecoid

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18
Q

what is the gradual thinning, shoertening, and drawing up of the cervix measured in percents from 0-100

A

effacement

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19
Q

what is the gradual opening of the cervix measures in cm from 0-10

A

dilation

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20
Q

what is dilation caused by?

A

fetal axis pressure (uterus contracts, pushes fetus down)

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21
Q

what is complete dilation

A

cerviz is fully dialted (10cm), cant feel cervix

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22
Q

what do 0% and 100% effacement mean?

A

0 = thick cervix
100 = paper thin

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23
Q

what is when the largest diameter of the presenting part passes through the pelvic inlet (BPD=bi-parietal diameter)

A

engagement

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24
Q

what is the relationship of the presenting part to the ischeal spines

A

station

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25
Q

what is zero station

A

baby is at the presenting part of the ischial spines

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26
Q

what is the strength of contractions called?

A

intensity

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27
Q

what is the frequency of contractions described as

A

the start of one contraction to the start of the next

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28
Q

what is duration of a contraction described as

A

start of one contraction to the relaxation of that same ocntraction

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29
Q

what is lightening

A

engagement, baby drops and settles

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30
Q

what are premonitory signs of labor?

A

-lightening
-increased frequenct/duration of cont.
-vaginal bleeding
-cervix ripening (soft/thin)
-back pain
-SROM
-sudden energy burst (nesting)

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31
Q

what is done to confirm rupture of membranes?

A

ferning test (test amniotic fluid appearance)
nitrazine / amnio indicator (to r/o other secretions)

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32
Q

what are characteristics of true labor

A
  • regular contractions
  • inc. frequency, duration, strength
  • progressive dilatation and effacement!!!!
  • discomfort starts in back and radiates around body
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33
Q

what are characteristics of false labor?

A
  • irregular contraction
  • do not increase in frequency, duration, and strength
  • do not lead to dilatation and effacement
  • “hardening”sensation
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34
Q

what is pitocin, what is it used for, and what does it promote

A

-chemically manufactured version of oxytocin
-used to augment or induce labor
-promotes increased uterine tone following delivery

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35
Q

what is the cardiovascular response to labor?

A
  • increase in cardiac output
  • increased BP during contractions
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36
Q

what are fluid and elec responses to labor?

A
  • diaphoresis
  • hyperventilation
  • inc. temp from muscle activity
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37
Q

respiratory responses to labor

A
  • increased O2 demand
  • mild metabolic acidosis compensated by respiratory alkalosis
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38
Q

renal responses to labor?

A
  • increased renin & angiotensin to control uterine blood flow
  • bladder pushed forward and up
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39
Q

GI responses to labor?

A
  • motility reduced
  • gastric emptying prolonged
  • increased acidity of gastric contents
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40
Q

immune responses to labor?

A
  • increased WBC (25-30,000) due to stress
  • decreased blood glucose
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41
Q

what is a birth plan?

A

plan for the mother and the team for the best outcomes

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42
Q

name and describe the stages of labor/birth?

A
  • 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
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43
Q

what are the phases within the first stage of labor?

A
  • early/latent phase
  • active phase
  • transition phase
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44
Q

what phase of the first stage of labor starts with the onset of contractions?

A

early/latent phase

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45
Q

how are pain/contractions during the early/latent phase

A

mild contractions, able to cope with pain

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46
Q

what phase of the first stage of labor is where contractions intensify and anxiety increases?

A

active phase

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47
Q

how far is fetal descent during the active phase?

A

4-7cm

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48
Q

what is the typical pattern/distance of descent for nullipara and multipara?

A

nullipara: 1.2cm/hour
multipara: 1.5cm/hour

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49
Q

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?

A

transition phase

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50
Q

how much is dialted during the transition phase?

A

8-10 cm

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51
Q

how long does the transition phase last for nullipara and multipara?

A

nullipara: less than 3 hours
multipara: less than an hour

52
Q

what stage of labor involves pushing with the urge to push?

A

second stage

53
Q

how long does the secong stage of labor last for nullipara and multipara?

A

null: 2 hr
multi: 15 min

54
Q

what are some tops for coaching the mother through pushing?

A
  • reassurance
  • encouragement
  • birthing bar
  • pulling
  • open glottis pushing (don’t hold breath)
55
Q

what is the sign that birth is imminent

A

crowning

56
Q

what are the 7 cardinal movements of labor?

A
  • descent
  • flexion
  • internel rotation
  • extension
  • restitution
  • external rotation
  • expulsion
57
Q

describe the cardinal movement of descent

A

head enters the inlet d/t
1. pressure from amniotic fluid
2. pressure from uterus
3. contraction of abd muscles
4. extension of fetus

58
Q

describe the cardinal movement of flexion

A

chin flexes downward onto chest d/t resistance from soft tissues in pelvis

59
Q

describe the cardinal movement of internal rotation

A

occiput rotates from left to right in order to fit the diameter of the pelvic cavity

60
Q

describe the cardinal movement of extension

A

fetal head extends as it passes under the symphysis pubic d/t resistance of the pelvic floor and opening of vulva

61
Q

describe the cardinal movement of restitution

A

head emerges and turns to one side and aligns with position of the back (neck became twisted through process of shpuldrs entering pelvis)

62
Q

describe the cardinal movement of external rotation

A

head turns farther to one side becasue the shoulders are rotating to the anterior/posterior position in the pelvis

63
Q

describe the cardinal movement of expulsion

A

anterior shoulder moves under the symphysis pubis. flexion of the shoulder and head occur
-anterior shoulder born, followed by posterior shoulder and body

64
Q

what is where the vaginal tissue tears where it is weakest to allow greater opening for delivery?

A

perineal laceration

65
Q

what are the pros/cons of perineal laceration

A

pro: tears where it is weakest
con: may be difficult to repair, may extend to 4th degree, labia, or urethra

66
Q

how to prevent perineal lacerations

A

massage/mineral oil

67
Q

what is lengthening the vaginal opening to allow for delivery by cutting the tissue

A

episiotomy

68
Q

what are the pros and cons of episiotomy

A

pro: controlled, repair is cleaner
con: may be unnecessary

69
Q

placental separation, delivery of the placenta, and retained placenta happen during what stage of labor?

A

third stage

70
Q

why does placental separation begin?

A

d/t inc. uterine tone and dec. surface area

71
Q

how is the placenta delivered?

A

pushing, don’t pull cord

72
Q

what are the guidelines for a retained placenta

A

placenta is not delivered within 30 mins following delivery of the baby

73
Q

what stage of labor/birth is prime time for breastfeeding, mother may be shaking, and has hypotonic baldder

A

4th stage

74
Q

the 4th stage of L/D is __-__ hours after delivery

A

1-4

75
Q

how should the fundus feel in the 4th stage of L/D

A

firm and between the umbilicus and symphysis pubis

76
Q

what do BP and pulse look like during the 4th stage

A

drop in BP and increase in pulse

77
Q

what are some pain management techniques used during L/D?

A

nonpharm: relax techniques, comfort measures, distraction, massage, effleurage (finger mvmt on abd), position
pharm: narcotics, epidural, spinal

77
Q

what narcotics are used during L/D?

A

stadol, nubain, demerol, morphine

78
Q

what is an epidural?

A

local anesthetic and narcotic into epidural space

79
Q

what is a spinal

A

local anesthetic into the spinal fluid in the spinal canal (often for c/s birth)

80
Q

what are the pros/cons of epidural?

A

pros:
* fully awake
* can be adjusted
* allows urge to push
cons:
* skilled procedure
* takes 30 mins
* no ctrl of mvmt below waste
* costly

81
Q

what are possible side effects of epidural?

A
  • HYPOTENSION
  • seizures (rare)
  • meningitis (rare)
  • arrest (rare)
  • spinal HA
82
Q

for a patient wanting an epidural, platelets must be at least ___

A

100,000 mm3

83
Q

what should be monitored during an epidural

A
  • BP (might be low)
  • position
  • effectiveness
  • bladder, straight cath q2h
84
Q

how can a low BP from epidural effect fetus

A

can cause fetal HR to decrease, less o2

85
Q

what are contraindications for epidural?

A
  • platelets less than 100,000 mm3
  • coag disorder
  • spinal abnormality
  • infection
  • uncooperative
86
Q

what are indications for c section

A
  • prior c/s
  • breech
  • failure to progress
  • fetal distress
  • placental complications
87
Q

what is the most common c/s incision

A

low transverse, allows for VBAC too

88
Q

what is done for prep for c/s

A
  • shaving
  • foley
  • SCDs
  • prep for spinal
89
Q

what are usual orders during a c/s

A
  • pitocin
  • DVT prevention/SCD
  • advance diet
  • pain management
90
Q

what does a TOCO measure?

A

muscle tone or contraction strength on fundus

91
Q

what does an EFM (external fetal monitor) show?

A

placed where fetal heartbeat is, shows heartbeat on graph

92
Q

when should external monitors (TOCO and EFM) be used?

A

when things are well! only shows duration

93
Q

what are pros/cons of EFM?

A

pro: external, not invasive
con: con’t show contraction strength, might not be accurate with movement

94
Q

what are the internal monitors?

A

-IFM (scalp electrode)
-IUPC (intra uterine pressure catheter)

95
Q

what does an IUPC measure?

A

intensity in cintractions in mg

96
Q

when are internal monitors used?

A

when the externals are inaccurate

97
Q

what are drawbacks of internal monitors?

A

needs ROM, baby needs to be vertex, infection, perforation

98
Q

how is frequency of contractions measured?

A

beginning of one contraction to beginning of the next, OR peak to peak

99
Q

how is duration of contraction measured

A

from beginning to end

100
Q

how does the fundus feel during mild contractions?

A

like pressing on your nose, easily indented

101
Q

how does the fundus feel during moderate contractions

A

like ppressing your chin, difficult to indent

102
Q

how does the fundus feel during string contractions?

A

like pressing your forehead, hard

103
Q

what are contractions recorded in?

A

MVUs

104
Q

how to calculate contraction MVUs?

A

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

105
Q

what is the normal fetal HR

A

110-160, slows with increased gestational age

106
Q

what is fetal tachycardia?

A

greater than 160 (lasting longer than 10 mins)

107
Q

what is fetal bradycardia

A

less than 110 (lasting longer than 10 mins)

108
Q

what is jaggedness of FHR called?

A

variability

109
Q

is variability good or bad?

A

good!!

110
Q

what does variability represent?

A

interaction between sympathetic and aprasympathetic NS

111
Q

what does absent variability mean and what should we do?

A

potentially nonreassuring, give mom a sugary drink to stimulate, use buzzer to startle baby

112
Q

what is fetal elevation of greater than 15 bpm lasting at least 15 sec?

A

accelerations

113
Q

are accelerations good?

A

yes!!! reassuring

114
Q

what is shown with a “flat line” on fetal heart rate tracings?

A

lack of variability

115
Q

nursing interventions for lack of variability

A

reposition, stimulate

116
Q

what is important to look at for decelertions

A

where they begin in relation to contraction

117
Q

what causes early decelerations?

A

head compression

118
Q

what are interventions for early decelerations

A

reposition, vaginal exam!!!!!

119
Q

what causes late decelerations?

A

uteroplacental insufficiency, sign of stress and hypoxia

120
Q

what are nursing interventions for late decelerations?

A

5 Ps
* turn pt to left side
* turn fluids on
* turn pitocin off
* turn o2 on
* turn call light on

121
Q

what are variable decelerations like?

A

abrupt onset and abrupt return to normal, vary in timing of contraction

122
Q

what causes variable decelerations?

A

cord compression

123
Q

what are interventions for variable deceleration?

A

positioning

124
Q

what is the time calssification of a prolonged deceleration?

A

greater than 2 minutes

125
Q

what are indirect methods of fetal assessment?

A

-scalp stimulation
-cord blood analysis at birth (bllod gasses, pH)

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