Labor and Delivery Flashcards
Uterine contractions and cervical changes that occur between 20 wks and 37 wks
Preterm labor
UTI
Vaginal infections
chorioamnionitis
previous preterm birth
multifetal pregnancy
low socioeconomic status
smoking
substance abuse
Risk factors for Preterm labor
Cervical changes could include
Shortening , softening thinning or dilation of cervix
Mucus plug prevents bacteria if ruptured …
have to deliver with in 24 hours d/t risk for infection
domestic violence
DM
HTN
incompetent cervix
placenta previa or abruption
frequent conception
dehydration
risk factors for preterm labor
Lower back pain
pressure in pelvis
cramping in abdomen
vaginal discharge (increase or change)
bleeding
cervical dilation
Manifestations of Preterm labor
Braxton hicks vs Real labor
Braxton hicks go away with water or rest 1-2 hours, lay on left side
Real increases with exercise
Cervical cultures
CBC
UA
Fetal Fibronectin
lab test for Pre term labor
Swab of cervical secretions to detect protein that bond amniotic sac to uterus
determine imminent preterm labor and birth
low levels= possible preterm = stop labor and tx underlying issues
hydration, bedrest , tx infection
Fetal fibronectin testing
Terbutaline
Magnesium Sulfate
Indomethacin
Betamethasone
Preterm labor medications
Relaxes smooth muscle
PO or Subcut
Monitor Pulse + 120 HOLD
not used prior to 24wks or beyond 34wks
Terbutaline
Relaxes smooth muscle of the uterus, stopping contractions
IV by RN
Monitor signs of toxicity
CALCIUM GLUCONATE antidote
Magnesium sulfate
NSAID, suppress preterm, blocking the production of prostaglandin, stopping contractions
Used LESS than 32wks,
after 32wks affect closure of ductus arteriosus
With food to prevent GI upset
monitor postpartum hemorrhage if delivery while taking drug - reduces platelet aggregation
short term use
Stop if Respirations less than 12 or urine output less than 30
Indomethacin
Glucocorticoid IM - Promote fetal lung maturity and surfactant
2 doses given 24 hours apart
Betamethasone
spontaneous rupture of membranes ONE hour PRIOR to true labor
PROM
Spontaneous rupture of membranes after 20wks or before 37 wks -labor do not have to follow
PPROM
Infection
Risk factor for PROM and PPROM
Gush of fluid
maternal fever
increase maternal or fetal HR
Foul smelling fluid or vaginal discharge
Manifestations of PROM or PPROM
prolapsed cord
placenta abruption
cord compression
With PROM or PPROM clients have a increased risk for
activity restrictions
no sex
hydration
s/s of infection
monitor fetal Heart rate and contractions
Nursing care for preterm labor
decrease in deep tendon reflexes, changes in mental status and Decreased RR
MG toxicity
Nitrazine paper test
Amnisure test
lab test for PROM and PPROM
asses pH of leaked fluids
vaginal fluids: yellow to light green
Amniotic/cervical mucus: Darker green/blue
False positives with blood, soap, semen, infection or intermittent
Nitrazine Swab
Fetal fibronectin in Vag = PROM (present with any disruption)
Alfa fetoprotein in vag fluids suggest rupture
blood may cause false positive
Amnisure test for PROM/ PPROM
Prepare for delivery
determine cervical dilation
assess FHR and contraction pattern
maintain bedrest
monitor vital signs
Nursing care for PROM/PPROM
Confirm gestational age
assess fetal well being
uterine activity
cervical changes
monitor temp and vital signs
PROM and atleast 36 wks go into labor with in 24 wks of rupture
If earlier delivery may be delayed if possible to administer steroid for fetal lung maturity
Goal is prevent infection and deliver healthy infant
Nursing care once confirmation of ROM
used to treat infections or as prophylaxis
medications with ROM
Ampicillin
Low constant backache r/t relaxing of pelvic muscles
Lightening (dropping of fetal head) usually 2-4 wks prior -cause waddle in walk
contractions (mild/irregular similar to menstrual cramps, lower back to abdomen)
bloody show (vaginal discharge with thick mucus like with blood tinged streaks)
energy burst (nesting)
GI changes (N/V)
ROM
Client in labor
Power
Passage
Passenger
Psyche
Position
Components of birth process
involuntary uterine contractions that increase in intensity and regularity dilating and thinning
(effacement) the cervix
Ferguson reflex is the reflex to push upon complete dilation during delivery
Power
The clients pelvis
Passage
Fetus
passenger
mind set of client
psyche
assist in dilation and effacement of cervix
Uterine contractions
time from beginning of one contraction to the beginning of next
frequency of contraction
length of contraction
duration of contraction
strength of contraction at peak
mild - tip of nose
moderate - pushing out chin
firm- pushing top of forehead
intensity of contraction
tone of the uterus between contraction
Resting Tone of contraction (Soft or Firm)
stretching of the cervical OS to allow fetal passage
Cervical dialtion
thinning and shortening of the cervix
Primigravida = cervix thins then completely dilate
multigravida= dilate and thin when the cervix is nearly completely dilated
Cervical Effacement
using the ischial spines as ) station, the descent of the fetus can be measured
position above the ischial spines is (-) and below is (+)
Fetal station
Fetal head is down and presenting part (chin to chest)
chin out neck straight
brow enters pelvis 1st with neck extended
face enters pelvis 1st
cephalic/ vertex
sinciput
brow
facial
fetal presentation
Feet of the fetus presenting part (fetal feet)
one foot presenting
both feet present
footling breech
single footling
double footling
fetal presentation
buttocks presenting part with hip flexed and feet toward head
buttocks with legs crossed
frank breech
complete breech
fetal presentation
shoulder presenting
shoulder presenting
the relationship of the presenting part of the maternal pelvis related to the skull and portion of the occipital bone and its position anterior or posterior to the pelvis and direction facing the mothers buttocks
described with 3 letters ex. LOA
Occiput anterior/posterior
Fetal position
