Labor And Delivery Flashcards
Physiological changes before labor
Backache, bloody show/mucus plug (brown, blood tinged vaginal discharge), nesting (burst of energy), contractions (Braxton hicks or true), lightening (baby drops lower into pelvis), rupture of membranes
Characteristics of true contractions vs. Braxton hicks contractions
True: affect the length and dilation of cervix, gets stronger, comes at regular interval and happens more frequently, walking/activity increases intensity of contraction, presenting part of fetus is engaged in pelvis
Braxton hicks: weak, not timeable, activity decreases pain of contraction, presenting part of fetus is not engaged in pelvis
What are the three factors affecting labor?
Passageway (birth canal, anatomical structures), powers (contractions), passenger (fetus)
Fetal position
- Right (R) or Left (L)
- Occipital (back of head) (O), mentum (chin) (M), scapula (SC), sacrum (S) — describes what part of body is presenting in the pelvis
- Anterior, posterior, transverse
Example: if the baby is LOA, that means the baby is positioned so that the occiput is left for the mother and anterior
What is the optimal fetal position?
LOA: left occiput anterior
Fetal _________ describes how far the head or presenting part has descended into the pelvis
Station
Fetal station ___ is at the level of the ischial spines
0
Anything higher that fetal station 0 will be a _________ number
Negative
Anything lower than fetal station 0 will be a _________ number
Positive
How many stages are there to labor?
4
What are the three phases of stage one of labor?
Latent, active, and transition phase
Stage ___ of labor occurs from the onset of labor until the cervix is fully dilated
1
Characteristics of the latent phase of labor (stage 1)
- mom is talkative and excited
- pain is not too bad
- 0-3 cm dilated
Characteristics of the active phase of labor (stage 1)
- 4-7 cm dilated
- stronger contractions
- mom might be a little apprehensive
Characteristics of the transition phase of labor (stage 1)
- 8-10 cm dilated
- hallmark sign: mom feels very strong urge to push or have a bowel movement
- mom may start verbalizing fear or apprehension (“I can’t do this!,” “I don’t want to do this anymore”)
Stage ___ of labor occurs from full dilation until the baby is born
2
Stage ___ of labor occurs from the birth of baby to the delivery of the placenta
3
Stage ___ of labor occurs from the time the placenta is delivered to the time that mom has been stabilized
4
_________ refers to thinning of the cervix and is described as percentages from 0-100%
Effacement
_________ describes how big the cervix is getting/how wide the opening is and is measured in centimeters
Dilation
Non-pharmacological pain management characterized by lightly stroking the abdomen typically in rhythm with patient’s breathing during contractions
Effleurage
Non-pharmacological pain management for back pain during labor
Sacral counterpressure
Major side effect of epidural
Maternal hypotension
Spinal anesthesia is commonly used for _________ and is a one-time injection that relieves pain and sensation from the nipples down
C-sections
Interventions for maternal hypotension related to epidural or spinal anesthesia
IV fluid bolus, reposition patient on side or place pillow under hip
Performing Leopold maneuvers
Palpate fundus (top of uterus) to assess what is there (feet, head, etc), feel along both sides of uterus (feeling for baby’s back), palpate above pubic bone (if whatever is there does not move, this means part is fully engaged in pelvis), if cephalic, identify fetal attitude
Fetal heart rate monitoring depends on
Where the baby’s back is
Normal fetal heart rate baseline
110-160 bpm
FHR accelerations are classified as an increase in HR by at least ___ bpm and sustained for at least ___ seconds
15; 15
Deceleration that is normal and mirrors contractions
Early deceleration
Deceleration that is normal and mirrors contractions
Early deceleration
Fluctuations (variability) of FHR by ___ to ___ bpm around the baseline are normal and expected
6-25
Reassuring type of variability
Moderate variability
Fetal bradycardia is defined as FHR below 110 that is sustained for greater than or equal to ___ min
10
What can cause fetal bradycardia?
Prolonged cord compression, umbilical cord prolapse, anesthetic medications, fetal heart abnormalities
Interventions for fetal bradycardia
Side-lying position, oxygen, IV fluids, stay at bedside and notify provider
Fetal tachycardia is defined as FHR greater than ___ sustained for 10 min or more
160
Causes of fetal tachycardia
Maternal fever or infection, fetal hypoxia, maternal hyperthyroidism, cocaine use
Fetal tachycardia accompanied by decreased variability is indicative of
Severe fetal distress
Treatment for late decelerations
LIONS: Left-lying position, IV fluids, Oxygen and d/c Oxytocin, Notify provider, prep for Surgery
Interventions for variable decelerations/cord compression
Trendelenburg position, knee-chest position, oxygen, d/c oxytocin, notify provider, amnioinfusion (indicated for oligohydramnios)
VEAL CHOP
V- variable decelerations; C- cord compression
E- early decelerations; H- head compression
A- accelerations; O- okay! This is a good thing
L- late decelerations; P- uteroPlacental insufficiency
Non-invasive procedure by which the baby’s head is rotated from the outside of mom (external)
External cephalic inversion
Indication for external cephalic inversion
Breach positioning of fetus
Risks associated with external cephalic inversion
Umbilical cord compression, placental abruption, preterm labor
External cephalic inversion should not be performed before ___ weeks gestation
37
Score that helps to determine the maternal readiness for labor induction
Bishop scoring
Components assessed with bishop scoring
Cervical consistency, dilation, effacement, position, station of presenting part
A bishop score of ___ or higher in a multiparous patient would be considered to be ready for induction
8
A bishop score of ___ or higher for a nulliparous patient indicates they are ready for labor induction
10
Preparing the cervix for labor through prostaglandins such as Misoprostol, mechanical methods like balloon catheters, cervical dilators, and membrane stripping
Cervical ripening
Complications of prostaglandins for cervical ripening
Uterine tachysystole/hyperstimulation, risk for uterine rupture
Procedure that artificially ruptures the membrane for labor induction
Amniotomy
Complications of amniotomy
Infection, cord prolapse
Amniotomy nursing care
Ensure presenting part is fully engaged in pelvis prior to procedure, monitor FHR, assess maternal temperature every 2 hours (d/t risk for infection)
Administration of IV synthetic hormone _________ can augment or induce labor
Oxytocin (increases strength, frequency, and force of uterine contractions)
Oxytocin indications
- augmentation or induction of labor
- controlling postpartum bleeding
- firm up uterus after delivery
Nursing care of the patient on oxytocin
monitor FHR, d/c oxytocin if it results in uterine tachysytole
contractions that occur more than every __ mins, last longer than __ sec, intensity greater than __ mmHg with intrauterine pressure catheter, or a resting tone greater than __ mmHg indicate uterine tachysystole and the need for discontinuation of oxytocin
2; 90; 90; 20
_________ is a tocolytic that can be used to decrease uterine activity due to complications like uterine tachysystole
Terbutaline
Complications of vacuum or forceps-assisted delivery
Cephalohematoma or caput, birth trauma (maternal or fetal lacerations), infant subdural hematoma
Assisted delivery indications
Prolonged second stage of labor, abnormal fetal presentation, fetal distress, maternal exhaustion, ineffective pushing
Nursing care for assisted delivery
Patient in lithotomy position, ensure bladder is empty, ensure membranes are ruptured and that fetal part is engaged in maternal pelvis
Rupture of membranes prior to the onset of true labor
Premature rupture of membranes (PROM)
Rupture of membranes prior to true labor AND during preterm gestation (<37 weeks)
Pre-PROM
PROM risk factors
Maternal infection, incompetent cervix, previous preterm birth
Diagnosis/confirmation of PROM
Assess fluid through pH testing (nitrosamine paper will turn blue in presence of amniotic fluid); positive ferning test (fern-like crystals indicate amniotic fluid)
Treatment of PROM
Ampicillin (for tx of possible infection), betamethasone (promotes fetal lung maturity)
Complications of PROM
Infection, prolapsed umbilical cord
Uterine contractions that cause cervical changes between 20-37 weeks gestation
Preterm labor
Preterm labor risk factors
Infection, DM, HTN, smoking, multifetal pregnancy, PROM, placenta previa, previous preterm delivery
S/S of preterm labor
Cervical dilation, vaginal discharge of amniotic fluid, uterine contractions
Amniotic enzyme that correlates with increased risk for preterm labor if present in vaginal swab
Fetal fibronectin
Magnesium can be give to patients to
Relax uterus, slow contractions
Nursing care for magnesium toxicity
Assess DTRs and respiratory effort, administration of antidote calcium gluconate
Calcium channel blocker indicated for preterm labor as it helps to relax uterine muscles
Nifedipine
NSAID that can be used to suppress labor
Indomethacin
Prolonged or difficult birth
Labor dystocia
Reasons for labor dystocia
Fetal macrosomia, maternal fatigue, uterine abnormalities, cephalopelvic disproportion (head is too big to go through cervix), fetal malpresentation, anesthetic or analgesic use
S/S of labor dystocia
Failure to progress in labor (dilation, effacement, fetal station/descent)
Nursing care for labor dystocia
Encourage or assist with position changes, position patient on hands and knees if goal is to get fetus from posterior to anterior position
Nursing interventions for shoulder dystocia
Put pressure on suprapubic region, perform mcroberts maneuver
General interventions for labor dystocia
Assist with amniotomy, administer oxytocin as ordered, prepare for assisted delivery or surgery (C-section)
Protrusion of the umbilical cord through the cervix before the baby
Prolapsed umbilical cord
Complications of prolapsed umbilical cord
Cord compression which can result in fetal hypoxia, fetal distress, and compromised fetal circulation
Prolapsed umbilical cord nursing care
Call for assistance but do not leave patient, apply sterile gloves, insert fingers into vagina, position fingers on each side of cord and lift the fetal presenting part off the cord to reduce compression; position mom in knee-chest or trendelenburg; cover with warm, sterile saline-soaked towel over cord if it is exposed outside of vagina, administer oxygen, prepare for birth of infant via c-section
C-section risk factors
Labor dystocia, fetal malpresentation, failure to progress, fetal distress, previous c-section
C-section complications
Hemorrhage, infection
C-section nursing care
Ensure patent IV, start Foley catheter, administer IV fluids and pre-op meds, provide analgesia for post-op pain, assess incision site for signs of infection and dehiscence
Uterine rupture risk factors
Uterine tachysystole, overdistention of uterus d/t multigravida, uterine trauma, previous uterine surgery
S/S of uterine rupture
Patient reports sudden, sharp tearing sensation, non-reassuring FHR patterns, S/S of shock (low BP, high HR and RR)
Complications of uterine rupture
Hemorrhage, fetal hypoxia, maternal or fetal death
Interventions for uterine rupture
Emergency c-section, surgery to repair uterus
The leakage of amniotic fluid into maternal circulation resulting in obstruction of pulmonary vessels
Amniotic fluid embolism (AFE)
S/S AFE
S/S of PE: Respiratory distress, circulatory collapse, sudden chest pain, dyspnea, sense of impending doom, tachycardia, hypotension
Complications of AFE
DIC
AFE nursing care
Administer O2, IV fluids, blood products, may need to assist with CPR and mechanical ventilation
Labor that lasts less than 3 hours from the onset of contractions to the delivery of the fetus
Precipitous labor
Precipitous labor risk factors
Hypertensive disorders, oxytocin, younger maternal age, preterm delivery, lower infant birth weight, placental abruption
Complications of precipitous labor
Maternal lacerations, tissue trauma, uterine rupture, postpartum hemorrhage**, trauma to infant
Precipitous labor nursing care
Side-lying position, IV fluids, oxygen, d/c oxytocin if indicated, assist with emergency delivery, assess mom more frequently for postpartum hemorrhage
