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Maternity & OB > Labor and Delivery > Flashcards

Labor and Delivery Flashcards

1
Q

What does labor include

A

onset of uterine contractions until the expulsion of the placenta

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2
Q

What does the 4 stages of labor include?

A
  • dilation and effacement
  • expulsion of the fetus
  • expulsion of the placenta
  • recovery
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3
Q

how is labor triggered in the mother? how are the hormones related?

A
  • uterine muscles are stretched to threshold
  • pressure on cervix -> oxytocin released
  • oxytocin stimulates contractions
  • estrogen increases, progesterone decreases
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4
Q

what affects labor in the fetus?

A
  • corisol increases -> increased prostaglandins -> stimulates uterine contraction
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5
Q

what are the s/s of impending labor?

A
  • Braxton-Hicks contractions
  • Cervical changes
  • Nesting
  • Weight loss
  • Losing mucus plug
  • Low backache
  • Bloody show
  • Lightening
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6
Q

what are the cervical changs with labor?

A
  • softens
  • moves posterior to anterior
  • thins and dilates
  • increased vaginal discharge
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7
Q

what is lightening in impending labor

A
  • fetus descends into the pelvis -> less pressure on diaphragm -> easier for mom to breathe
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8
Q

what are the 5 P’s affecting labor and its significance?

A

significance: these are all factors that can affect labor

  1. Power of labor
  2. Passenger
  3. Position
  4. Passage
  5. Psyche
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9
Q

what is the powers of labor

A

strength and timing of contractions

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10
Q

what does primary powers of labor include?

A
  • Dilation and effacement
  • Uterine contractions
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11
Q

what is the pupose of palpating the uterus during contractions

A

to test the strength of each contraction

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12
Q

what is the difference between the UC palpation categories - mild, moderate, and strong

A

Mild
* easily indented
* similar to tip of nose

Moderate
* resistant to indentation
* chin

Strong
* can’t be indented
* forehead

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13
Q

what are the factors to assess during a UC

A
  • duration: start to end 45-50 secs
  • intensity: measured by palpation, IU pressure catheter, tocodynamometer
  • frequency: strart to the beginning of another 3-4 mins

DIF

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14
Q

what are the 3 phases of contraction?

A
  1. increment phase
  2. acme phase
  3. decrement phase
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15
Q

what does the increment phase include

A

start in the fundus with peristaltic contractions towards the cervix
* longest part of the contractions

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16
Q

what does the acme phase include

A
  • peak intensity
  • shortest part of contractions
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17
Q

what does the decremnt phase include?

A
  • uterine muscles start to relax
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18
Q

what does the secondary powers include?

A

voluntary expulsive efforts; passage to birth canal

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19
Q

when should the mother start pushing

A

when the cervix is dilated to 10cm, effacement 100%

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20
Q

what is the ferguson reflex

A

activated stretch receptors tell the hypothalamus to release more oxytocin -> stronger contractions during secondary phase of powers of labor

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21
Q

What are the 2 different parts of the bony pelvis and what do they include?

A

False pelvis
* shallow upper part
True pelvis
* inlet, midpelvis, and outlet

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22
Q

what does a gynecoid pelvis look like

A

round circle -> optimal

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23
Q

what does the android pelvis look like

A

heart shaped with limits to the posterior -> more difficult

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24
Q

what does the anthropoid pelvis look like

A

oval shaped egg, narrow pubic arch; adequate for childbirth

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25
Q

what does the platypelloid pelvis look like

A

flat inlet, short AP, transverse oval-heart; difficult

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26
Q

what hormones contributes to softening of the cartilages and increasing elasticity of the ligaments

A

estrogen and relaxin

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27
Q

how does the fetal skull impact Passenger (through the birth canal)

A
  • largest portion to go through
  • can mold to fit into pelvis
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28
Q

what is used on the skull to determine fetal head positioning through the canal

A

fontanels are used during vaginal exam

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29
Q

how does fetal attitude or posture affect the birthing process

A
  • normal - back convex, chin to chest, thighs over abd, knees bent
  • abnormal - back concave, head extended -> difficult birth
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30
Q

how does fetal lie affect birth

A
  • longitudinal lie: parallel is good
  • transver lie: perpendicular is not good
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31
Q

what are the 4 different presentations in childbirth

A
  • cephalic: head first
  • breech: buttock or feet first
  • shoulder: transverse
  • compound: presenting part + another part (head and hand)
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32
Q

what 3 parts of the cephalic can be presented during birth

A
  • vertex: head flexed, chin touching thorax
  • frontum (brow): partial extension of neck
  • mentum (face): occiput arching to fetal back
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33
Q

what are the 4 different types of breech presentations

A
  • complete: buttocks 1st, legs tucked
  • Frank breech: buttocks 1st, legs extended
  • incomplete: extension of 1 or both legs (footling breech)
  • shoulder
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34
Q

In the 3 letter abbreviation for fetal position, what does O, S, M, A indicate

A
  • O: occiput
  • S: sacrum
  • M: mentum
  • A(cromion): shoulder
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35
Q

how to tell L vs R, A vs. P in the 3 letter abbreviation for fetal positioning

A

Always look at the occiput to identify
* back of head towards back of mom is posterior
* transverse is occiput parallel

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36
Q

what does each letter of the 3-letter abbreviation for fetal positioning tell you

A
  1. L or R
  2. presenting part
  3. A, P or transverse
37
Q

what does station tell you related to fetal position

A

measures how far the baby has descended into the pelvis: inlet, midpelvis, and outlet
* negative: higher in ischial spine
* goes from -5 -> 0 -> +5
* change from negative to positive # indicates the labor is progressing

38
Q

what does monitoring the mother’s psyche include

A
  • support system
  • hx of abuse?
  • safety of birth setting
  • is a Doula present
  • cultural sensitivity

increased anxiety and stress -> slower labors

39
Q

describe the differences between true vs. false labor

A

True labor
* regular contractions that get stronger and closer
* cervical changes
* presenting part becomes engaged in pelvis

False
* irregular contractions that stop with position changes
* no changes in cervix
* fetus not in the pelvis

40
Q

what are the 7 cardinal movements of labor

A
  1. engagement
  2. descent
  3. flexion
  4. internal rotation
  5. extension
  6. external rotation
  7. expulsion

EDFIEEE

41
Q

7 cardinal movements of labor: Engagement

A

greatest diameter of head passes through the inlet in a left or right occipto-transverse position

42
Q

7 cardinal movements of labor: Descent

and reason for this to occur

A

movement of fetus through the birth canal d/t:
* uterine contractions
* amniotic fluid pressure
* abdominal muscle contraction

43
Q

7 cardinal movements of labor: Flexion

A
  • fetal head comes into contact with pelvic floor -> cervical flexion
44
Q

7 cardinal movements of labor: Internal rotation

A
  • head rotates from L/R occipto-transverse into occipto-anterior position
  • results in crowning: widest part of the head through the narrowest part of the pelvis
45
Q

7 cardinal movements of labor: Extension

A
  • occiput slips beneath suprapubic arch as the head extends and the neck pivots against the arch
  • extension of head -> stretches perineum
46
Q

7 cardinal movements of labor: External rotation

A
  • head externally rotates to face the L/R medial-thigh of the mom
  • shoulders rotate from transverse to A-P position
  • shoulders realign with head
47
Q

7 cardinal movements of labor: Expulsion

A
  • get upwards traction: anterior shoulder below suprapubic arch
  • then downwards traction: posterior shoulder out
  • baby out
48
Q

what are the best positions for the fetus during labor

A
  • ROA
  • LOA
    OA thank OkAy
49
Q

what are the worst positions for the fetus during labor

A
  • OP: oh poop not good
  • OT: oh trouble
50
Q

what does the 1st stage of labor include

A

onset of labor to complete vervical dilation & effacement

51
Q

what are the 3 phases of the 1st stage of labor based on cervix size

A
  • latent phase: up to 5cm
  • active phase: > 6cm
  • transition phase: 8-10cm
52
Q

what occurs during the latent phase of the 1st stage of labor

A
  • amniotic sac breaks
  • contractions becomes stronger and closer
  • blood-tinged mucus
  • cramps, backaches
  • CO increases, HR increases
  • GI motility slows
53
Q

what assessments should be done & how frequently for the mother during the 1st stage of labor

A
  • response to labor and pain q30 mins
  • cervical changes
  • VS qhr, T q2hrs
  • bladder q30 mins, encourage voiding q2hrs
54
Q

how often should you monitor the FHR during the 1st stage of labor

A

q 30 mins

55
Q

The ________ ________ is done to assess the fetal position during 1st stage of labor

A

Leopold Maneuver

56
Q

what interventions should be done during the 1st stage of labor

A
  • Encourage frequent position changes
  • Labs: CBC, clot time, urinalysis, blood typing & Rh
  • IV access
  • Pain management
57
Q

what occurs during the active phase in the 1st stage of labor

A
  • contractions q2-5 mins w/ duration ~1min
  • increased blood-tinged mucus
  • intense pain - epidural
  • N/V, exhaustion, diaphoresis, trembling
  • strong urge to bear down and push
58
Q

where are the external vs. internal FHR monitoring devices placed

A

external:
* toco transducer: upper abd
* ultrasound transducer: lower abd

internal:
* fetal scalp electrode
* intrauterine pressure catheter

59
Q

contraindications for IUPC

A
  • chorioamnionitis: bacterial infection of the amniotic fluid, placenta, and fetal membranes
  • herpes, group B strep
  • placenta previa, undiagnosed vaginal bleeding
60
Q

the cervix must be at least ____ cm at least to place a FSE & IUPC

A

2 cm

61
Q

What is normal FHR

A

110-160 bpm

62
Q

what defines as tachycardia in FHR

A

160+ bpm for at least 10 mins

63
Q

what is bradycardia for FHR

A

less than 110 bpm for at least 10 mins

64
Q

how do you count the baseline FHR

A

average HR over a 10 mins period rounded to the nearest 5 bpm

65
Q

what defines minimal, moderate, and marked amplitude change in FHR monitoring?

A
  • minimal: undetectable below 5bpm range
  • moderate (normal): peak to trough is less than 25 bpm
  • marked: amplitude changes above 25bpm
66
Q

what does having a moderate normal amplitude in FHR indicate

A

good oxygenation
normal acid-base balance

67
Q

what does normal accelerations in FHR look like

A

15 bpm x 15 secs < 2 mins

68
Q

what does early decelerations look like in FHR

A

shallow, bowel shapes that mirror the contractions

69
Q

are early decelerations good or bad? what does it indicate

A

it is good
indicates head compression

70
Q

what do variable decelerations look like on FHR monitor

A

“V-dips”
* abrupt decrease in FHR of less than 30 seconds to nadir

71
Q

what are normal vs. abnormal variable decelerations in terms of time frames

A

normal
* < 60 secs, rapid return to baseline
abnormal
* prolonged, overshot tachycardia, repetitive

72
Q

what do late decelerations look like in FHR

A

dips after contractions

73
Q

Pneumonic for FHR monitoring changes & their associated issue

A

VEAL CHOP
* V: variable decelerations
* E: early decelerations
* A: acceleratinos
* L: late accelerations

  • C: cord compression -> change mom position
  • H: head compression -> happy
  • O: okay O2 for baby good
  • P: uteroplacental insufficiency
74
Q

what is the accronym for what to do if the FHR shows late decelerations

A

ROAD
R: reposition to left side
O: O2 via face mask
A: alert PCP
D: d/c oxytocin, give tocolytics (terbutaline)

75
Q

what does the 2nd stage of labor include during the latent and active phase

A
  • latent phase: fully dilated with no push
  • active pushing phase: bearing down
76
Q

what are the interventions for the 2nd stage of labor

A
  • instruct to bear down & breathe between contractions
  • check FHR q5-15 mins
  • check infant resuscitation equippment
  • support fetal head and perineum
  • episiotomies: sx incision of perineum
77
Q

what is recommended instead of episiotomies

A

warm compresses, massage the perineum, may use oil

78
Q

what’s the difference between 1st through 4th degree perineum lacerations

A
  1. injury to skin and subq tissue
  2. into perineal body
  3. into external anal sphincter muscle
  4. into rectal mucosa and anal spincter
79
Q

what does the 3rd stage of labor include

A

delivery of the placenta

80
Q

what mechanism does the uterine muscles do to deliver the placenta

A
  • uterine muscles contract naturally
  • uterus becomes smaller
  • decreased SA causes placenta to pull away and the shearing forces cause placental detachment
81
Q

what are s/s of impending placental delivery

A
  • rising of the uterus into a ball shape
  • lengthening of the umbilical cord
  • sudden gush of blood
82
Q

what to do if the placenta is retained

A
  • give uterotonics
  • manual removal
83
Q

what occurs after the placenta is delivered

A
  • skin-to-skin contact
  • uterine massage to prevent hemorrhage
  • PCPs give oxytocin with controlled traction on umbilical cord
84
Q

VS should be monitored every ____ hrs during the 3rd & 4th stage of labor

A

q15 mins

85
Q

how often should you check the fundus firmness in the 4th stage of labor

A

q 15 mins

86
Q

what should you assess during the 4th stage of labor

A
  • fundus until firm
  • check perineum for unusual swelling or hematoma
  • assess lochia (vaginal discharge) q15mins
  • assess placenta for cord
  • check blood flow amount, repair episiotomy
  • urine output
  • first breastfeeding
87
Q

what do you do if the fundus feels soft (uterine atony)

A
  • massage and icepack
88
Q

how should the lochia appear over the course of up to a month

A

red -> pink/brown -> white/clear

89
Q

what are the abnormal s/s that should be reported to the PCP after labor

A
  • large clots
  • malodorous odor
  • excessive bleeding
  • Fever

Maternity & OB (4 decks)

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