Labor and Delivery Flashcards
What does labor include
onset of uterine contractions until the expulsion of the placenta
What does the 4 stages of labor include?
- dilation and effacement
- expulsion of the fetus
- expulsion of the placenta
- recovery
how is labor triggered in the mother? how are the hormones related?
- uterine muscles are stretched to threshold
- pressure on cervix -> oxytocin released
- oxytocin stimulates contractions
- estrogen increases, progesterone decreases
what affects labor in the fetus?
- corisol increases -> increased prostaglandins -> stimulates uterine contraction
what are the s/s of impending labor?
- Braxton-Hicks contractions
- Cervical changes
- Nesting
- Weight loss
- Losing mucus plug
- Low backache
- Bloody show
- Lightening
what are the cervical changs with labor?
- softens
- moves posterior to anterior
- thins and dilates
- increased vaginal discharge
what is lightening in impending labor
- fetus descends into the pelvis -> less pressure on diaphragm -> easier for mom to breathe
what are the 5 P’s affecting labor and its significance?
significance: these are all factors that can affect labor
- Power of labor
- Passenger
- Position
- Passage
- Psyche
what is the powers of labor
strength and timing of contractions
what does primary powers of labor include?
- Dilation and effacement
- Uterine contractions
what is the pupose of palpating the uterus during contractions
to test the strength of each contraction
what is the difference between the UC palpation categories - mild, moderate, and strong
Mild
* easily indented
* similar to tip of nose
Moderate
* resistant to indentation
* chin
Strong
* can’t be indented
* forehead
what are the factors to assess during a UC
- 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
what are the 3 phases of contraction?
- increment phase
- acme phase
- decrement phase
what does the increment phase include
start in the fundus with peristaltic contractions towards the cervix
* longest part of the contractions
what does the acme phase include
- peak intensity
- shortest part of contractions
what does the decremnt phase include?
- uterine muscles start to relax
what does the secondary powers include?
voluntary expulsive efforts; passage to birth canal
when should the mother start pushing
when the cervix is dilated to 10cm, effacement 100%
what is the ferguson reflex
activated stretch receptors tell the hypothalamus to release more oxytocin -> stronger contractions during secondary phase of powers of labor
What are the 2 different parts of the bony pelvis and what do they include?
False pelvis
* shallow upper part
True pelvis
* inlet, midpelvis, and outlet
what does a gynecoid pelvis look like
round circle -> optimal
what does the android pelvis look like
heart shaped with limits to the posterior -> more difficult
what does the anthropoid pelvis look like
oval shaped egg, narrow pubic arch; adequate for childbirth
what does the platypelloid pelvis look like
flat inlet, short AP, transverse oval-heart; difficult
what hormones contributes to softening of the cartilages and increasing elasticity of the ligaments
estrogen and relaxin
how does the fetal skull impact Passenger (through the birth canal)
- largest portion to go through
- can mold to fit into pelvis
what is used on the skull to determine fetal head positioning through the canal
fontanels are used during vaginal exam
how does fetal attitude or posture affect the birthing process
- normal - back convex, chin to chest, thighs over abd, knees bent
- abnormal - back concave, head extended -> difficult birth
how does fetal lie affect birth
- longitudinal lie: parallel is good
- transver lie: perpendicular is not good
what are the 4 different presentations in childbirth
- cephalic: head first
- breech: buttock or feet first
- shoulder: transverse
- compound: presenting part + another part (head and hand)
what 3 parts of the cephalic can be presented during birth
- vertex: head flexed, chin touching thorax
- frontum (brow): partial extension of neck
- mentum (face): occiput arching to fetal back
what are the 4 different types of breech presentations
- complete: buttocks 1st, legs tucked
- Frank breech: buttocks 1st, legs extended
- incomplete: extension of 1 or both legs (footling breech)
- shoulder
In the 3 letter abbreviation for fetal position, what does O, S, M, A indicate
- O: occiput
- S: sacrum
- M: mentum
- A(cromion): shoulder
how to tell L vs R, A vs. P in the 3 letter abbreviation for fetal positioning
Always look at the occiput to identify
* back of head towards back of mom is posterior
* transverse is occiput parallel
what does each letter of the 3-letter abbreviation for fetal positioning tell you
- L or R
- presenting part
- A, P or transverse
what does station tell you related to fetal position
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
what does monitoring the mother’s psyche include
- support system
- hx of abuse?
- safety of birth setting
- is a Doula present
- cultural sensitivity
increased anxiety and stress -> slower labors
describe the differences between true vs. false labor
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
what are the 7 cardinal movements of labor
- engagement
- descent
- flexion
- internal rotation
- extension
- external rotation
- expulsion
EDFIEEE
7 cardinal movements of labor: Engagement
greatest diameter of head passes through the inlet in a left or right occipto-transverse position
7 cardinal movements of labor: Descent
and reason for this to occur
movement of fetus through the birth canal d/t:
* uterine contractions
* amniotic fluid pressure
* abdominal muscle contraction
7 cardinal movements of labor: Flexion
- fetal head comes into contact with pelvic floor -> cervical flexion
7 cardinal movements of labor: Internal rotation
- 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
7 cardinal movements of labor: Extension
- occiput slips beneath suprapubic arch as the head extends and the neck pivots against the arch
- extension of head -> stretches perineum
7 cardinal movements of labor: External rotation
- 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
7 cardinal movements of labor: Expulsion
- get upwards traction: anterior shoulder below suprapubic arch
- then downwards traction: posterior shoulder out
- baby out
what are the best positions for the fetus during labor
- ROA
- LOA
OA thank OkAy
what are the worst positions for the fetus during labor
- OP: oh poop not good
- OT: oh trouble
what does the 1st stage of labor include
onset of labor to complete vervical dilation & effacement
what are the 3 phases of the 1st stage of labor based on cervix size
- latent phase: up to 5cm
- active phase: > 6cm
- transition phase: 8-10cm
what occurs during the latent phase of the 1st stage of labor
- amniotic sac breaks
- contractions becomes stronger and closer
- blood-tinged mucus
- cramps, backaches
- CO increases, HR increases
- GI motility slows
what assessments should be done & how frequently for the mother during the 1st stage of labor
- response to labor and pain q30 mins
- cervical changes
- VS qhr, T q2hrs
- bladder q30 mins, encourage voiding q2hrs
how often should you monitor the FHR during the 1st stage of labor
q 30 mins
The ________ ________ is done to assess the fetal position during 1st stage of labor
Leopold Maneuver
what interventions should be done during the 1st stage of labor
- Encourage frequent position changes
- Labs: CBC, clot time, urinalysis, blood typing & Rh
- IV access
- Pain management
what occurs during the active phase in the 1st stage of labor
- 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
where are the external vs. internal FHR monitoring devices placed
external:
* toco transducer: upper abd
* ultrasound transducer: lower abd
internal:
* fetal scalp electrode
* intrauterine pressure catheter
contraindications for IUPC
- chorioamnionitis: bacterial infection of the amniotic fluid, placenta, and fetal membranes
- herpes, group B strep
- placenta previa, undiagnosed vaginal bleeding
the cervix must be at least ____ cm at least to place a FSE & IUPC
2 cm
What is normal FHR
110-160 bpm
what defines as tachycardia in FHR
160+ bpm for at least 10 mins
what is bradycardia for FHR
less than 110 bpm for at least 10 mins
how do you count the baseline FHR
average HR over a 10 mins period rounded to the nearest 5 bpm
what defines minimal, moderate, and marked amplitude change in FHR monitoring?
- minimal: undetectable below 5bpm range
- moderate (normal): peak to trough is less than 25 bpm
- marked: amplitude changes above 25bpm
what does having a moderate normal amplitude in FHR indicate
good oxygenation
normal acid-base balance
what does normal accelerations in FHR look like
15 bpm x 15 secs < 2 mins
what does early decelerations look like in FHR
shallow, bowel shapes that mirror the contractions
are early decelerations good or bad? what does it indicate
it is good
indicates head compression
what do variable decelerations look like on FHR monitor
“V-dips”
* abrupt decrease in FHR of less than 30 seconds to nadir
what are normal vs. abnormal variable decelerations in terms of time frames
normal
* < 60 secs, rapid return to baseline
abnormal
* prolonged, overshot tachycardia, repetitive
what do late decelerations look like in FHR
dips after contractions
Pneumonic for FHR monitoring changes & their associated issue
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
what is the accronym for what to do if the FHR shows late decelerations
ROAD
R: reposition to left side
O: O2 via face mask
A: alert PCP
D: d/c oxytocin, give tocolytics (terbutaline)
what does the 2nd stage of labor include during the latent and active phase
- latent phase: fully dilated with no push
- active pushing phase: bearing down
what are the interventions for the 2nd stage of labor
- 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
what is recommended instead of episiotomies
warm compresses, massage the perineum, may use oil
what’s the difference between 1st through 4th degree perineum lacerations
- injury to skin and subq tissue
- into perineal body
- into external anal sphincter muscle
- into rectal mucosa and anal spincter
what does the 3rd stage of labor include
delivery of the placenta
what mechanism does the uterine muscles do to deliver the placenta
- uterine muscles contract naturally
- uterus becomes smaller
- decreased SA causes placenta to pull away and the shearing forces cause placental detachment
what are s/s of impending placental delivery
- rising of the uterus into a ball shape
- lengthening of the umbilical cord
- sudden gush of blood
what to do if the placenta is retained
- give uterotonics
- manual removal
what occurs after the placenta is delivered
- skin-to-skin contact
- uterine massage to prevent hemorrhage
- PCPs give oxytocin with controlled traction on umbilical cord
VS should be monitored every ____ hrs during the 3rd & 4th stage of labor
q15 mins
how often should you check the fundus firmness in the 4th stage of labor
q 15 mins
what should you assess during the 4th stage of labor
- 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
what do you do if the fundus feels soft (uterine atony)
- massage and icepack
how should the lochia appear over the course of up to a month
red -> pink/brown -> white/clear
what are the abnormal s/s that should be reported to the PCP after labor
- large clots
- malodorous odor
- excessive bleeding
- Fever
