Labor and Delivery Flashcards
Cephalic presentation
Head first (vertex, military, brow, face)
Breech presentation
Buttocks first (frank, full, footing)
Shoulder presentation
May require cesarian section
Steps that begin labor
- Fetus descends into the pelvis
- Braxton-hicks contractions begin
- Increase in vaginal discharge and passing of blood
- Cervix softens
Leopolds Maneuver
Method of palpating the fetus to determine position. Aids in locating heart sounds.
Fetal monitoring
Monitor displays fetal heart rate, uterine activity, assesses the strength and duration of contractions.
Fetal heart rate
110-160 bpm
Fetal tachycardia
> 160 bpm
Fetal bradycardia
FHR below 110 ppm
A decrease in FHR indicates
- Hypoxemia
- Acidosis
- Sleep state
Acceleration of FHR
- Indicated by an increase of at least 15 bpm for at least 15 seconds
- Good sign
- Associated with fetal movement
Early decelerations
Occur during contractions to at least 100 ppm, usually indicates the fetus head is against the pelvis or cervix. Rate rebounds after the contraction. This is a normal occurrence.
Late decelerations
Non-reassuring patterns which indicate impaired placental exchange or placental insufficiency.
Pattern begins well after the contraction and returns to baseline after it ends.
Interventions for late decelerations
- improve oxygenation
2. improve blood flow
Variable decelerations
Caused by conditions which restrict blood flow through the umbilical cord.
Is significant when the fetal heart rate declines to 60 bpm and remains for at least 60 seconds before returning to baseline.
Aminoinfusion
Instillation of warm saline into the placenta to reduce pressure on the umbilical cord.
Parts of 1st Stage Labor
- Latent Phase - dilation 1-4 cm, mild contractions
- Active Phase - dilation 4-7 cm, moderate contractions
- Transition phase - dilation 8-10cm, strong contractions
Shoulder presentation
May require cesarian section
Steps that begin labor
- Fetus descends into the pelvis
- Braxton-hicks contractions begin
- Increase in vaginal discharge and passing of blood
- Cervix softens
Leopolds Maneuver
Method of palpating the fetus to determine position. Aids in locating heart sounds.
Fetal monitoring
Monitor displays fetal heart rate, uterine activity, assesses the strength and duration of contractions.
A decrease in FHR indicates
- Hypoxemia
- Acidosis
- Sleep state
Acceleration of FHR
- Indicated by an increase of at least 15 ppm for at least 15 seconds
- Good sign
- Associated with fetal movement
Interventions for variable decelerations
- reposition the mother
- administer oxygen
- discontinue pitocin
- notify HCP
- aminoinfusion
Aminoinfusion
Instillation of warm saline into the placenta to reduce pressure on the umbilical cord.
Hypertonic Uterine Activity
Assessment of uterine activity including frequency, duration, intensity and resting tone.
Done by palpation or intrauterine catheter.
There should be 60+ seconds between contractions.
50-75mm/Hg first stage
up to 110mm/Hg second stage
Resting tone of uterus
5-15 mm/Hg
Hypertonic Uterus
Uterine resting tone is high reducing uterine blood flow and reducing fetal oxygen levels.
Non-reassuring fetal heart rate patterns
- Tachycardia
- Bradycardia
- Late deceleration
- Prolonged deceleration
- Hypertonic uterine activity
- Low or absent variability
- Variable decelerations where FHR is lower than 70 ppm and stays for 60+ seconds.
Four Stages of Labor
- Cervical Dilation
- Expulsion of Fetus
- Separation and expulsion of placenta
- Recovery
Parts of 1st Stage Labor
- Latent Phase - dilation 1-4 cm, mild contractions
- Active Phase - dilation 4-7 cm, moderate contractions
- Transition phase - dilation 8-10cm, strong contractions
Schultze mechanism
Center of placenta separates first - shiny, fetal side
Duncan mechanism
Margin of placenta separates first - dull, rough, red side - maternal side
Local anesthesia
Administered just before birth, no effect on fetus
Lumbar Epidural Block
Injected into L3, L4. Numbs contraction pain, perineum and vagina. May cause hypotension, bladder distention and longer phase 2. Mother should be positioned on left side, IV fluids administered, observe for effects of opioid.
Intrathecal opioid
Injected into the subarachnoid space, rapid onset.
Subarachnoid (spinal) block
Injected into subarachnoid space L4,L5. Administered just before birth, numbs uterus, vagina, perineum and lower extremities. Mother must lie flat for 8-12 hours after.
Induction
Administration of pitocin infusion until contractions of 2-3 minutes lasting up to 60 seconds is achieved.
Bishop Score
Used to determine maternal readiness for labor, evaluates both the cervical status and fetal position. Used prior to the induction of labor. 5 factors evaluated with a score of 0 or 3. 6+ indicates a readiness for induction.
Amniotomy
Artificial rupture of the membranes by the HCP or midwife to stimulate labor. Increases the risk of prolapsed umbilical cord and infection
External version
Manipulation of the fetus from an abnormal presentation to a normal position. Used at 34 weeks. IV fluids may be administered to enable easier fetal manipulation. Tocolytic medication may be administered. Abdominal wall then manipulated.
Tocolytic medications
Used to delay delivery for up to 48 hours.
Episiotomy
Incision made to the perineum to enlarge the vaginal outlet and facilitate delivery.
Forceps delivery
Spoon-like blades used to assist in delivery of the head.
Vacuum extraction
Cap-like suction is applied to the fetal head to facilitate extraction.
Station
Refers to how far the baby’s head has descended into the mother’s pelvis. At 0 is it even with the ischial spines (lowest bony part of pelvis). At -1 it is 1 cm above this, at +1 it is 1 cm below.
Treatment for hypertonic contractions
Administer analgesia and encourage rest.
Dystocia
Labor that is harder or more prolonged than expected.
Disseminated Intravascular Coagulation (DIC)
Condition in which clotting factors are consumed leading to widespread bleeding.
The presence of petechiae, oozing from injection sites, and hematuria are signs associated with DIC.
