Labor And Delivery Flashcards
What is stage 1 of labor
Onset of labor and last until complete cervical dilation and effacement
What is stage 2 of labor
Complete dilation of cervix until delivery of infant
What is stage 3 of labor
After delivery of infant until delivery of placenta
When do you admit a pt for active labor
Regular contractions and dilation of cervix 3-4cm
Positive rupture of membranes
What are the two stages of stage 1 of labor
Active and latent stage
What is the active stage of labor
From 3-4cm to 10cm dilation,
What is the latent stage of labor
Onset of labor until 3-4cm dilated (slow)
What are the 3 “P’s” of labor
Passenger=size and position of fetus
Power= Stregnth and frequency of uterine contractions
Pelvis= size and shape of maternal pelvis
During what phase of stage 1 do you want to use the cervical exam sparingly
Latent phase to reduce the risk of infection
How often do you check the cervix in active phase
Every 2 hours
What is effacement
Thinning of the cervix, subjective movement
What is station
Relation of fetal head to Ishial spine
What are the 3 diagnostic test for rupture of membranes
Pool test
Nitrazine
Fern test
What is the pool test for testing for rupture of membranes
Collection of fluid pooling in vagina/speculum: ask pt to bear down and more fluid will come
What is the Nitrazine test
If it turns blue it’s positive, its testing the vaginal secreations and amniotic fluid is alkaline
What is the fern test for rupture of membranes
A fern pattern is seen under microscope (estrogen in the amniotic fluid causes crystallization of salts in amniotic fluid when it dries)
What is the most accurate way to measure fetal heart rate
Fetal scalp electrode-used more often for non-reassuring FHT
What is a normal fetal HR
110-160
What is considered a reactive heart rate
2 accelerations of at least 15 bpm over baseline lasting at least 15 seconds over a period of 20 min
What are the 3 types of deceleration
Early
Variable
Late
What is early deceleration
Drop in HR that begins and ends with contractions
What is variable deceleration
Occur at anytime, abrupt drop in HR
What is late deceleration
Begin at the peak of contractions and slowly return to baseline after contraction over
What deceleration is due to the increase vag also tone from compression of head during contractions
Early
What deceleration is due to umbilical cord compression
Variable
What deceleration is a result of uteroplacental insufficiency
Late deceleration
When do you need to take immediate action for a heart rate? (At what rate)
HR <90 for more than 2 minutes
What is used to measure contractions
Totcodynamometer
What are some common indications to induce labor
Pre-eclampsia, non-reassuring FHT, PROM, post-term
What drug causes uterine contractions
Pitocin
What do you need to do to induce labor
Cervical ripening
Pitocin
Amniotomy
What do you need to check for after an amniotomy
Cord prolapse
What is known as intervening to help labor progress, generally by increase uterine contractions
Augmentations of labor
What do you do to augment labor.
AROM and/or Pitocin
What do you need to be sure to check for with AROM
Meconium in fluid…can lead to meconium aspiration
What are the 6 cardinal movements of labor
Engagement Descent Flexion Internal rotation Extension External rotation
What shoulder normally gets impacted with shoulder dystocia
Anterior
What are some complications of shoulder dystocia
Fracture of humerous and clavicle
Brachial plexus injury
Hypoxic brain injury
Death
What diagnosis is made when the head delivers then retracts back
Shoulder dystocia
What is the treatment for shoulder dystocia
McRoberts maneuver
Suprapubic pressure
What is often given to help with the delivery of the placenta
Oxytocin
What are signs of cord seperation
Gush of blood, cord legnthing, and uterine fundal rebound
How much blood loss is considered a postpartum hemorrhage
> 500mL after vaginal
>1,000mL after c-section
What is it called if you have a pt who has a postpartum hemorrhage, is hypovolemic, and failure to lactate
Sheehan syndrome
Was is lack of effective uterine contractions after delivery of placenta
Uterine Atony
What is the leading cause of postpartum hemorrhage
Uterine atony
How does the uterus feel if there is uterine atony
Instead of feeling firm it is soft, enlarged, and boggy
What is the treatment for uterine atony
IV oxytocin and uterine massage
if needed IV misoprostol
If needed IV Hemabate
If needed IV consider tamponade balloon
IF there is more bleeding after deliver what do you want to check for
Retained products of conception
What is torn in a 3rd degree perineal tear
Anal sphinctor and perineal muscle
What is torn in a 2nd degree tear
Perineal muscles
What are the two types of assisted delivery
Vacuum assisted
Forcep assisted
What is the most common reason for a c-section
Previous c-section
What are the signs of a uterine rupture
Abd pain, “pop” sensation, drop in FHR/bradycardia
When do you measure the APGAR score
Check 1 & 5 min after birth
What is a good/normal score for APGAR
What about a poor/severe depression
8-10
0-3
If you have a prenatal rubella titer negative what do you need to do
Give MMR
