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RGU Exam 2 > Labor and Delivery > Flashcards

Labor and Delivery Flashcards

1
Q

Changes that occur prior to labor

A
  1. Uterine contractions w/ no cervical dilation

*Braxon Hicks contractions

  1. Fetal head descends into the pelvis
  2. Blood tinged mucous = effacement w/ extrusion of mucous from the endocervical glands
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2
Q

Mechanisms of Labor

A
  • AKA cardinal movements
  • Refers to the changes of the position of the fetus as it passes thru the birth canal
  • The occipital portion of the head descends into the pelvis, rotates toward the larget pelvic segment to accommodate the maternal bondy pelvis
  • Mechanisms are accomplished by contractions of the uterus and maternal expulsive force
  • Usual presentation is vertex, where the occiput of the head is in the lowest w/ regard to the longitudinal axis of the mother
  • Pelvic inlet = from the sacral promontory to the symphysis pubis
  • Biparietal diameter = largest part of the head
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3
Q

The Cardinal Movements of Labor

A
  • Engagement
  • Descent
  • Flexion
  • Internal rotation
  • Extension
  • External rotation
  • Expulsion
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4
Q

Mechanisms of labor - Engagement phase

A
  • Engagement

*biparietal diameter of the head is below the pelvic intlet

*palpate presenting part below the level of the ischial spines

*suggests the bony pelvis is adequate to allow descent of the fetal head

  • Descent
  • Flexion
  • Internal rotation
  • Extension
  • External rotation
  • Expulsion
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5
Q

Mechanisms of labor - Descent phase

A
  • Engagement
  • Descent

*movement of the fetus downward

*greatest rate occurs during the latter portions of the 1st and 2nd stage of labor

  • Flexion
  • Internal rotation
  • Extension
  • External rotation
  • Expulsion
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6
Q

Mechanisms of labor - Flexion phase

A
  • Engagement
  • Descent
  • Flexion

*fetal head flexed w/ chin to chest

*allows for the smallest diameters of the fetal head into the pelvis

  • Internal rotation
  • Extension
  • External rotation
  • Expulsion
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7
Q

Mechanisms of labor - Internal rotation phase

A
  • Engagement
  • Descent
  • Flexion

- Internal rotation

*occiput of the head rotates toward the maternal symphysis pubis or sacrum

  • Extension
  • External rotation
  • Expulsion
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8
Q

Mechanisms of labor - Extension phase

A
  • Engagement
  • Descent
  • Flexion
  • Internal rotation

- Extension

*as the fetal head reaches the introitus, it extends to accommodate the upward curve of the birth canal

  • External rotation
  • Expulsion
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9
Q

Mechanisms of labor - External rotation phase

A
  • Engagement
  • Descent
  • Flexion
  • Internal rotation
  • Extension

- External rotation

*after delivery of the head, the head rotates to the shoulders

*also called restitution

  • Expulsion
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10
Q

Mechanisms of labor - Expulsion phase

A
  • Engagement
  • Descent
  • Flexion
  • Internal rotation
  • Extension
  • External rotation

- Expulsion

*delivery of the fetus

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11
Q

Stages of labor

A
  • 1st stage = onset of labor to full cervical dilation
  • 2nd stage = full dilation to delivery of the baby
  • 3rd stage = immediately after delivery of the baby to delivery of the placenta
  • 4th stage = immediate postpartum period to 2hrs after delivery of placenta
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12
Q

1st stage of labor

A
  • Onset of labor to full cervical dilation
  • Further divided by friedman into phases
  • Friedman’s curve plots dilation against time and station
  • Late phase is from 0-4cm

*may last 20hr in a primiparous or 14hrs in a multiparous

*change of the slope on the curve

*factors that affect latent phase: sedation, epidurals, unripe cervix

  • Active phase is from 4-10cm

*usually ~4-6hrs

*also called the maximal phase (rapid change in cervical dilation)

*primips dilate ~1cm/hr

*multips dilate ~1.5cm/hr

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13
Q

2nd stage of labor

A
  • Full dilation to delivery
  • Usually ~2hrs
  • Most of the cardinal mvmts are done here
  • May be prolonged due to sedation, epidural, persistent occiput posterior
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14
Q

3rd stage of labor

A
  • Immediately after delivery of the baby to delivery of the placenta
  • May last 30min or longer
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15
Q

4th stage of labor

A
  • Immediate postpartum period to 2hrs after delivery of placenta
  • Most likely to have complications of post partum hemorrhage during this time
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16
Q

Management of labor: 1st stage

A
  • Maternal vital signs every 30min
  • NPO except ice
  • Labs: CBC, Blood type and screen, RPR
  • IV line for hydration and access to the intravascular space
  • Foley catheter (prn)
  • External fetal monitor
  • Analgesics and/or anesthetics: demerol, stadol nubain, fentanyl, epidural blocks, spinal blocks, pudendel or local blocks
  • Pelvic exams
  • May perform artificial rupture of membranes
  • Monitor for adequate contraction pattern
  • Need contractions strong enough and frequently enough to dilate cervix
  • Can measure strength of contractions w/ intrauterine pressure catheter by adding Montevideo units

*need contraction >200 MVU to dilate cervix

17
Q

Management of labor: 2nd stage

A
  • Begin pushing (valsalva maneuver) to increase intraabdominal pressure to aid in fetal descent
  • Molding of the fetal head occurs to adjust to the bony pelvis
  • Patient in dorsal lithotomy position
  • Slow and controlled delivery of the fetal head
  • Suction mouth and nose
  • Clamp and cut cord
  • Baby to warmer
  • Obtain cord blood
  • Obtain umbilical cord blood for stem cell banking
18
Q

Management of labor: 3rd stage

A
  • Delivery of placenta- usually note a gush of blood and umbilical cord lengthens
  • Suprapubic pressure and gentle traction on cord to deliver placenta
  • Do not pull on cord

*causes inversion of uterus or avulsion of cord

  • May take 30min to deliver
  • Check cord for vessels, inspect placenta
  • Inspect perineum, vaginal canal, cervix, rectum for lacerations and repair them
19
Q

Management of labor: 4th stage

A
  • First 1-2hrs after delivery
  • Watch for post partum hemorrhage and uterine atony
  • Vital signs evey 15min
  • Fundal and bleeding checks every 15min
  • Keep NPO and IV access

RGU Exam 2 (21 decks)

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