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Maternity > Labor and Delivery > Flashcards

Labor and Delivery Flashcards

1
Q

Stages of Labor: First Stage

A 
Latent Phase
- 0 to 3 cm
- onset of labor
- frequency: 5 to 30 mins
- duration: 30 to 45 seconds 
Active Phase
- 4 to 7 cm
- contractions are more regular, moderate to strong
- frequency: 3 to 5 mins
- duration: 40 to 70 seconds 
Transition Phase
- 8 to 10 cm
- contractions are strong to very strong 
- frequency: 2 to 3 mins 
- duration: 45 to 90 seconds
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2
Q

Stages of Labor: Second Stage

A
  • Full dilation

- Progresses to intense contractions every 1 to 2 mins

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3
Q

Stages of Labor: Third Stage

A
  • Delivery of the neonate to delivery of the placenta
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4
Q

Stages of Labor: Fourth Stage

A
  • Delivery of placenta to maternal stabilization of vital signs
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5
Q

Rupture of membranes

A
  • Spontaneous rupture of membranes can initiate labor or can occur anytime during labor
  • Prolonged rupture of membranes greater than 24 hours before delivery of fetus can lead to an infection
  • Immediately following the ROM, a nurse should assess the FHR for abrupt decelerations, which are indicative of fetal distress to rule out umbilical cord prolapse
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6
Q

Five P’s

A
  • Passenger
  • Passageway
  • Powers
  • Position
  • Psychological response
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7
Q

Leopold maneuvers

A

Performing external palpations of the maternal uterus through the abdominal wall to determine the following

  • number of fetuses
  • presenting part, fetal lie, and fetal attitude
  • degree of descent of the presenting part into the pelvis
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8
Q

Assess uterine labor contraction characteristics

A
  • Frequency
  • Duration
  • Intensity
    Resting tone of uterine contractions
  • a prolonged contraction duration (greater than 90 sec.) or too frequent contractions (more than 5 min a 10 minute period) without sufficient time for uterine relaxation in between can reduce blood flow to the placenta
  • this can result in fetal hypoxia and decreased FHR
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9
Q

Continuous electronic fetal monitoring

A
  • Ultrasound transducer over the client’s abdomen, which records the FHR pattern, and a tocotransducer on the fungus that records the uterine contractions
  • A normal FHR baseline at term is 110 to 160 bpm
  • Expected variability should be moderate variability
  • Periodic changes occur with uterine contractions. Ex) accelerations and decelerations
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10
Q

Accelerations

A

An increase in the FHR above the baseline
- healthy fetal/placental exchange
- uterine contractions
- intact fetal CNS response to fetal movement
- fundal pressure
No interventions required

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11
Q

Fetal Bradycardia

A

FHR less than 110 bpm for 10 min or more
- uteroplacental insufficiency
- umbilical cord prolapse
- maternal hypotension
- prolonged umbilical cord compression
Assist the client to a side-lying positino
Administer oxygen

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12
Q

Fetal tachycardia

A 
FHR greater than 160 bpm
- maternal infection 
- maternal dehydration 
Administer prescribed antipyretics
Administer oxygen
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13
Q

Early Deceleration

A

Slowing of FHR with start of contraction with return of FHR to baseline at end of contraction
- compression of the fetal head resulting from uterine contraction
- vaginal exam
- fundal pressure
No interventions required

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14
Q

Late Deceleration

A 
Slowing of FHR after contraction has started with return of FHR to baseline well after contraction has ended 
- uteroplacental insufficiency causing inadequate fetal oxygenation 
- Preeclampsia
- Maternal hypotension or diabetes
- placental previa or abruption 
Place client in side lying
Administer oxygen 
Discontinue oxytocin and call doctor
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15
Q

Variable Deceleration

A

Transitory, abrupt slowing of FHR less than 110/min
- umbilical cord compression
- short cord
- prolapsed cord
Reposition client form side to side or knee chest
Administer oxygen

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16
Q

First Stage of labor

A

Lasts from onset of regular uterine contractions to full effacement and dilation of cervix

  • Cervical dilation is the single most important indicator of the progress of labor
  • when there is suspected ROM, the nurse should first assess the FHR to ensure there is no fetal distress from possible umbilical cord prolapse
  • discourage pushing efforts until the cervix is fully dilated
17
Q

Second Stage of labor

A

Lasts from the time the cervix is fully dilated to the birth of the fetus
- Promote rest between contractions

18
Q

Third Stage of labor

A

Lasts from the birth of the fetus until the placenta is delivered
Placental separation from the uterus as indicated by
- funds firmly contracting
- swift gush of dark blood
- umbilical cord appears to lengthen as placenta descends
- Instruct the client to push once findings of placental separation are present

19
Q

Fourth Stage

A

Begins with the delivery of the placenta and includes at least the first 2 hours after birth

  • assess vitals q 15 mins for the first two hours
  • assess funds and loch q 15 mins for the first hour
  • massage the uterine funds and/or administer oxytocics as prescribed to maintain uterine tone and to prevent hemorrhage
20
Q

Cervical Ripening

A

Def: increases readiness for labor through promotion of ervical softening, dilation, and effacement

21
Q

Induction of Labor

A

Def: the deliberate initiation of uterine contractions to stimulate labor before spontaneous onset to bring about the birth

  • administration of IV oxytocin
  • nipple stimulation to trigger release of endogenous oxytocin
22
Q

Episiotomy

A

Def: an incision made into the perineum to enlarge the vaginal opening to facilitate birth and minimize soft tissue damage
- facilitate birth of a large infant

23
Q

Cesarean Birth

A

Def: delivery of the fetus through a trans abdominal incision of the uterus to preserve the life or health of the client and fetus when there is evidence of complications

24
Q

Prolapsed umbilical cord

A

Def: occurs when the umbilical cord is displaced, preceding the presenting part of the fetus, or protruding through the cervix

  • results in cord compression and compromised fetal circulation
  • Client states she feels something coming through her vagina
  • elevate part of the cord and reposition the client in a knee-chest, Trendelenburg, or side-lying position
25
Q

Dystocia (Dysfunctional labor)

A

a difficult or abnormal labor related to the five 5’s of labor

  • lack of progress in dilation, effacement, or fetal descent during labor
  • use of oxytocin and position changes during labor

Maternity (4 decks)

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