Labor And VD Care Flashcards
Bishop scoring system. >8 cervix is favorable for induction
Scoring system.
Dilation
Posistion of Cervix
Effacement
Station
Cervical Consistency
Dilation
O. closed
1.1-2 cm
2. 3-4 cm
3. 5-6 cm
Posistion of Cervix
- Posterior
- Mild posistion
- Anterior
Effacement
- 0-30%
- 40-50%
- 60-70%
- 80%
Station
- -3
- -2
- -1,0
- +1,+2
Cervical Consistency
- Firm
- Medium
- Soft
Posistion of Cervix that indicates processing towards labor
Anterior cervix
Normally before preggers the cervix is located in a (posterior/anterior) position?
As labor progesss at 37-38 weeks it shifts to midline
As a mother is progressing towards labor the cervix is located (posterior/anterior)
Pre preggers cervix is located posterior
Before labor is it Anterior
Process of stimulating uterine contractions before natural labor begins, with the goal of delivering the baby.
Induction
Dif between Induction & Augmentation of labor
Induction Starts the labor process
Augmentation is when labor already started and increases strength, duration, or frequency of contractions
Reasons to induce labor
Post-term pregnancy: When a pregnancy extends beyond 41-42 weeks, due to less Amniotic fluid
PROM happens but labor hasn’t started
preeclampsia or gestational diabetes
Fetal concerns:
Intrauterine growth restriction (IUGR)
Low amniotic fluid (oligohydramnios)
Infection: Chorioamnionitis,
Induction methods
Mechanical
Hormonal
Mechanical: Foley bulb or Cook catheter
Hormone: Misoprostol / Pitocin
Cook Cervical Ripening Ballon
1st preform ______
To confirm Singleton, Vertex Presentation, and rule out partial / complete Placenta Previa / Placenta Percreta
Explain the terms
Ultrasound
Singleton = 1 baby
Vertex Presentation = head first in cervix pointed toward birth canal (Determine by US or Leopold Maneuver)
Placenta Previa = Placenta covers the cervix either partially or completely
Placenta percreta severe form of placenta accreta. Placenta invades through the uterine wall and may attach to other organs like the bladder.
PAINFUL contractions with ACTIVE cervical change
Labor
How do you know labor has begun
- Regular Contractions
Regular, consistent contractions.
Occur every 3-5 minutes.
Last 30-60 seconds each.
Grow in intensity and frequency over time.
Differ from early, sporadic contractions (like Braxton Hicks), which are irregular and mild.
- Cervical Changes
Labor truly begins when the cervix starts to dilate (open) and efface (thin out).
- Number of pregnancies lnclude all pregnancies regardless of outcome including Current pregnancy
- Number of pregnancies (not babies) delivered after 37 weeks
- Number of pregnancies (not babies) delivered between 20 and 36 6/7 weeks
- Any fetal loss that occurs before 20 weeks
- Number of babies born living
- Multiples are only counted in the Living number
- Gravida
- Term
- Preterm
- Abortions
- Living
3 main nursing objectives of L&D nursing
- Establishing therapeutic relationship
- Maternal assessment include labor progression
- Fetal assessment
All part of what?
EFM
VS
SVE
EDC
GTPAL/OB History
Meds & Allergy
Leopold Maneuver/ US
Last food intake
Meds, herbs, drugs
Birth plan, pain management plan, support person involvement
LABS & PIV (NEEDS ORDER): CBC, T&S, PLT, Bloodtype / Rh, UA protein, VDRL
Maternal assessment: Admissions
T&S (type and screening) Blood type
PLT = Platelets
UA protein = Urine analysis Protein
Why LR instead of 0.9NS
LR maintain stable Ph longer
Ideal posistion of the fetua
Vertex presentation
Head-down in the mother’s pelvis, with the back of the head (occiput) facing the front of the mother’s pelvis. This is also known as the cephalic presentation, specifically in the occiput anterior (OA) position.
Nitrazine…
Checks pH of (amniotic) fluid
Ph and color of ruptured membrane fluid
> 6.5 basic
Dark blues
Nursing Diagnosis for ROM
Risk for infection r/t ROM
How often to check temperature after ROM
Delivery within _____
2hr temp check
Delivery within 24hrs
5 Ps of Labor
Passenger
Passageway
Powers
Posistion
Psychological Response
Breech Presentation:
Definition: The baby’s buttocks or feet are positioned to be delivered first.
Types:
Frank Breech: ________
Complete Breech: _________
Footling Breech: _________
Frank Breech: Baby’s legs are up near the head, with the buttocks closest to the birth canal.
Complete Breech: The baby’s knees are bent, and both feet and buttocks are positioned to come out first.
Footling Breech: One or both feet are positioned to exit the birth canal first.
Definition: The baby is lying horizontally in the uterus, with the shoulder or back facing the birth canal.
Complications: This position makes vaginal delivery impossible and almost always requires a C-section.
Transverse Lie
The baby’s face is the first part presenting in the birth canal.
Brow Presentation: The baby’s forehead is the presenting part.
Challenges: These presentations can cause labor to stall because the widest part of the head is entering the pelvis, leading to longer or more difficult deliveries.
Face or Brow Presentation:
Definition: The baby’s head is down but facing the mother’s abdomen (back-to-back position).
Challenges: This position can cause back labor and may require assistance (e.g., forceps or vacuum) or even a C-section if the baby doesn’t rotate to an anterior position.
Occiput Posterior (OP):
Types of pelvis.
Which is better for birthing babies
Gynaecoid = Wider & Broader / Less prominent ischial spines
Android = Longer Sacrum / Narrower Sub-pubic arch
Involuntary contractions can vary in
Duration
Intensity
Frequency
Peanut Ball ….
Used to promote dilation & decent with well positioned baby.
Use while mother is in bed, probably due to epidural
Stages of labor 1st stage
Cervix dilates from _____ to _____
Begins with _____
Ends with _____
Includes 3 phases
Cervix dilates from 0 - 10 cm
Begins with contractions
Ends with complete dilation of Cervix
3 phases Latent, Active, Transitional
Stage 1 of labor
Describe the 3 phases
Dilation, Contraction Regularness, Strength, Frequency, Duration
- Latent Phase:
Dilation: 0-3 cm
Regularness: Irregular
Strength: Mild/ Mod
Frequency: 5 - 30 mins
Duration: 30 - 45 seconds - Active Phase:
Dilation: 4 - 7 cm
Regularness: Regular
Strength: Moderate/ Strong
Frequency: 3 - 5 mins
Duration: 40 - 70 seconds
Transitional phase:
Dilation: 8 -10cm
Regularness: Regular
Strength: Very Strong
Frequency: 2 -3 minutos
Duration: 45 - 90 secs
(Clinet will often state: They need to make a BM)
Stage 2 of labor is called the Pushing Stage
Begins….
Ends….
Nursing actions
Begins complete dilation of Cervix (10cm)
Ends Delivery of baby
Nursing Action: q5min assessment of fetal HR
Coach through pushing and posistion changes
Record delivery time and posistion
Assessment of bladder & straight catherization
Describe how a woman should push…
Push like your pooping
FAVD (Forecep assisted vag delivery)
Due to exhaustion or fetal distress. Damage is more likely to occur to…
VAVD
A hoover shopvac is used to suction child out. More risk to…
Mother
Child
Stage 3 aka…
Begins with …
Ends with…
Placental delivery
Begins delivery of baby
Ends Delivery of placenta
Placental Delivery
Umbilical cord lengthens (then)
Record time placenta gushes out
Be ready with …. (this medication)
Cord lengthns then gushes blood
Pitocin
Administer Pitocin 10 - 20 units IV 1000mL LR, 20 - 40 tts/min, rate adjusted for uterine firmness
When….
After delivery of placenta
Stage 4: Early postpartum & passage of lochia
Recovery phase q15min assessment
Including
Repair of lacerations
Fundal assessment & vigorously massage
Assessment of Lochia
VS
Highest risk of PPH
Cord blood to lab to determine Cord gas and possibly baby blood type
Afterhead crowns the woman should do this…
Stop pushing / Slow down the birth to avoid laceration
Hand placement for active delivery
Hand supporting perineum
Other hand on top of babies head
( Misoprostol / Pitocin)
Used for cervical ripening and labor induction.
It can also be used to manage postpartum hemorrhage and induce abortions.
( Misoprostol / Pitocin) is a synthetic form of the hormone oxytocin and is used to induce or augment labor, strengthen labor contractions, and manage postpartum hemorrhage.
Misoprostol is primarily used for cervical ripening and labor induction, particularly in cases where the cervix is not ready for labor (unfavorable cervix). It can also be used to manage postpartum hemorrhage and induce abortions.
Pitocin is a synthetic form of the hormone oxytocin and is used to induce or augment labor, strengthen labor contractions, and manage postpartum hemorrhage.
