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OB Nursing > Labor & Delivery > Flashcards

Labor & Delivery Flashcards

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1
Q

1st stage of labor

A

True labor to complete cervical dilation (10 cm)

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2
Q

Complete cervical dilation

A

10 cm

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3
Q

In which labor stage do the phases of labor occur?

A

First stage

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4
Q

Latent phase of labor

A

0-5 cm, longest, begins w/ onset of regular contractions which become established and increase in frequency/duration/intensity but usually remain mild

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5
Q

Active phase of labor

A

6-10 cm, faster, esp multiparous

Contractions more frequent & intense (moderate to strong per palpation)

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6
Q

Transition phase of labor

A

8-10 cm, quickest, may vomit shake, become anxious

Intense, frequent contractions

aka deceleration phase

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7
Q

Second stage of labor

A

Cervical dilation to 10 cm in preparation for birth; seen with cervical effacement

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8
Q

Cervical effacement

A

Thinning of cervix

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9
Q

Cervical dilation

A

Opening of cervix

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10
Q

Third stage of labor

A

Birth to placental separation/expulsion

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11
Q

Fourth stage of labor

A

First 4 hours after delivery

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12
Q

In what stage of labor does crowning occur?

A

Second stage

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13
Q

What position should the fetus be in during the latent phase of labor?

A

Head at the internal cervical os but cervix is still closed to maintian integrity of amniotic sac

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14
Q

What causes cervical dilation?

A

Rippling effect from repetitive uterine contractions pulling it and stretching it open

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15
Q

What may be a sign of transition from the latent to active phase of labor in the birthing person?

A

Contractions become more intense and they’re breathing deeply/having difficulty speaking

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16
Q

How can you gauge the strength of a contraction?

A

Palpate abdomen at tip of fundus and compare to other body parts

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17
Q

What does palpating a mild contraction feel like?

A

Tip of nose

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18
Q

What does palpating a moderate contraction feel like?

A

Tip of chin

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19
Q

What does palpating a strong contraction feel like?

A

Forehead consistency

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20
Q

How long between contractions is needed to reperfuse/reoxygenate fetus?

A

60 seconds

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21
Q

What may happen to fetal heart rate as contractions increase in frequency/intensity?

A

Decelerate

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22
Q

After 5-6 cm, which birthing persons dilate quickly?

A

Primi- or multiparous

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23
Q

After 5-6 cm, which birthing persons dilate slower & at what rate?

A

Nulliparous; 1 cm q1-2 hours

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24
Q

What are the 6 P’s of birth?

A 
Passageway (birth canal)
Passenger (fetus, placenta)
Powers (contractions) 
Position (maternal)
Psyche
Pain
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25
Q

Define pelvimetry

A

Measure between ischial spines

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26
Q

4 pelvic shapes

A

Gynecoid (optimal)
Platypelloid
Android (resembling male)
Anthropoid

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27
Q

What pelvic shape favors the occiput posterior position?

A

Anthropoid

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28
Q

What makes gynecoid pelvis optimal for vaginal delivery?

A

It’s wider side-to-side than front-to-back, parallel sides, dull ischial spines, pubic arch 90 degrees or wider

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29
Q

What is a posterior occiput (OP) birth?

A

Baby born face up

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30
Q

What are potential complications of OP birth?

A

Fetal elongation altering FHR

Apneic episodes causing low APGAR scores

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31
Q

Why is android pelvis problematic?

A

Too narrow, usually does not progress to vaginal birth; if so, may have occipital bruising

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32
Q

Why is platypelloid pelvis not conducive to vaginal delivery?

A

Fetus has to pass through pelvis with head in a transverse/sideways position

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33
Q

How is cervical effacement measured/documented?

A

By percentage; 0% (long/thick, 40 mm) to 50% (20 mm) to 100% (paper thin)

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34
Q

Where is an incision made for a C-section?

A

In the lower 1/3 of uterus w/ direction of muscle fibers

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35
Q

What is the dividing line of the upper 2/3 and lower 1/3 of uterus called?

A

Physiologic retraction ring

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36
Q

What happens to the upper uterus during labor contractions?

A

Thickens

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37
Q

What happens to the lower uterus during labor contractions?

A

Thins and is pulled upward

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38
Q

Why does amniotic rupture cause pain?

A

Loss of cushion and fetal head begins pressing directly on cervix

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39
Q

How do dilation & effacement differ in nulli- vs multiparous birthing persons?

A

Nulliparous - complete effacement before dilation

Multiparous - effacement & dilation may occur simultaneously

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40
Q

What are important aspects of the fetus to assess/monitor?

A

Fetal: head, attitude, lie, presentation, position, station, engagement

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41
Q

3 major parts of the fetal head

A

Face (well fused)
Base of skull (well fused)
Vault of cranium) (not fused)

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42
Q

How can a fetus head squeeze through the birth canal?

A

Sutures can override one another, allowing caput molding to pass through

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43
Q

Which is larger, anterior or posterior fontanelle?

A

Anterior

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44
Q

How might you be able to determine which direction the fetus is looking?

A

Location of fontanelles

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45
Q

Define fetal attitude

A

Relation of the fetal parts to one another

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46
Q

Normal fetal attitude

A

Chin flexed to chest, extremities flexed into torse

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47
Q

Non-normal fetal attitude

A

Chin extended away from chest, head tilted to one side, extremities extended

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48
Q

Define fetal lie

A

Relationship of fetal long axis to maternal long axis

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49
Q

Longitudinal lie

A

Fetal spine is parallel to maternal spine

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50
Q

Transverse lie

A

Fetal spine is perpendicular to maternal spine

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51
Q

Transverse lie complications

A

Shoulder presenting so may require C-section if fetus does not spontaneously rotate

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52
Q

Define fetal presentation

A

Part of fetus entering pelvic inlet first & leading through birth canal during labor

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53
Q

Possible fetal presentations

A

Vertex/occiput (normal head first), breech (feet or sacrum first), shoulder (scapula), face, brow, chin (mentum)

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54
Q

Which fetal presentation is optimal for vaginal birth?

A

Vertex/occiput

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55
Q

Which fetal presentation(s) likely require C-section?

A

Face, breech, shoulder

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56
Q

What is a clue it may be a face or breech presentation?

A

If you can put your finger in a hole –> mouth (face) or anus (breech)

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57
Q

What are some signs of a brow, face, or undiagnosed breech presentation?

A

Higher FHR, abnormal contractions

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58
Q

Define compound presentation

A

Presentation of extra body part near presenting fetal part such as a hand or foot

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59
Q

Types of breech presentations

A

Complete, incomplete, frank

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60
Q

Why can breech births be complicating for the fetus?

A

When a fetus’ limb feels cold, it wants to take its first breaths which can lead to apnea

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61
Q

Which position can a face presentation be delivered in?

A

Mentum/chin anterior only

62
Q

Define fetal position

A

Relationship of presenting part of fetus to four maternal pelvic quadrants

63
Q

How is fetal position documented?

A

By 3 letters:

1) R or L side of maternal pelvis
2) O, S, M, Sc (presenting fetal part)
3) A, P, T (transverse) (part of maternal pelvis)

64
Q

What is the most common fetal position?

A

OA = occiput anterior

65
Q

Define fetal station

A

Relationship of presenting fetal part to reference line at ischial spines of maternal pelvis

Measurement of fetal descent in cm

66
Q

Where is station 0 in terms of fetal station?

A

At ischial spines

67
Q

What indicates a minus station?

A

Fetal station above ischial spines

68
Q

What indicates a plus station?

A

Fetal station below ischial spines

69
Q

What is the range of fetal station?

A

-5 to 0 to +5

70
Q

Define fetal engagement

A

Largest diameter of presenting fetal part reaches/passes through pelvic inlet; cannot be moved out of it

71
Q

What measurement is used for fetal engagement in vertex/occiput presentations?

A

Biparietal diameter

72
Q

What is a term biparietal diameter and what does it indicate?

A

9.25 cm; fetal head size

73
Q

What measurement is used for fetal engagement of a breech presentation?

A

Intertrochanter diameter

74
Q

What is the smallest and most critical anteroposterior diameter?

A

Suboccipitobregmatic diameter (nl = 9.5 cm)

75
Q

Define contractions

A

Rhythmic tightening & shortening of uterine muscles during labor

76
Q

Define contraction duration

A

Beginning to completion of one contraction

77
Q

Define contraction frequency

A

Time between beginning of one contraction & beginning of next contraction

78
Q

Define contraction intensity

A

Strength of uterine contraction in mmHg

79
Q

How is contraction intensity measured?

A

Mild, moderate, strong

80
Q

Early labor contractions

A

25-40 mmHg

81
Q

Active labor contractions

A

50-70 mmHg

82
Q

Transition phase contractions

A

80-100 mmHg

83
Q

Second (pushing) stage contractions

A

> 100 mmHg

84
Q

Second stage of labor characteristics

A

Complete cervical effacement & dilation
Contractions q1-2mins, 90 sec, strong
Fetal descent stimulates urge to push
Lasts 2 hrs (primi) or 30-40 min (multi)

85
Q

What type of pushing is recommended for birthing persons?

A

Open glottis pushing (grunting, yelling, exhaling)

86
Q

How long can a birthing person hold their breath before O2 delivery to the fetus declines?

A

7 seconds

87
Q

What station should the fetus be at before pushing begins?

A

+2

88
Q

What may crowning feel like for the birthing person?

A

Burning, tearing, pressure, pain

89
Q

What might the birthing person feel during second stage of labor?

A

Relief to be able to push & birth is near
Pain w/ pushing
Helpless, fearful, irritable
Accomplished

*Provide reassurance & encouragement

90
Q

What device is used to measure contractions?

A

Intrauterine pressure catheter

91
Q

Characteristics of contractions

A

Increment (buildup)
Acme/Peak
Decrement (regression)

92
Q

At what contraction intensities does uterine blood flow stop?

A

40-60 mmHg

93
Q

Define cardinal movements/mechanisms of labor?

A

How a fetus navigates the birth canal

94
Q

Define fetal descent

A

Progress of presenting fetal part through the pelvis

95
Q

How is fetal descent measured?

A

By station

96
Q

Define fetal flexion

A

Fetal head meets resistance at pelvis/cervix causing flexion to decrease diameter

97
Q

Define internal rotation of the fetus

A

Fetal occiput rotates to lateral anterior position in corkscrew motion to pass through pelvis

98
Q

Define fetal extension

A

Fetal occiput passes under symphysis pubis and head extends anteriorly as it is born

99
Q

Define external rotation of the fetus

A

After head is born, rotates to position it occupied in pelvic inlet in alignment w/ fetal body and then does a 1/4 turn to transverse position as anterior shoulder passes under symphysis pubis

100
Q

Define fetal expulsion

A

After birth of head/shoulders, trunk is born by flexion toward symphysis pubis

101
Q

What are some common maternal positions?

A

Lithotomy - feet up in stirrups

Semi-sitting w/ pillows underneath knees, arms, back

Lateral/side-lying w/ curved back & upper leg supported by partner

Hydrotherapy - shower, tub

102
Q

What maternal positions can gravity assist w/ fetal descent?

A

Upright, sitting, kneeling, squatting

103
Q

Advantages of birthing stool

A

Opens pelvis, gravity, helps pushing

104
Q

Advantage of squatting

A

Gives birthing person sense of control

105
Q

Why are frequent position changes helpful?

A

Increase comfort, relieve fatigue, promote circulation

106
Q

What determines position during second stage of labor?

A

Maternal preference, provider preference, condition of birthing person & fetus

107
Q

What are some things to avoid with water births?

A

Do not put baby back into water once out as it is breathing independently

Do not deliver placenta into water

108
Q

How can the birthing person’s emotional state influence labor?

A

Catecholamines can affect uterine contractions, slowing labor, due to decreased uterine blood flow

109
Q

Types of labor pains & when they occur

A

Visceral - 1st stage (T10-L2, fundus of uterus level)

Somatic - late 1st/2nd stage (S2-S4)

110
Q

Factors influencing labor pain

A

Young maternal age, hx of dysmenorrhea, fetal position, large maternal and/or fetal weight, nulliparity

111
Q

At what spinal level is an epidural typically given?

A

L3-L4; higher needs different meds to avoid respiratory complications

112
Q

What are characteristics of labor analgesics to consider?

A

Maternal/fetal safety, ease of admin, consistent/predictable/rapid onset, allowing maternal movement, retention of maternal expulsive efforts

113
Q

Types of labor analgesics

A

Opioids - fentanyl, morphine (need to give at certain time b/c affects fetus)

Antagonist-agonist opioids - nubain

Epidural - pain med + anesthetic

Spinal - similar to epidural

Pudendal block - lidocaine

Local anesthesia - lidocaine

114
Q

Where is the pudendal nerve located?

A

Ischial spines

115
Q

Where is the epidural space relative to the spinal space?

A

Inferior to spinal space

116
Q

What is a common complication of an epidural?

A

Headache, may require blood patch

117
Q

What are Leopold maneuvers?

A

Abdominal palpation of fetal presenting part, lie, attitude, descent, and probable location where fetal heart tones can be best auscultated

118
Q

What are two types of external fetal monitors?

A

External electronic monitoring (tocotransducer)

External fetal monitor

119
Q

What does an external electronic monitor (tocotransducer) do?

A

Applied over fundus to display contraction patterns

Must be repositioned w/ maternal movement

120
Q

What does an external fetal monitor measure?

A

FHR patterns during labor, birth

121
Q

Advantages of external fetal monitors?

A

Easy to apply, quicky evaluation

122
Q

Disadvantages of external fetal monitors

A

Difficult in birthing persons with more adipose tissue or fetus is in awkward position

123
Q

Advantage of internal fetal monitors

A

More accurate than external monitors

124
Q

Disadvantages of internal fetal monitoring

A

Increases risk of infection for birthing person & fetus

Fetal scalp electrode (FSE) must avoid soft spots (fontanelles), eyes, etc

125
Q

Characteristics of true labor

A

Regular & increase in duration, intensity
Discomfort begins in back and radiates to front of abdomen
Intensified by walking
Resting/relaxing in warm water does not decrease intensity
Cause cervical dilation
Fetal engagement

126
Q

What does progesterone do during labor/delivery?

A

Relaxes smooth muscle tissue

127
Q

What does estrogen do during labor/delivery?

A

Stimulates uterine contractions

128
Q

What hormones mostly stimulates uterine contractions?

A

Oxytocin

129
Q

What do prostaglandins do during labor/delivery?

A

Contract smooth muscle

Cervical ripening

130
Q

When estrogen drops after delivery, what hormone sharply increases?

A

Prolactin for milk production

131
Q

Why is it important to not skip feedings overnight if breastfeeding?

A

Can cause estrogen increase which inhibits PRL and decreases milk production

Can also cause ovulation and possible pregnancy so effective contraception use is vital

132
Q

When is the placenta typically delivered?

A

~30 minutes after delivery of fetus

133
Q

What is uterine tamponade?

A

Intense contraction to push out placenta

134
Q

What is uterine atony?

A

Lack of uterine contraction

135
Q

How much blood can a birthing person lose per minute during delivery?

A

1000 mL/cc

136
Q

What can be used to assist in placental delivery?

A

IV oxytocin

137
Q

How often should maternal temperature be checked?

A

q2hrs if membranes ruptured

138
Q

How do you assess fetal wellbeing during L&D?

A

FHR

139
Q

What is assessed during a vaginal exam during L&D?

A

Dilation & effacement
Fetal descent & station
Fetal position, presentation, & lie
Membranes - intact or ruptured

140
Q

Nursing assessments during labor

A 
Maternal health hx
Physical assessment
Fetal assessment
Labs
Pysch assessment
141
Q

Labs collected during labor

A

GBS - IV penicillin if (+)

Urinalysis (clean catch) - dehydration, ketonuria, proteinuria, glucosuria, UTI

Blood tests - CBC, ABO/Rh typing

142
Q

Signs of symptomatic hemorrhage

A

SOB, orthostatic hypotension

143
Q

1st stage assessments

A 
Review prenatal hx/labs
Labor status
Fetal status
Maternal status
Culture, language, religion
VS
Labs
Weight at last prenatal visit
Edema, proteinuria
Fundus
Hydration status
Level of fatigue
144
Q

Active phase assessments

A

See L&D admission assessment

Birthing person & support person may need more direction, encouragement, confirmation

Comfort measures

145
Q

3rd stage assessments & interventions of birthing person

A 
Meet newborn
Placental delivery
Fundus tone
Answer questions, educate
Relax abdomen
Prepare meds if PP hemorrhage anticipated
146
Q

3rd stage assessments & interventions for newborn

A

Resuscitation as needed - ABCs!

1 & 5 min Apgar scores

Ensure warmth, skin-skin contact

Initiate breastfeeding

Get acquainted w/ parents/family

147
Q

If fundus is boggy in 3rd stage, what should the nurse do?

A

Massage to express clots

If not responding, give meds
-IM or IV Pitocin
-IM methergine (not w/ HTN)
IM hemabate
-Rectal, vaginal Cytotec
148
Q

4th stage assessments for birthing person

A

q15mins for 1st hour - pain, VS (esp BP), fundus, lochia, bladder, perineum, hemorrhage, bonding & breastfeeding

BP drops to pre-pregnant level
HR 60-90, slightly lower than labor
RR 12-20, easy, quiet

149
Q

4th stage interventions for birthing person

A

Educate, answer questions
Assist parents in exploring newborn
Assist w/ breastfeeding
Assist w/ elimination
Comfort measures/position, perineum, pain meds
Fluids, nutrition
Allow birthing person/family to debrief L&D experience

150
Q

When should BP & HR be assessed after delivery?

A

q15mins for 2 hrs after birth

151
Q

When should temp be assessed after delivery?

A

q4hrs for first 8 hrs then at least q8hrs

OB Nursing (7 decks)

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