Labor & Delivery Flashcards
True Labor
contractions are regular with the interval getting shorter and shorter with time, contractions continue with rest, intensity increases, start in lower back and move towards the front of the abdomen
False Labor
irregular contractions that do not get closer together, stop with walking/resting/changing position, generally weak, pain felt in front
Amniotic sac rupture
can occur in active labor or when woman starts contracting, if rupture happens first contractions will follow, rarely gush of fluid will be more of a steady trickle of fluids
PROM
premature rupture of membranes; ruptures before contractions begin, can accurately tell by pH strip (blue/alkalotic = amniotic fluid)
PPROM
preterm premature rupture of membranes; before 37 weeks, if stays ruptured for long period of time and baby is not delivered soon there is risk for infection, commonly undiagnosed
AROM
artifical rupture of membranes (amniotomy); provider breaks water to induce labor using an amni hook
effacement
as cervix dilates it also thins out, is measured in percentages with help of index finger
measuring effacement
when finger inserted into cervix: goes to 2nd knuckle = 0%, goes to 1st knuckle = 50%, only fingertip = 100%
Tocolytics
slow contractions; terbutaline, magnesium sulfate
ocytotics
stimulate contractions; ocytocin
oxytocin is always given via
IV and piggy back
Misoprostol
prostaglandin; causes cervix to soften and uterus to contract
Dinoprostone
prostaglandin; stimulate muscles of uterus to contract and also causes cervical dilation
systemic analgesics in labor
lessens pain without loss of feeling or muscle movement, typically opioids given IV, do cross placenta so limited use is better as it can lead to resp depression in both mom and baby
local anesthetics in labor
often used if incision needs to be made to make vaginal opening bigger (episiotomy) or to repair a lac/tear that occurred during delivery
epidural
small catheter placed into lower spins that slowly pumps pain meds into that area, stops pain signals from traveling from spine to brain. Removed pain without slowing labor too much, mother is awake and lart and should still be able to feel pressure/contractions to know when to push, can drop bp closely
Spinal Block
used for pain during planned C section, injected directly into spinal cord fluid and will block pain for a couple of hours, takes effect very quickly so it may also be given if painful procedure needed during a vaginal delivery (such as a vacuum assist). May drop bp, can also lead to drop in FHR (rare cases)
Spinal headache
medication goes into membrane and CF begins to drain causing intense headache; occurs 24-48 hrs after epidural; if relief measures such as hydration and NSAIDs do not work can do a epidural blood patch (small amount of blood product inject into where epidural was to block CF from leaking)
general anesthesia in labor
reserved for only emergency situations, may rarely be used if epidural/spinal block does not work, will delay how quickly mother can bon to baby and often impacts BF
right fetal presentation
baby is facing R side
left fetal presentation
baby is facing the L side
occiput fetal presentation
baby’s head is presenting first
mentum fetal presentation
chin is presenting first
sacrum fetal presentation
sacrum is presenting first
anterior fetal presentation
baby (its back) is pointing towards the front
posterior fetal presentation
baby’s back is facing towards back
transverse fetal presentation
baby is laying directly towards one hip or the other (horizontally in womb)
station
how far down the baby is in the birth canal, measures in relation to mom’s ischial spine (at the most narrow spot), at ischial spine = 0 station, the higher the + number the closer baby is to delivery (further down birth canal baby is)
first stage of labor
when labor starts, contractions begin and cervical changes, latent phase, active phase, transition phase, first stage ends when cervix is fully dilated to 10cm
an arrest of labor happens when
lack of cervical dilation for 4 hours or greater (despite adequate contraction) OR no change of cervix for 6 hours or greater; both of these are unlikely to lead to a spontaneous delivery an will likely be going for a c-section
latent phase
when cervix dilates from 0 to 3 cm, slower period and less predictable
active phase
dilation goes from 4 - 7 cm, faster and more predictable rate of cervical changes
transition phase
dilation occurs from 8 - 10 cm, fetus continues to move into the pelvis
second stage
begins when fully dilated and ends when neonates is fully delivered; 7 cardinal movements during this stage, typically lasts up to 3 hrs for nulliparous and up to 2 hrs for multiparous women, can take longer if mom gets epidural
7 cardinal movements
engagement: active steady decent down birth canal
decent and flexion: happen at the same time; baby’s head is moving down through bony part of pelvis (ischeal spine) flexion is the chin pulling down to go through the birth canal
internal rotation: baby rotates head and body side-to-side and wiggling to navigate through narrow portion of pelvis
extension: delivery of head, face, and chain
external rotation: after head of baby is born it pauses and will slowly move 90 degrees towards one of the maternal thighs, does this to get the shoulders out
expulsion: rest of the body follows the head
third stage
starts when fetus is fully delivered and ends when placenta has been delivered; usully takes 5-10 minutes, if takes >30min risk for PPH increases, placenta needs to be cleared to reduce risk of further bleeding
3 distinct signs of placental separation
gush of blood from the vagina (this is the placenta detaching from the wall), lengthening of umbilical cord, globular shaped uterine fundus when palpate
fourth stage
first 1-2 hrs after delivery; monitor mother closely for signs of infection, hemorrhage, and uterine atony, preliminary assessments and treatments for the baby
placenta previa
placenta has attached over the brith canal instead of at the top of uterus, fetus cannot get through without causing trauma and hemorrhage
placenta previa S&S
painless and bright red bleeding, can be complete or partial
placenta previa interventions
never perform vaginal exam if suspected, monitor for blood loss, bed rest, c-section, monitor baby
Placental abruption
placenta is properly attached at top of uterus but begins to tear/pull away and detach. Incomplete: only small portion tears away (blood will begin to fill gap where tear is happening), complete: entire placenta tears away from wall (massive amounts of blood loss)
Placental abruption S&S
dark red bleeding, intense abdominal pain, board like abdomen (d/t internal bleeding), rigid uterus, hypotension (d/t blood loss), maternal tachycardia, fetal bradycardia
placental abruption interventions
monitor for signs of fetal distress, monitor maternal bleeding, changes in fundal height, keep BP up with IVF and/or blood products, prepare for delivery, likely to be a c-section
Prolapse umbilical cord
umbilical cord slip through cervix and into vagina after rupture of membranes and before baby descends into the birth canal, during delivery cord can be compressed by presenting part of fetus and cuts off oxygen to fetus
prolapsed cord S&S
cord visualized protruding through vagina, cervical exam: something squishy, pulsing, mom might feel something between her legs
prolapsed umbilical cord interventions
elevate part of presenting fetus off of the cord, knees to chest position (opens pelvis), trendelenburg (lets gravity shift baby off the cord), administer O2, wrap cord in moist sterile towel, never attempt to push cord back in, emergency C-section
shoulder dystocia
one or both of the baby’s shoulers get stuck behind the mother’s pubic bone or sacrum during birth, recognized in second stage of labor after head is delivered and before rest of baby is born, noticed when pause of rotation to one side is longer than normal
Complications of shoulder dystocia
maternal: 3rd or 4th degree tears, hemorrhage, damage to nerves, rectovaginal fistula, uterine rupture, separation of pubic bones
fetus: brachial plexus palsy, clavicle or humerus fractures, Horner’s syndrome, compresse umbilical cord
Should dystocia diagnosed based on
baby’s head delivered but mother is not able to push shoulders out, at least one minute has passed since baby’s head was delivered, baby is determined to need medical intervention to be delivered successfully
Turtle sign
after baby’s head has been delivered the head emerges and then pulls back into the perineum
Shoulder dystocia interventions
evaluate for episiotomy, hold legs up so thighs are pressed against abdomen, press on lower abdomen above pubic bone to push shoulders out, HCP reaches in to vagina and tries to turn baby, HCP pulls out one arm, roll client onto hands and knees
in shoulder dystocia fundal pressure should not be applied due to increased risk of
uterine rupture
chorioamnionitis
membranes that surround the fetus are infected, complications for both mom and baby, caused by bacteria typically from the vagina or rectum that then spread to the uterus after water breaks
chorioamnionitis S&S
fever, maternal and/or fetal tachycardia, very tender and painful uterus, vaginal discharge/lochia with a foul smell and unusual color, WBCs elevate, culture, gram stain, amniotic fluid sampling
fetal complications of chorioamnionitis
sepsis, meningitis, pneumonia
PPH S&S
boggy uterus, blood loss, shock (if large amounts of blood are lost), saturated 4+ pads in an hour
PPH interventions
fundal massage (Q15min at minimum), estimate blood loss; weight pads 1g=1ml, monitor hemoglobin and hematocrit, oxytocin, methylergonovine, blood products
Baby Blues vs depression
lasts for up to 2 weeks vs lasts longer than 2 weeks
frequent/prolonged crying vs does not feel like she can bond with baby, frequent recurring thoughts of death and suicide
Postpartum Psychosis
can be delayed until months after delivery, confused/lost, obsessive thoughts about baby, hallucinations/delusions, paranoia, attempts to harm self or baby
