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Labor & Delivery Flashcards

1
Q

what is lightening

A

settling of fetal head into brim of pelvis

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2
Q

when does lightening occur

A

about 2 wks before labor in 1st pregnancy. If multip, does not occur until labor

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3
Q

symptoms of lightening

A

increases pelvic discomfort, pressure, urinary frequency

woman may feel less discomfort w/ SOB, heartburn

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4
Q

Braxton Hicks contractions

A

painless, irregular contractions that may occur at any time during the pregnancy
4-8 wks before delivery intensify in frequency & strength
completely benign/ should not change cervix

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5
Q

what is sometimes dubbed “false labor” aka “prelabor”

A

Braxtom Hicks contractions

can be intensely uncomfortable & go on for wks w/o changing the cervix; they often go away if woman starts walking

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6
Q

bloody show

A

expulsion of mucous plug in some pts

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7
Q

bloody show is a result of what?

A

cervical dilatation & effacement days to 2 wks before labor

multips can be 1-3 cm dilated for wks & not even know

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8
Q

energy spurt

A

24-48 hrs before labor some women get a burst of energy & begin organizing, cleaning, cooking, nesting

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9
Q

GI upset

A

sx similar to early pregnancy w/ n/v, may have diarrhea, heartburn a week before labor

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10
Q

intensity of labor depends on?

A

fetopelvic relationships, quality & strength of UCs, emotional & physical status of pt
-nml labor is usually painful

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11
Q

hx of contractions

A

start w/ a gradual buildup of intensity that climaxes & dissipates

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12
Q

5 P’s of labor

A 
passenger
position of passenger
passage
power of the uterus
psych status
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13
Q

passenger

A

EFW (estimated fetal wt)

tolerance

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14
Q

position of passenger

A

presenting part
station
flexion (head nicely tucked into chest so skull comes through cervix w/ apex first)

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15
Q

position station

A

relationship of the lowermost part of the presenting part to an imaginary line drawn between the mother’s ischial spines
“0” station (-5 to +4)

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16
Q

passage of passenger

A

clinical pelvimetry

cx dilatation & effacement

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17
Q

power of the uterus

A

frequency

force & duration of UCs

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18
Q

psych status

A

coping
accepting
fearful
in pain/denial

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19
Q

characteristics of labor

A

a continuous process divided into 3 stages:

1st, 2nd, 3rd stage

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20
Q

first stage

A

results in cervical effacement & dilatation

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21
Q

early/latent/prodromal phase of 1st stage

A

0-3 cm of dilatation
relatively strong contractions q 5-7 min x 30-60 sec
can last days
usually able to talk thru UCs & smile in between
UCs do not go away w/ activity change or hydration

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22
Q

active phase of 1st stage

A

4-10 cm
contractions are stronger & more coordincated
usually q 2-3 min x 50-70 sec
follows fairly consistent timeline
woman needs to concentrate w/ UCs, no longer cheerful, may cope w/ controlled breathing, visualization

23
Q

transition of first stage

A

last part of active phase
7-10 cm dilated
often feels “rectal pressure” & urge to push
often defecates
VERY intense, shaking, toes curl, often vomiting, “I cant’ do it!”

24
Q

second stage of labor

A

marked by fully dilated cervix (10cm)
may experience physiologic rest where UCs seem to cease for up to 1 hr & she may actually sleep; involuntary “pushing” usually begins either just before fully or right after; moves baby down the vaginal canal;contractions usually q 1.5-2 min x 60 sec & strong

25
3rd stage of labor
UCs all but cease, accompanied by enormous relief delivery of placenta & membranes via mild utering cramping usually w/in 5-10 min of delivery of infant can take up to 1 hr, but most guidelines recommend manual extraction after 30 min
26
Friedman Curve
A graphic representation of the hours of labor plotted against cervical dilation in centimeters. a guideline
27
triage of labor
time of onset of contractions, frequency, bleeding, ROM med/OB hx, pregnancy complications, allergies, meds, last PO intake GBS status VS, UA
28
possible causes of 3rd trimester bleeding that presents to L&D
``` mucous plug normal bloody show laceration/trauma infxn ruptured uterus placenta previa/abruption (can be life threatening) ```
29
placenta previa
malposition of the placenta in the lower uterine segment that completely or partially covers the os (partial, complete, low lying, migrating) assoc. w/ increased fetal mortality NOT related to bleeding
30
risk factors for placenta previa
``` multiparity AMA multiple pregnancy previous uterine surgery smoking previous previa previous therapeutic abortion ```
31
S/sx of placenta previa
painless bleeding sudden onset 3rd trimester may be accompanied by uterine irritability
32
mgnt of placenta previa
DO NOT DO VAGINAL EXAM!!!!! sono to confirm placement inpatient bedrest serial hct, type & cross match, Rh, indirect Coomb's, coag studies fetal surveillance (growth, mvnt, NSTs) pelvic rest, no orgasm deliver prior to term by c/s partial/marginal previa can sometimes deliver vaginally assoc. w/ placenta accreta (careful 3rd stage mngt)
33
placental abruption (abruptio placentae)
premature separation of the normally implanted placenta
34
risk factors of placental abruption
``` maternal HTN folic acid deficiency sever abdominal trauma short umbilical cord malnutrition sudden decrease in uterine volume for size AMA external version cocain/crack use ```
35
S/sx of placental abruption
``` rigid, board-like abdomen painful, localized uterine tenderness colicky, discoordinate uterine activity possibly back pain possible fetal distress uterine enlargement (if occult) shock violent fetal mvnt ```
36
mgnt of placental abruption
type & cross match Utox deliver, induction if necessary management of severe hemorrhage- ocags, stat IV x 2, Trendelenburg, EFM, O2, emergency c/s
37
monitoring during L&D clinical mgnt
contraction frequency, strength by palpation FHR by EFM or intermittent doppler confirm status of membranes, dilatation, effacement & station EFW (est. fetal wt)
38
decision to admit
usually only if in active labor or complication noted (including ROM or GBS+) or fetus compromised can send home in early labor if reactive tracing, VSS, no know complications
39
labs to draw if going to admit
``` CBC w/ plts blood type Rh Ab screen RPR ```
40
what to do for mom during 1st stage of labor
ambulate, sit, side lie nourishment (avoid dehydration) continuous/intermittent monitoring VS q 4 hrs unless otherwise indicated encourage voiding analgesia prn, anesthesia usually once active can use lamaze type breathing/ visualization (Bradley) for coping & comfort
41
fetal monitor during 1st & 2nd stage
noted q 15-30 min in active labor, q 5-10 min during second stage (usually by RN per protocol) UCs are usually noted as above (pts on pit, VBACs need continuous EFM & toco
42
sedative (seconal) analgesia
- to rest false labor/ prolonged latent labor | - part of tx for hypertonic uterus
43
narcotic analgesics
can be used as a sedative to rest prolonged latent labor & treat hypertonic uterine dysfunction (morphine 10-15 mg IM/ or 5mg IVP)
44
for pain relief during active phase
demerol 50mg IM or 12.5-25mg IV nubain/ stadol 1-2mg IM, IV fentanyl 50-100mcg IVP
45
ataractics (phenergan, vistaril)
given w/ opioids to potentiate their action & decrease maternal axiety/ apprehension also mild antiemetics
46
spinal anesthesia
better for brief/ minimal use primarily for delivery & 3rd stage anesthetic injected into subarachnoid space produces aneshesia in lower half of body can produce postpartum h/a, respiratory failure high
47
epidural
bolus or continuous injection of anesthesia via catheter into epidural space good for vaginal labor & delivery or c/s narcotics often added to enhance the quality can make active labor faster but prolong the 2nd stage no drowsiness, few tangible side effects can cause maternal HoTN & subsequent transient fetal bradycardia usually limits mobility increases use of vacuum & forceps can cause postpartum h/h respiratory failure if "high"
48
pudendal block
regional anesthesia blocking the pudendal n. anesthetizes the vulva & perineum has no effect on uterus or UCs minimal danger to mother & baby used mostly 2nd stage before impending delivery
49
anmiotomy
artificial rupture of membranes | to check fluid, augment, apply internals
50
augmentation
to tx protracted or arrested labor | pitocin, nipple stim, amniotomy
51
anmioinfusion
using an intrauterine pressure catheter (IUPC) infuse NS into uterus to bolster fulid level & relieve cord compression
52
how to help mom in 2nd stage
pt usually in bed (may be standing, squatting) can coach to push once she feels the urge monitor descent, flexion, rotation
53
how to help mom in 3rd stage
delivery of the placenta usually w/in 30 min cut & clamp cord immed. after delivery gentle retraction on cord utilizing Brandt-Andrews technique Administer pit after delivery of shoulder or immediately after delivery of baby after placenta check fundus & massage to firm check vaginal vault, cervix, perneum for lacerations & repair
54
signs of placental separation
gush of blood cord lengthens fundus rises in abdomen uterus becomes firm & globular

OB (13 decks)

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