Labor & Delivery

Question 1

what is lightening

Answer 1

settling of fetal head into brim of pelvis

Question 2

when does lightening occur

Answer 2

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

Question 3

symptoms of lightening

Answer 3

increases pelvic discomfort, pressure, urinary frequency

woman may feel less discomfort w/ SOB, heartburn

Question 4

Braxton Hicks contractions

Answer 4

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

Question 5

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

Answer 5

Braxtom Hicks contractions

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

Question 6

bloody show

Answer 6

expulsion of mucous plug in some pts

Question 7

bloody show is a result of what?

Answer 7

cervical dilatation & effacement days to 2 wks before labor

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

Question 8

energy spurt

Answer 8

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

Question 9

GI upset

Answer 9

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

Question 10

intensity of labor depends on?

Answer 10

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

Question 11

hx of contractions

Answer 11

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

Question 12

5 P’s of labor

Answer 12

passenger
position of passenger
passage
power of the uterus
psych status

Question 13

passenger

Answer 13

EFW (estimated fetal wt)

tolerance

Question 14

position of passenger

Answer 14

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

Question 15

position station

Answer 15

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)

Question 16

passage of passenger

Answer 16

clinical pelvimetry

cx dilatation & effacement

Question 17

power of the uterus

Answer 17

frequency

force & duration of UCs

Question 18

psych status

Answer 18

coping
accepting
fearful
in pain/denial

Question 19

characteristics of labor

Answer 19

a continuous process divided into 3 stages:

1st, 2nd, 3rd stage

Question 20

first stage

Answer 20

results in cervical effacement & dilatation

Question 21

early/latent/prodromal phase of 1st stage

Answer 21

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

Question 22

active phase of 1st stage

Answer 22

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

Question 23

transition of first stage

Answer 23

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!”

Question 24

second stage of labor

Answer 24

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

Question 25

3rd stage of labor

Answer 25

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

Question 26

Friedman Curve

Answer 26

A graphic representation of the hours of labor plotted against cervical dilation in centimeters.
a guideline

Question 27

triage of labor

Answer 27

time of onset of contractions, frequency, bleeding, ROM
med/OB hx, pregnancy complications, allergies, meds, last PO intake
GBS status
VS, UA

Question 28

possible causes of 3rd trimester bleeding that presents to L&D

Answer 28

mucous plug
normal bloody show
laceration/trauma
infxn
ruptured uterus
placenta previa/abruption (can be life threatening)

Question 29

placenta previa

Answer 29

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

Question 30

risk factors for placenta previa

Answer 30

multiparity
AMA
multiple pregnancy
previous uterine surgery
smoking
previous previa
previous therapeutic abortion

Question 31

S/sx of placenta previa

Answer 31

painless bleeding
sudden onset
3rd trimester
may be accompanied by uterine irritability

Question 32

mgnt of placenta previa

Answer 32

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)

Question 33

placental abruption (abruptio placentae)

Answer 33

premature separation of the normally implanted placenta

Question 34

risk factors of placental abruption

Answer 34

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

Question 35

S/sx of placental abruption

Answer 35

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

Question 36

mgnt of placental abruption

Answer 36

type & cross match
Utox
deliver, induction if necessary
management of severe hemorrhage- ocags, stat IV x 2, Trendelenburg, EFM, O2, emergency c/s

Question 37

monitoring during L&D clinical mgnt

Answer 37

contraction frequency, strength by palpation
FHR by EFM or intermittent doppler
confirm status of membranes, dilatation, effacement & station
EFW (est. fetal wt)

Question 38

decision to admit

Answer 38

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

Question 39

labs to draw if going to admit

Answer 39

CBC w/ plts
blood type 
Rh
Ab screen
RPR

Question 40

what to do for mom during 1st stage of labor

Answer 40

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

Question 41

fetal monitor during 1st & 2nd stage

Answer 41

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

Question 42

sedative (seconal) analgesia

Answer 42

• to rest false labor/ prolonged latent labor

- part of tx for hypertonic uterus

Question 43

narcotic analgesics

Answer 43

can be used as a sedative to rest prolonged latent labor & treat hypertonic uterine dysfunction (morphine 10-15 mg IM/ or 5mg IVP)

Question 44

for pain relief during active phase

Answer 44

demerol 50mg IM or 12.5-25mg IV
nubain/ stadol 1-2mg IM, IV
fentanyl 50-100mcg IVP

Question 45

ataractics (phenergan, vistaril)

Answer 45

given w/ opioids to potentiate their action & decrease maternal axiety/ apprehension
also mild antiemetics

Question 46

spinal anesthesia

Answer 46

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

Question 47

epidural

Answer 47

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”

Question 48

pudendal block

Answer 48

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

Question 49

anmiotomy

Answer 49

artificial rupture of membranes

to check fluid, augment, apply internals

Question 50

augmentation

Answer 50

to tx protracted or arrested labor

pitocin, nipple stim, amniotomy

Question 51

anmioinfusion

Answer 51

using an intrauterine pressure catheter (IUPC) infuse NS into uterus to bolster fulid level & relieve cord compression

Question 52

how to help mom in 2nd stage

Answer 52

pt usually in bed (may be standing, squatting)
can coach to push once she feels the urge
monitor descent, flexion, rotation

Question 53

how to help mom in 3rd stage

Answer 53

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

Question 54

signs of placental separation

Answer 54

gush of blood
cord lengthens
fundus rises in abdomen
uterus becomes firm & globular