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Term 5: OB > Labor & Delivery > Flashcards

Labor & Delivery Flashcards

1
Q

Labor definition

A

Series of events by which uterine contractions and abdominal pressure expel the baby form the mother’s body

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2
Q

CPD

A

cephalopelvic disproportion

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3
Q

Amniotic fluid embolism

A

Placental circulation carries amniotic fluid into venous flow

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4
Q

Version

A

Turning infant from malposition to cephalic

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5
Q

Preliminary signs of labor

A
  • Lightening
  • Increase in level of activity
  • Braxton Hicks contractions
  • Ripening of the cervix
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6
Q

Signs of true labor

A
  • Uterine contractions

- ROM

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7
Q

False contractions

A
  • begin and remain irregular
  • remain confined in abdomen and groin
  • disappear with ambulation and sleep
  • do not increase in duration, frequency, or intensity
  • do not achieve cervical dilation
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8
Q

True contractions

A
  • begin irregular but become regular
  • first felt in lower back then the abdomen in a “wave”
  • continued no matter level of activity
  • increase in duration, frequency, and intensity
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9
Q

4 Components (“4P”s) of Labor

A
  • Passenger
  • Passage
  • Powers
  • Psyche
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10
Q

Passenger (4P’s)

A

Passengers - fetus, placenta, cord, fluid, and membranes

refer to slide 13

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11
Q

Passage (4P’s)

A

Pelvis, Vagina, Perineum

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12
Q

Powers (4P’s)

A

Involuntary uterine contractions, bearing down efforts

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13
Q

Psyche (4P’s)

A

Fear, pain, anxiety

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14
Q

Attitude

A
  • Pose assumed within the uterus – flexion most common

- Relationship of fetal body parts to each other

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15
Q

Fetal lie

A
  • Relationship of long axis of fetus to long axis of mother

- Longitudinal most common

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16
Q

Fetal positions

A

Relationship of fetal head/bottom/shoulder to the Mom’s pelvis

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17
Q

Vertex Presentation (Occiput)

A

LOA, LOP, LOT, ROA, ROP, ROT

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18
Q

Breech Presentation (Sacrum)

A

LSA, LSP, LST, RSA, RSP, RST

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19
Q

Face Presentation (Mentum)

A

LMA, LMP, LMT, RMA, RMP, RMT

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20
Q

Shoulder Presentation (Acromion process)

A

LAA, LAP, RAA, RAP

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21
Q

Leopold’s Maneuver

A
  • Determines the position of the baby so can see the points of maximum intensity of the FHT
  • Performed by nurses/providers
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22
Q

Malpresentations

A

include: face, brow, breech, (can try to change this with version) transverse lie, shoulder

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23
Q

Malposition

A

most common is posterior (OP) try hands/knees position & counter pressure (back)

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24
Q

Multiples

A

small babies, uterine dystocia, abn presentations of twins (?surgery), anomalies

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25
Q

Abnormalities of placenta

A
  • Placenta succenturiata
  • Placenta circumvallata
  • Battledore placenta
  • Velamentous insertion of the cord
  • Vasa previa
  • Placenta accreta
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26
Q

Abnormalities of the cord

A
  • Two-vessel cord

- Unusual cord length

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27
Q

Vena caval syndrome

A
  • If Mom on back, baby puts pressure on vena cava = poor perfusion to uterus – Possible fetal distress
  • TX: side lying
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28
Q

Previa

A

Complete, partial, marginal

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29
Q

Pt at risk for previa

A

pts with hx of:

  • uterine scarring
  • multiple gestation with lg placenta
  • endometritis
  • previous low implantation,
  • older multips
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30
Q

Previa s/s

A
  • intermittent, painless bleeding - usually starts about 28 weeks
  • can become hypovolemic
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31
Q

Previa tx

A
  • NO vag exams
  • T&C for 2 units (on call)
  • Double set up for delivery
  • Marginal - can leak fluids thereby put pressure on bleeding point.
  • Bed rest
  • IV
  • Frequent FHT
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32
Q

Abruption

A
  • Marginal, central, complete

- Can occur at any time in the pregnancy

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33
Q

Abruption s/s

A
  • MAY have vag bleeding
  • Fetus hyperactive at first then ceases to move
  • Uterine tenderness
  • Pain
  • Change in contr, (tone>hypertonic Fierce contractions)
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34
Q

Abruption tx

A
  • Determine amt of separation and age of fetus
  • May treat conservatively with BR, sedatives, and observation
  • If severe will need to support blood volume and do c-section
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35
Q

Acreta

A

Placenta has invaded the uterine muscle

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36
Q

Acreta tx

A

May require hysterectomy

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37
Q

Cord Prolapse

A

Occurs with ROM when head NOT engaged or firmly fitted against cx, with CPD, malpresentations, polyhydramnious

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38
Q

Cord prolapse s/s

A
  • Visual or tactile dx

- Deep long variable decel

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39
Q

Cord prolapse tx

A

Position change

  • AROM with slow release of fluid (esp if head is high, BR if ROM & high head)
  • If prolapses KNEE CHEST, FILL BLADDER etc to keep head off cord!!
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40
Q

Cord compression

A
  • Occurs when there is not enough fluid to “float” the baby

- Cord around the neck

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41
Q

Cord compression s/s

A

Deep long variable decel

42
Q

Cord compression tx

A
  • amniofusion

- position changes

43
Q

Polyhydramnios

A
  • > 2000 cc fluid
  • seen by 3rd trimester
  • associated with fetal GI anomalies that inhibit swallowing, CNS defects, sometimes multilpe gestation, and severe diabetes
44
Q

Complications of Polyhydramnios

A
  • prolapsed cord

- pressure symptoms

45
Q

Polyhydramnios tx

A
  • Amniocenteses
  • Slow/careful ROM in labor
  • Pt education
  • Indocin to reduce fetal voids
46
Q

Oligohydramnios

A
  • < 500 cc fluid at term
  • associated with renal/GI anomalies, Maternal hypertension, vasoconstriction, IUGR, PROM
  • Can be life-threatening as fetus cannot move lungs, cord compression, amniotic leak
47
Q

Oligohydramnios tx

A
  • Amniofusion

- C-section

48
Q

Amniofusion risks

A
  • Overdistention of uterus

- Increased uterine tone

49
Q

Nursing role in amniofusion

A
  • Careful monitoring of infusion,
  • Monitoring of intensity and frequency of contractions
  • Maternal and fetal vital signs
50
Q

Immediate interventions of ROM

A
  • Check FHT immediately, observe for cord
  • Note color, odor, amount, particulate material
  • Chart findings along with the time
51
Q

Pelvic dystocia

A
  • Pelvis too small or abnormally shaped
  • Secondary to maternal anomaly, trauma, malnutrition, low spine disorder, immature
  • Leads to malpresentation, cord prolapse
52
Q

Uterine dystocia (Hypotonic Contraction)

A

Infrequent and/or mild in intensity, usually in active phase

53
Q

What is uterine dystocia (hypotonic) r/t?

A
  • Analgesia
  • CPD
  • Malposition
  • Overdistention
54
Q

Uterine dystocia tx with hypotonic contractions

A
  • Rest uterus
  • Augmentation
  • Evaluate glucose depletion
55
Q

Uterine dystocia (Hypertonic Contraction)

A

Increased frequency, increased resting tone, may see decrease in intensity due to lack of resting tone

56
Q

Uterine dystocia (hypertonic) r/t?

A

malfunction of Uterine “pacemakers”

57
Q

Uterine dystocia (hypertonic) complications

A

May cause fetal hypoxia, uterine rupture

58
Q

Uterine dystocia (hypertonic) tx

A

Medicate, support, comfort measures, evaluate fluid status & stress

59
Q

PC’s of “powers”

A
  • Precipitate labor
  • Uterine rupture*
  • Contraction rings
  • Inversion of the uterus**
  • Amniotic fluid embolism**
60
Q

Uterine rupture

A

Emergency situation!!!

  • Hypotonic to no contractions
  • Burning tearing pain
  • Hypovolemic shock
  • Palpable fetal parts
  • Fetal distress
61
Q

Bandl’s Ring

A
  • Causes uncoordinated contractions
  • Can be identified by sonogram
  • Emergency - Can cause uterine rupture, fetal death and hemorrhage if occurs in 3rd stage
62
Q

Interventions for Bandl’s Ring

A
  • IV Morphine
  • Inhalation of Amyl Nitrate
  • Tocolytic
  • C- section and manual removal of placenta under anesthesia
63
Q

Psyche

A
  • Increase catacholamines -> dereased blood flow to uterus -> weak contractions -> fetal distress -> anxiety
  • Can be seen as lack of control
64
Q

Psyche tx

A

Consider preparation

  • Culture
  • Support
  • Self confidence
  • Reassure and support
65
Q

Psychological Responses to Labor (Psyche)

A
  • Fatigue
  • Fear
  • Cultural influences
66
Q

Fetal labor danger signs

A
  • Heart rate
  • Meconium staining
  • Hyperactivity
  • Fetal acidosis
67
Q

Maternal labor danger signs

A
  • Blood pressure
  • Abnormal pulse
  • Inadequate or prolonged contractions
  • Pathologic retraction ring (contraction ring) PC: ruptured uterus
  • Abnormal lower abdominal contour
  • Apprehension
68
Q

How is cervical ripening done?

A
  • Prostaglandins (suppository, pill form)
  • Luminaria
  • AROM
69
Q

Induction with oxytocin

A
  • Monitored labor!!!!!!!

- Meds on pumps or controller

70
Q

S/S of preclampsia

A
  • headache
  • epigastric pain
  • blurred vision
71
Q

Reasons for induction

A
  • PIH
  • post term babies
  • rh problem (get baby out before more damage done)
  • small babies
72
Q

Side effects and contraindications of prostaglandins

A
  • n/v, diarrhea

- asthma, glaucoma, heart probs

73
Q

Augmentation

A

-crazy contractions, going to stop and try again

74
Q

Pitocin

A
  • contractions more painful
  • bp may drop
  • contractions & fetal distress
  • uterine rupture
  • water intoxication (like a antidiuretic)
  • watch pt output
75
Q

S/S of water intoxication

A
  • headache
  • vomiting
  • seizure
  • coma
76
Q

Amniotomy

A
  • breaking bag of water

- document what fluid looked like

77
Q

First responsibility of Amniotomy

A
  • Check the FHT
  • Temp q 2 hours
  • Minimal vaginal exams
  • Documentation
78
Q

First stage of labor

A
  • Latent phase (0-3 cm dilated last 4-6 hr, contractions q5 min)
  • Active phase (4 cm dilated, contraction harder & stronger)
  • Transition phase (irritable, leg tremors, vomit)
79
Q

Second stage of labor

A
  • Period from full dilatation and cervical effacement to birth of the infant
  • Pushing time (grunt)
80
Q

Third stage of labor

A
  • Placental separation
  • Placental expulsion
  • Getting ready to deliver placenta (should take 30-45 min, if longer could be placenta acreta)
81
Q

Placental acreta

A
  • Placenta has dug into wall of uterus

- Has to undergo surgery

82
Q

Fourth stage of labor

A

postpartum, recover—>vs, check fundus
ask pt what they want done with placenta
placenta blood done for research, membranes can be used for burn victims

83
Q

Nursing care: 1st stage

A
  • Change positions (for back ache, and to prevent ulcers)
  • Voiding and bladder care (if epidural needs catheter, if not KEEP EMPTY)
  • Pain management (let her know meds are available)
  • Do not let mother push during transitional phase (can tear cervix)
  • Digestion slows down during labor (can give toast, cracker, broth)
84
Q

Dysfunctional labor problems

A
  • Prolonged latent phase (teach breathing exercise)
  • Protracted active phase
  • Prolonged descent (deceleration)
  • Secondary arrest of dilation
  • Fetal Distress
85
Q

Nursing care: 2nd stage

A
  • Preparing for birth
  • Positioning for birth
  • Pushing
  • Perineal cleaning
  • Episiotomy (midline or mediolateria)
  • Birth
86
Q

Cutting and clamping of cord

A

Premature or sick baby you want the cord to be a little longer (for iv)

87
Q

Wartens jelly

A

Gushy stuff in cord

88
Q

Interventions for dysfunctional labor 1 & 2

A
  • Monitor for distress (Maternal/fetal)
  • Assist with forceps, extractor, section
  • Keep pts sugar up
89
Q

Advantages of vacuum assist

A
  • Little anesthesia

- Fewer lacerations

90
Q

Disadvantages of vacuum assist

A
  • Large caput (knot on head)
  • Tentorial tears (put pressure & ice)
  • Cervical bruising tear
  • Cannot be used on premies (head too thin)
91
Q

McRoberts

A

Pulling back on legs (opens pelvis)

92
Q

Nursing Care: 3rd & 4th Stage

A
  • Cutting, clamping and examination of the cord
  • Oxytocin
  • Placental delivery
  • Perineal repair
  • Assessment
  • Aftercare
  • Observer for complications
93
Q

Non-pharmacological pain management during labor

A
  • Positioning and Movement
  • Breathing
  • Music
  • Relaxation
  • Other attention-focusing strategies
    • Guided imagery
      - Massage and touch
  • Hydrotherapy
  • Heat/cold application
  • Biofeedback, TENS, intradermal water block
  • Accupressure/acupuncture
94
Q

What can cause fetal dystocia?

A
  • size, (esp head), macrosomia
  • malpresentations
  • malposition
  • multiples
95
Q

Fetal distress s/s

A

Decelerations, meconium stained fluids

96
Q

Fetal distress tx

A

treat the cause –(? Overdue, Cord, placenta), with fluids, positioning, amniofusion, O2, Meds, delivery, C/S

97
Q

IUGR

A

Intrauterine growth restriction

98
Q

Precipitate labor

A

Labor that lasts less than 3 hr from the onset of contractions to time of birth

99
Q

Inversion of the uterus

A

Uterus turns inside out after birth

100
Q

labor augmentation

A
  • ambulation
  • hydrotherapy
  • ROM
  • nipple stimulation
  • oxytocin infusion
101
Q

Mechanisms of labor

A
  • Descent
  • Flexion
  • Internal rotation
  • Extension
  • External rotation
  • Expulsion

Term 5: OB (6 decks)

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