Labour Flashcards
Definition of latent vs active labour
Transitions at 4-3 cm nilated (mullipara) or 4-5 cm dilated (multipara)
Definition of dystocia
<2 cm in 4hrs or 2 hours with 0 cm
Causes of dystocia
Power
Passage
Passenger
Psyche
How to monitor in active phase of first stage
Intermittent EFM
List three non pharm and three pharm pain relief for the first stage
Hypnosis
Acupuncture
Water immersion
TENS
Nitrous oxide
Opiouds (not demerol)
Pudendal nerve block
Epidural
How to monitor in the 2nd stage
Continuous or q 5 min fetal monitoring
Monitor head descent, can wait up to 2 hours to start pushing
Dystocia in second stage
Nulliparous no epidural >3 hrs
Nulliparous epidural >4 hrs
Parous no epidural >2 hrs
Parous with epidural >3 hrs
List five steps of management of the third stage
Oxytocin IM
Delayed cord clamping (1 minute
controlled cord traction
GBS management
Screen 35-37 weeks
IV penicillin
Cefazolin of pen allergy
Give at start of labour
Risks of induction of labour
Uterine rupture
Cord prolpase
Abnormal FHR
Risk of operative vag delivery or c section
Contraindications for vaginal delivery
Previous uterine rupture Transverse lie Placenta pravia Cervical cancer Active genital herpes
What is the bishop score
Dilation, effacement, station, conssitency, position
Can do cervical ripening with catheter PGE prepidil if <6
Do not use PGE if vbac
If >6 can use oxytocin
Risks of oxytocin
Uterine rupture
Hypotension
Overcontractility
What to do it too much uterine activity on oxytocin
Reposition
IV fluids
O2
Discontineu Oxytocin
Concering in fetal heart rate
> 60 seconds
60 below baseline
<60 bpm
Overshooting back past baseline
How to deal with concerning tracing
LLD position O2 Stop oxytocin Fluids Fetal scalp monitor Cs
Risks for placental abruption
Prvious Htn Smoking Etoh Multiparity PPROM Fibroids Trauma
Placental abruption presentation and treatment
Painful baginal bleeding Get CBC, Type and screen, fibrinogen IVF, O2, montior Blood produtcs Rhogam if necessary CS
Signs of uterine rupture
Abdo pain
Bleeding
Palpable parts
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