Labour Flashcards
1
Q
Risk Factors for GBS
A
Preterm labour before 37 weeks with or without ruptured membranes
Term rupture of membrane over 18 hrs
Mild fever during labour
2
Q
Marker Screening test
A
- AKA prenatal serum screening
- Blood test/serology offered to women to determine the risk of aneuploidy carry an infant with down syndrome (trisomy 21) Edwards syndrome (trisomy 18) or open neural tube defect (trisomy 13)
- Client is told if they are high or low risk
- Down syndrome and total chromosome abnormalities increase as maternal age increase at 25 it is 1/1250 and 1/94 when the mother is 40
- Testing offered to everyone and recommend it more for patients over 35
3
Q
Additional non routine tests and screening
A
- Ultrasound beyond the recommended
a. Previous history of early fetal losses
b. Bleeding or other complications
c. Measure fetal growth and identify intrauterine growth restriction (IUGR)
d. Measure amniotic fluid
e. Confirm position of fetus
f. Additional ultrasounds usually occur after 20 weeks - Doppler flow studies
a. Measure the velocity of blood flow via ultrasound - Marker screening tests/prenatal serum screening/NIPT/cfDNA
- Nuchal translucency
- Amniocentesis
- Chorionic villus
a. Embryonic tissue from placenta
b. Results sooner than U/S - Non stress test
a. Electronic fetal monitoring, not in labor - Biophysical profile (BPP_
a. NST + U/S like fetal movement, tone, breathing and amniotic fluid
b. Non stress test-look at the heart rate when stimulated - Measurement of amniotic fluid
a. Increases in volume as the pregnancy progresses
i. 1 L at birth
ii. Two sources-fluid from the maternal blood across amnion and fetal urine
iii. AFI measurements-
iv. Adequate volume is needed for proper growth and development protection of fetus, infection control, temperature control, lung and GI development to practice using those muscles, muscle and bone development so they can float and move around, umbilical cord support to prevent compression
b. Adequate volume is needed for proper growth and development
i. Protection of fetus
ii. Infection control
iii. Temperature control
iv. Lung and GI development (swallow and breathing, practice using these muscles)
v. Muscle and bone development (as floats arounds allows development)
vi. Umbilical cord support by preventing compression
c. Oligohydramnios vs polyhydramnios/hydramnios
i. these tells us we need to send patient to additional screening
4
Q
First trimester serum screen
A
- 11-14 weeks
- PAPP-A and BhCG
- Determines risk of chromosomal disorders and anomalies
5
Q
second trimester serum screen
A
- 15-20 weeks
- Quad screen (AFP, E3, inhibin A and bhCG)
- Determines risk of chromosomal disorders, anomalies and open neural tube defect
6
Q
Counselling should include consider further testing
A
- Amniocentesis, detailed ultrasound to exclude anomalies, and nuchal translucency
- If the test comes back as high risk here is what we can do
7
Q
Amniocentesis
A
- In the 2nd trimester for genetics
a. 15-16 weeks and takes 2-3 weeks for results
b. Decisions about pregnancy 18 weeks and termination more difficult after 20 weeks
c. CONFIRMATION of disorder - 3rd trimester for fetal maturity
a. L/S ratio (lecithin/sphingomyelin) should be 2:1 over 35 weeks
b. 2 components of surfactant which line alveoli of lungs and reduces surface tension when the infant exhales
c. Phosphatidylglycerol (PG) appears around 35 weeks. Low means risk of respiratory distress upon birth
d. Determines if the fetal lungs are mature.
e. If there is a need to deliver fetus early do this so we can weight the risk of fetal affects vs affects of continuing pregnancy - Carry risk for miscarriage
8
Q
Nuchal scan for translucency
A
- A collection of fluid under the skin at the back of a fetus’ neck
- Ultrasound examination offered between 11-14 weeks gestation
- From the measured thickness of the nuchal translucency combined with maternal age the risk of chromosomal abnormality can be calculated
- Can be recommended more if something is seen abnormal at the first ultrasound
9
Q
Non Invasive prenatal testing or cell free DNA testing
A
- NIPT works by taking a blood sample from a pregnant client and analyzing for abnormalities of specific chromosomes (13, 18, 21, X and Y) associated with conditions like down syndrome a turner syndrome
- NIPT carries no risk of miscarriage because there is no need to pierce the amniotic sac.
a. Can be performed 9-10 weeks into pregnancy vs 16 weeks amniocentesis - Not yet publicly funded through all Canadian provinces
- An option available to clients at higher risk
- It can confirm abnormalities within fetus’
- Costs $500
10
Q
5 Ps of labor
A
- Passage(way)
- Passenger
- Powers
- Position
- Psyche
10
Q
prenatal care
A
- Values pregnancy as a state of health
- Diversity of needs recognized, a variety of personal and cultural meanings are brought by families to pregnancy and birth
a. Get to know your clients and their family on a personal level - Accessing care in pregnancy can provide opportunities for health teaching and positive contributions to overall health status of the woman and her family
10
Q
Prenatal Classes
A
- Varying lengths and times
- Different groups
a. Single parent, high risk, adolescent, culture and languages, methods (Lamaze, Bradley) - Tour of hospital
- Preparation for birth
a. Education
b. Breathing, relaxation and pain control
c. Operative deliveries
d. Postpartum adjustment
e. Infant care - Breastfeeding classes
- Very important for good outcomes in labor, birth and postpartum timeframe
- Classes are becoming les popular as online resources are becoming more popular
11
Q
passenger
A
- Has a lot to do with successful birth
- Ability of the fetus to complete birth process
- Molding
a. Cranial bones overlap under pressure of the powers of labor and demands of unyielding pelvis
b. Leads to triangle head
c. Fontanels may not be palpable right after birth because of this - Fetal
a. Attitude
i. Relationship of fetal parts to one another
ii. Head can be extended, brow or flexed (we want flexed)
iii. Want to see the “fetal position”
b. Lie
i. Refers to relationship fetal spine (cephalocaudal axis) to maternal spine (cephalocaudal) axis
ii. Longitudinal (Fetus spine is lined up with mother spine) can be breech
iii. Transverse (fetal spine is 90 degrees to mother’s spine)
iv. Oblique (the head or bum of the baby is pressing into the hips
v. Transverse and oblique can’t be delivered
c. Presentation
i. Determined by fetal lie and by body part of fetus that enters pelvic passage first (called presenting part)
ii. Cephalic (head, vertex, brow, face, child, depending on attitude)
iii. Breech (buttocks, complete, frank, incomplete i.e. footling)
iv. Shoulder (oblique or transverse)
v. Compound (more than 1 presenting body part
d. Position
i. The second photo matter here
ii. Smallest diameter is the suboccipital bregmatic
iii. The occipital should be presenting at first so the suboccipitobregmatic is delivered
e. Station
i. Progressing downward
Types of cephalic presentation
12
Q
Passage way
A
- Ability of pelvis and cervix to accommodate passage of fetus
- 4 classes of pelvis types
a. Gynecoid
i. 50%
b. Android
i. 25%
c. Anthropoid
d. Platypelloid - We want gynecoid and android for ease
- The care provider can do a cervical exam during pregnancy to look at the size and shape of the pelvis but many people don’t know until problems
- People can deliver with any pelvis type
13
Q
Optimal fetal lie for delivery
A
Longitudinal
14
Q
best potion for delivery?
A
Flexed vertex LOA or ROA
15
Q
Fetal station
A
relationship of presenting part to imaginary line drawn between ischial spines of maternal pelvis
16
Q
Engagement
A
head stationed at 0 is engaged
16
Q
How can frequency of contractions be measured
A
total number in a 10-min period
Time from start of one to the start of another
