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2021 OB > M1 Labor and Birth > Flashcards

M1 Labor and Birth Flashcards

1
Q

Infant Mortality Rate in the U.S.

A

6.2/1,000

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2
Q

In 2008, the U.S. infant mortality rate was 6.9/1,000 live births. How did we rank worldwide?

A

30th

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3
Q

What is a major cause of the U.S. infant mortality rate?

A

preterm birth

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4
Q

How much blood is emptied from the uterus into the maternal system during a ctx?

A

400 mL

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5
Q

How do ctx affect maternal cardiac OP in 1st and 2nd stages of labor?

A
  • ↑ 15% 1st stage
  • ↑ 30-50% 2nd stage
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6
Q

What happens to maternal BP and pulse during ctx?

A

­­­↑

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7
Q

Valsalva maneuver

A
  • Pinch your nose closed.
  • Close your mouth.
  • Try to exhale, as if inflating a balloon.
  • Bear down, as if having a bowel movement.
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8
Q

effects of the Valsalva maneuver

A
  • maternal
    • ↑ intrathoracic pressure
    • ↑ venous pressure
    • ↑ BP
    • ↓ pulse
  • fetal hypoxia
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9
Q

The Valsalva maneuver should not be used in the ____ stage of labor.

A

2nd

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10
Q

When should you check VS during active labor?

A

between ctx

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11
Q

Blood flow ____ during labor.

A

↓

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12
Q

How often do you measure BP during active labor?

A

hourly

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13
Q

What position should a pregnant mother not assume?

A

supine

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14
Q

CV changes during ctx

A
  • maternal
    • cardiac OP ↑
    • BP ↑
    • HR ↑
    • +400 mL blood
  • fetal
    • ↓ blood flow/O2
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15
Q

respiratory changes during labor

A
  • ↑ physical activity → ↑ 02 consumption
  • respiratory rate and depth
    • ↑ if anxious
    • hyperventilation
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16
Q

hyperventilation

A
  • → respiratory alkalosis
    • blowing off too much CO2
  • Sx
    • tingling
    • numbness
    • dizziness
  • Tx: breathe into cupped hands
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17
Q

maternal GI changes during labor

A
  • ↓ motility
  • very thirsty/dry mouth
  • N/V or belching: common @ full dilation
  • interventions
    • may need antiemetic (promethazine)
    • usually NPO + ice or small sips
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18
Q

Mendelson’s syndrome

A

aspiration of food or acidic gastric contents → pneumonia

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19
Q

Mendelson’s recommendations

A
  • develop clear masks
  • only trained people deliver gases
  • all laboring women NPO in case GETA needed
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20
Q

GETA

A

general endotracheal anesthesia

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21
Q

Evidence shows aspiration is very rare, but laboring women are still kept NPO. Why?

A

don’t take a chance that even one woman will die

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22
Q

Current research shows withholding food and fluids is unlikely to be _______.

A

beneficial

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23
Q

Use of glucose solutions during labor is linked to what neonatal conditions?

A
  • fetal hypoglycemia
  • transient tachypnea of newborn (TTN)
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24
Q

What advances in GETA reduce likelihood of aspiration?

A
  • cuffed ET tubes
  • meds to ↑ pH (bicitra)
  • masks no longer kept on face while sedated
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25
Q

What percentage of laboring mothers use an epidural?

A

70%

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26
Q

Regional anesthesia is used in what percentage of emergency C/S?

A

84%

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27
Q

Why are IV fluids without glucose not optimal during labor?

A

They don’t provide energy.

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28
Q

What happens to the acidity of gastric contents while fasting?

A

↑

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29
Q

Is the stomach every empty?

A

no

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30
Q

consequences of starvation in labor

A

ketosis → labor slows

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31
Q

Current recommendations for intake during labor

A
  • liberalization of fluids
    • water
    • fruit juice
    • carbonated drinks
    • tea
    • coffee
    • broth
    • jell-o
  • give antacid before GETA
  • IV sedation, then place ET tube
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32
Q

GU changes during birth

A
  • spontaneous voiding may be difficult
  • proteinuria 1+ is normal r/t breakdown of muscle tissue
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33
Q

What factors affect spontaneous voiding during/after childbirth?

A
  • tissue edema
  • regional anesthesia
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34
Q

interventions for difficulty voiding

A
  • catheter if necessary
  • encourage voiding q2h
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35
Q

maternal hematologic changes r/t childbirth

A
  • WBC (esp. leukocytes) are ­­↑↑
  • Clotting factors (esp. fibrinogen) are ­­↑↑
  • expected blood loss
    • SVD: EBD = 500 cc
    • C/S: EBD = 1000 cc
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36
Q

What H&H levels will help prevent maternal hematologic complications in childbirth?

A
  • Hgb ≥ 11 g/dL
  • Hct ≥ 33%
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37
Q

Why do clotting factors increase during pregnancy?

A

to prevent hemorrhage

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38
Q

EBL for spontaneous vaginal delivery

A

500 cc

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39
Q

EBL for c-section

A

1000 cc

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40
Q

EBL

A

estimated blood loss

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41
Q

C/S

A

caesarean section

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42
Q

SVD

A

spontaneous vaginal delivery

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43
Q

nursing implications for blood changes during/after delivery

A
  • know admission H&H and compare with PP
  • monitor blood loss
  • monitor VS
    • 1st sign of hypovolemia: tachycardia
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44
Q

expected FHR findings during labor

A
  • normal baseline: 110-160 bpm
  • fetal movement → accels in healthy baby
  • early decels expected during ctx and vag exam
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45
Q

Most MDs in hospitals use _______ _____, but _______ monitoring is just as effective on low-risk pts.

A
  • continuous EFM
  • intermittent
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46
Q

Stresses to the utero-fetal-placental unit result in characteristic FHR patterns. What two patterns indicate inadequate oxygenation for baby?

A
  • variable decels
  • late decels
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47
Q

What do variable decels indicate?

A

cord compression

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48
Q

What to late decels indicate?

A

utero-placental insufficiency

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49
Q

UPI

A

utero-placental insufficiency

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50
Q

FHR

A

fetal heart rate

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51
Q

What is the nurse’s role in ensuring adequate oxygenation to baby?

A

ensure ctx don’t get too frequent or last too long

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52
Q

fetal lung changes

A
  • in utero: lungs filled with amniotic fluid
  • during labor
    • environment changes stimulate urge to breathe
    • squeezing helps expel fluid into upper airway
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53
Q

How does fetal oxygenation during labor prepare baby to initiate respiration after birth?

A

internal and external environment changes stimulate urge to breathe

  • Sp02 ↓ + C02 ↑ + pH ↓
  • external temp ↓ → body temp change
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54
Q

doula

A

female labor attendant

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55
Q

benefits of doulas

A
  • one-on-one physical and emotional care
  • advocacy
  • present for whole labor process
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56
Q

What does a doula not do?

A

provide medical care

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57
Q

What starts birth?

A
  • distension of uterus
  • release of oxytocin
  • uterine ctx
  • more oxytocin
  • cervical ripening
  • hormone changes
    • estrogen
    • progesterone
    • prostaglandins
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58
Q

When do the changes that initiate labor start?

A

days and weeks before

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59
Q

S/Sx preceding labor

A
  • Braxton Hicks ctx
  • lightening
  • bloody show
  • mucous plug lost
  • ↑ energy and nesting instinct
  • wt loss
  • GI S/Sx
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60
Q

lightening

A

baby ↓ into pelvis

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61
Q

When does lightening occur?

A
  • primip: 2 wks before
  • multip: during labor
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62
Q

What causes bloody show?

A

cx capillaries break, mixing blood w/ mucus

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63
Q

When is the mucus plug lost?

A

≤ 2 wks before labor

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64
Q

What causes wt loss just before labor?

A
  • 1-3 lb r/t changing hormone levels → excretion of fluid
  • GI S/Sx
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65
Q

7 cardinal movements

A
  • engagement
  • descent
  • flexion
  • internal rotation
  • extension
  • restitution
  • expulsion
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66
Q

engagement

A

widest presenting part @ ≤ 0 station

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67
Q

descent

A
  • concurrent with other steps
  • accelerates after dilation of 5-7 cm
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68
Q

flexion

A
  • head is fully flexed
  • smallest diameter (crown down) presented to pelvis
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69
Q

internal rotation

A
  • fetus enters pelvic inlet transverse
  • head reaches 0 station
  • fetus rotates toward OA or OP position
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70
Q

extension

A
  • fetus must extend neck when passing under symphysis pubis
  • head born occiput, face, chin
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71
Q

restitution (external rotation)

A

head turns 45 degrees to LOT or ROT to realign with shoulders

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72
Q

expulsion

A
  • anterior, then posterior, shoulders are born
  • followed by body
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73
Q

5 Ps

A

passenger

passageway

power

position

psyche

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74
Q

factors r/t passenger

A
  • size of head
  • presentation
  • lie
  • attitude
  • position
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75
Q

fetal presentation

A

part that enters pelvis first

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76
Q

What characteristics of the fetal skull allow for molding?

A
  • fontanels
  • bones not fused
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77
Q

fontanels

A

wide spaces where sutures meet

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78
Q

Fontanels allow bones to ____ in _____ during childbirth.

A
  • shift
  • molding
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79
Q

molding

A

skull bones shift to allow head to conform to birth canal

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80
Q

anterior fontanel

A
  • large
  • diamond-shaped
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81
Q

posterior fontanel

A
  • small
  • triangular
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82
Q

Skull bones are joined by ______.

A

sutures

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83
Q

presentation rates by body part

A
  • cephalic: 96%
  • breech: 3%
  • shoulder: 1%
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84
Q

cephalic presentation variations

A
  • vertex
  • military
  • brow
  • face
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85
Q

vertex presentation

A
  • head fully flexed
  • most favorable
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86
Q

military presentation

A

head in neutral position

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87
Q

brow presentation

A

head partly extended

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88
Q

face presentation

A
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89
Q

breech presentation

A
  • buttocks enter pelvis first
  • usually r/t problem
  • birth usually by C/S
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90
Q

problems r/t breech presentation

A
  • preterm birth
  • fetal anomaly
  • uterine or pelvic abnormalities
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91
Q

shoulder presentation

A
  • transverse lie
  • will need C/S
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92
Q

situations in which shoulder presentation is seen

A
  • preterm birth
  • high parity
  • PROM
  • polyhydramnios
  • placenta previa
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93
Q

fetal lie

A
  • vertical relationship of fetal spine to maternal spine
  • three categories
    • longitudinal
    • transverse
    • oblique
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94
Q

longitudinal lie

A
  • 99% of fetuses
  • head or buttocks in the pelvis
  • long axis of baby’s spine is parallel to mom’s
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95
Q

transverse lie

A

long axis of baby is at a right angle to mom’s spine

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96
Q

oblique lie

A

long axis of baby is at some angle between longitudinal (0°) and transverse (90°)

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97
Q

fetal attitude

A
  • relationship of fetal parts to each other
  • normal: flexion
  • extension possible
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98
Q

normal fetal attitude

A

flexion

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99
Q

flexed fetal attitude

A
  • head flexed toward chest
  • arms and legs flexed over thorax
  • back is convex C shape
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100
Q

fetal position

A
  • relationship of fetal landmarks to 4 quadrants of maternal pelvis
  • 3-letter abbreviation
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101
Q

parts of fetal position abbreviation

A
  • presenting part
  • right or left of pelvis
  • anterior, posterior, or transverse of pelvis
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102
Q

fetal positions

A
  • presenting part
    • occiput (O)
    • sacrum (S)
    • mentum (M)
  • presenting part side-to-side
    • right (R)
    • left (L)
  • presenting part front-to-back
    • anterior (A)
    • posterior (P)
    • transverse (T)
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103
Q

ROA

A

right occiput anterior

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104
Q

ROT

A

right occiput transverse

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105
Q

ROP

A

right occiput posterior

106
Q

LOA

A

left occiput anterior

107
Q

LOT

A

left occiput transverse

108
Q

LOP

A

left occiput posterior

109
Q

RMA

A

right mentum anterior

110
Q

RMP

A

right mentum posterior

111
Q

LMA

A

left mentum anterior

112
Q

LSA

A

left sacrum anterior

113
Q

LSP

A

left sacrum posterior

114
Q

passage components

A
  • bony pelvis
  • soft tissues
    • vagina
    • cervix
    • pelvic floor muscles
    • introitus
115
Q

pelvic shapes

A
  • most women have a mixture
  • gynecoid
  • android
  • anthropoid
  • platypelloid
116
Q

gynecoid pelvis

A
  • classic female type
  • 50%
117
Q

android pelvis

A
  • Resembles male pelvis
  • Inlet: heart-shaped
  • Outlet: narrow
118
Q

anthropoid pelvis

A
  • Resembles ape pelvis
  • Inlet: oval
  • Diameter: wider A-P
119
Q

platypelloid pelvis

A
  • Inlet: flattened
  • Diameter: wider transverse
120
Q

problems with passage

A
  • soft tissue obstruction
  • cephalopelvic disproportion
121
Q

most common soft tissue obstruction

A

full bladder

122
Q

effects of soft tissue obstruction

A
  • decreased space for baby
  • intensified maternal discomfort
123
Q

interventions for soft tissue obstruction

A
  • void q 1-2 hrs
  • cath PRN
124
Q

powers of labor

A
  • primary: ctx
  • secondary: pushing
125
Q

primary power of labor

A
  • ctx
  • effect
    • effacement
    • dilation
    • descent
126
Q

secondary power of labor

A
  • pushing
  • effect: descent
127
Q

ctx frequency

A

time from start of one ctx to start of the next

128
Q

ctx duration

A

time from start of ctx to end of same ctx

129
Q

ctx intensity

A
  • strength of ctx
  • palpate at fundus
    • mild: tip of nose
    • moderate: chin
    • strong: forehead
130
Q

characteristics and purpose of uterine contractions during labor

A
  • characteristics
    • coordinated
    • involuntary
    • intermittent
    • involves upper 2/3 of uterus
  • purpose
    • aids fetal descent
    • puts pressure on cx to cause dilation and effacement
131
Q

stages of labor

A
  • 1st stage
    • latent phase
    • active phase
    • transition
  • 2nd stage
  • 3rd stage
132
Q

effacement

A
  • thinning and shortening of cervix during 1st stage
133
Q

dilation

A
  • cervix opening during labor
  • estimate of width of cervical os
134
Q

How long is the cx before labor?

A

about 2-3 cm

135
Q

How is an estimate of effacement written?

A

% reduction of original length

136
Q

timing of effacement

A
  • primips: before dilation
  • multipls: after dilation
137
Q

How is dilation documented?

A
  • in cm
  • full dilation: 10 cm (about 4 in)
138
Q

fetal station

A
  • measure of fetal descent
  • relation of presenting part to mom’s ischial spines
139
Q

landmarks involved in fetal station

A
  • presenting part
  • mom’s ischial spines
140
Q

How is fetal station measured?

A
  • in cm
  • 0 station = level of mom’s ischial spines
  • –5 (superior) to +5 (inferior)
141
Q

0 station timing

A
  • primips
    • 2-3 wks before birth
    • “baby has dropped”
  • multips: occurs during labor
142
Q

What triggers the secondary power (pushing)?

A

baby’s head reaching pelvic floor

143
Q

station of pelvic floor/Ferguson reflex

A

+1 or lower

144
Q

Ferguson reflex

A
  • involuntary urge to push and bear down
  • bearing down
    • ↑ intra-abd pressure
    • compresses uterus
    • aids fetal descent
145
Q

position

A
  • position of woman
  • position of baby inside uterus
  • both affect
    • ease of labor process
    • oxygenation of baby
    • comfort of mom
146
Q

Frequent position changes help with …

A
  • fatigue
  • circulation
  • comfort
147
Q

nursing role: mom’s position

A
  • encourage and assist mom to
    • change positions frequently
    • find comfortable positions
148
Q

upright maternal positions during labor

A
  • gravity aids and shortens labor
  • positions
    • walking
    • sitting
    • kneeling
    • squatting
  • better cardiac OP → ↑ blood to placenta
149
Q

mom squatting during labor helps with

A

pushing

150
Q

Why is the supine position contraindicated in PG and labor?

A
  • causes vena cava syndrome
  • can result in fetal distress and acidosis
151
Q

vena cava syndrome

A
  • compression of aorta and vena cava by gravid uterus
  • → hypotension in mom, less blood to uterus
  • can → fetal distress, acidosis
152
Q

psyche

A

concerns mom’s state of mine during labor and mental adaptation to any adverse or unplanned events

153
Q

birth plan not realized →

A
  • anxiety
  • fear
  • grief
  • loss of control
154
Q

What previous experience affects mom’s psyche during labor?

A
  • positive
  • negative
  • Hx of abuse
155
Q

Does knowledge of birth horror stories affect mom’s psyche during labor?

A

YES

156
Q

Name some aspects of culture that affect mom’s psyche during labor.

A
  • modesty
  • gender of attendant
  • stoic
  • loud
157
Q

What else can negatively affect mom’s psyche during labor?

A

no support person

158
Q

When should a primip go to the hospital for SVD?

A

ctx regular, painful, q 5 min x 1-2 hrs

159
Q

When should a multip go to the hospital for SVD?

A

ctx regular, painful, q 5-10 min x 1 hr

160
Q

Signs for any pregnant woman to go to the hospital.

A
  • vaginal bleeding bright red and like a period
  • ROM
  • ↓ FM
161
Q

normal FM count

A

4-6/hr

162
Q

true vs. false labor: ctx

A
  • true: regular, painful
  • false: irregular, may or may not be painful
163
Q

true vs. false labor: walking

A
  • true: walking ↑ regularity, pain
  • false: walking stops ctx
164
Q

true vs. false labor: pain location

A
  • true: begins in low back, wraps around front
  • false: mainly in low back, menstrual-like
165
Q

What is the most significant difference between true and false labor?

A

True labor is accompanied by progressive cervical change.

166
Q

tests for determining ROM

A
  • definitive: fern test
  • pooling of amniotic fluid in vagina
  • nitrazine tape or pH paper
167
Q

What is the only definitive test for ROM?

A

fern test

168
Q

fern test

A
  • only definitive test for ROM
  • sample gathered with sterile speculum exam observed under microscope
  • fern leaf-like structures = amniotic fluid
169
Q

nitrazine tape/pH paper

A
  • can be used to test for ROM
  • drawback is false postivies
    • blood, semen, and soaps are also alkaline
170
Q

things to document about amniotic fluid

A
  • color
  • viscosity
  • odor
  • amount
  • time of ROM
171
Q

normal color for amniotic fluid

A

pale with white vernix

172
Q

normal viscosity of amniotic fluid

A

watery

173
Q

normal odor of amniotic fluid

A

mild/no odor

174
Q

normal amount of amniotic fluid at ROM

A

1000 mL

175
Q

What does yellow or cloudy, thick, and foul-smelling amniotic fluid indicate?

A

infection

176
Q

What are the implications of green or brown amniotic fluid?

A
  • fetal hypoxia
  • breech presentation
  • meconium aspiration
  • > 40 wks GA
177
Q

What does amniotic fluid < 500 mL indicate?

A

lower GI problems

178
Q

What does amniotic fluid > 2000 mL indicate?

A

upper GI problems

179
Q

characteristics of pain in childbirth

A
  • normal (not r/t injury or illness
  • woman has prep time
  • self-limiting
  • intermittent
  • there’s a prize at the end
180
Q

physiologic component of pain

A

reception of stimuli by sensory nerves and transmission of impulses to CNS

181
Q

psychological component of pain

A
  • recognizing sensation
  • interpreting as pain
  • reacting to pain
182
Q

GCT

A

Gate Control Theory

183
Q

Gate Control Theory

A

by sending alternative signals to CNS, pain signals can be blocked

184
Q

physiologic effect of unrelieved pain

A

fight or flight response

185
Q

How does the fight-or-flight response work in labor?

A

stimulation of SNS

↓

↑ catecholamines

↓

vasoconstriction

↓

↓ blood flow to uterus

↓

↓02 to fetus

↓

fetal distress

186
Q

psychological effects of pain during childbirth

A
  • poor bonding
  • unpleasant memories
  • poor sexual
187
Q

How does unrelieved pain affect bonding?

A

When physical needs are unmet, psychological needs cannot be addressed. (Maslow’s Hierarchy)

188
Q

How does unrelieved pain affect future childbearing?

A
  • creates unpleasant memories, which can
    • affect desire for more children
    • cause anxiety in subsequent labor experiences
189
Q

How does unrelieved pain affect a woman’s sexual life?

A

creates fear of PG or perineal pain

190
Q

causes of pain in labor

A
  • visceral
    • cervical dilation
    • contractions
  • somatic
    • fetal descent
191
Q

visceral labor pain

A
  • during 1st stage of labor
  • causes
    • cervical dilation
    • contractions
192
Q

cervical dilation pain

A
  • slow, deep pain
  • visceral
  • “it hurts everywhere
193
Q

contraction pain

A
  • pulls on pelvic structures
  • referred to back and legs
  • “my back hurts”
194
Q

somatic labor pain

A
  • descent of fetal head
  • localized, intense, sharp
  • splitting, tearing pain (perineal)
  • “it’s burning”
195
Q

Differences in pain perception can be caused by

A
  • previous experience
  • preparation
  • support system
  • anxiety and fear → tensing → ↑ pain
196
Q

What preparation can help mom’s perception of labor pain?

A
  • childbirth classes
  • coping skills
197
Q

nursing role in pain relief during labor

A
  • look for ways to ↓ anxiety and fear
  • pharmcological interventions as prescribed
198
Q

Studies in sheep show ____ ↑ catecholamine release and significantly ↓ ______ ______ to the ______.

A
  • pain
  • blood flow
  • uterus
199
Q

nonpharm pain relief in labor

A
  • cutaneous stimulation
  • mental stimulation
  • breathing and relaxation
200
Q

physiologic response to relaxation techniques in labor

A
  • ↑ uterine blood flow
  • →
    • ↑ 02 to fetus and ctx effiency
    • ↓ pain perception and tension
  • → fetal descent
201
Q

psychological effects of relaxation techniques during labor

A
  • ↑ maternal comfort
  • ↓ anxiety/fear
  • empowers mom
202
Q

cutaneous stimulation physiological effect

A

↑ circulation → ↓ muscle tension

203
Q

types of cutaneous stimulation

A
  • self-massage
  • counterpressure (sacral)
  • thermal
    • heat or cold
    • shower or tub
    • washcloth
  • hydrotherapy: tub
  • acupressure
  • acupuncture (by licensed specialist)
  • transcutaneous electrical nerve stimulation (TENS)
  • frequent position changes
204
Q

effleurage

A

massage using circular motion with the palm of the hand

205
Q

hydrotherapy effects

A
  • ↓ catecholamines
  • triggers oxytocin release
  • releases endorphins
206
Q

The cervix can dilate ____ cm in 30 min.

A

2-3

207
Q

TENS

A

transcutaneous electrical nerve stimulation

208
Q

purpose of mental stimulation

A
  • occupy mind to compete with pain
  • promote tranquil environment
209
Q

aspects of mental stimulation

A
  • focal point: eyes open or closed
  • imagery to promote warmth and security
210
Q

quality of environment can

A

influence a woman’s ability to cope with pain

211
Q

effects of breathing techniques

A
  • alters focus
  • interferes with pain transmission
  • ↑ O2 to mom and baby
212
Q

basics of breathing techniques

A
  • patterned from simple to complex
  • all incorporate cleansing breath, pattern, cleansing breath
213
Q

Slow-paced breathing is used in what stage of labor?

A

1st

214
Q

using slow-paced breathing

A
  • focus on relaxation
  • slow and deep breaths
  • in through nose, out through mouth
  • use as long as possible in labor
215
Q

modified-paced breathing

A
  • shallow and faster chest breathing
  • focus on relaxation
  • can combine patterns
216
Q

patterned-paced breathing

A
  • pant-blow (“hee hee hee hoo”)
  • focus on pattern
  • can alter pattern to prevent pushing in transition
217
Q

problems with breathing during labor

A
  • hyperventilation → respiratory alkalosis
  • dry mouth: breathing + NPO
218
Q

S/Sx of respiratory alkalosis

A
  • dizziness
  • lightheadedness
  • tingling of fingers
219
Q

dry mouth interventions

A
  • ice
  • mouth wash
  • hard candy
  • washcloth
220
Q

effects of support in labor

A
  • significantly relieves pain
  • improved outcomes
  • ↓ interventions and complications
  • enhanced satisfaction
221
Q

How do drugs enhance labor?

A
  • allow relaxation of tense muscles
  • stimulate contractions
222
Q

When do drugs slow labor?

A
  • given too early
  • prevent effective pushing
223
Q

drugs with direct effects on fetus

A
  • those that cross placenta
  • example: ↓ FHR variability from
    • meperidine (demerol)
    • MgSO4
  • admin
    • give slowly IVP over 1-2 ctx
    • ↓ blood flow in ctx → ↓ drug to baby
224
Q

indirect drug effects on baby

A
  • drug affects mother, causing side effect for baby
  • example
    • epidural → vasodilation
    • if mom’s BP ↓ too much → fetal hypoxia/acidosis
  • admin
    • give 500-1000 cc fluid bolus before epidural admin
    • will ↑ intravascular volume, keep BP ↑
225
Q

major method of labor pain relief if epidural is not possible

A

opioid analgesics

226
Q

benefits of opioid analgesics for labor pain

A
  • good pain control
  • fast-acting
  • no LOC
227
Q

adverse effects of opioid analgesics for labor pain relief

A
  • No. 1 side effect is respiratory depression in baby
  • neurologic and behavioral depression in baby x 2-4 days
  • depression in attention and social response in baby for 6 wks
228
Q

meperidine (Demerol) in labor

A
  • timing
    • rapid onset
    • long duration (2-4 hrs)
    • peak: 30-60 min
  • side effects
    • N/V
    • sedation
    • delirium
229
Q

fentanyl (Sublimaze) for labor pain

A
  • timing
    • rapid onset
    • short duration (1 hr)
  • SE: less N and sedation than meperidine (Demerol)
230
Q

opioid analgesics for labor pain

A
  • meperidine (Demerol)
  • fentanyl (Sublimaze)
231
Q

opioid agonist-antagonists for labor pain

A
  • drugs
    • butorphanol (Stadol)
    • nalbuphine (Nubain)
  • rapid onset
  • no respiratory depression in mom or baby
  • less N/V than agonists
  • risk: withdrawal Sx in drug-addicted moms
232
Q

butorphanol for labor pain

A
  • onset: rapid
  • duration: 3 hrs
  • peak: 30-60 min
  • don’t give to pt who previously had agonist
    • reverses analgesic effect of opioid agonist
233
Q

nalbuphine for labor pain

A
  • timing
    • onset: rapid
    • duration: 1 hr
  • don’t give to pt who previously had agonist
    • reverses analgesic effect of opioid agonist
234
Q

naloxone (Narcan) in labor

A
  • reverses opioid-induced respiratory depression
  • timing
    • duration: short
    • may need > 1 dose
  • dosage
    • 0.1-0.2 mg IV q 2-3 min
    • 0.01 mg/kg IV, IM, SQ q 2-3 min
235
Q

antiemetic/tranquilizing drugs used during childbirth

A
  • promethazine (Phenergan)
  • hydroxyzine (Vistaril)
236
Q

promethazine during labor

A
  • use
    • ↓ anxiety
    • potentiate opioids
    • ↓ N/V
  • admin
    • IV or IM
    • 50 mg meperidine + 12.5 mg promethazine
237
Q

hydroxyzine (Vistaril) during labor

A
  • use
    • ↓ N/V
    • sedation/promote rest
  • admin: IM only (Z-track)
238
Q

giving narcotics during labor

A
  • give at beginning of ctx to ↓ amt to baby
  • time dose so baby’s not born at peak of drug action
    • if baby born within 60 min, prep for resuscitation
    • monitor resp status of baby
239
Q

regional pain management in labor

A
  • use: temporary loss of sensation
  • method: anesthetic injected in direct contact with nerves
  • types
    • epidural
    • subarachnoid (spinal) block
    • local infiltration
240
Q

regional anesthesia benefits

A
  • no LOC
  • discomfort greatly ↓
  • fetal effects based on maternal rxn, not direct
241
Q

AE of regional anesthesia

A
  • hypotention r/t vasodilation (most common)
  • bladder distention r/t ↓ sensation
  • prolonged 2nd stage r/t pelvic relaxation; interferes with internal rotation
  • catheter migration: leaves half of body numb
  • ↑ C/S rate
  • fever r/t longer labor
  • pruritis of face and neck
242
Q

nursing care: epidurals

A
  • monitor BP, HR and FHR during and after procedure
  • give pre-epidural IV fluid bolus (500-1000 cc LR)
  • help pt into position and help her maintain it
  • palpate bladder q 2 hr (may need Foley)
  • monitor anesthesia level
  • help with position changes q 30 min (to distribute med evenly)
  • encourage to push when baby’s @ +1/+2 station
  • keep side rails up
243
Q

spinal block during labor

A
  • quicker than epidural for C/S (onset in 1-2 min)
  • med injected deeper than epidural
  • done just before birth or C/S
  • hypotention likely
  • shorter-acting (1-3 hr)
  • transfer and ambulation precautions (motor involvement)
  • lay flat x 8-12 hrs to prevent spinal HA
244
Q

spinal block vs epidural

A
  • spinal block
    • injected deeper
    • quicker onset
    • shorter duration
    • affects motor fxn
  • epidural
    • given during labor, not just for delivery
    • longer duration
    • slower onset
    • motor fxn largely intact
245
Q

spinal HA

A
  • AE of spinal block
  • prevention: lay flat x 8-12 hrs after
  • S/Sx
    • severe when upright
    • often disappears when flat
    • begins within 2 days and can last wks
  • Tx
    • bedrest
    • hydration
    • caffeine
246
Q

local anesthesia use in L&D

A
  • injected into perineum before episiotomy or sutures for laceration
  • doesn’t provide pain relief of ctx or birth
  • rapid onset
  • drug burns during injection
  • AE rare except if toxic
  • most common: 1% lidocaine
247
Q

general anesthesia in L&D

A
  • GETA: general endotracheal anesthesia
  • involves LOC
  • rarely used except in absolute emergencies
248
Q

What type of anesthesia is used in 84% of emergency C/S?

A

regional

249
Q

AE of GETA

A

acid aspiration syndrome (AAS): rare

250
Q

AAS

A

acid aspiration syndrome

251
Q

What does acid aspiration syndrome (AAS) lead to?

A

chemical pneumonia

252
Q

chemical pneumonia

A
  • caused by aspiration of noxious chemical
  • e.g. stomach acid aspiration
253
Q

prevention of AAS

A
  • NPO if
    • surgery planned, or
    • high risk and in labor
  • before surgery
    • ​↑ gastric pH
      • non-particulate antacid: Bicitra
      • H2 blocker: Pepcid, Zantac, etc.
    • speed gastric emptying: Reglan
    • block esophagus upon intubation: cricoid pressure
254
Q

What meds to we give to prevent AAS?

A
  • non-particulate antacid: sodium citrate/citric acid (Bicitra)
  • H2 blocker
    • famotidine (Pepcid)
    • ranitidine (Zantac)
    • etc.
  • GI stimulant/antiemetic: metoclopramide (Reglan)
255
Q

What pH can cause chemical pneumonia?

A

< 2.5

256
Q

AE of GETA

A
  • respiratory depression for mom or baby
  • uterine relaxation
257
Q

What can uterine relaxation 2/2 GETA cause?

A

PPH

258
Q

PPH

A

postpartum hemorrhage

259
Q

Tx for uterine atony

A
  • pitocin or methergine
  • fundal massage
  • empty bladder if needed
  • Tx for PPH if necessary
260
Q

Tx for PPH

A
  • check uterus and bladder
  • start fundal massage
  • call for help
    • attend to family and/or baby
    • take over fundal massage
    • check lines/catheter
  • before you call MD, make sure you know
    • VS, LOC
    • estimated blood loss
    • current meds/flow rates
  • as ordered
    • pitocin or methergine
    • fluids
    • blood products
  • simultaneously
    • communicate with/reassure patient and family
    • comm with team lead

2021 OB (9 decks)

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