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NURS3112 > M7.1: Stages of Labour > Flashcards

M7.1: Stages of Labour Flashcards

1
Q

what are signs of labour?

A
  • lightening
    -sudden burst of energy
  • braxton hicks contractions
  • bloody show
  • ROM
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2
Q

What is lightening?

A

effects that occur when the fetus begins to settle into the pelvic inlet (engagement)

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3
Q

What may lightening lead to?

A
  • Leg cramps or pains
  • Increased pelvic pressure
  • Increased venous stasis = edema in lower extremities
  • Increased urinary frequency
  • Increased vaginal secretions
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4
Q

Define: Membranes ruptured by physician using amniohook

A

amniotomy or artificial rupture of membranes (AROM)

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5
Q

What is PROM?

A

Premature rupture of membranes

SROM before the onset of labour at any gestational age

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6
Q

What is the risk of ruptured membranes before engagement?

A

prolapsed cord: umbilical cord expelled with fluid

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7
Q

What is PPROM?

A

Preterm premature rupture of membranes (PPROM)

Rupture occurs before 37 weeks of gestation

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8
Q

What is SROM?

A

Occurs at height of intense contraction with gush of fluid out of vagina

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9
Q

What should we assess if ROM occurs?

A

assess the FHR because of the risk of prolapsed umbilical cord (would show decelerations & drop in HR),

assess the color of the amniotic fluid, because meconium-stained fluid can indicate fetal distress

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10
Q

What is the risk if there is ROM but no labour within 12-24 hours?

A
  • Rupture = open pathway into uterine cavity = infection
  • Note: induction done only if pregnancy is near term
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11
Q

Is this a characteristic of true or false labour?
contractions produce progressive dilatation and effacement of the cervix

A

True labour

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12
Q

Is this a characteristic of true or false labour?
discomfort of contractions starts in the back and radiates around to the abdomen

A

True labour

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13
Q

Is this a characteristic of true or false labour?
irregular and do not increase in frequency, duration, and intensity

A

False labour

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14
Q

Is this a characteristic of true or false labour?
discomfort may be relieved by ambulation, changes of position, resting, or a hot bath or shower

A

False labour

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15
Q

Is this a characteristic of true or false labour?
contractions may be perceived as a hardening or “balling-up” without discomfort or discomfort may occur mainly in the lower abdomen and groin.

A

false labour

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16
Q

What is the 1st stage of labour?

A

beginning of true labour and ends when cervix is 10 cm dilated

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17
Q

What is the 2nd stage of labour?

A

begins with complete dilation and ends with birth of neonate

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18
Q

What is the 3rd stage of labour?

A

begins with birth of neonate and ends with expulsion of placenta

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19
Q

What are the phases of the 1st stage of labour?

A
  • latent phase
  • active phase
  • transition phase
20
Q

Dilation and contractions of latent phase

A
  • cervical dilation: 0-3

Contractions:
- Frequency: 10-30 mins
- Duration: 20-30 secs
- Intensity: mild-moderate

21
Q

Dilation and contractions of active phase

A

cervical dilation: 4-7 cm

Contractions:
- Frequency: 2-3 mins
- Duration: 40-60 secs
- Intensity: moderate - strong

22
Q

Dilation and contractions of transition phase

A
  • cervical dilation: 8-10 cm

Contractions:
- Frequency: 1.5-2 mins
- Duration: 60-90 secs
- Intensity: strong by palpation

23
Q

What are the potential priorities for care in first stage?

A
  • Pain
  • Anxiety
  • Fatigue
  • Knowledge deficits
  • Potential for fluid deficits
  • Promotion of labour progress
  • Safety
24
Q

What are factors that influence labour pain?

A
  • Cervical dilation: primary source
  • Perineal distension
  • Intensity and duration of contractions
  • Fetal position
  • Fetal size
  • Other
25
Q

Where is the pain located in the 1st stage of labour?

A

Lower abdominal wall and areas over lower lumbar region and upper sacrum

(around the lower back and lower stomach)

26
Q

What fetal position can cause back pain?

A

posterior

27
Q

What are interventions we can do for pain?

A
  • Encourage regular position change
  • Assist with personal comfort measures
  • Decreasing anxiety
  • Providing information
  • Use specific supportive relaxation techniques
  • Back pain = firm pressure on lower back or sacral area and warm compress
  • Encourage paced breathing
  • Nurse presence
  • Give medications as requested by woman
28
Q

Why is fluid deficits an issue during labour?

A
  • Profuse perspiration/diaphoresis occurs during labour
  • Hyperventilation also occurs = changing electrolyte and fluid balance from insensible water loss

-Muscle activity increases temp = inc sweating and evaporation

29
Q

How do you know a woman is becoming dehydrated?

A

Poor skin turgor, fever, tachycardia

30
Q

What are potential priorities in 2nd stage of labour?

A
  • Pain
  • Ineffective coping and fatigue
  • Promotion of progress in labour (pushing!)
31
Q

What is the pain caused by in the 2nd stage of labour?

A
  • Hypoxia of contracting uterine muscle cells
  • Distention of vagina and perineum
  • Pressure on adjacent structures including lower back, buttocks, and thighs
32
Q

What is crowning?

A

fetal head is encircled by external opening of vagina and means birth is imminent

33
Q

Should woman push through pain and burning?

A

Yes.

34
Q

What happens if woman is pushing and cervix is not completely dilated?

A

cervical edema = slows dilation = possible tearing and bruising of cervix and exhaustion

35
Q

What is the valsalva maneuver?

A

natural, preprogrammed instinct. “When you hold your breath and tense, you create an air pressure “ball” inside your abdominal cavity. This pressure ball serves to stabilize your spine by acting as a support beam (more like a pillar) for your spine, minimizing anterior stress when you’re trying to lift something”

36
Q

T or F: Directed pushing uses valsalva maneuver

A

True

37
Q

Difference between directed and spontaneous pushing

A

Directed pushing involves taking a deep breath at the beginning of a contraction, holding it and bearing down throughout the contraction. Conversely, spontaneous pushing allows women to follow their own instincts

38
Q

What is directed pushing associated with?

A
  • Lowers maternal BP and therefore placental flow
  • Lower fetal pH and PO2
  • Lower Apgar scores
  • Can cause structural and neurologic injury to pelvic floor
  • Increase in maternal stress and fatigue
  • Increase in perineal tears
39
Q

What is spontaneous pushing associated with?

A
  • Allowing the woman to follow her body’s directions
  • Generally push for 5-7 seconds, followed by several breaths for 2 seconds each and push approximately 3-5 times per contraction
  • Prevents fetal hypoxic effects
  • Reduces perineal traumas
  • Fewer risks of adverse maternal, fetal and neonatal outcomes
  • Less maternal fatigue
40
Q

What are some positions for pushing?

A
  • lithotomy (recumbent)
  • side lying (left lateral sims)
  • squatting
  • hands and knees
41
Q

What are the advantages of squatting positiong for pushing?

A
  • Size of pelvic outlet is increased.
  • Gravity aids descent and expulsion of newborn.
  • Second stage may be shortened
42
Q

What are advantages and disadvantages of sidelying position for pushing?

A

Advantages:
- Does not compromise venous return from lower extremities.
- Increases perineal relaxation and decreases need for episiotomy.
- Appears to prevent rapid descent.

Disadvatage: difficult for woman to see birth

43
Q

What are advantages and disadvantages of lithotomy position for pushing?

A

Advantages:
- Enhances ability to maintain sterile field.
- May be easier to monitor FHR.
- Easier to perform episiotomy or laceration repair

Disadvantages:
- May decrease blood pressure.
- It is difficult for the woman to breathe due to pressure on the diaphragm.
- increased risk of aspiration.
- May increase perineal pressure, making laceration more likely.
- May interfere with uterine contractions.

44
Q

What are the signs of placental separation?

A
  • usually within 5-30 mins after birth
  • Globular-shaped uterus
  • Rise of fundus in abdomen
  • Sudden gush or trickle of blood
  • Further protrusion of umbilical cord our of vagina
45
Q

When is the placenta considered retained?

A

Considered retained if more than 30 minutes have passed from completion of second stage of labour

46
Q

What is a nursing priority in the 3rd stage of labour?

A

postpartum hemmorhage

NURS3112 (10 decks)

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