Maternal - Unit 2 exam Flashcards
`1st stage of Labor
what is it? onset of uterine contractions and ends with complete cervical effacement and dilation categorized in Latent (3 cm cervical dilation), Active (4-7 cm cervical dilation), and transition phase (8-10 cm dilation)
what does it look like? smiling, talking, eager, good for admission assessment, cultural/family concerns, assess support
what are you going to do about it? ask about birth plan/ check cervical effacement/ dilation/ position/ station/ presentation/ fetal position/ vital signs/ urinanalysis for proteinuria/ Labs for STI’s/ and Fetal reserves (FHR)/
comfort interventions start saline and an iv for patient and only give clear liquids
2nd Stage of labor
what is it? active pushing, fully dilated composed of 2 phases Latent (urge to bear down is not strong) and active (strong urge to bear down)
what does it look like? 10 cm dilated, increased bloody show (imminent birth)/ GROWLING
what are you going to do about it?
provide support/ monitor mom vital signs and babies/ help mom bear down
3rd stage of labor
what is it? lasts from birth of the infant until the placenta is delivered
what does it look like? infant delivered placenta not (the placenta should detach from the uterine wall after the 3rd or 4th contraction)
what are you going to do about it? assess Vs every 5 minutes until placental separation, then every 15 minutes for first hour on the mom/ assess the newborn APGAR 1 5 and assess cord/ assess for placental separation
4th stage of labor
what is it? when the placenta is delivered (mom bonding-time)
what does it look like? big gush of blood is sign the placenta is on the way
what are you going to do about it? examine the placenta to make sure it is whole, talk to patient about what is coming up next, ask about skin to skin
the 5 P’s
what is it? the process of labor and birth these are the powers, passageway, passenger/passageway relationship between/ Passenger fetus and fetal membrane/ psychosocial influences
True labor
what is it? labor that is happening / cervical dilation and effacement are progressive
what does it look like? Uterine contractions are regular, Uterine contractions increase in duration and intensity, disomfort begins in the back and radiates to the abdomen, Uterine contractions do not decrease with rest or warm bath/shower
what are you going to do about it?
bring mom back to a room and start to monitor vital signs of mom and baby
False Labor
what is it? Labor is not happening false labor/ no change in cervical dilation and effacement
what does it look like? irregular uterine contractions,Uterine contraction are not getting closer together, Uterine contractions without change in duration and intensity, discomfort usually in abdomen only, uterine contractions decrease with rest
what are you going to about it?
tell mom to wait in the waiting room and we will be able to check their cervical dilation soon
Pain Management Intrapartum
what is it? Anesthetic or nerve block to comfort mom during labor to help manage pain
what does it look like?
Puedendal Block, Local Anesthesia, and systemic analgesia
what are you going to about it? monitor patient for respiratory distress for mom and fetal respiratory distress by monitoring
can’t give anymore IV pain meds after the second stage
Precipitious Birth
what is it? Labor that lasts less than 3 hours from the onset of contractions to the birth.
what does it look like? crowning of the babies head,
what are you going to do about it? stay calm , stay with mom, call for help, prepare for a precipit kit, encourage woman to pant and breathe, support the perieneum prior to birth of head, control birth of head to avoid perineal and subdural or dural teats, check for nuchal cord, keep baby and level of uterus, then once baby is delivered suction mouth then nose, dry and stimulate and remove wet blankets, cut cord, skin to skin if new mom is stable and anticipate for the delivery of placenta within 5-15 minutes
Intrauterine Fetal Demise
what is it? death of the fetus in Utero
what can be possible causes? chronic conditions such as autoimmune or labor with fetus less than 24 weeks, malnutrition, maternal trauma, post term pregnancy, cord accidents, genetic abnormalities, Cocaine use can lead to placental abruption
what does it look like? absence of fetal heart action on ultrasound
what are you going to do about it? provide mementos, be of close presence with patient, offer tissues and support, reality testing, provide small, simple, appropiate amounts of anticipatory guidance, talk directly to patient/family, allow time with infant after delivery
Uterine Rupture
what is it? partial or complete tear of the uterine muscle
what does it look like? s/s related to hypovolemia, ripping abdominal pain can be referred to shoulder pain,
what are the risk factors for uterine rupture? TOLAC, trauma, abortion, uterine distension from macrosomnia, poly, multiples
what are you going to do about it?immediate surgery to repair the uterine muscle.
Amniotic Fluid Embolus
what is it? Amniotic fluid with fetal debris enters maternal circulation and lungs through placental separation or cervical tears
what does it look like? sudden respiratory distress, circulatory collapse, acute hemorrhage, cor pulmonale, dyspnea, cyanosis, hemorrhagic shock, coma,
adverse signs to look for? Chest pain, frothy sputum, tachycardia,hypotension
what are you going to do about it?monitor mom for anaphylactic reaction, call doctor due to it being a medical emergency
Dystocia
what is it? dysfunctional labor
what does it look like? lack of progress in birth for any reason/ problems with one of the 5 P’s/ CPD/ malpresentation
what are you going to do about it? Cesarean birth imminent immediate
Malpresentation of the fetus
what is it? the fetal presentation in something other than cephalic presentation and is a complication in birth
what does it look like? Occiput posterior, Face presentation, Brow presentation, frank breech, complete breech, footling breech
what are you going to about it? try to reposition mom to attempt to position change the fetus, manual rotation of fetus,
Operative Vaginal Delivery
what is it? assisted delivery of baby through vaccum or forceps
what does it look like? lack of progress for 2 hours with anesthesia 1 hour without contractions
what are you going to about it? hematoma with vaccum, hemmorrhage r/t uterine atony or rupture, bladder trauma, perineal wound infection, scalp lacerations or bruising of newborn
Shoulder Dystocia
what is it? fetal anterior shoulder at pubic arch
what does it look like? turtle sign, brachial plexus injury, clavicle fracture, neurological injury, asphyxia
what are you going to about it? bring knees up to their earlobes (place woman in trendelenburg knee chest or modified sims) to open up their inlet, insert your hand into vagina to push fetal head off the cord to prevent disruption of the cord supply, Prepare for emergency C section
Prolapsed Cord
what is it? cord you can’t see presenting meaning you can’t see it seen typically in Artifical rupture of membranes or Spontaneous rupture of membranes
what does it look like? you see the cord presented in the vaginal opening
what are you going to do about it?
prepare for an emergency c section, don’t leave the bedside call for help, insert hand in vagina to push fetal head off the cord and remain there put mom in Trendelenburg knee chest or modified sims
