Maternity Ch. 8 Flashcards
What hormones stimulate contractions?
Prostaglandins and oxytocin
What happens as placenta ages?
Begins to breakdown, triggering initiation of contractions
Lightening
descent of the fetus into true pelvis; normally around 2 weeks before term
-Feels she can breathe better but causes urinary frequency due to bladder pressure
Braxton-Hicks
Irregular UC’s and do not cause cervical change
True labor
regular UC with cervix dilation and effacement
5 P’s
● Powers (the contractions) ● Passage (the pelvis and birth canal) ● Passenger (the fetus) ● Psyche (the response of the woman) ● Position (maternal postures and physical positions to facilitate labor)
Frequency
● Frequency: Time from beginning of one contraction to the beginning of another. It is recorded in minutes (e.g., occurring every 3 to 4 minutes).
Duration
● Duration: Time from the beginning of a contraction to the end of the contraction. It is recorded in seconds (e.g., each contraction lasts 45 to 50 seconds).
Intensity
● Intensity: Strength of the contraction
- Done during a contraction
- Nose +1
- Chin +2
- Forehead +3
What two powers are for external monitoring
Frequency and duration
what power is for internal monitoring
Intensity
How to place toco?
palpate area that has no fetus
What must be done for before internal monitor is used?
Membrane must be ruptured
Why do we want to know the intensity of a contraction?
b/c we want to see cervical change
What is one purpose of internal monitoring?
May need to do an aminoinfusion
Phases of Contractions (Powers): Increment phase
Ascending or buildup of the contraction that begins in the fundus and spreads throughout the uterus; the longest part of the contract
Phases of Contractions (Powers): Acme phase
Peak of intensity but the shortest part of the contraction
Phases of Contractions (Powers): Decrement phase
Descending or relaxation of the uterine muscle
What is dilation and how big is it?
- enlargement or opening of the cervical os
- 10 cm = cervix can no longer be palpated on vaginal exam
What is effacement?
Shortening and thinning of the cervix
Longitudinal lie
Baby and mom are parallel
-Needed for vaginal birth
Transverse lie
Baby is perpendicular
-Can not be delivered vaginally
True vs False Labor
True:
- Contractions bring cervical effacement and dilation
- UC are regular and increase in frequency and intensity
False:
- US are irregular with no cervical change
- Hydration, laying down, or sedation slows or stops contractions
SROM/AROM
Spontaneous/Artificial rupture of membranes
- Can occur before but normally during labor
- With fluids gone = increase risk of infection
- Need to deliver within 24 hours
- If at home and this happens go to hospital
- Go to ER if having intense pain or bloody show
TACO
-assessment of rupture of membranes
Time/Amount/Color/Odor
Techniques to confirm rupture of membranes
- Speculum = rapid test
- Ferning = Fluid sample placed on slide
- Amnisure = rapid test
- Nitrazie = will turn blue (done at bedside)
Normal FHR
110-160
Fetal Tachycardia
above 160 for 10 mins or longer
Fetal Bradycardia
Below 110 for 10 mins or longer
Goal of external fetal monitoring
is to interpret and continually assess fetal oxygenation to prevent significant fetal acidemia while minimizing unnecessary interventions and promote family centered-care
What to do is baby is bradycadiac?
Check moms radial pulse because could be picking up moms HR (do this before getting water or side laying)
ALSO
Check mom for vaginal bleeding and abnormal pain because s/s of placenta aburpto
Category 1 FHR
= well oxygenated
When to use scalp electrode vs when not to
when to use = if baby moves too much or when mom moves too much or is obese
When not to use = if mom has gonorherra/ HIV/ herpes/ Group B Strep
What to do if FHR is erratic?
Mom and baby will move around so may need to adjust toco to get better reading
First stage of labor
onset of labor to complete cervical dilation (10 cm)
Second stage of labor
Burst of energy and urge to push
Third stage of labor
Delivery of baby to delivery of placenta
- Once placenta is delivered give bolus of oxytocin to decrease bleeding
- Assess placenta (AVA and completely out; not in pieces/no abnormality)
Meds used to prevent PPH?
Oxytocin (pitocin)
Methylergonvine (Methergine)
Thromethamine (Hemabate)
Misoprostol (Cytotec)
Given during third stage
Fourth stage of labor
Immediate PP
- Skin to skin
- Assess lochia
Phases of First stage of labor
- Early/latent phase: Excited; mild UCs, up to 5cm
- Active phase: dilate up to 7 cm; more intense/regular UCs, fatigue
- Transition phase: 8-10 cm dilated, completely effaced, empty bladder b/c gets in the way of passageway, shortest/most difficult phase
What to assess for mom with epidural?
Assess bladder often b/c can’t she feels like she has to void
Ferguson’s Reflex
types?
urge to bear down
- Mother instated: mom feels urge to push
- Delayed bearing down: let baby come down on own; sitting mom up saves energy
- Active direct pushing: nurse letting mom push
APGAR
Appearance Pulse Grimace Activity Respiratory
Given to baby after birth
Hep B
Vit K
Erythromycin ointment on eyes
What to do before giving mom epidural?
- Give bolus b/c risk of hypotension
- Assess mom (Monitor VS)
- Assess baby (Monitor on strip for 20 mins before and after)
Basic principles when using analgesia include:
● Labor should be established.
● Medication should provide relief to the woman with minimal risk to the baby.
● Neonatal depression may occur if medication is given within an hour before delivery.
● Women with a history of drug abuse may have a lessened effect from pain medication and require higher doses.
Basic principles for anesthesia include:
● Local anesthesia is used at the time of delivery for episiotomy and repair.
● Regional anesthesia is used during labor and at delivery.
● Regional anesthesia includes the pudendal block, epidural block, and spinal block.
● Regional or general anesthesia is used for cesarean deliveries.
