Mod 2 L&D and Postnatal Changes Flashcards
GTPAL
GPA provides details about maternal pregnancy history.
- Refer to quizlet for practice, but upload the pic here.
Stages of Labor and Delivery (3)
- First (Cervical):
- Second (Pelvic):
- Third (Placental):
First (Cervical) stage of L&D
- Phases: Early, Active, and Transitional.
- Duration: Onset of contractions to full dilation and effacement of cervix (10 cm), 16-18 hours.
Second (Pelvic) stage of L&D
- Full dilation and effacement to delivery,
- Duration of 1-2 hours
Third (placental) stage of L&D
- Delivery of placenta
- Duration of 3-45 mins
Stage 1 of Labor
- Longest stage of pregnancy with 3 phases.
- Phases: Early (Latent) labor, Active labor, Transitional (Advanced) Labor.
Characteristics of Early (Latent) Labor
Cervix dilates to 3 cm, cervix begins effacement.
- mild to moderate contractions lasting 30-45 seconds, spaced 5-20 minutes apart
Characteristics of Active Labor
- contractions grow stronger and longer, usually lasting 2-3.5 hours
- cervix dilates to 7 or 8 cm, contractions last 40-60 seconds, spaced 3-4 minutes apart.
Characteristics of Transitional (Advanced Labor)
The last and most intensive phase of labor
- Approx 15-60 mins long
- Cervix dilates to 10 cm
- Contractions are very strong (usually 60-90 seconds long) and intense, spaced 2-3 minutes apart.
Characteristics of an uncomplicated birth?
Mom delivers baby, baby is assessed, mom delivers placenta, abdominal/pelvic exam checks for bleeding, infection, or injury, mom receives post-partum care, parents get to hold the baby (skin-to-skin encouraged).
Complications During Delivery and Monitoring Fetal Distress
Categories:
- Normal and Abnormal Presentation
- Cord Complications
- Monitoring Fetal Distress.
Breech position
Head up and butt or feet down
- Most babes are head down by week 36, failure to turn results in breech position
Types:
- Frank (butt first, feet near head)
- Complete (knees bent, feet near butt)
- Incomplete or Footling (one or both feet stretched out below butt).
Face Presentation
The chin presents first with the neck hyper-extended.
Note: Vaginal delivery is not possible if the chin is posterior.
What is the Transverse or Shoulder Lie presentation?
Fetus presents with the long axis of its body not parallel to the mother’s.
- Possibilities: May present shoulder first or turn during birth.
- Note: Caesarean may be the only option if the fetus can’t be manipulated.
Cord Complications During Labor
Nuchal Cord, Knots, Prolapse.
Describe Nuchal Cord and the risks of it
Umbilical cord coiled around the baby’s neck, common (25%-35% of the time).
- Risk: Compression leading to compromised oxygen delivery may require a c-section.
Describe Knots in the Umbilical Cord and the implications
Rare, found after delivery, especially when the umbilicus is abnormally long.
- Impact: If tight, may affect fetal blood flow and lead to variable decelerations
What is Prolapse?
Umbilical cord squeezed between fetus and the delivery canal, reducing blood flow to the fetus.
- not common
How is prolaspe diagnosed?
fetal heart monitoring, especially bradycardias or profound decelerations after membrane rupture.
Why would Failure to Progress occur?
Maternal fatigue & weak/ineffective contractions
Episiotomy vs. Natural Tearing
Episiotomy widens the vaginal opening, not recommended routinely; healthcare providers prefer natural tearing.
Common Indications for C-Section
- Failure to progress
- fetal distress
- large head
- placental abnormalities
- cord problems
- genital herpes,
- multiples
- breech
- severe anomalies
- prior c-section (VBAC more common).
C-Section Complications
- Maternal Complications: Scarring, placental problems, bladder/bowel injuries, excessive bleeding, post-op recovery, long healing times, difficulty moving and lifting.
- Babe Complications: Surgical wounds and trauma, lack of exposure to fetal lung fluid purging, fetal distress.
How does Fetal HR Monitoring work?
- what does it measure?
- what is normal?
- Method: Monitoring fetal responses to labor via an abdominal transducer called a Tocodynamometer.
- Measures: Strength of uterine contractions and fetal heart rates.
- Normal Fetal HR: Varies between 120-160 bpm with normal baseline variability (5-10 bpm).
Fetal Heart Rate Categories
- Category I: Normal tracing, predictive of normal fetal acid-base status, routine follow-up.
- Category II: Indeterminate tracing, inadequate evidence to classify as abnormal or normal, requires continued surveillance and reevaluation.
- Category III: Abnormal tracing, predictive of abnormal fetal acid-base status, requires prompt evaluation and intervention, includes sinusoidal or recurrent late/variable decelerations or bradycardia.
What is the procedure and interpretation of Fetal Scalp Sampling (scalp pH)
- Procedure: Transvaginal sample of fetal blood obtained via scalp puncture.
- Interpretation: N scalp pH > 7.25 is reassuring, pH < 7.15 indicates fetal acidosis and necessitates immediate delivery, often an emergent c-section
Composition of Fetal Hemoglobin?
About 75-80% of hemoglobin in newborns is fetal hemoglobin
- Has a higher affinity for oxygen.
what is happening for Fetal Preparedness for transition?
Gets ready to shift from placental support to pulmonary gas exchange (liq->gas ventilation)
- Alveoli development
- pulmonary and bronchial circulations are well developed
- right sided heart pressures are high
- Neuromuscular control of respiration is established with
active fetal breathing periods
What is happening to the alveoli to support the babe so it can be independant after birth?
- Alveolar Type II pneumocytes produce immature surfactant at, approximately 22 weeks (or 26? need to confirm)
- Alveoli are open, stable, and at near normal neonatal lung
volumes
Why is shunting, as a result of right sided heart pressures aiding in transitioning the fetus to independance?
forcing open the foramen ovale and the ductus arteriosus
[shunts most of the right ventricular output into the aorta and a little bit of cardiac output getting to the lungs
What hormonal changes occur when the fetus before and during labor?
- Catecholamines reduces the amount of water in the lungs
- Epinephrine has been shown to inhibit secretion of fetal lung liquid
- Vasopressin and prostaglandin, which are secreted around the
time of birth, may reduce production of lung luminal liquid
During Vaginal Birth Progression, what changes are occuring to the babe?
Fetus is compressed as it progresses via birth canal.
- Lung liquids are removed
- Babe needs this to overcome wet lungs and surface tension so gas exchange can occur normally
When does the Foramen Ovale functionally close post natal?
once pulmonary circulation is establsihed (pressure in left heart becomes greater than right)
When does the ductus arteriosus shunt/transition to the ligmentum arteriosum?
Gradually, within the 24-96 hours of age
Benefits of delayed cord clamping for preterm:
- Decreased mortality
- Higher blood pressure and volume
- Less need for blood transfusion
- Decreased rates of IVH
- Lower risk of NEC
What is NEC?
Necrotizing Enterocolitis, characterized by the inflammation and, in severe cases, death of the tissue in the intestine
What is the LISA technique?
LISA = Less Invasive Surfactant Administration
- Used to admin exogenous surfactant to premature infants who have RDS w/o the need to intubation & mech. ventilation
- BLES is usually admired w/this technique
What is BLES?
Bovine Lipid Extract Surfactant.
What is the “golden hour”?
First hour after traumatic injury or medical event, quick trauma care is crucial to improve patient survivability.
Why is transcutaneous monitoring preferred in babes over CGBs?
- noninvasive continuous monitoring
- reduced pain and discomfort
- Continuous oxygen saturation monitoring of PaO2
What is the purpose of Tocolysis?
- Stop contractions via tocolytic agents
- Delay infections via antibiotics
- Encourage lung maturity via glucososteroids
What are 4 Tocolytics typically used?
- Magnesium Sulfate (MgSO4)
- Progesterone
- Nitrates
- Salbutamol
What drugs encourage lung maturity and how do they do it?
Dexamethasone or Betametahsone are used to promote surfactant production and decrease the severity of neonatal distress?
What are Tocolytics?
Given when delivery would result in premature birth
- Anti-contraction meds or labor represents (technically smooth muscle relaxants)
What are 2 main complications of prematurity?
RDS and BPD (as a result of oxygen therapy)
What are 2 induction agents for pregnancy?
Prostaglandin and Oxytocin
Function of Prostaglandin?
Hormone that aids in softening/thinning out the cervix
- help induce contractions
Function of oxytocin
Hormone that stimulates contractions.
- admin is gradual increases from low doses until labor progresses well.
What is Amniotomy?
Amniotic sac is ruptured (on purpose) during a vag exam. once broken, the cervix is ready for labors to start
What is Dystocia?
Prolonged difficult labor secondary to uterine, pelvic, or fetal factors
- When 1st and 2nd stage of labor exceed 20 hrs.
What are causes of dystocia?
- Weak contractions
- abnormal fetal presentation
- fetal head to big for pelvis
- hydrocephalus
What does a neonate demonstrate during their first breath?
high WOB
Pressure in the left atrium is normally higher than the pressure in the right atrium for how long?
Within minutes after delivery
How is the oxyhemoglobin curve shifted for Fetal hemoglobin?
Fetal hemoglobin shifts left, demonstrating a increased affinity for O2.
(aka ready more uptake)
How do moms oxyhemoglobins curve shift for the infant?
In this case, Maternal hemoglobin will shift right, demonstrating a decreased affinity for O2.
- This means mom is ready to offload O2 for the fetus
What can be concluded about the number of alveoli in babes as they get older?
Gas exchange surface area grows proportionally with an increase in body surface area
