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PA 3 (RESP 315 ) > Mod 2 L&D and Postnatal Changes > Flashcards

Mod 2 L&D and Postnatal Changes Flashcards

1
Q

GTPAL

A

GPA provides details about maternal pregnancy history.

  • Refer to quizlet for practice, but upload the pic here.
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2
Q

Stages of Labor and Delivery (3)

A
  • First (Cervical):
  • Second (Pelvic):
  • Third (Placental):
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3
Q

First (Cervical) stage of L&D

A
  • Phases: Early, Active, and Transitional.
  • Duration: Onset of contractions to full dilation and effacement of cervix (10 cm), 16-18 hours.
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4
Q

Second (Pelvic) stage of L&D

A
  • Full dilation and effacement to delivery,
  • Duration of 1-2 hours
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5
Q

Third (placental) stage of L&D

A
  • Delivery of placenta
  • Duration of 3-45 mins
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6
Q

Stage 1 of Labor

A
  • Longest stage of pregnancy with 3 phases.
  • Phases: Early (Latent) labor, Active labor, Transitional (Advanced) Labor.
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7
Q

Characteristics of Early (Latent) Labor

A

Cervix dilates to 3 cm, cervix begins effacement.

  • mild to moderate contractions lasting 30-45 seconds, spaced 5-20 minutes apart
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8
Q

Characteristics of Active Labor

A
  • 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.
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9
Q

Characteristics of Transitional (Advanced Labor)

A

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.
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10
Q

Characteristics of an uncomplicated birth?

A

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).

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11
Q

Complications During Delivery and Monitoring Fetal Distress

A

Categories:
- Normal and Abnormal Presentation
- Cord Complications
- Monitoring Fetal Distress.

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12
Q

Breech position

A

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).
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13
Q

Face Presentation

A

The chin presents first with the neck hyper-extended.

Note: Vaginal delivery is not possible if the chin is posterior.

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14
Q

What is the Transverse or Shoulder Lie presentation?

A

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.
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15
Q

Cord Complications During Labor

A

Nuchal Cord, Knots, Prolapse.

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16
Q

Describe Nuchal Cord and the risks of it

A

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.
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17
Q

Describe Knots in the Umbilical Cord and the implications

A

Rare, found after delivery, especially when the umbilicus is abnormally long.

  • Impact: If tight, may affect fetal blood flow and lead to variable decelerations
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18
Q

What is Prolapse?

A

Umbilical cord squeezed between fetus and the delivery canal, reducing blood flow to the fetus.

  • not common
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19
Q

How is prolaspe diagnosed?

A

fetal heart monitoring, especially bradycardias or profound decelerations after membrane rupture.

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20
Q

Why would Failure to Progress occur?

A

Maternal fatigue & weak/ineffective contractions

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21
Q

Episiotomy vs. Natural Tearing

A

Episiotomy widens the vaginal opening, not recommended routinely; healthcare providers prefer natural tearing.

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22
Q

Common Indications for C-Section

A
  • Failure to progress
  • fetal distress
  • large head
  • placental abnormalities
  • cord problems
  • genital herpes,
  • multiples
  • breech
  • severe anomalies
  • prior c-section (VBAC more common).
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23
Q

C-Section Complications

A
  • 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.
24
Q

How does Fetal HR Monitoring work?

  • what does it measure?
  • what is normal?
A
  • 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).
25
Q

Fetal Heart Rate Categories

A
  • 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.
26
Q

What is the procedure and interpretation of Fetal Scalp Sampling (scalp pH)

A
  • 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
27
Q

Composition of Fetal Hemoglobin?

A

About 75-80% of hemoglobin in newborns is fetal hemoglobin
- Has a higher affinity for oxygen.

28
Q

what is happening for Fetal Preparedness for transition?

A

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
29
Q

What is happening to the alveoli to support the babe so it can be independant after birth?

A
  • 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
30
Q

Why is shunting, as a result of right sided heart pressures aiding in transitioning the fetus to independance?

A

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

31
Q

What hormonal changes occur when the fetus before and during labor?

A
  • 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
32
Q

During Vaginal Birth Progression, what changes are occuring to the babe?

A

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

33
Q

When does the Foramen Ovale functionally close post natal?

A

once pulmonary circulation is establsihed (pressure in left heart becomes greater than right)

34
Q

When does the ductus arteriosus shunt/transition to the ligmentum arteriosum?

A

Gradually, within the 24-96 hours of age

35
Q

Benefits of delayed cord clamping for preterm:

A
  • Decreased mortality
  • Higher blood pressure and volume
  • Less need for blood transfusion
  • Decreased rates of IVH
  • Lower risk of NEC
36
Q

What is NEC?

A

Necrotizing Enterocolitis, characterized by the inflammation and, in severe cases, death of the tissue in the intestine

37
Q

What is the LISA technique?

A

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
38
Q

What is BLES?

A

Bovine Lipid Extract Surfactant.

39
Q

What is the “golden hour”?

A

First hour after traumatic injury or medical event, quick trauma care is crucial to improve patient survivability.

40
Q

Why is transcutaneous monitoring preferred in babes over CGBs?

A
  1. noninvasive continuous monitoring
  2. reduced pain and discomfort
  3. Continuous oxygen saturation monitoring of PaO2
41
Q

What is the purpose of Tocolysis?

A
  1. Stop contractions via tocolytic agents
  2. Delay infections via antibiotics
  3. Encourage lung maturity via glucososteroids
42
Q

What are 4 Tocolytics typically used?

A
  1. Magnesium Sulfate (MgSO4)
  2. Progesterone
  3. Nitrates
  4. Salbutamol
43
Q

What drugs encourage lung maturity and how do they do it?

A

Dexamethasone or Betametahsone are used to promote surfactant production and decrease the severity of neonatal distress?

44
Q

What are Tocolytics?

A

Given when delivery would result in premature birth

  • Anti-contraction meds or labor represents (technically smooth muscle relaxants)
45
Q

What are 2 main complications of prematurity?

A

RDS and BPD (as a result of oxygen therapy)

46
Q

What are 2 induction agents for pregnancy?

A

Prostaglandin and Oxytocin

47
Q

Function of Prostaglandin?

A

Hormone that aids in softening/thinning out the cervix

  • help induce contractions
48
Q

Function of oxytocin

A

Hormone that stimulates contractions.
- admin is gradual increases from low doses until labor progresses well.

49
Q

What is Amniotomy?

A

Amniotic sac is ruptured (on purpose) during a vag exam. once broken, the cervix is ready for labors to start

50
Q

What is Dystocia?

A

Prolonged difficult labor secondary to uterine, pelvic, or fetal factors
- When 1st and 2nd stage of labor exceed 20 hrs.

51
Q

What are causes of dystocia?

A
  • Weak contractions
  • abnormal fetal presentation
  • fetal head to big for pelvis
  • hydrocephalus
52
Q

What does a neonate demonstrate during their first breath?

A

high WOB

53
Q

Pressure in the left atrium is normally higher than the pressure in the right atrium for how long?

A

Within minutes after delivery

54
Q

How is the oxyhemoglobin curve shifted for Fetal hemoglobin?

A

Fetal hemoglobin shifts left, demonstrating a increased affinity for O2.

(aka ready more uptake)

55
Q

How do moms oxyhemoglobins curve shift for the infant?

A

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
56
Q

What can be concluded about the number of alveoli in babes as they get older?

A

Gas exchange surface area grows proportionally with an increase in body surface area

PA 3 (RESP 315 ) (13 decks)

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