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OB > Module 3 Exam > Flashcards

Module 3 Exam Flashcards

1
Q

What are the 5 Ps of labor?

A 
Passageway
Passenger
Psyche
Powers
Position
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2
Q

Passageway

A

pelvic canal: the inlet, the pelvic cavity (midpelvis), the outlet

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3
Q

What are the 4 types of pelvis?

A

Gynecoid: female, most common, + vaginal delivery
Android: - vaginal delivery, pelvic descent slow, fetal head enters in transverse or posterior position, arrest of labor
Anthropoid: + vaginal delivery
Platypelloid: - vaginal delivery, fetal head engages in transverse position, difficult descent through midpelvis, delay of progress at the outlet of the pelvis.

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4
Q

Passenger

A
  • the fetus

- sufficient passage of the passenger depends on: fetal head, fetal attitude, fetal lie, and fetal presentation

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5
Q

Fetal head

A
  • the least compressible and largest part of the fetus.
  • fetal skull has 3 parts: face, base of the skull, vault of cranium (roof)
  • bones of the base are not fused, allowing the head to mold as it passes through the narrow portions of the pelvis.
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6
Q

Fetal attitude

A
  • refers to the relation of the fetal parts to one another.
  • it is the fetal position
  • it is how the baby is flexed
  • normal attitude is moderate flexion of the head, flexion of the arms onto the chest, and flexion of the legs onto the abdomen (fetal position)
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7
Q

Fetal lie

A
  • refers to the relationship of the cephalocaudal (spinal column) axis of the fetus to the cephalocaudal axis of the woman
  • the fetus will assume either a longitudinal or a transverse lie.
  • longitudinal is vertex or breech
  • transverse is shoulder presentation
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8
Q

Fetal presentation

A
  • determined by fetal lie and by the body part of the fetus that enters the pelvic passage first.
  • this portion of the fetus is referred to as the presenting part
  • fetal presentation may be cephalic, breech, or shoulder
  • most common presentation is cephalic
  • breech and shoulder presentations are associated with difficulties during labor; called malpresentations
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9
Q

Vertex presentation

A
  • most common
  • head flexed to the chest, occiput is presenting part
  • Suboccipitobregmatic diameter is 9.5 cm
  • occiput is the area of the fetal skull occupied by the occipital bone, beneath the posterior fontanelle.
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10
Q

Sinciput presentation

A
  • the fetal head is not flexed or extended
  • top of head is presenting part
  • “military presentation”
  • Bregma (anterior fontanelle) is the large diamond-shaped anterior fontanelle
  • occipitofrontal diameter is 11.75 cm
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11
Q

Brow presentation

A
  • fetal head is partially extended
  • sincipt or forehead is presenting part
  • largest AP diameter
  • occipitomental diameter is 13.5 cm
  • sinciput is the anterior area known as the brow.
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12
Q

Face presentation

A
  • the fetal head is hyperextended
  • face is presenting part
  • submentobregmatic diameter is 9.5 cm
  • sphenoid fontanelle is right behind the eyes and the sinciput
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13
Q

Complete breech presentation

A
  • knees and legs are flexed

- buttocks and feet are presenting parts

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14
Q

Frank Breech presentation

A
  • hips flexed, knees extended
  • buttocks presenting part
  • baby appears to be folded in half with feet by face and butt presenting
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15
Q

Footling breech presentation

A
  • hips and legs are extended
  • foot/feet are presenting part
  • this baby appears to be standing
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16
Q

Engagement

A
  • occurs when largest diameter of the presenting part reaches or passes through the pelvic inlet
  • an engaged fetus will not move
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17
Q

Ballottable

A

-fetus is not engaged and can be easily moved

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18
Q

Station

A
  • the relationship of the presenting part to the maternal ischial spines.
  • Zero station is at the level of the ischial spines
  • Above spines is negative
  • Below spines is positive
  • *Fetal position is the relationship of the fetal presenting part (ie head) and the maternal pelvis.**
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19
Q

Landmarks of the presenting part are:

A

O - occiput (vertex position)
M - mentum (face presentation)
S - sacrum (breech)
A - acromion (shoulder presentation)

A - anterior
P - posterior
T - transverse

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20
Q

Powers/Physiologic Force

A

Primary Force: contractions that contribute to cervix dilation and effacement
Secondary Force: abdominal muscles pushing

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21
Q

Phases of a contraction

A
  • increment - build up
  • acme - the peak
  • decrement - letting up
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22
Q

Characteristics of contractions

A 
Frequency (min)
Duration (seconds)
Intensity (measured during acme)
** you want 5 or less per 10 minutes**
**timed from beginning of contraction to beginning of contraction**
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23
Q

Contraction Assessment

A

Palpation: feeling with hands the frequency, duration and intensity. Mild: nose, Moderate: chin, Strong: forehead
External monitoring: TOCO. Provides continuous contraction frequency and duration.
Internal monitoring: IUPC. Measures all 3 (F/D/I)

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24
Q

Psyche

A
  • a woman’s emotional readiness for the labor process
  • Can affect entire experience
  • Includes fears, anxieties, birth fantasies, level of support, preparedness
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25
Q

Progesterone Withdrawal Hypothesis

A
  • Progesterone is decreased toward the end of pregnancy

- Available estrogen is now the dominant hormone and causes uterine muscle contractility

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26
Q

Prostaglandin Hypothesis

A
  • prostaglandin release from the membranes stimulate ctx

- manual release or synthesis related to increased estrogen and decreased progesterone levels

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27
Q

Corticotropin-Releasing Hormone Hypothesis

A
  • released from hypothalamus
  • increases near the end of pregnancy
  • stimulates synthesis of prostaglandins
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28
Q

Leopold’s Maneuver 1st

A
  • palpate the fundus
  • fetal head is firm, hard and round
  • the buttocks is softer and has bony prominences
  • should start feeling at about 30 weeks gestation
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29
Q

Leopold’s Maneuver 2nd

A
  • determine location of fetal back
  • fetal back will feel firm and smooth
  • fetal extremities will feel small and knobby
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30
Q

Leopold’s Maneuver 3rd

A
  • determine which fetal part is lying in the pelvic outlet

- grasp abdomen just above symphysis pubis, should confirm opposite what was found with 1st maneuver.

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31
Q

Leopold’s Maneuver 4th

A
  • Attempt to locate the cephalic prominence

- A fetal head that is well flexed, will have the cephalic prominence on the opposite side of the back

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32
Q

Where is the external EFM placed in relation to Leopold’s/fetal position?

A
  • FHR hears most clearly at the fetal back
  • Cephalic: lower quadrants of maternal abdomen
  • Breech: at or above maternal umbilicus
  • Transverse: just above or below maternal umbilicus
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33
Q

What is a nurse feeling/assessing for when performing a sterile vaginal exam (SVE) as part of the intrapartum nursing assessment?

A
  • cervical effacement
  • dilation
  • fetal station
  • presenting part
  • fetal descent
  • position of the fetus
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34
Q

FHR baseline

A
  • the average FHR rounded to increments of 5 bpm observed during a 10-minute period of monitoring.
  • excluded episodic changes, marked variability, and segments that differ by more than 25 bpm.
  • you need at least 2 min w/in 10 min and they do not need to be consecutive.
  • Normal FHR 110-160
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35
Q

FHR variability

A
  • Absent: amplitude undetectable
  • Minimal: amplitude detectable but less than 5 bpm
  • Moderate(normal): amplitude 6 to 25 bpm <– desired
  • *reduced variability is the best single predictor for determining fetal compromise.
  • *fetal acidosis and subsequent hypoxia are highest in fetuses that have absent or minimal variability.
36
Q

Why is moderate variability so important?

A
  • moderate variability tells us the baby is doing well and is well oxygenated
  • reduced variability is the best single predictor for determining fetal compromise.
37
Q

Accelerations

A
  • an abrupt increase of at least 15 bpm in FHR above the baseline that lasts at least 15 seconds. 15 x 15
  • in pregnancies less than 32 weeks, accelerations are defined as an increase of 10 x 10.
38
Q

Prolonged Acceleration

A
  • lasts for 2 minutes or more during a 10 minute period.

- Accelerations that are 10 minutes or longer are considered a baseline change.

39
Q

Decelerations

A

Early: good/ok
Late: bad
Variable: bad
Prolonged: bad

40
Q

Early decelerations

A
  • defined as a usually symmetrical, gradual decrease in FHR and return to baseline associated with uterine ctx.
  • Nadir of the deceleration usually occurs at the same time of the peak of the ctx.
  • usually caused by head compression
41
Q

Late decelerations

A
  • defined as a usually symmetrical, gradual decrease in FHR and return to baseline associated w/ uterine ctx.
  • Nadir of the decal usually occurs after the peak of the ctx
  • This is a sign of uteroplacental insufficiency
42
Q

Variable decelerations

A
  • defined as an abrupt decrease in FHR below the baseline which may or may not be associated with uterine ctx
  • can occur at any time
  • u, v, or w shaped
  • sign of cord compression
43
Q

Prolonged deceleration

A
  • defined as a decrease in FHR below the baseline lasting for 2 minutes or more
  • prolonged decel lasting more than 10 minutes is a change from baseline
44
Q

V C
E H
A O
L P

A

Variable……cord compression
Early………….head compression
Accel…………OK
Late…………..placental insufficiency

45
Q

Sinusoidal

A
  • smooth, sine-like undulating wave pattern with 3 to 5 bpm and lasting for at least 20 minutes.
  • Sign of m/f hemorrhage, twin/twin transfusion, ruptured umbilical vessels
  • Pseudo sinusoidal: fetal thumb sucking and meds like stadol/fentanyl
46
Q

Category 1 tracing

A
  • things are ok
  • normal FHR range
  • normal variability in the moderate range
  • absence of late decels
  • early decels may or may not be present
47
Q

Category 2 tracing

A

Provide interventions

48
Q

Category 3 tracing

A
  • rushing to C-section
  • absent variability in baseline FHR
  • recurrent late decels
  • recurrent variable decels
  • bradycardia
  • sinusoidal for more than 20 minutes
49
Q

How do we manage non-reassuring FHR tracings?

A
  • prompt evaluation
  • expeditiously resolve the abnormal FHR pattern
  • maternal O2
  • change maternal position
  • discontinuation of labor stimulation
  • tx of maternal hypotension
  • C-section
50
Q

Dysfunctional uterine contractions

A
  • dysfunctional or uncoordinated uterine contractions
  • result in a prolonged labor
  • typically irregular in strength, time, or both
  • not effective in producing dilation or effacement
51
Q

True labor

A
  • progressive dilation and effacement of the cervix
  • ctx occur regularly
  • ctx increase with frequency, duration, and intensity
  • ctx start in back and radiate to abdomen
  • ctx not relieved by ambulation
52
Q

False labor

A
  • no progressive dilation or effacement
  • ctx irregular, do not increase in F/D/I
  • ctx felt in lower abdomen and groin
  • ctx relieved by ambulation, position changes, hydration, rest
53
Q

Premonitory (early) signs of labor

A
  • lightening
  • Braxton hicks contractions
  • cervical changes
  • ROM
  • nesting
  • increased backache
  • weight loss of 1 to 3 pounds
  • diarrhea
  • indigestion
  • N and/or V
54
Q

First stage of labor (phases)

A

Latent phase
active phase
transition phase

55
Q

Latent phase

A
  • begins with onset of regular ctx that increase
  • ctx are 10 to 30 minutes apart and mild (nose)
  • cervix 0-3 cm
  • mom anxious but excited
56
Q

Active phase

A
  • ctx become more frequent and increase to moderate (chin) intensity
  • ctx occur less than ever 5 min
  • cervix 4-7 cm
  • mom has to focus and work though ctx
  • mom may feel that she’s losing control
57
Q

Transition phase

A
  • ctx have increased to every 1.5 to 2 min, strong (f.head)
  • cervix 8-10 cm
  • mom may feel increased rectal pressure, need to push
  • mom may be restless and cannot get comfortable
  • mom focused internally and exhausted
  • mom wants company but to be “left alone”
58
Q

Second stage

A
  • pushing
  • begins with complete cervical dilation and ends with birth of infant
  • average time P: 2-3 hrs M: 15-30 min
  • crowning
  • mom has new found sense of purpose and strength
59
Q

Third stage

A
  • placenta
  • beings with delivery of infant and ends with delivery of placenta
  • this stage should not last for more than 30 minutes
60
Q

Fourth stage

A
  • recovery
  • 1 to 4 hours after birth
  • mother’s body begins to recover
  • VS return to normal
  • increased hunger and thirst r/t exhaustion from labor
  • shaking r/t physical exertion
61
Q

Which fetal presentation would you most like to see a fetus in?

A

ROA, LOA, OA. Vertex

62
Q

How will you manage a patient who presents with a fetus in a malpresentation?

A

Malpresentations usually result in a C-section.

63
Q

What is a TOLAC?

A

Trial of labor after C-section

64
Q

What influences a successful TOLAC?

A
  • one previous C-section
  • low transverse uterine incision
  • clinically adequate pelvis
  • 2 previous C-sections with a successful vaginal delivery
  • must be able to do C-section within 30 min
  • dr, staff, anesthesia, must be readily avail for C-section
  • *classic(vertical) or T uterine incision is a contraindication to VBAC!!**
65
Q

What is an external cephalic version (ECV)?

A

the fetus is changed from a breech to a cephalic presentation by external manipulation of the maternal abdomen.

66
Q

What are the criteria for an ECV?

A
  • 36 wks gestation or more
  • reactive NST right before procedure
  • fetal breech not engaged
  • adequate AFI
  • single fetus
67
Q

What are contraindications for an ECV?

A
  • maternal problems: uterine anomalies, uncontrolled preeclampsia or 3rd trimester bleeding
  • complications of pregnancy: ROM, oligohydramnios, hydramnios, placenta previa, vasa previa
  • multiple gestations
  • nonreassuring FHR
  • fetal abnormalieis: IUGR or nuchal cord
68
Q

How can nurses help prevent the need for an episiotomy?

A
  • perinatal massage during pregnancy for nulliparous women
  • natural pushing during labor
  • avoiding the lithotomy position
  • side-lying position for pushing
  • warm or hot compress on the perineum
  • firm counterpressure
  • push, breath, push, breath
  • avoid immediate pushing after epidural placement
69
Q

What defines (PTL) preterm labor?

A

Labor that occurs between 20 and 36 completed weeks of pregnancy.

70
Q

What tocolytics are used for preterm labor?

A

-Beta-adrenergic agonists (Beta-mimetics
-magnesium sulfate
-cyclooxygenase (prostaglandin synthesis) inhibitors
-calcium channel blockers
**most widely used are terbutaline sulfate (Brethine) and magnesium sulfate
Also used are nifedipine/Procardia, indomethacin/Indocin

71
Q

Describe fetal fibronectin.

A
  • fFN is a protein normally found in the fetal membranes and decidua.
  • it is in cervicovaginal fluid in early pregnancy but is not usually present in significant quantities between 22 and 37 weeks gestation
    • fFN puts mom at increased risk for PTL
  • Negative fFN is associated with a very low risk of birth within 7 to 14 days.
  • test is over 99% accurate for predicting no preterm birth within 7 days.
72
Q

What is the ultimate goal of PTL management?

A

Delay birth long enough for corticosteroids to be administered, ideally 48 hours.

73
Q

Polyhydramnios

A
  • also called hydramnios
  • More than 2000 mL of amniotic fluid
  • 500 mL is normal
  • exact cause is unknown
  • often occurs in cases of major congenital anomalies
74
Q

Oligohydramnios

A
  • less than normal amniotic fluid; less than 500 mL
  • exact cause unknown
  • common in postmaturity of fetus, maternal HRN, IUGR from placental insufficiency, fetal renal malformations
75
Q

What do you watch for with polyhydramnios and oligohydramnios?

A

Polyhydramnios: mom for SOB, edema in LE, compression of vena cava. Placental abruption with ROM, postpartum hemorrhage
Oligohydramnios: fetal adhesions, cord compression, respiratory issues at birth, skin and skeletal abnormalities due to restricted movement.

76
Q

Placenta previa

A

when placenta is implanted in the lower uterine segment rather than the upper portion of the uterus

77
Q

Abruption placenta

A

the premature separation of a normally implanted placenta from the uterine wall.

78
Q

Non-pharmacological/physical pain management

A
  • back rub
  • counter pressure
  • showers/tub
  • cool cloths
  • ambulation/position change
  • hypnobirth
79
Q

Systemic medications for pain management

A
  • analgesia
  • stadol/dutophanol (don’t give with HTN)
  • nubain/nalbuphine
  • Demerol/meperdine
  • sublimaze/fentanyl
  • morphine
80
Q

Regional anesthesia

A
  • provide temporary loss of sensation by preventing nerve impulse transmission.
  • most common meds used are Marcaine and Naropin
81
Q

Pudendal block

A
  • provides perineal anesthesia for the latter part of the first stage of labor, the 2nd stage, birth, and episiotomy repair.
  • does not provide relief from the pain of contractions
82
Q

What side-effects may you see after an epidural?

A

Mild: palpations, tinnitus, metallic taste
Moderate: N/V, hypotension (most common, IV bolus)
Severe: respiratory depression, cardiac arrest, coma

83
Q

Think about the most common side effect of an epidural. how might that influence the FHR pattern?

A

It can cause fetal bradycardia.

84
Q

What is a Bishop score?

A
  • a scoring system that is helpful in predicting the potential success of induction.
  • Ratings are 0, 1, 2, and 3
  • Components evaluated are cervical dilation, effacement, consistency, and position, as well as station of the fetal presenting part.
  • higher score = more likely that labor will occur.
85
Q

How would you manage an unfavorable cervix?

A
  • attempt cervical ripening
  • this is softening and effacing of the cervix
  • pharmacologic methods of cervical ripening include the use of prostaglandin agents and Cytotec.
86
Q

What are some medications/methods used for cervical ripening & induction of labor?

A

-Misoprostol (Cytotec) is a synthetic PGE analogue that can be used to soften and ripen the cervix and to induce labor.
-Dinoprstone (Cervidil or Prepidil)
Induction of labor: oxytocin (Pitocin)

87
Q

What is the nurses role in an “operative vaginal birth?”

A
  • Documentation: type of instrument, duration of application, number of contractions, fetal and maternal response.
  • Stop the line: if duration/use exceeds guidelines, vacuum pop-offs, chain of command.

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