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ACP226 Obstetrics > Module 4: Process Of Labour And Delivery > Flashcards

Module 4: Process Of Labour And Delivery Flashcards

1
Q

Recommended number of prenatal visits for average obstetrical risk patients

A

8-10:
First visit 6-10wks
Every 4wks up to wk 28
Every 2wks for wk29-36
Every wk from 37wks to birth

Fetal assessment begins between 12-14wks

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2
Q

3 methods used to monitor contractions

A

Palpation
External
Internal

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3
Q

3 phases of uterine contraction

A

Increment (building - longest)
Acme (peak)
Decrement (letting up)

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4
Q

Assessment of uterine contractions includes

A

Frequency
Duration
Intensity/strength
Resting tone

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5
Q

Rupture of membranes

A

Usually about 1L
Most women begin labour within 12-24hrs after

Note time, colour, odour, amount, consistency, FHR on rupture.

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6
Q

Bloody show (mucous plug)

A

Occurs with softening and effacement of cervix.
Sign of impending labour (24-48hrs)

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7
Q

Longitudinal lie

A

Uterus is positioned up/down.

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8
Q

Transverse lie

A

Uterus shape left to right

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9
Q

Leopold maneuver

A

4 maneuvers to evaluate uterus.
1) palpate upper abdomen/fundus
2) palpate Sagittal (L and R) to determine fetal back
3) palpate above pubic symphysis to determine presenting part
4) palpate inguinal area to determine descent

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10
Q

Effacement

A

Drawing up of cervical os and cervical canal into uterine side walls.

Primips: effacement usually occurs before dilation

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11
Q

Dilation

A

Cervical os and can widen from less than 1 cm to approx 10 cm.

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12
Q

Factors affecting the labour process

A

Passageway (birth canal)
Passenger (fetus and placenta)
Powers (contractions)
Position (of labouring client)
Psych response

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13
Q

Five additional P’s of labour

A

Philosophy
Partners
Patience
Patient preparation
Pain management

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14
Q

Factors affecting passenger in labour

A

Fetal head
Fetal attitude
Fetal lie
Fetal presentation
Fetal position
Fetal station
Fetal engagement

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15
Q

Passenger - fetal attitude

A

Refers to relationship of fetal body parts to one another.
Normal attitude is termed general flexion

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16
Q

Passenger presenting part

A

Cephalic.
Breech
Shoulder

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17
Q

Cephalic presentations

A

Vertex (occiput. Most common. Head flexed to chest)
Military (top of head. Head partially flexed)
Brow (head partially extended)
Face (head hyperextended)

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18
Q

Fetal breech presentation

A

Frank (buttocks first)
Complete (cross legged)
Footling (1 or both legs presenting)

Frank can result in vaginal birth. Complete, footling, and incomplete generally require C section.

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19
Q

Shoulder presentation

A

Transverse lie
1/300 births

Associated with: previa, premature, high parity, PROM, multiple gestation, fetal abnormality

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20
Q

Passenger fetal position

A

Relationship of presenting feral part to maternal pelvis.
Pelvis related in 4 imaginary quadrants.
Left anterior
Right anterior
Left posterior
Right posterior

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21
Q

Notations used to describe fetal position

A

L or R (side of pelvis)
Vertex (occiput), mentum (face) sacrum (breech) shoulder (Acromion)
Anterior, posterior, or transverse.

22
Q

Most common and most favourable passenger position for birthing

A

LOA
Left
Occiput
Anterior

23
Q

Passenger engagement/station

A

Engagement occurs when the largest diameter of presenting part passes through pelvic inlet.

Station is relationship of presenting part to line drawn between ischial spines of maternal pelvis.

24
Q

Fetal position cardinal movements of labour

A

Engagement
Descent
Flexion
Internal rotation
Extension
External rotation (restitution)
Expulsion

25
Q

Power (contractions)

A

Primary (uterine contractions)
Secondary (intra-abdominal pressure from mother pushing)

26
Q

Premonitory signs of labour

A

Lightening
Braxton-hicks
Ripening
Mucous plug
ROM
Sudden burst of energy
Weight loss
Backache/pelvic pressure increase
Diarrhea
Indigestion
N/V

27
Q

Maternal cardiovascular response to labour

A

CO increase 30%
BP increase
HR increase

CO peaks immediately after birth and starts to decrease in first 10 minutes. CO remains elevated approx 24hrs

28
Q

Maternal respiratory response to labour

A

50% of increased O2 used by placenta.
Mild metabolic acidosis/respiratory alkalosis

29
Q

Maternal renal response to labour

A

Polyuria (due to CO)
Slight proteinuria
Edema May occur

30
Q

Maternal GI system response to labour

A

Motility reduced
Gastric emptying prolonged

31
Q

Stages of labour

A

1st: beginning of true labour. Ends with complete cervical dilation
2nd: complete dilation and ends with birth of baby
3rd: after birth of baby and ends with placental delivery
4th: 1-4 hrs after birth

32
Q

1st stage of labour

A

Divided into latent, active, and transition phases.

33
Q

Latent or early phase of 1st stage of labour

A

Begins with onset of regular contractions. May be little or no fetal descent.
Cervix dilates 0-3cm
Membranes May rupture
Contractions q5-10 lasting 40-45 seconds (NP: 9hrs, MP 5-6hrs)

34
Q

Active phase of 1st stage of labor

A

Anxiety increases
Cervix dilates 4-7cm and effaces. Progressive fetal descent.
Contractions q2-5 lasting 45-60s.
Contraction begins and moderate and progresses to strong.
Show present
NP up to 6hr, MP up to 4hr.

35
Q

Transition phase of 1st stage of labor

A

Short but intense
Cervix progresses from 8-10cm
Increase in show
Contraction q1-2min lasting 60-90s
NP up to 1hr, MP 30min

36
Q

2nd stage of labor

A

Contraction q2-3m lasting 60-90s.
NP up to 1hr, MP up to 30m
Pelvic phase (fetal descent)
Perineal phase (active pushing)

37
Q

3rd stage of labor

A

Delivery of placenta
Signs of separation usually appear around 5 minutes after birth but can take up to 30 minutes.
500ml blood loss normal
Over 1L considered severe.

38
Q

Dystocia

A

Delay or arrest in the progress of labor.
Most common cause is dysfunctional or uncoordinated uterine contractions

39
Q

Precipitous labor

A

Labor completed in less than 3 hours from the start of contractions to birth.
Risk of injury to both mother and fetus.

40
Q

Causes of dystocia

A

Dysfunctional uterine contractions
Precipitous labor
Cephalopelvic disproportion
Passenger orientation and presentation

41
Q

Cephalopelvic disproportion

A

Occurs when there is a size mismatch between mother’s pelvis and fetus’ head.

42
Q

McRoberts maneuver

A

Application of suprapubic pressure to relieve shoulder dystocia

43
Q

Compound presentation

A

Occurs with 2 presenting parts. Can happen when the presenting part doesn’t completely fill the inlet.

44
Q

Non reassuring fetal status (fetal distress)

A

O2 supply doesn’t meet demand of fetus.
Most common cause is cord compression or uteroplacental insufficiency

45
Q

Prolapsed cord

A

Occur when cord falls and lies with or ahead of presenting part.
50% occur in 2nd stage of labor.

46
Q

Retained placenta

A

Diagnosed if placenta hasn’t been delivered after 30 minutes

47
Q

Amniotic fluid embolism

A

Occurs when amniotic fluid, fetal cells or hair, or other debris enters maternal circulation.

48
Q

Fetal arrhythmias and dysrhythmias

A

Normal:
Predictive of normal fetal acid-base status
Atypical:
Not predictive of abnormal fetal acid base.
Abnormal:
Predictive of abnormal fetal acid-base

49
Q

Fetal tachycardia

A

Baseline FHR greater than 160bpm lasting 10 mins or longer

50
Q

Fetal bradycardia

A

FHR below 110 lasting 10 mins or longer.

ACP226 Obstetrics (3 decks)

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