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BCIT Perinatal Theory One > Module Five > Flashcards

Module Five Flashcards

1
Q

Defining sign of labour

A

presence of regular uterine contractions that become progressively stronger, frequent, and longer

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2
Q

Positive sign of labour

A

regular contractions with cervical changes - cervix moving from posterior –> anterior, shortening, thinning (effacing) and dilating

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3
Q

Maternal Prep for Labour

A
  • inc estrogen activates uterus
  • inc oxytocin and prostaglandin –> cervical ripening
  • inc inflm activates cervix & uterus
  • inc uterine oxy receptors
  • inc central receptors (brain) for beta-endorphins continuing to endogenous analgesia in labour
  • inc mammary & central oxytocin and prolactin receptors
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4
Q

Fetal Prep for Labour

A
  • Pre-Labour lung and organ maturation
  • develop. of oxy neuroprotection
  • inc epinephrine and norepinephrine receptors to protect from hypoxia
  • preservation of blood supply to <3 and brain via catecholamine surge and neuroprotection effects
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5
Q

Oxytocin

A

produced by posterior pituitary gland, optimizes rhythmic contractions, promotes calm, reduces fear and stress, promotes attachment

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6
Q

Beta-Endorphins

A

secreted by posterior pituitary gland, provides analgesia and adaptive responses to stress and pain

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7
Q

Catecholamines

A

epinephrine, norepinephrine, dopamine- released in response to fear, stress and perceived danger. Supports newborn transition to extrauterine life. Primary mediators that prepare fetus for birth and support multi-organ transition.

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8
Q

Cortisol

A

Stress hormone, elevated during labour, may promote contractions, increase central oxytocin effects on mat adaptations, attachment, postpartum mood. Prepares fetus for birth- promotes lung maturation and clearance of fetal lung fluid

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9
Q

True Labour

A
  • Regular contractions that become stronger, longer, and more frequent
  • Contractions become more intense with walking
  • Contractions felt in lower back and radiates to lower abdomen
  • Contractions continue despite use of comfort measures & rest
  • Cervix softens, moves from post–> ant position, thins and dilates
  • Presenting part of fetus is engaged in pelvis
  • Bloody Show
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10
Q

False Labour

A
  • Contractions continue irreg or stop/start
  • Contractions may stop with activity or stop with rest
  • Contractions can be felt in low back or abdomen above umbilicus
  • Contractions stop/slow with comfort measures
  • Cervix does not change
  • Fetus may not be engaged
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11
Q

5 Ps of Labour

A 
Passenger
Passage
Powers
Position
Psyche
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12
Q

Passenger

A

Fetus- size, presentation, lie, attitude, position

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13
Q

Passage

A

Mat pelvis- bones, soft tissues, cervix, pelvic floor, vagina

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14
Q

Powers

A

Contractions, voluntary bearing down efforts

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15
Q

Position

A

Woman’s position as she labours

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16
Q

Psyche

A

Woman’s strength, PMHx, ability to cope, perception of pain, level of fear/anxiety, values & beliefs, intentions

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17
Q

6 bones of fetal skull

A

two parietal, two temporal, occipital, frontal

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18
Q

fontanelles

A

anterior- diamond shaped, posterior - triangular

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19
Q

Primary powers

A

uterine contractions

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20
Q

Secondary powers

A

maternal pushing efforts

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21
Q

Position changes

A

relieve fatigue, increase comfort, improve circulation, gravity, opening pelvic diameters

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22
Q

7 Cardinal movements

A
  1. Engagement
  2. Flexion
  3. Descent
  4. Internal Rotation
  5. Extension
  6. Restitution and External Rotation
  7. Expulsion
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23
Q

First Stage

A

onset of regular contractions and ends when cervix fully dilated

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24
Q

Latent Phase (First Stage)

A

Starts when contractions become regular and painful, cervical effacement and dilation commences, complete at 3cm. Lasts 6-8h, contractions q5-30mins

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25
Q

Active Phase (First Stage)

A

time when labour is well established, contractions more painful, frequent, longer - cervix dilates from 4-7cm. Lasts 3-6 hours, contractions q3-5mins

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26
Q

Transition (Accelerated) Phase (First Stage)

A

cervix 8-10cm, signals approach of 2nd stage, contractions more expulsive in nature

27
Q

Second Stage

A

Commences with full dilation and ends with birth of baby

Expulsive contractions and maternal efforts, gravity enhancing positions. Fetal head descends under public arch, gradually thinning and stretching the vaginal opening.

28
Q

Crowning

A

Widest diameter of the head distends the opening

29
Q

Restitution

A

Once head is born it rotates briefly to position it was in when entering the pelvis

30
Q

Latent Phase (Second Stage)

A

Cervix fully dilated, fetus continues to descend, no urge to push

31
Q

Active Phase (Second Stage)

A

Stretch receptors in pelvic floor trigger a strong urge to push - Ferguson’s reflex

32
Q

Third Stage

A

Birth of a baby –> delivery of placenta and membranes

33
Q

Signs of Placenta separation

A
  • firmly contracted fundus
  • change in uterine shape
  • sudden gush of blood
  • apparent lengthening of cord
  • Feeling of vaginal fullness
34
Q

Fourth Stage

A

One - Four hours postpartum

- physiologic adjustment & stabilization, uterus well contracted, moderate amount of vaginal bleeding

35
Q

Assessing Fetal Well-being

A

FHR- 110-160 bpm

Assess q 15-30 min in active phase, q5min in 2nd stage

36
Q

Assessing Contractions

A

palpate before, during, after contraction

  • resting tone
  • strength, duration, frequency
37
Q

Non-pharmacological pain management

A
  • intradermal sterile water injection
  • music
  • hypnosis
  • relaxation
  • breathing techniques
  • massage
  • heat/cold application
  • acupressure & acupuncture
  • transcutaneous electrical nerve stimulation
  • water therapy
  • position changes
38
Q

Pharmacologic

A
  • Inhalation - Nitronox and Entonox
  • Narcotics- Opioids in early stages
  • Regional Analgesia/Anesthesia - Epidural
39
Q

Assessments during Second Stage

A 
Mat VS q1h
FHR q5min 
Contraction strength, freq, dur
Descent
Pushing strength, effectiveness
Pain and Coping
Position Changes- q20mins
Spontaneous Pushing
40
Q

Risk of PPH

A

10 IU Oxy @ delivery
Cord Clamped within 3 mins
Controlled traction to help with placental delivery

41
Q

Maternal Assessment

A

signs of placental separation
VS q15mins for first hour
fundus and flow Q15 mins
assess pain

42
Q

Newborn Assessment

A 
Apgar 1+5 mins
VS within 15mins
VS hourly until temp stable
Head to Toe
Readiness to feed
43
Q

Labour Dystocia

A

long, difficult, abnormal labour - variance in one of the 5Ps –> leading cause of c/s

Increased risk: obesity, short stature, advanced mat age, infertility, uterine abn, malpresentation, malposition, overstimulation of uterus with oxy, mat fatigue, dehydration, fear, use of epidural

44
Q

Dysfunctional Labour

A

alteration in characteristics of uterine contractions - lack of progress in cervical dilation, lack of progress in fetal descent and expulsion

45
Q

Passenger Variations

A

fetal size, fetal presentation, multifetal pregnancy, fetal anomalies

46
Q

Cephalopelvic Disproportion

A

fetal head too big to move through pelvis - may result from malposition

47
Q

Macrosomia

A

SFH measures larger than wk gest. Excess wt gain, partner above average height and weight

48
Q

Shoulder Dystocia

A

Obstetrical Emergency***
head is born but ant shoulder cannot pass under pubic arch - asphyxia, fractures to humerus/clavicle, brachial plexus nerve injury, trauma, rectal injuries, PPH

49
Q

Malpresentation

A

something other than head is presenting part

50
Q

External Cephalic Version

A

OB attempts to turn fetus from breech –> cephalic

51
Q

Malposition

A

most common- persistent occiput posterior position - OP, ROP, LOP

  • irreg contraction pattern, long and slow labour, back pain
  • Upright forward leaning, lunging, rocking –> fetal descent and rotation
52
Q

Deflexed Head

A

presents a wider diameter of the head and is associated with a longer, slower labour

53
Q

Asynclitism

A

Head is tilted to one side or other instead of in alignment with the shoulders

54
Q

Persistent Cervical lip

A

thin ribbon or lip of cervix at front or side

55
Q

Oxytocin for Induction

A

RISKS: uterine hyperstimulation, Placental abruption, uterine rupture, unnecessary c/s d/t abn FHR, PPH, poor fetal oxy, hypoexmia, acidosis

56
Q

hyperstimulation

A

6 or more contractions in 2 consecutive 10 min windows OR contractions lasting >120s

57
Q

tachysystole

A

more than 5 contractions per 10 min period over 30 mins

58
Q

hypertonus

A

contraction lasting greater than 120s

59
Q

Vacuum Assisted Delivery

A

Trauma to perineum, vagina, cervix, cephalhematoma, scalp lacerations, subdural hematoma

60
Q

Forcep Assisted Birth

A

Trauma to vagina, cervix, perineum, PPH, lacerations, bruising, facial palsy, subdural hematoma

61
Q

Conditions for Vac & Forcep deliveries

A
  • Fully dilated cervix
  • Ruptured Membranes
  • Empty Bladder
  • Engagement
  • Maternal Pelvis Assessment
  • Maternal Consent
62
Q

C/S complications

A 
Anesthesia issues
Hemorrhage
Bowel/Bladder injury
Amniotic Fluid Embolism
UTI
Abd Wound Hematoma
Wound Dehiscence
Infection
Thromboembolism

Preterm Birth
Inc incidence of resp distress and tachypnea
separation of mum and babe affecting attachment

63
Q

Contraindications to VBAC

A

“T’ Classic scar from prev C/S
prev uterine rupture
presence of contraindication to labour

64
Q

Uterine Rupture- S&S

A
  • atypical/abn FHR pattern
  • cessation of contractions
  • constant abd pain
  • vag bleeding
  • hematuria
  • mat shock

BCIT Perinatal Theory One (4 decks)

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