Normal L&D Flashcards
Definition of labor
Progressive cervical effacement or dilatation or both resulting from regular uterine contractions that occur at least every 5 minutes and last 30-60 seconds
Definition of lightening
When fetal head settles into brim of pelvis
“Baby has dropped”
Primigravids - 2 wks before labor
Multigravids - in early labor
False labor
Braxton Hicks
Irregular contractions without cervical change
Cervical effacement
Thinning of cervix as it is taken up into the lower uterine segment
Results in the bloody show where mucous plug from cervix mixes with blood
Molding
Alteration of the shape of the fetal head during labor
Caput
Localized edematous swelling of the fetal scalp
Caused by pressure of cervix on the presenting portion of fetal head
Induction of labor
Process whereby labor is initiated by artificial means
Augmentation of labor
Artificial stimulation of labor that has begun spontaneously
Stages of labor
First - from onset of true labor to complete cervical dilatation
Second - Complete cervical dilatation to birth of baby
Third - From birth of baby to delivery of placenta
Fourth - From delivery of placenta to stabilization of pt (usually 6 hours post partum)
Two phases of the first stage of labor
Latent phase - cervical effacement and early dilatation. Considered completed at 3 cm dilatation
Active phase - begins when cervix is 2-4 cm dilated in presence of regular contractions. Consists of an acceleration, max slope, and theoretical deceleration
Management of first stage
May ambulate with intermittent monitoring
IV fluids ONLY
High risk necessitates continuous monitoring
If pt on pitocin for induction or augmentation should be monitored extensively
Amniotomy
Artificially breaking the bag of water
Six cardinal movements
Descent Flexion Internal rotation Extension External rotation Expulsion
Descent
Results from force of uterine contraction
Continuous until delivery of fetus
Flexion
Natural m. tone of fetus
Resistance from cervix, walls of pelvis, and pelvic floor
Internal rotations
When fetal head turns anteriorly towards the symphysis pubis from transverse or oblique diameter
Occurs at pelvic floor when head meets muscular sling
Extension
During descent fetal head will extend as it meets the vaginal outlet (which is direct upward and forwar)
Crowning
Bulging of the perineum which indicates that the largest diameter of fetal head is encircled by vulvar ring
External rotation
Rotation of fetal head back to it’s original position at time of engagement to realign itself with it’s back and shoulders
Expulsion
Usually ant. shoulder under pubic symphysis
Posterior shoulder
Rest of fetus in rapid succession
Ritgen’s maneuver
Controls delivery of head
Fingers of one hand press posterior to rectum extending the fetal head
Counterpressure is applied to the occiput
Two types of episiotomies
Midline
Mediolateral
Signs of imminent placental delivery
Fresh show of blood
Lengthening of umbilical cord
Elevation of fundus
Uterus becomes firm and globular
Why should you not pull on the cord?
Inversion of uterus
Laceration types
1st degree - vaginal epithelium or perineal skin
2nd degree - extends into subepithelial tissues of vagina or perineum w/ or w/o perineal body
3rd degree - anal sphincter
4th degree - rectal mucosa
What should be watched for in the 1st hour after delivery?
Bleeding, hematoma (pelvic or rectal pain)
Increased pulse rate out of proportion to decreased blood pressure
Maternal indications for induction of labor
Pre-eclampsia
Diabetes
Heart disease
Maternal indications for augmentation of labor
Abnormal labor (inadequate contractions) Prolonged latent phase Prolonged active phase
Fetoplacental indications for induction/augmentation of labor
Prolonged pregnancy IUGR Abnormal fetal testing RH incompatibility Fetal abnormality PROM Chorioamnionitis
Absolute maternal contraindication for induction/augmentation
Contracted pelvis
Which type of c-section is NOT a contraindication for induction/augmentation?
Low transverse
Relative maternal contraindications for induction/augmentation
Prior uterine surgery
Classic C-section
Complete transection of uterus
Overdistended Uterus
Fetal contraindications for induction/augmentation
Preterm fetus w/o lung maturity
Acute fetal distress
Abnormal presentation
Placenta previa
When is it ok to induce prior to 37 weeks?
Indicated only if continuation of pregnancy is a risk to mom or baby
If there is no medical indication for induction, what MUST be present and documented prior to 39 weeks?
Fetal lung maturity
What does the BISHOP SCORE indicate?
Whether or not there is a good chance of the induction working High score (9-13) = high likelihood of vaginal delivery Low score (<5) = decreased likelihood
BISHOP must be taken prior to what?
Cervical ripening
Prior to induction what needs to be done?
BISHOP
Cervical ripening
What is used to ripen the cervix?
Prostaglanding gel; PGE 2 gel, cervidil, and prepidil
Osmotic dilator - laminaria
Induction should not exceed how long?
72 hours
When to do c-section after an induction
If membranes ruptured and no progress after 12 hours may do c-section
Complications of induction
Hyperstimulation Rupture of uterus Antidiuretic effect can lead to water intoxication, convulsions, coma especially if > 24 hours Muscle fatigue Postpartum uterine atony
Puerperium
Period following delivery to approx 6 weeks postpartum
What are the major proteins synthesized in breast milk that are not in cow’s milk?
Casein
Lactalbumin
B-lactoglobulin
