Normal Labor Flashcards
Labor definition
Baby and placenta with umbilical cord are expelled out of the uterus
Labor definition
Baby and placenta with umbilical cord are expelled out of the uterus
Components of birthing kit
Surgical scissors or a scalpel Umbilical cord clamps A small rubber bulb syringe Towels 4x4 gauze sponges and/or 2x10 gauze sponges Sterile gloves Infant blankets Sanitary napkins Infant sized bag-mask device Goggles A plastic bag
When is a due date?
40 weeks from the first day of her last period.
How is due date determined?
Based on ultrasound and LMP
When due date is adjusted?
When there is >7d difference in 0-13wk
When there is >10 difference in 14-20wk
What is term?
Normal timing
37-42
What is preterm?
What are contraindication to normal vaginal delivery?
Complete placenta previa (baby cannot get out without life-threatening bleed)
Activeherpes simplex lesion
Previous vertical uterine incision or uterine surgery (risk for rupture)
Malpresentation (breech, transverse)
Components of birthing kit
Surgical scissors or a scalpel Umbilical cord clamps A small rubber bulb syringe Towels 4x4 gauze sponges and/or 2x10 gauze sponges Sterile gloves Infant blankets Sanitary napkins Infant sized bag-mask device Goggles A plastic bag
When is a due date?
40 weeks from the first day of her last period.
How is due date determined?
Based on ultrasound and LMP
When due date is adjusted?
When there is >7d difference in 0-13wk
When there is >10 difference in 14-20wk
What is term?
Normal timing
37-42
What is preterm?
What are contraindication to normal vaginal delivery?
Complete placenta previa (baby cannot get out without life-threatening bleed)
Activeherpes simplex lesion
Previous vertical uterine incision or uterine surgery (risk for rupture)
Malpresentation (breech, transverse)
Events during onset of labor
Labor is defined as regular, painful, uterine contraction resulting in progressive cervical effacement (thinning) and dilation
What is the name for contractions that do not dilate cervix
Braxton-Hicks
What are the signs of labor
Onset of contractions
Bloody show
Leaking fluid (rupture of membranes) (ROM)
What is the difference between early vs. active labor
will deliver in hours immediate delivery
What are prime events during
1st stage of labor
2nd stage of labor
3rd stage of labor
Cervix dilation
Delivery of baby
Delivery of placenta
How much is cervix dilated during 1st stage of labor?
10cm
What is important to monitor during 1st stage of labor?
Fetal heart beet 110-160 every 5-15min
What needs to be done if fetal heart rate is lower than 90/m for more than 60-90s?
1) Woman is on her right side
2) Consider administering Lactated Ringer’s or 0.9% saline w/ oxygen 10L/min by non-rebreather mask
3) Considering to a hands and knees position
What starts second stage of labor?
Active maternal pushing efforts
What should be checked as head is pulled out? What can be done?
Nuchal cord
Clamped twice
How to proceed with delivery after getting the head out?
Gentle downward traction with one globed hand on each side of the fetal head
Condition when shoulders are stuck
Shoulder dystocia
What should be done when baby comes out?
Dry it (prevent hypothermia, and stimulate breathing)
Delaying clamping 2-3minbenefit and risk
+increase iron storage
-jaundice
What consists the 3rd stage of labor?
Traction on the cord/placenta
Oxytocin 10U IM or 20U/liter NS IV at 250 cc/h
(to decrease bleeding)
Purpose of uterine massage
Uterus contract limiting bleeding
What should be done if there is a laceration of the perineum or vagina
Gauze should be applied
What questions should be asked when evaluating pregnant woman?
Length of Gestation/ Due date (fetal viability/prematurity)
Gravidity and Parity (previous deliveries, live births, premature births)
OBGYN Complications (cesarean or mymectomy)
Pregnancy Complications
Medical Problems
Allergies
Medications
Habits
Prenatal Care
How is due date determined?
From the first date of the woman’s last menstrual period
How gestational age can be estimated w/o LMP?
Fundal heights in the 2nd and 3rd trimester or bimanual pelvic exam in 1st trimester
How prenatal care affects weight on infants?
It decrease number of low birth weight infants
What effect on pregnancy does tobacco and other illicit drugs have?
Risk of abruption
Preterm labor
Small for gestation age
In pregnant woman, what does urge to bear down or having bowel movement may indicate?
Imminent delivery
Vaginal fluid (examples)
- normal
- infection
- gush
- vaginal discharge can be normal
- foul smelling
- rupture of membranes
Dark & Spotting vs. Red & Heavy bleeding
Dark & Spotting = Benign (e.g. polyp, cervical change)
Heavy bleeding = Uterine rupture, placental abruption
Patterns of blood pressure during pregnancy in pregnant woman
Decrease in 2nd
Come back in 3rd
What is the difference between chronic HTN and preclampsia?
20 wks
What is the difference between severe and mild preclampsia?
160/110
How does pulse of pregnant women is different than normal individual?
Increases 15-20
What is normal temperature for pregnant woman?
Can be 1-2 degree higher
It should not be higher than 100.4 F
What causes increased respiratory rate and tidal volumes during pregnancy?
Progesterone
How fundal height can predict age of the fetus?
Measure pubic symphysis to top of uterus
Centimeters estimate weeks
Before 20wk hard to palpate
At 20wk at pubic symphysis
What is the indication of:
Tender uterus
Tender adnexa
Uterine infection, rupture, or abruption
Ectopic pregranancy, infection or ovarian cyst
What is the timing and frequency during labor?
45-60 seconds ever 3-5 min
What is placenta previa?
Placenta attachment to the uterus is either covering or close to the cervix
What are symptoms of placenta abruption?
Back pain and vaginal bleeding
What is vasa previa?
Blood vessels of the umbilical cord traverse the amniotic membranes prior entering to the cord
Presentation of vasa previa
No pain to mother
Bleeding bright
Loss of blood to fetus
Alignments of fetus with respect to the birth canal?
Vertex (head down)
Breeech (buttock or feet down)
Transverse (sideways)
Purpose of Leopold’s maneuver
Determine orientation of fetus
Causes for caridopulmonary arrest associated with pregnancy
Amniotic fluid embolism
Preeclampsia
Excess of magnesium sulfate
Postpartum hemorrhage
How position in pregnancy can affect blood flow?
Uterus can pressure aorta and IVC
Modification for CPR with pregnancy
25-30 degree tilt left lateral Increasing chest wall compression Use cricoid pressure Compression higher on strenum Defibrilaion removal of devices Heimlich maneuver
