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ENRP > Normal Labor and Delivery > Flashcards

Normal Labor and Delivery Flashcards

1
Q

Define Labor

A

Progressive cervical dilation resulting from uterine contractions that last 30-60 seconds and occur at least every 5 minutes

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2
Q

Define Labor

A

Progressive cervical dilation resulting from uterine contractions that last 30-60 seconds and occur at least every 5 minutes

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3
Q

False Labor (Braxton Hicks)

A

Irregular uterine contractions WITHOUT cervical change

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4
Q

1st stage of labor

A

Onset of labor to complete cervical dilation

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5
Q

Onset of labor to complete cervical dilation

A

1st stage of labor

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6
Q

2nd stage of labor

A

Complete cervical dilation to delivery of infant

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7
Q

Complete cervical dilation to delivery of infant

A

2nd stage of labor

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8
Q

3rd stage of labor

A

Delivery of infant to delivery of placenta

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9
Q

Delivery of infant to delivery of placenta

A

3rd stage of labor

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10
Q

4th stage of labor

A

Delivery of placenta to stabilization of patient

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11
Q

Delivery of placenta to stabilization of patient

A

4th stage of labor

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12
Q

What phases are included in the 1st stage of labor and what are they?

A
  1. Latent phase = Onset of labor with slow cervical dilation
  2. Active phase = Faster cervical dilation
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13
Q

When technically does the Active phase of the 1st stage of labor begin?

A

When the cervix is dilated to 6 cm

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14
Q

With a primipara patient (1st birth), what is the usual duration of the 1st stage of labor and the usual rate of cervical dilation?

A

1st stage duration = 6-18 hours

Cervical dilation rate = 1.2 cm/hour

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15
Q

With a multipara patient (has had previous births), what is the usual duration of the 1st stage of labor and the usual rate of dilation of the cervix?

A

1st stage duration = 2-10 hours

Cervical dilation rate = 1.5 cm/hour

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16
Q

With the 1st and 2nd stages of labor, how often should you monitor the baby in an uncomplicated pregnancy?

A

1st stage = every 30 minutes

2nd stage = every 15 minutes

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17
Q

With the 1st and 2nd stages of labor, how often should you monitor the baby in a complicated pregnancy?

A

1st stage = every 15 minutes

2nd stage = every 5 minutes

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18
Q

What type of fetal monitoring gets you the most accurate tracings?

A

Internal monitoring

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19
Q

How often should cervical checks occur during the active phase of the 1st stage of labor?

A

Every 2 hours

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20
Q

What does a Tocodynamometer or Internal Pressure Catheter measure?

A

Strength of uterine contractions

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21
Q

How will the mom act during the 2nd stage of labor?

A

Increase in bloody show and will want to bear down with each contraction

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22
Q

List the typical duration of the 2nd stage of labor with a primipara and multipara mother with AND without an Epidural

A

Primipara without epidural = 2 hours
Primipara with epidural = 3 hours
Multipara without epidural = 1 hour
Multipara with epidural = 2 hours

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23
Q

During the 2nd stage of labor, in what position should the mom be and what should she do with each contraction?

A

Dorsal Lithotomy = on back with hips flexed to 90

– hold breath, bear down and push with each contraction

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24
Q

With the delivery of the baby, how do you deliver the anterior and posterior shoulders?

A
  • Pull head down to get anterior shoulder out

- Pull head up to get posterior shoulder out

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25
Q

With delivery of the baby, you may need an episiotomy or Ritgen Maneuver. What are those respectively?

A

Episiotomy = surgical cut at vaginal opening to aid in delivery
Ritgen Maneuver = extension of the delivered head with counterpressure

26
Q

With an Episiotomy, what type of cut is the best and has less postpartum pain?

A

Medial (midline)

– mediolateral cut = worse pain/bleeding/etc.

27
Q

What are the 7 cardinal movements of labor?

A

EDFIEEE

  • Engagement
  • Descent
  • Flexion
  • Internal rotation
  • Extension
  • External rotation
  • Expulsion
28
Q

What are the 7 cardinal movements of labor?

A

EDFIEEE

  • Engagement
  • Descent
  • Flexion
  • Internal rotation
  • Extension
  • External rotation
  • Expulsion
29
Q

Engagement movement of labor

A

Presenting part at zero station

30
Q

What brings about the Descent movement of labor?

A

Force of uterine contractions and valsalva efforts

31
Q

Flexion movement of labor

A

Baby’s chin brought to chest

– presenting part = suboccipitobregmatic

32
Q

Internal Rotation movement of labor

A

Baby’s head rotates occiput anteriorly or posteriorly toward pubic symphyses

33
Q

Extension movement of labor allows what to be delivered?

A

Head

34
Q

Crowning occurs with the Extension movement of labor. What is that?

A

Largest diameter of head is encircled by vaginal introitus

35
Q

External Rotation movement of labor

A

Head returns to original position to align with back and shoulders once it is free

36
Q

Expulsion movement of labor

A

Anterior shoulder

  • -> posterior shoulder
  • -> body
37
Q

1st degree perineal laceration

A

Involves vaginal mucosa and/or perineal skin

38
Q

2nd degree perineal laceration

A

Extends into muscles of perineal body

39
Q

3rd degree perineal laceration

A

Extends into anal sphincter

40
Q

4th degree perineal laceration

A

Involves rectal mucosa

41
Q

With the 3rd stage of delivery, how long does it usually take? What is a Retained Placenta?

A

2-10 minutes

– Retained placenta = one that has not delivered within 30 minutes

42
Q

What are the signs of placental separation with the 3rd stage of labor?

A
  • Gush of vaginal blood
  • Lengthening of umbilical cord
  • Uterine fundus rises up and changes to globular shape
43
Q

What are the signs of placental separation with the 3rd stage of labor?

A
  • Gush of vaginal blood
  • Lengthening of umbilical cord
  • Uterine fundus rises up and changes to globular shape
44
Q

What should you do during the 3rd stage of labor?

A

Apply counterpressure between the uterine fundus and pubic symphyses

45
Q

If you do NOT see signs of placental separation during the 3rd stage of labor, what should you NOT do and why?

A

Do NOT pull on the umbilical cord

–> uterine inversion

46
Q

What should you do during the 4th stage of labor?

A

Monitor patient
Uterine fundal checks
Assess for vaginal bleeding

47
Q

In what stage of labor are postpartum hemorrhages most common?

A

4th stage of labor

48
Q

What are some contraindications for Induction? (4)

A
  • UNSTABLE fetus
  • Previous C-section/uterine surgery
  • Placenta previa
  • Contraindications for vaginal delivery
49
Q

What are some contraindications for Induction? (4)

A
  • UNSTABLE fetus
  • Previous C-section/Uterine surgery
  • Placenta previa
  • Any contraindications for vaginal delivery
50
Q

What 5 things does the BISHOP score take into account?

A 
Cervical dilation
Cervical effacement
Cervical consistency
Cervical position
Station
51
Q

If a BISHOP score is less than 6, what does that mean?

A

Induction is UNFAVORABLE

52
Q

If a BISHOP score is greater than 8, what does that mean?

A

Probability of vaginal delivery after induction will be EQUAL TO that of a spontaneous labor

53
Q

What is a drug that can be used for induction and augmentation of labor?

A

Pitocin (synthetic oxytocin)

54
Q

What are 3 side effects that can occur with Pitocin?

A

Uterine Tachysystole
Antidiuretic effect
Uterine muscle fatigue

55
Q

What spinal levels correlate with uterine contractions/cervical dilation and the pelvic floor/vagina/perineum?

A

Uterine contractions/cervical dilation = T10-L1

Pelvic floor/vagina/perineum = S2-S4

56
Q

Regional anesthesia with labor will cause loss of pain sensation below what level?

A

T10

57
Q

Are parenteral pain methods effective? What can they cause?

A

Only early in the 1st stage of labor

–> can cause neonatal respiratory depression

58
Q

What are 2 regional pain methods?

A
  1. Epidural

2. Spinal

59
Q

Regional pain methods involve local anesthesia and a narcotic. What is the difference between an Epidural and Spinal?

A

Epidural - inserts catheter for continuous infusion

Spinal - 1 shot only

60
Q

What is a General Anesthetic that can be used in emergent cases and what does it cause?

A

Propofol

–> maternal LOC

ENRP (45 decks)

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