Normal Labor/Delivery Flashcards
What is the 1st stage of labor?
- onset of regular contractions to complete dilatation
- latent + active labor
Define latent labor
“Are you having regular contraction and cervical change?”
< 4 cm dilated with irregular or regular uterine contractions (Ucs) → HOME
Define active labor
4cm to 10 cm with regular UCs → Admit and Expectant Management
- Primiparous = 1.2cm cervical dilation/hr
- Multiparous = 1.5cm cervical dilation/hr
Define 2nd stage of labor
complete dilatation to delivery
Define 3rd stage of labor
delivery of infant to delivery of placenta
What is placenta accreta?
when the placenta attaches too deep in the uterine wall but it does not penetrate the uterine muscle.
What are the 3 P’s?
Power (uterine contractions)
Passenger (fetal position or size)
Pelvis (cephalo-pelvic disproportion)
Rule of 5-1-1
if a patient has contractions 5 minutes apart, lasting for a minute each, for at least one hour, then she is probably in true labor
What is required from contractions for labor to progress?
contractions must be sufficiently strong and frequent enough to effect cervical change
How do you measure contractions?
-internal uterine pressure catheter (IUPC) is required
NOTE: an external tocometer does not accurately measure the strength of contractions
Define fetal lie
“Lie” refers to the relationship of the cephalocaudal axis (spinal column) of the fetus to that of the mother.
- Vertex, breech, or transverse
- Should be known prior to labor
Define fetal presentation
“Presentation” is determined by the fetal lie and the body part that enters the pelvic passage first.
- Cephalic, breech, or shoulder
- May be determined with cervical dilation or labor
What 3 ways can we monitor progress in labor?
- Cervical dilatation
- Cervical effacement
- Fetal station
What are the 3 labor curves?
- prolonged latent phase
- prolonged active phase
- arrested active phase
Define prolonged latent phase
- described as taking more than 20 hours for a primiparous patient or more than 14 hours for a multiparous patient to reach 4 cm dilation with regular contractions ( active labor)
- may treat with a therapeutic rest or pitocin or c/s if urgently indicated.
Define prolonged active phase
- reflective of a protraction disorder
- this describes a rate of cervical dilation less than 1.2 cm/hr for multips OR 2cm descent/hr and 1.5 cm/hr for primips OR less than 1 cm descent of the fetal head per hour.
- may treat with expectant management or c/s if CPD suspected.
Define arrested active phase
- defined as 2 hours without cervical change or fetal descent in a patient with clinically adequate contractions.
- treatment most frequently is c/s for delivery
- depending upon the clinical scenario, therapeutic rest or pitocin may be reasonable before proceeding with c/s.
Cervical dilation
-closed to 10cm
- closed = 0 cm = can’t place a finger inside the os
- 1 cm = 1 finger
- 2 cm = 2 fingers laid on top of each other
- 3 cm = 2 fingers side by side
- 4 -5 cm = active labor
- complete = 10 cm
Define cervical effacement
-the thinning and
shortening of the cervix that occurs as the fetus descends into the pelvis
-described as a “%”
How are cervical exams reported?
-Dilatation in cm
-Effacement
-Station
-Written in OB “shorthand”:
5/50/-1 = 5 cm dilated; 50% effaced; -1 station
Define fetal station
describes the relationship of the presenting part of the fetal head to the maternal pelvis—in other words, how far down has the fetus descended in the birth canal
What is zero (0) station?
represents when head is at the level of the ischial spines
When do we use the term “engaged”?
when the largest diameter of the fetal head passes through the pelvic inlet
Define fetal position
-refers to the position of the fetal head in the maternal pelvis as it presents in Stage II of labor
What landmarks are used to determine fetal position?
fetal fontanelles and sutures
Occiput Anterior (OA)
- Fetus is face down
- Occipital bones present anteriorly
- The lambdoid suture is major landmark to identifying this position
- **Preferred position for delivery
Occiput Posterior (OP)
- Fetus is face up
- Occipital bones are posteriorly located
- Anterior fontanelle is the landmark to identify this position
- Alternatively, sutures may be palpated as a “3 pronged fork”
- **Not ideal for vaginal delivery
Right Occiput Transverse Position
- Fetal head lies sideways
- Landmarks are the sagittal suture, lambdoid suture, and anterior fontanelle
- Orientation based upon position of fetal occiput to maternal side
- This fetus lies in a Right Occiput Transverse position
- *Must rotate for delivery: this often happens naturally
List the cardinal movements of labor
- Descent
- Engagement
- Flexion
- Internal Rotation
- Extension
- External Rotation
- Expulsion
Analgesia and Anesthesia
- None
- IV Meds – Stadol
- Local – Pudendal
- Epidural – Regional anesthesia
What are complications of analgesia and anesthesia?
Maternal Hypotension!!
When is an episiotomy indicated?
Indicated in urgent situations to increase the vaginal outlet
- Shoulder Dystocia
- Fetal Macrosomia
Complications of episiotomy
- Bleeding
- Hematoma
- Swelling
- Infection
- Leaking of stool or gas
- Pain during sex
List the indications for Cesarean-section
- Previous c-sec
- Fetal Distress
- Malpresentation
- Active Mat HSV
- Severe Mat Condylomata
- Fetal Congenital Anomalies
- Placenta Previa/Abruption
- Failure to Progress/CPD
- HIV
C-section complications to baby
breathing problems
C-section complications to mother
- Increased bleeding
- Reactions to anesthesia
- Blood clots
- Wound infection
- Surgical injury
- Inflammation and infection of the membrane lining the uterus
- Increased risks during future pregnancies
Maternal indications for forceps/vacuum
- Maternal Exhaustion
- Prolong 2nd stage
- Cardiac/Pulm dz
Fetal indications for forceps/vacuum
- FTP at low station
- Failure of fetal head to rotate
- Fetal distress
- Control of fetal head in vaginal breech delivery (forceps only)
Contraindications to forceps/vacuum
1- Breech 2- Should not be used vacuum for preterm 3- Face presentation 4- Fetal Coagulopathy 5- Previous scalp sample
Forceps/Vacuum Complications
-Maternal
- Vaginal laceration due to entrapment of vaginal mucosa b/t suction cup & fetal head
- Trauma to the soft tissues: 3rd & 4th degree double the risk compared to vacuum
- Trauma to urethra & bladder
- Bleeding from laceration
- Pain
Forceps Complications
-Fetal
- Bruising & laceration of the face
- Injury to fetal scalp
- Cephalohematoma
- Retinal hemorrhage
- Skull fracture (rare)
- Facial nerve damage (rare)
Vacuum Complications
-Fetal
- Injury to fetal scalp: chignon, abrasion, lacerations, scalp necrosis
- Cephalohematoma
- Retinal hemorrhage
- Birth asphyxia (related to the extraction force & time – vacuum))
- Neonatal jaundice
- Subgaleal hematoma: potential bleeding into the space the scalp & skull
