OB Class 2 Flashcards
False labor contractions
inconsistent
changing activity doesnt alter contractions
activity may decrease them
4Ps of labor
Passage
Passenger
Power
Psyche
true labor contractions
consistent
increasing frequency, duration and intensity
walking tends to increase contractions
discomfort of false labor
abdomen and groin
more annoying that painful
discomfort of true labor
begins in lower back and sweeps around to the abdomen like a girdle
feels like menstrual cramps
warning signs that labor is near
braxton hicks contractions lightening increased clear nonirritating vaginal secretions energy spurt "nesting" small weight loss of 1-3lbs
First stage of labor
stage of dilation
1st stage: stage of dilation
3 stages
latent
active
transition
latent phase
0-3cm
contractions 10min apart
bloody show
ROM: gush of fluids
active phase
4-7cm
change in cervix
contractions 5min apart
***not encouraged to push
transition phase
6-10cm
contractions frequent and close together
increased pressure on rectum and perineum
2nd stage of labor
begins with complete cervical dilation and ends with delivery of baby
2nd stage of labor
contractions 2min apart (60-90 sec long) feel of vulva splitting pain radiate to back and legs urge to push avoid valsalva (decreases fetal oxygen)
3rd stage of labor
delivery of placenta
have mother nurse baby to stimulate contraction of uterus to prevent hemorrhage
when to present to the hospital or birth center
contractions of increasing regularity/ frequency/ duration/ intensity Nullipara: 5min apart for 1hr Multipara: 10min for 1hr ROM: with or w/o contractions Bleeding: bright red blood w/o mucus decreased fetal movement
assessment for fetal oxygenation
FHR
contractions
amniotic fluid characteristics
maternal VS
interventions to promote fetal oxygenation
promoting placental function
:maternal position
:AVOID SUPINE
APGAR score
A: acitivity P: pulse G: grimace (reflex irritability) A: appearance (skin color) R: respirations
APGAR scoring
0: absent
1: present but not adequate
2: within normal
APGAR scoring: severely depressed
sever depressed: 0-3
***infant needs resuscitation
APGAR scoring: moderately depressed
moderately depressed: 4-6
***stimulate by rubbing the infants back while administering oxygen
APGAR scoring: excellent condition
excellent condition: 7+
***support infants spontaneous efforts and continue to observe
fluctuations in the baseline FHR that cause the printed line to have an irregular wavelike appearance rather than a smooth flat one
baseline FHR variability
temporary increase in FHR that peaks at least 15bpm above the baseline and last at least 15sec
accelerations
accelerations occur with
fetal movement vaginal exams contractions mild cord compression ***accelerations are a reassuring sign reflecting the fetus has a responsive CNS
early decelerations occur with
contractions
***not associated with compromis
nadir of FHR
low point
- **occur at same time the contraction peaks
- **usually no lower than 30-40bpm
late decelerations caused by
impaired exchange of oxygen and waste in the placenta
cause of uteroplacental insufficiency
***not reassuring
variable decelerations caused by
conditions that reduce flow thru the umbilical cord
***fall and rise abruptly with relief of cord compression
can receive an epidural
5-7cm
effacement 100%
contractions close together
epidural side effects
prolonged 2nd stage of labor ineffective/ no urge to push bladder distention hypotension spinal headache
station meaning
the closer to being born (+)
the farther from being born (-)
3/50/-1
dilation/ effacement/ station
dilation up to 10cm
effacement up to 100%
station: more positive
opioid analgesics
crosses placental barrier if given to mother to close to time of delivery can cause resp. depression in neonate
opioid analgesics given only with
- labor well established
- vaginal exam shows cervical dilation of 4cm at minimum and fetus engaged
dont give opioid IV when
in labor at 9cm
***causes fetal compromise
epidural and spinal regional analgesia
use of short acting opioids administered as a motor block into epidural and intrathecal space w/o anesthesia
***still allow pt to sense contractions and maintain ability to bear down
side effects of epidural and spinal regional analgesia
hypotension
- **elevated temp
resp. depression
Epidural block dont give at
0-3cm
epidural block give at
4-7cm
***dont give past 7cm
pt has to stick back out which causes baby to move down leading to urge to push
increased risk in harm w/ multibirth
epidural block
local anesthetic w/ an anlagesia injected into epidural space
eliminates all sensation from level of umbilicus to thighs
spinal block
local anesthetic injected into subarachnoid space into spinal fluid
can be done with analgesia
eliminates all sensations from level of nipples to feet
***not used for labor
postpartum headache from cerebral spinal fluid leak
place pt in supine position
recieve autologous blood patch from pharmacy
wait 6-12hrs before standing to prevent leakage
