OB Exam 1 Study Guide Flashcards
What are the different stages of Labor?
4 Stages of Labor
Series of events during which a woman’s uterus contracts and expels a fetus and completes the VAGINAL birthing process
Stage I Dilation
- no pushing/waiting/walking
- Starts true contractions
- Water breaking
- ends with Cervix fully effaced and dilated
- Dilation
opening of the cervix
measured by cm
complete cervix dilation is 10 cm
- Effacement
thinning of cervix
measured by percentage
complete cervix effacement is 100%
Stage II Expulsion
- worst contractions/pushing/baby out
- pushing
- ends in birth of baby
Stage III Placental
- afterbirth/fundal massage
- Ends In delivery of placenta
Stage IV Recovery
- breastfeed colostrum/bleed out/exhausted
- uterine contractions continue and close off open blood vessels to prevent excessive blood loss
Phases of Stage 1 Dilation
Latent
- irregular, mild contractions lasting 30-50 sec
- duration: every 5-10 minutes
- 0 - 4 cm dilated
Active
- Regular moderate to strong lasting 45-60 sec
- Duration: every 2-4 minutes
- 4-8 cm dilated
Transition
- Regular, very strong, lasting 60-90 sec
- Duration: every 2-3 minutes
- 8-10 cm dilated
New Terminologies
-Gestation: conception to birth
-Total length of gestation: 40 weeks
-Fertilization: sperm + egg and then to implantation
-Last normal menstrual period (LMP or LNMP)
-Trimester: 3 month time span during pregnancy
-First trimester: First day of LMP through week 13
-Second trimester: weeks 14 through 27
-Third trimester: weeks 28 through 40
-Gravida: pregnant client primigravida: pregnant for the first time
-Multigravida: more than one pregnancy
-Para: delivery
-Preterm: 20-37 weeks
-Post term: >42 weeks
-GTPAL or TPAL: gestations, term pregnancies, preterm pregnancies, abortions, living children
-Antepartum period: pregnancy
-Prenatal care: care before birth
-Puerperium: period between birth and 42 days after delivery
-Engagement: Fetal head has moved downward in birth canal; can no longer be pushed up and out of pelvis
-Position: Relationship between the presenting part of the fetus and designated point on 1 of 4 quadrants of the mom’s pelvis
-Station: Descent level of the fetal presentation part into birth canal
-Lie: comparison between positions of fetal spinal cord to client
-Presentation: Refers to the body part of the fetus that lies closest to the pelvic inlet
-Ballottement: tapping on the abdomen and causes the fetus to bounce
-Episiotomy: a surgical cut made at the opening of the vagina during childbirth
-Lightening: settling of fetus into the pelvis
-Braxton Hicks: normal and non-dangerous; practice contractions a few weeks before labor
-Show: dislodgement of mucous plug sealing cervix
-SROM: spontaneous rupture of membranes
-AROM: rupture of memnbranes via amniotomy or “breaking the water”
What to document for during labor (how the baby came out).
- Complete info about the type of delivery + procedures used who was present
- Sex + condition of baby (including Apgar score)
- Time of birth + time at which placenta was expelled/presentation
- Condition of the fetus
- Any medication administered
- If an episiotomy was done, and its type
- Condition and vital signs of the mother and measured maternal blood loss
Presentation of Placenta (shiny aka baby side vs dirty)
Shiny Schultze – fetal side
Dirty Duncan – maternal side which is rough and irregular
Hormonal changes that happens when pregnant and after giving birth which hormones are responsible for producing milk?
HCG (human chorionic gonadotropin) - found in small amounts in urine on the 7th to 10th days of pregnancy
HPL (human placental lactogen)
Prolactin – responsible for milk production
Oxytocin - stimulates milk and contractions for labor
*Nausea may begin soon after the first missed menstrual period and usually disappears after the 3rd month of pregnancy. If the condition lasts beyond the 4th month, results in weight loss of 8 lbs or more, or affects the women’s general health, it is considered a complication of pregnancy, hyperemesis gravidarum (a lot of vomiting while pregnant).
Presentation and station (what is shown as baby exits the canal)
Presentation: Refers to the body part of the fetus that lies closest to the pelvic inlet
Cephalic presentation: vertex presentation, face presentation, brow presentation
Breech presentation: butt, feet, et (c-section)
Shoulder presentation (c-section)
Variations of Breech Position
Complete breech: Both legs drawn up, bent at both hip + knee
Frank breech: Hips bent, but the knees are extended
Kneeling breech: Either 1 or both legs are extended at hip, flexed at knee
Footling breech: Either 1 or both legs are extended both at the hip + knee
Station: refers to descent level of fetal presenting part into birth canal
Station -1 to -5
Pelvic Inlet
Baby’s head is above mom’s ischial spine
Station 0
Ischial spine & engagement
Fully engaged!
Head is engaged and ready for labor
Station +1 to +5
Crowning and emerging from vagina
Baby’s head is coming out
“Crowning!” “Start pushing!
Pregnancy discomforts refer to table 65-2 page 1043-1045
- Stretch marks
- Itching of the skin
- Melisma
- Sleeplessness
- Moodiness
- Low back pain and back ache
- Braxton hicks
- Round ligament pain
- Vaginal discharge
- Breast enlargement and tenderness
- Nasal stuffiness or bleeding
- Sore or bleeding gums
- Excess saliva production (ptyalism)
- Food cravings
- Heartburn
- Constipation
- Nausea and vomiting
- Hemorrhoids
- Headaches
- Syncope
- Frequency and urgency nocturia
- Varicose veins
- Swollen feet
Difference between presumptive, probable and positive signs of pregnancy
Presumptive signs
- Amenorrhea (can mean something else not just pregnancy)
- Fetal movement in the uterus- quickening (first movements, 18-20 weeks, fluttering)
- Nausea and vomiting
- Fatigue
- Urinary frequency
- Breast changes
Probable signs of pregnancy (objective data)
- 6th week: cervix become blueish
- Softening of the lower uterine
- + serum and urine sample
- Braxton hicks at the 4th month
- 16 weeks ballottement
Positive signs of pregnancy ( proof of a developing fetus)
- Visualization of fetus, via ultrasound
- Fetal heartbeat
- Fetal movements felt by examiner
Signs that are dangerous for pregnancy (if they’re bleeding, def do not stick your finger in there)
Danger signs in first trimester
-Vaginal bleeding or spotting; may or may not indicate miscarriage, the amount does not reflect outcome unless saturates 1 pad per hour
-pelvic/abdominal cramping; if increases over time and if accompanied by bleeding may indicate threated abortion
-No longer feeling pregnant; no more headache, nausea or breast tenderness after fetus no longer viable
Danger signs in second and third trimester
-vaginal bleeding with or without cramping, pressure, or pain
- bleeding with severe abdominal pain
-vaginal or lower abdominal pressure
-preterm labor (s&s backache, cramping, rhythmic pelvic pressure, diarrhea, change in vaginal discharge, spotting, fluid leakage, and malaise)
-Premature labor/Premature rupture of membranes; gush or trickle of fluid
-Decreased fetal movement
-PIH (pregnancy induced hypertension) s&s severe headache, visual changes, sudden edema, abdominal pain
Definition of Fetal accelerations and decelerations (VEAL CHOP)
Accelerations: Brief increases of the fetal heart rate of 15 bpm or more
- Most accelerations are considered healthy
- Accelerations of 60 bpm or more are considered dangerous situation or complication
Deaccelerations: Slowing of the fetal heart rate in correlation with contractions.
- Some deaccelerations are expected; early deaccelerations beginning early in the contraction
- Abnormal deaccelerations; late deaccelerations beginning as contraction eases in considered a potential for problems with fetus
Education and patient teaching on engorgement
Engorgement is the response of breasts to the presence of an increased volume of milk and sudden change in hormones.
- Usually occurs in the 3rd to 5th postpartum day
- Breasts become swollen, tender, hot, and hard. Discomfort accompanied by headache and possible fever
- Relieving engorgement:
Nursing mothers:
Supportive bra
Frequent breastfeeding
Applying warm packs to the breast for 15 mins before nursing, or standing in shower with warm water for 15 min before nursing
Non-nursing mothers:
Supportive bra
Avoiding excessive fluid intake
Placing cold packs on their breasts 3-4 times per day
Avoiding stimulation (hot shower spray)
Avoiding manual expression or pumping
Using medications (usually Tylenol) as prescribed for. comfort
Breast care education
-Breast changes occur following childbirth in preparation for child’s nourishment
-breasts produce colostrum; yellow secretion thar provides vitamin and immune system boosters for newborn
-lactation is the production of milk, occurs due to release of hormones Oxytocin and Prolactin. These hormones sometimes cause uterine contractions while breastfeeding
-each time a baby is put to breast, milk is secreted
-first few days breasts should be soft, nipples in tact without drying or cracking or fissures
- engorgement occurs usually after 3-5 days following birth
GTPAL calculations
G- gravida number of pregnancies
T- term pregnancies over 37 weeks
P- preterm pregnancies 20-37 weeks
A- Abortions (either spontaneous(miscarriage) or elective)
L- living children number of children living as of today
Terms in pregnancy
Trimester 1 is 1-12 weeks
Trimester 2 is 13-28 Weeks
Trimester 3 is 29-40
Preterm: pregnancy of about 20-37 weeks
Full Term: 39- 40 weeks’ gestation
Late Term: 41 weeks’ Gestation
Post term: born after 42 weeks’ gestation
Dietary concerns for pregnancy (folic acid, iron A B C D X)
-The pregnant client should make the following dietary adjustments: Increase caloric intake by approximately 300 calories daily.
-Increase calcium intake before the last half of the pregnancy. Increase milk intake to 3–4 cups daily. Supplemental calcium is sometimes prescribed. (Rationale: Calcium is essential to the development of the fetus’ bones and teeth and for blood clotting.)
-Maintain iron intake. Most providers order an iron supplement during pregnancy because of its dietary importance. (Rationale: Iron is essential in the production of hemoglobin. Because breast milk contains little iron, the developing fetus stores iron for use after birth.)
-Maintain folic acid intake. Taking 400 μg daily of folic acid (folate) in a supplement is recommended for all women of childbearing age when not pregnant, in addition to food sources of folate. During pregnancy, the recommendation increases to 600 μg from a supplement, plus food sources. Most prenatal vitamins contain 1 mg of folic acid. (Rationale: Folic acid, a B vitamin, helps to prevent congenital neural tube defects, most notably spina bifida.)
-Increase intake of most vitamins. Many healthcare providers prescribe supplemental vitamins during pregnancy.
-Increase protein intake. (Rationale: Protein is essential to the building and repair of all body tissues and aids in the production of milk for the nursing mother.)
-Avoid empty calories, including alcohol, sugared soda drinks, other sweets, and salty foods. Use iodized salt. (Rationale: It promotes proper functioning of the thyroid gland.)
-Eat a wide variety of foods.
(Rationale: A variety of foods will encourage proper nutrition, especially during the first few months of pregnancy if the client is experiencing nausea.)
-Avoid laxatives and enemas unless the healthcare provider specifically orders them.
-Stool softeners, such as docusate sodium (Colace), are ordered more often than laxatives.
-Fiber is also essential to prevent and to treat constipation.
-Increase fluid intake to 10 glasses daily to assist in kidney and bowel function.
Water is the preferred fluid.
