OB exam 2 Flashcards
intermittent monitoring
fetoscope, doppler, ultrasound transducer
- fetal well-being
- s/s compromise
- response of FHR & uterine contractions
EFM
- toco
- palpation
uterine contractions/activity
internal FHR
fetal scalp electrode (FSE)
internal uterine activity/contractions
intrauterine pressure catheter (IUPC)
if receiving pitocin/epidural, what type of monitoring is needed?
continuous
how often are strips reviewed during 1st stage labor?
q30min
how often are strips reviewed while pushing?
q15min
- measured from time start to time ends
- 10sec blocks
- dark lines 1min
duration
beginning of one contraction to beginning of another contraction
frequency
intensity of contractions can be measured by:
palpation, IUPC
how much HR changes from second to second
variability
absent variability
flatline
minimal variability
0-5 beats change
moderate variability
6-25 beats change, goal
marked variability
25beats+ change
15beats lasting for 15 sec above baseline
acceleration
deceleration: variable
lasting less than 15 sec below baseline
varibale decels are due to
cord compression
early decels are due to
head compression
late dedels are due to
uteroplacental insufficiency
abrupt decreased FHR at least 15bpm lasting >2min but <10min
prolonged decels
variable decel interventions
- change maternal position
- decrease oxytocin
- admin amniofusion PRN
early decel interventions
none needed, baby coming down pelvis
late decel interventions
- change maternal position
- discontinue oxytocin
- IV bolus (999)
- O2 admin
- notify MD
- anticipate c-section
only occur with contractions –> late & early decels
periodic changes
not always associated with contractions, but sometimes do –> acels (can be both), variable decels, prolonged decels (can be both)
episodic changes
nonstress test (NST)
20min monitoring EFM, goal = 2 acels
2+ acels observed during 20mins
reactive NST
<2 acels observed during 20mins
nonreactive NST
contraction stress test (CST)
mom has contraction, monitor FHR; goal = no late decels
no late decels observed after contractions start in CST
negative CST (goal)
late decels observed after contractions start inn CST
positive CST (bad)
measures frequency and duration of contractions only
toco
T/F: A fetal scalp electrode can be put in before ROM has occurred
F
guidelines:
- HIV neg, Hep B neg
- skilled practitioner inserts
- presenting fetal part low enough ti allow placement
- cervical dilation at least 2cm
fetal scalp electrode
- internal contraction monitoring
- goes inside uterus around baby, measures pressure around uterus
- MVUs = measurement
IUPC
how many MVUs are required to progress labor & dilate cervix?
over 200, no more than 300
used for moderate-severe varibale decels, procider order
- infusion by gravity sterile NS or LR via IUPC
amnioinfusion
uterine contractions & pushing effort
power
anatomy of mother’s bony pelvis & soft tissues; ability of soft passageway to stretch
passageway
ideal pelvis shape for labor/delivery
gynecoid
scale to tell where baby is positioned
-5 to +5
ideal station positon:
head down
soft spots, head bones not fused at birth
fontanels
what attitude do we want the baby in?
vertex(full flexion)
relationship of spine of fetus & spine of mother
lie
baby & mom’s spines parallel
longitudinal lie (ideal)
baby & mom’s spines perpendicular
transverse lie
position of the presenting part of fetus as it comes down birth canal
presentation
ideal presentation
face
floating station
-3, -2
fixed statin
-1
engaged station
0
midpelvis
+1, +2
crowning
+3, +4
anxiety, stress, dear, pain intolerance can have what affect on labor?
slow labor
s/s labor:
- SROM
- regular contractions
- bloody show
- lightening
- nesting impulse
-wt loss 1-3lb - abdominal/back pain that intensifies with walking, not affected by mild sedation
labor is confirmed by
cervical change (dilation, effacement)
begins with regular contraction along w/ dilation & effacement of cervix, fetal descent
labor
- contractions may feel like menstrual cramps
- mild to palpation
- 5-30min apart, lasting 30-45sec
- dilation may be 0-3cm
- 6-8hrs
- clear, pink mucous discharge or plug, scant amount
latent phase labor
- focused, anxious, restless
- contractions regular & more painful
- 3-5min apart, 40-70 sec
- moderately strong to palpation
- epidural
- dilation 4-7cm
-3-6h - +1/+2
- pink or bloody mucous, scant-moderate amount
active phase labor
- strong & close together contractions
- 2-3mins aprt, 45-90sec
- out of control, irritable, dependent
- intense urge to push
- 8-10cm
- 20-40min total
- bloody mucous, copious amoutn
- +2, +3
transition phase labor
T/F: to prevent supine hypotension, always have a lateral tilt to the pt position
T
IV fluids
- maintain hydration in labor
- bolus prevention maternal hypotension following regional anesthesia
- safety measure
opening of cervical os
dilation
thinning of cervix
effacement
assessing, using sterile gloves, lubricant, gentle insertion middle & index fingers into vaginal opening
vaginal exam
1/0/-3; 9/100%/+1
dilation/effacement/station examples
- pink, contains mucous, scant at first
- increases w/ effacement & dilation
bloody show
PROM
premature ROM
PPROM
preterm premature ROM
positve “pool” of fluid in vagina
pooling
positive when amniotic fluid turns pH paper dark blue/black
nitrazine paper test
protein & sodium chloride content in amniotic fluid, smear fluid dried on one side, positive test shows presence of fern-like patterns –> amniotic fluid crystals
ferning
concerns for meconium-stained amniotic fluid
aspiration of baby at delivery
as baby delivers & after delivery of head amniotic fluid meconium stained; benign
terminal meconium
- facilitates uterine contractions
- ## control bleeding PP
pitocin/oxytocin
> 5 contractions within 10min
tachysystole
second stage of labor
pushing; 10cm until fetus delivers
fetal head at ischial spines
engagement
fetal head past ischial spines
descent
chin touches chest
flexion
fetal chin comes off chest, neck arches as head is born
extension
head rotates as shoulders move into new position
external rotation
body born
expulsion
vaginal, perineal; 1-4 degree
laceration
only performed in emergencies, 1-4 degree
episotomy
look for bright red bleeding with these injuries (rare)
cervical injuries
3rd stage labor
placental delivery; from fetus to delivery placenta
- 5-30min
- uterus continues to contract
failure to contract
uterine atony
most common cause PP hemorrhage
uterine atony
a bolus of what is indicated after delivery of the placenta?
oxytocin
4th stage labor
recovery
goal of pain management is to
reduce fear, control pain
activation of nocioceptors of pelvic, thoracic, or abdominal organs
visceral pain
first stage of p=labor pain is from:
contractions, baby descent, cervical change
2nd stage pain
perineal pressure, pushing, tissues stretching
what will help with 2nd stage labor pain?
delivery of baby
3rd/4th stage pain is due to
contractions, cramping w/ fundal massage
circular stroking of abdomen
effleurage
fentanyl is a
short-acting opioid
promptly reverse narcotic efects for newborn if mom had IV narcotics/opioids in 0-3h before delivery
narcan/naloxone
most effective, most commonly continuous infusion w/ PCA
- numbs from umbilicus to toes
- can still feel pressure
- can have hot spots
epidural block
disadvantages epidural
prolonged 2nd stage labor (pushing), limited mobility, urinary retention, hot spots/pressure points, hypotension
nursing intervenitons prior to epidural administration:
verify/witness consent, IV fluid bolus, continuous EFM
actions if pt becomes hypotensive during/after epidural
IV bolus, turn to side, lower HOB, notify MD, stay w/ pt
one time injection into spinal space numbing nipple-feet, used for c-section
spinal block
- 2nd stage pain management
- injection of lidocaine into pudendal nerves
- numbs saddle area
- 10-20min onset
- admin for rapid labor, forceps delivery, episotomy, repair of perineum
pudendal block
