OB - Module 4 Flashcards
5 P’s
Passage, Power, Passenger, Position, Psyche
Passage
Bony and Soft (vaginal canal)
Power
Passive - Stage 1 labor (uterine contractions)
Active - Stage 2 labor (mother pushing)
Passenger
Fetal lie (position): Longitidunal , transverse, or horizontal. Fetal attitude: Cephalic, Breech (butt), Shoulder
Position
R,L
M - Cephalic, O - Head flexed chin to chest, S- Sacral
ex. RM Right Cephalic presenting
Psyche
Individual/Cultural values
Common cardiovascular changes
Increased BP (check vitals between contractions) and side-lying hypotension
Urinary system
Decreased bladder sensations. must encourage woman to empty bladder.
Fetal Protective mechanisms during contractions
Hemoglobin carries 20-50% more oxygen than adult, Releases CO2 more easily, and has high cardiac output
Nesting syndrome
Sudden urge to set things up and get ready for the baby
Premonitory Signs of normal labor
Braxton hicks (irregular contractions), lightening, increased vaginal mucous secretions, bloody show, energy spurt (nesting syndrome), weight loss.
Descent
?
Engagement
?
Flexion
?
Internal rotation
?
Extension
?
External rotation
?
Expulsion
?
First Stage
Latent (contactions)
Active (cervix dilation)
Transition (strongest contractions and woman may lose control)
Second Stage
Woman is pushing and regains control.
Third stage
Delivery of infant to delivery of placenta.
Fourth stage
Recovery. Goal is to ensure uterus is firmly contracted and encourage infant contact and breastfeeding.
Evaluating Amniotic Fluid
TACO - Time, amount, color, and odor
Assessment for artificial rupture
vitals q 2 hours.
How is labor induced?
Pitocin (Oxytocin) drip diluted in electrolyte fluid as a secondary infusion plug into lowest port near the venipuncture site. Start slowly and increase gradually.
What happens when the baby has a non-reasuuring heart pattern?
Stop the infusion
Turn on side
Give O2-tight fitting mask
What happens if Mom-hypertonus occurs?
Stop infusion Turn on side Give O2 Assess BP/pulse Record I/O Watch for water intoxication
Version
Changing fetal position
Steps before Version can be attempted
Determine gestation age > 37 weeks, give tocolytic, ultrasound, and explain procedure and obtain written consent.
When to use Outlet forceps
Fetal head is on perineum
When to use Low forceps
Leading edge of skull is at 2+
When to use Mid-pelvis forceps
Leading edge of skull between 0 and 2+
Types of episiotomies
Midline (straight down) and Medial-lateral (to side)
What is the procedure for Cesarean?
Give famotidin and sodium citrate, perform CBC and PT/PTT, skin prep, indwelling foley catheter, and possible prophylactic antibiotics.
Uterine incisions
Low transverse (sideways near vagina), low vertical (up/down near vagina), and classic (straight in the middle of the belly)
VBAC
vaginal birth after cesarean
TOLAC
trial of labor after C-section
PAIN
Purposeful
Anticipated
Intermittent (not constant)
Normal
Somatic Pain
Quick, sharp, localized pain
Visceral
Slow, deep, poorly localized. Generally in the first stage
Four sources of labor pain
Tissue ischemia
Cervical dilation
Pressure (pulling on cervical structures
Distention of vagina/perineum
Systemic Opioid Drugs
Nubain, Stadol, Demerol
Systemic Opioid Drugs Indications
Given IV, alters perception of pain, and can cause respiratory depression.
Opioid antagonists
Naloxone and Naltrexone (used when patient has history of opioid dependence)
Opioid antagonists Indications
Given to reverse effects of pain medication such as respiratory depression. May have to repeat a dose as it has a shorter half life.
Adjunctive drugs
Phenergan, Vistaril (never IV)
Adjunctive drugs Indications
Antiemetic and tranquilizing effects but can cause respiratory depression
Intrathecal opioids
Fentanyl, Sufentanyl, Morphine
Intrathecal opioids indications
Allows woman to feel contractions, but no pain and is used in low-risk settings. Only last a short amount of times and may not give enough relief.
Pudendal block
Numbs lower vagina and perineum
Spinal block
Used ONLY for cesarean. Anesthetic is injected into subarachnoid space that removes sensory and motor functions below the level of insertion.
General Anesthesia
Used for emergency c-sections. Rarely used for birth and results in a loss of consciousness.
