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families > OB_ chapter 15 - Sheet1 > Flashcards

OB_ chapter 15 - Sheet1 Flashcards

1
Q

What are the 4 Ps of labor?

A

The passage (pelvis), the passenger (fetus), the powers of labor (uterine contractions), and the psyche (mental state).

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2
Q

What is the optimal fetal attitude?

A

Complete flexion, where the fetal head is flexed forward and the chin touches the sternum (vertex), occupying the smallest space possible.

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3
Q

What is fetal lie?

A

The relationship between the long axis of the fetal body and the long axis of the female’s body. It can be longitudinal (cephalic or breech) or transverse.

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4
Q

What are the types of fetal presentation?

A

Cephalic presentation (head first), breech presentation (buttocks or feet first), and shoulder presentation (in a transverse lie).

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5
Q

What is fetal position?

A

The relationship of the presenting part (usually the occiput in vertex presentation) to a specific quadrant and side of the pelvis.

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6
Q

What is the most common fetal position?

A

LOA (Left Occiput Anterior) is the most common and results in the fastest birth.

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7
Q

What happens if the fetal position is posterior (ROP or LOP)?

A

Labor may be extended and more painful due to pressure on the sacral nerves from the rotation of the fetal head.

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8
Q

What is engagement?

A

The settling of the presenting part of the fetus into the pelvis at the level of the ischial spines.

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9
Q

What is station in labor?

A

The relationship of the presenting part of the fetus to the level of the ischial spines.

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10
Q

What does a station of 0 mean?

A

The presenting part is at the level of the ischial spines, the midpoint of the pelvis.

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11
Q

What is the range of measurements for station?

A

-1 to -4 cm (above ischial spines), 0 cm (at the ischial spines), +1 to +4 cm (below ischial spines). At +3 station, crowning occurs, and the presenting part can be seen at the vulva.

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12
Q

What are false contractions?

A

Begin and remain irregular, felt first abdominally and confined to the abdomen and groin, often disappear with ambulation or sleep, do not increase in duration, frequency, or intensity, and do not achieve cervical dilation.

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13
Q

What are true contractions?

A

Begin irregularly but become regular and predictable, felt first in the lower back and sweep around to the abdomen in a wave, continue regardless of activity, increase in duration, frequency, or intensity, and achieve cervical dilation.

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14
Q

What is the duration of the first stage of labor?

A

Takes about 12 hours to complete and is divided into three segments: latent, active, and transition.

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15
Q

What is the latent phase of the first stage of labor?

A

From 0-5 cm dilated, contractions are mild and last about 30 seconds.

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16
Q

What is the active phase of the first stage of labor?

A

Begins at 6 cm dilated, cervical dilation occurs more rapidly, contractions are around 60 seconds and occur every 3-5 minutes.

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17
Q

What is the transition phase of the first stage of labor?

A

Contractions reach peak intensity, cervix dilates to 8 cm, the patient may experience intense discomfort, nausea/vomiting, loss of control, modesty, and increased irritability.

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18
Q

What is the second stage of labor?

A

From full dilation and cervical effacement to the birth of the infant. It’s the pushing stage where the fetal head is pushed out, extends, and rotates to bring the shoulder into line with the pelvis, followed by the birth of the baby’s body.

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19
Q

What is the third stage of labor?

A

The placental stage, beginning with the birth of the infant and ending with the delivery of the placenta. This includes placental separation and expulsion, which can take 1 to 30 minutes to be normal.

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20
Q

What are signs of placental separation?

A

Lengthening of the cord, sudden gush of blood from the vagina, placenta visible at the vaginal opening, and the uterus contracting and feeling firm again.

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21
Q

What is considered high blood pressure during labor?

A

> 140/90, which could indicate gestational hypertension.

22
Q

What does low blood pressure combined with elevated heart rate indicate?

A

It could be a sign of hemorrhage.

23
Q

What does an abnormal pulse (>100) indicate in labor?

A

It may be a sign of hemorrhage.

24
Q

What are inadequate contractions a sign of during labor?

A

It could indicate uterine exhaustion.

25
Q

What are prolonged contractions a sign of?

A

They could compromise fetal well-being because they interfere with adequate uterine artery filling.

26
Q

What does an abnormal lower abdominal contour indicate?

A

A full bladder during labor may cause a round bulge in the lower abdomen, which may obstruct the fetal head’s descent and could result in bladder injury. Encourage the patient to void every 2 hours.

27
Q

What is a danger sign related to fetal heart rate (FHR)?

A

High or low FHR. Normal FHR is between 110-160 bpm.

28
Q

What is meconium staining a sign of?

A

It is highly correlated with fetal distress and may indicate the fetus is experiencing hypoxia.

29
Q

What does fetal hyperactivity indicate?

A

It may be a subtle sign of hypoxia, often reflected in frantic motion.

30
Q

What is a danger sign related to fetal oxygen saturation?

A

An oxygen saturation below 40% requires further assessment.

31
Q

What are the components of a detailed assessment during the 1st stage of labor?

A

History (current pregnancy, past pregnancy, past health), physical examination (head-to-toe), vaginal exam (to assess cervical softening, effacement, dilation, fetal presentation, position, and descent), sonography, ROM assessment, pelvic adequacy, vitals, labs.

32
Q

What should you avoid when performing a vaginal exam?

A

Vaginal exams should not be performed in the presence of fresh bleeding as it may indicate placenta previa.

33
Q

How should fetal heart sounds be auscultated in a vertex presentation?

A

Fetal heart sounds are best heard through the fetal back.

34
Q

How should fetal heart sounds be auscultated in a cephalic presentation?

A

Fetal heart sounds are heard loudest low in the patient’s abdomen.

35
Q

What are the 3 parameters to assess in fetal heart rate (FHR)?

A

Baseline FHR, variability (accelerations and decelerations), and periodic changes in FHR.

36
Q

What is the normal range for baseline fetal heart rate (FHR)?

A

Normal FHR is between 110-160 bpm.

37
Q

What does moderate variability (5-15 beats/min) in FHR indicate?

A

It is a normal and reliable indicator of fetal well-being.

38
Q

What is absent variability in FHR?

A

It means there is no change in FHR, which can be concerning.

39
Q

What is minimal variability in FHR?

A

FHR variability less than 5 beats/min.

40
Q

What is marked variability in FHR?

A

FHR variability greater than 15 beats/min.

41
Q

What are accelerations in fetal heart rate?

A

An increase of 15 beats/min for at least 15 seconds, often caused by fetal movement.

42
Q

What are early decelerations?

A

Early decelerations occur late in labor when the fetal head has descended and are considered innocent.

43
Q

What are late decelerations a sign of?

A

Late decelerations occur after the onset, peak, and recovery of a contraction and suggest uteroplacental insufficiency or decreased blood flow to the fetus. Nurse action: immediately change the patient’s position to lateral, may give IV and O2.

44
Q

What are prolonged decelerations a sign of?

A

They may indicate cord compression or maternal hypotension.

45
Q

What are variable decelerations a sign of?

A

They may indicate cord compression, and they are unpredictable. Nurse action: change position to lateral. If cord prolapse, administer O2 and place the patient in a knee-to-chest position.

46
Q

What is Category I FHR monitoring?

A

FHR factors (baseline and variability) are normal. Action: Continue routine monitoring.

47
Q

What is Category II FHR monitoring?

A

FHR factors are indeterminate. Action: Continue surveillance and reevaluation.

48
Q

What is Category III FHR monitoring?

A

FHR tracings are abnormal. Action: Prompt evaluation and expedite actions such as changing position, administering O2, discontinuing labor stimulation. If it does not resolve, prepare for birth.

49
Q

What is the nursing care during the 1st stage of labor?

A
  • Respect contraction times.
  • Promote change of positions.
  • Help with fetal alignment (e.g., squatting or being on all fours).
  • Encourage voiding and provide bladder care (encourage pt to void every 2 hours).
  • Empower the birthing parent by encouraging them to assume any position they find comfortable and breathe in a natural way.
50
Q

What is a danger of a prolonged second stage of labor?

A

Chorioamnionitis (membrane infection) and an increased rate of cesarean birth.

51
Q

What is the nursing care during the 2nd stage of labor?

A
  • Assist with pushing as needed.
  • Empower the birthing parent during the birth.
  • Assist with the birth process, including cutting and clamping the cord.
  • Ensure that the placenta is delivered spontaneously.
52
Q

What is the nursing care during the 3rd stage of labor?

A
  • If the uterus has not contracted firmly on its own, massage the fundus to encourage contraction.
  • Administer oxytocin to help with uterine contraction.
  • If excessive bleeding occurs due to poor uterine contraction, administer IM Hemabate or Methergine (ensure there are no contraindications such as hypertension or asthma).

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