Onset of Labor, Early Labor, First Stage of Labor Flashcards
admission before active labor increases risk of:
use of oxytocin rate of C/S use of epidural fetal scalp electrode IUPCs
ketonuria is indicative of:
inadequate nutrition
Friedman’s definition of prolonged latent phase of labor
greater than 20 hours in a nulliparous woman and more than 14 hours in a multiparous woman
which medication has the longest half-life? Morphine Nubain Demerol Fentanyl
Demerol
SE of epidural
fever, hypotension
epidurals increase risk of:
operative vaginal birth
dextrose IV fluids in labor increases risk of:
newborn lactic acidosis, jaundice and hypoglycemia
women \_\_\_\_\_\_\_\_\_\_\_\_\_ are more likely to experience: diagnosis of active phase arrest amnionitis C/S birth oxytocin augmentation epidural use fetal scalp electrodes IUPCs
admitted prior to active labor
Friedman defined the onset of ACTIVE labor as the time when:
the RATE of dilation increases
Friedman found that the median dilation at the point of faster progress of labor (his definition of active labor) was about ___ centimeters
3
Friedman himself points out that is not accurate to define active labor based on _____________ as there is considerable variation among women
a particular dilation
Contemporary research shows that many women are not in active labor until __ - __ centimeters
5-6
based on the false assumption that this will be useful in diagnosing the phase of labor BUT there is no evidence to support this practice and it may have the negative result of increasing fatigue
recommendation of walking in early labor
_________________ in early labor should be based on individual woman’s circumstance NOT duration of early labor
medical intervention (sleeping pills, sedatives, etc.)
the CNM can increase diagnostic accuracy of ____ by:
- taking a thorough history
- knowing the reasons for false negatives/positives
- NOT relying on just one diagnostic test
ROM
causes for false positives in ROM pH testing:
blood semen urine BV infection trich infection
cause for false positives in ROM pH testing:
not enough fluid present
drying amniotic fluid for 10 minutes then using microscope to observe for ferning
aborization (ferning)
causes for false positives in ROM aborization testing:
possible fingerprints on slide
cervical mucus
semen
significant amount of blood
cause for false positives in ROM aborization testing:
not enough fluid present
operator error
Actim PROM
Amnisure ROM
tests that detect biomarkers present in amniotic fluid
rapid immunoassays
causes for false positives in ROM rapid immunoassay testing:
significant bleeding
higher vaginal concentration of biomarkers with labor
causes for false negatives in ROM rapid immunoassay testing:
not enough fluid present
operator error
some studies show high false ___________ rates of rapid immunoassay ROM tests if there are any symptoms of labor
positive
sensitivity is high in rapid immunoassays meaning false _________ are low
negatives
false ___________ may be high in rapid immunoassays
positives
- cervix moves from posterior to anterior position
- cervix ripens/softens
- cervix effaces
- cervix dilates
- fetal head prepares for descent: rotates, flexes, molds
- fetus descends, rotates further, birthed
Six Ways to Progress
Fentanyl half-life
3 hours
Morphine half-life
2 hours
Nubain half-life
2-5 hours
Stadol half-life
2-5 hours
Utiva half-life
9-10 minutes
Demerol half-life
3-25? hours
Age Parity EDD Gestational weeks Pregnancy Complications (GBS) Previous Pregnancy Complications Previous Labor Experience (Duration) Mode of Previous Births Size of Previous Babies Fetal Movement Pattern Last Oral Intake Vaginal Bleeding Membrane Status Contraction Onset/ Frequency/ Duration/ Character/ Intensity/ Aggravating+Relieving Factors
Health History Components of Labor Presentation
V/S Heart/Lung Auscultation Abdominal Palpation -fetal lie -presentation -position -engagement EFW Fundal Height Visual Inspection (scars) Presence of edema Cervical dilatation/effacement/position/fetal station Molding/Caput Tone/Elasticity of Vagina (potential for laceration) ROM tests FHR tracing
Physical Examination Components of Labor Presentation
CBC
Type and Cross + Antibody Screen
Urinalysis
Lab Tests for Labor Presentation
lab test that provides baseline of:
Hgb/Hct-anemia is a risk factor for PP hemorrhage
WBCs- infection (transient high level common w/ labor)
Plt count- anesthesia eligibility
CBC
lab test that confirms prenatal blood group and Rh status providing a comparative value to prenatal results allowing for assessment of maternal antibody development and providing basic information for blood bank in case transfusion is needed
Type and Cross + Antibody Screen
lab test that identifies proteinuria, glycosuria, ketonuria, hydration status, UTI
urinalysis
BP, HR, RR check frequency during first stage of labor
q1 hour
temp check frequency during first stage of labor
q2-4 hours if normal + intact membranes
q1-2 hours if abnormal and/or after ROM
frequency of FHR assessment in 1st stage of labor
q~30 min
q15 min in women w/ complications
cardiac output increases by an additional ___-___% in the first stage of labor
10-15%
cardiac output increases primarily due to:
increased left ventricular stroke volume
vascular resistance is ___________ in first stage of labor
decreased
shifts in blood volume that occur during contractions force approximately 300-500 mL of blood into the maternal venous system contributing to:
increased venous return
levels of coagulation factors, most notably Factor VIII, are markedly __________ during active labor
increased
increased coag factors during pregnancy enhanced during labor promote:
rapid hemostasis after placental separation
pain that leads to increased RR and hyperventilation causes respiratory ___________
alkalosis
combined effects of decreased gastric motility, relaxation of gastroesophageal sphincter, and increased intra-abdominal pressure all contribute to:
increased risk of emesis/aspiration if intubated
Friedman’s dilatation rate for first stage of labor
- 2 cm/hr (nulliparous)
1. 5 cm/hr (multiparous)
arrest disorders of first stage of labor as defined by Friedman
no dilatation x 2 hours
contemporary research dilatation rate for first stage of labor
at least 0.5 cm/hr or 0.5-1.3 cm/hr
when supine position is required during labor, lateral positions are better for these reason:
less vena cava compression
facilitated kidney function
less interference w/ uterine contraction coordination/frequency
women who remain upright during first stage of labor, have _________ labors and are less likely to have ____________ or __________
short labor by approx 1 hr
C/S; epidural
In both squatting and ‘‘hand‐to‐knee’’ positions, the sagittal outlet and interspinous diameter were significantly _________ than when women were supine
greater
squatting __________ the intertuberous diameter and ___________ the obstetric conjugate diameter
increases; decreases
potential SE of \_\_\_\_\_\_\_\_\_: N/V dizziness dysphoria **No neonatal effects
nitrous oxide
