Quiz 2 Content Flashcards
S/Sx of Labor
Lightening, braxton hicks, cervical changes, bloody show, ROM, “nesting.”
Definitions: Lightening
Fetus settles/drops into pelvis. Can happen a few weeks prior to labor or just before beginning of labor.
Lightening: Effects on Body
Easier breathing, increased urinary frequency, leg cramps, increased LE edema.
Definitions: SROM
Spontaneous Rupture of Membranes
SROM: Nursing Considerations
Increased risk of infection (ABX possible), optimal to deliver within 24 hr of rupture - can be induced with pitocin
Definitions: Bloody Show
Mucousy lining in cervix during labor is expelled.
Cervical Changes During Labor
Dilation (Door opening): 0-10 cm
Effacement (thinning/shortening): 0-100%
Definitions: Braxton Hicks
Backache and contractions of the uterus occur throughout pregnancy. They are intermittent and irregular. They do NOT cause cervical changes and can lead to women believing they are in labor.
Nursing Education for Nesting
Encourage women not to overdo it or become fatigue
Definitions: Pre-term Birth
Birth occurs before 37 weeks of pregnancy (5-18% of births).
Definitions: Pre-term Labor
Cervical changes and uterine contractions that occur between 20-37 weeks.
What is the Best Biochemical Marker for Preterm Birth?
Salivary Estriol
Definitions: PPROM
Preterm Premature Rupture of Membranes. Occurs in 25% of preterm cases, cause is unknown but is often preceded by infection (Chorioamnionitis).
Definitions: Post Term Pregnancy
Pregnancy extending beyond 42 weeks.
Post Term Pregnancy: Maternal Risks
Dysfunctional labor/birth canal trauma R/T large infant.
Post Term Pregnancy: Fetal Risks
Prolonged labor, shoulder dystocia, birth trauma, asphyxia R/T macrosomia, effects of “aging” placenta.
Definitions: Version
Turning of fetus from one presentation (position) to another.
Definitions: Shoulder Dystocia
Head of baby is “born,” but anterior shoulder cannot pass under the pubic arch.
Shoulder Dystocia: Infant Risks
Birth injury R/T asphyxia, brachial plexus damage, and fracture.
Shoulder Dystocia: Maternal Risks
Blood loss R/T uterine atony or rupture, lacerations, extension of episiotomy, or endometritis.
Definitions: Prolapsed Umbilical Cord
Cord lies below presenting portion of fetus.
Prolapsed Umbilical Cord: Etiology
Cord > 100 cm, breech position, transverse lying, unengaged presenting part.
Uterine Rupture: Etiology
Separation of scar from previous classic cesarean birth, uterine trauma (R/T accidents or surgery), congenital anomalies.
Amniotic Fluid Embolism: Pathophysiology
Amniotic fluid containing debris (e.g., hair, meconium) enters maternal circulation and obstructs pulmonary vessels resulting in respiratory distress and circulatory collapse.
Definitions: Pelvic Dystocia
Contractures of pelvic diameter that reduce size of the pelvis.
HELPPERR Mnemonic
H - help (call for assistance)
E - evaluate for episiotomy
L - legs (McRoberts Maneuver)
P - pressure (suprapubic)
E - enter the vagina
R - roll the patient to hands and knees
R - remove the posterior arm
Forceps Mnemonic
A - anesthesia
B - bladder
C - cervix
D - determine position (think dystocia)
E - equipment
F - forceps
G - gentle traction
H - handle
I - incision
J - jaw
Vacuum Mnemonic
A - anesthesia
B - bladder
C - cervix
D - determine position (think dystocia)
E - equipment and extractor
F - fontanelle; cup positioned near
G - gentle traction
H - halt traction or procedure
I - incision
J - jaw
Definitions: Decelerations
A decrease in fetal heart rate below the baseline rate. These can be early, variable, late - or a combination of more than one!
Early Deceleration: Cause
Head compression. Usually seen during the later portion of active labor or with breech babies. Not expected in early labor.
Late Decelerations: Cause
Uteroplacental insufficiency.
Variable Decelerations: Cause
Umbilical cord compression.
Definitions: Hypoxemia
Low levels of O2 in blood.
Definitions: Hypoxia
Low levels of O2 available in tissue - cannot meet metabolic needs.
Definitions: Intrauterine Growth Restriction (IUGR)
Growth restriction below the 10th percentile in gestation.
Compare/Contrast: Symmetric IUGR vs. Asymmetric IUGR
Symmetric: Results from perinatal infections (e.g., cytomegalovirus) and chromosomal abnormalities. Develops early in pregnancy. Less common than asymmetric. Poor prognosis.
Asymmetric: Occurs later in pregnancy, more common than symmetrical. R/T uteroplacental insufficiency. Better prognosis.
Definitions: Intermittent Decelerations
Decelerations that occur with < 50% of uterine contractions in any 20 minute window.
Definitions: Prolonged Deceleration
Decrease in fetal heart rate from baseline by > 15 bpm, lasting longer than 2 minutes but less than 10 ( > 10 minutes = baseline change).
Definitions: Recurrent Decelerations
Decelerations that occur with > 50% of uterine contractions in any 20 min window.
Definitions: Episodic Changes
Accelerations/decelerations occurring without relationship to uterine contractions (e.g., fetal movement).
Definition: Category I Fetal HR
Fetal HR tracings normal.
Definitions: Category II Fetal HR
Fetal HR tracings are indeterminate. Essentially, not adequate evidence to classify as category I or category III
Definitions: Category III Fetal HR
Fetal HR tracings are abnormal. Require prompt evaluation.
Category III Fetal HR: Interventions
Dependent on clinical situation. Can include: provision of maternal O2, d/c labor stimulation, Tx maternal hypotension.
When May Internal Fetal Monitoring Be Used?
When the external monitor is of questionable quality, maternal abdominal obesity, maternal movement impairing ability to externally monitor.
Internal Fetal HR Monitoring: Benefits
Eliminates need to readjust monitor, eliminated possibility of tracing maternal HR.
Internal Fetal HR Monitoring: Requirements
Membranes are required to be ruptured.
Definitions: Precipitous Labor
Labor lasting less than 3 hours.
Labor: Non-pharmacological Interventions
Massage, touch, heat, cold, focal point, distraction, effeurage, distraction, positioning, hydrotherapy, imagery, hypnosis.
General Anesthesia: Maternal/Fetal Risks
Maternal aspiration of gastric contents, maternal respiratory depression, uterine relaxation, neonate respiratory depression
Laboring Women With Hx Sexual Abuse: Nursing Considerations
Memories of abuse can be triggered by labor (e.g., exams, pain, loss of control, etc). Offer support, promote comfort, assess, and monitor.
Left/Right Side Lying is Optimal for Baby
Left side lying.
Nursing Interventions Throughout Labor (general)
Provide for maternal and infant safety, monitor maternal VS, monitor cervical dilation PRN, monitor fetal HR, monitor contractions, monitor labor progress, monitor coping, include coach.
Nursing Interventions: Active Labor (Stage 1, Phase 2)
Keep hydrated, provide comfort measures, pharmacologic interventions, provide reassurance, support to laboring woman and coach.
Stages of Labor: Stage 1
Dilation 0-10 cm
Further divided into phases
Latent
Active
Transition
Stages of Labor: Stage 1 (Latent Phase)
0-3 cm dilated
0-30 % effaced
Contractions short/far apart
Monitor fetal HR for late decels
Stages of Labor: Stage I (Active Phase)
4-7 cm dilated
100% effaced
Breathing techniques and pain management
Contractions stronger and longer
Stages of Labor: Stage 1 (Transition Phase)
7-10 cm dilated
100% effaced
Help mom focus and stay in control
Contractions strongest and closest
Anxiety/vomiting/BM
DO NOT push until 10 cm dilated
Bloody shown can be seen at this stage
Assess color of amniotic fluid
Stages of Labor: Stage 2
10 cm dilated - baby is TRANSITIONING out.
Here we see significant increase in contractions, urge to push (Ferguson reflex), and urge to poop.
Definitions: McRoberts Maneuver
Pressing the laboring woman’s legs to her abdomen. Used with shoulder dystocia to create more room for baby during delivery.
Stages of Labor: Stage 3
Baby to placenta is out
Stages of Labor: Stage 4
Recovery
Definitions: Station
Relationship of presenting part of fetus to ischial spines of pelvis (-4 to +4).
Station of +4 Indicates…
Baby being born
Station of -4 or Greater Indicates…
Fetus floating or unengaged
Primary Powers Include…
Uterine contractions (0-10 cm)
Secondary Powers Include…
Pushing (10 cm - birth)
Early Labor: Nursing Interventions
Early Labor = Early education and encouragement.
Orient to unit/room, admission Hx and physical, build rapport, intake of birth plan, order labs, begin comfort techniques.
How Can You Differentiate Between True and False Labor?
4 Signs of True Labor: Bloody show, SROM, true labor contractions (increasing in frequency, intensity, and duration. Not relieved with position/activity changes).
How Can You Differentiate Between Real vs. Braxton Hicks Contractions?
Braxton Hicks contractions are relieved with walking/position changes and are not accompanied by any cervical changes.
A Laboring Mom Should NOT Push Until They Are _____ cm Dilated
10 cm
Risk for cervical swelling and lacerations if they begin pushing sooner.
COAT Mneumonic
Assessment of amniotic fluid
Color
Odor
Amount
Time
Definitions: Caput Succedaneum
A complication of forceps assisted birth in which there is swelling of the top of baby’s WHOLE head
Definitions: Cephalohematoma
A complication of forceps assisted birth in which there is swelling of the top of baby’s head - DOES NOT CROSS MIDLINE.
511 Rule
True labor is when contractions are 5 minutes apart, last one minute each over the course of 1 hour.
Tocolytics: Nursing Considerations
Watch for respiratory depression. Give deca/betamethasone for fetal lung maturity.
The Dick-Read Method
Fear –> Tension –> Pain
What is the “Ideal”
Pelvic Shape for Birth?
GYNEcoid
