Sept12 A1-Labor and delivery Flashcards
labor def
regular painful contractions that result in progressive cervical dilation and effacement
3 stages of labor
- first stage (cervical changes) (effacement and dilation to 10 cm)
- second stage (pelvic stage) (from full dilation of cervix at 10 cm until delivery)
- third stage (placental stage (separation and expulsion of the placenta)
theoris of cause of labor
- progesterone withdrawal = more PGs and uterine activity
- PG release (drop in P)
- oxytocin stimulation
- fetal cortisol levels
- having sex (sperm has PGs)
3 components of labor (3 Ps)
- powers (contractions)
- passenger (fetus)
- passage (pelvis)
how contractions cause cervical dilation
put P on fetus head and baby head down presses on the cervix
powers charact
- early labor = irregular, pain is ok, weak. charact of false labor. every 5-10 mins last 30-45 sec
- advanced labor = every 2-3 min last 50-70 seconds
when to go to hospital
contractions every 4-5 minutes for 1-2 hours
tocometry is what
labor monitoring of fetal HR and frequency of contractions for specific pts (high risk pregnancies)
how much contraction is too much and why
- uterine hyperstimulation = more than 5 contractions per 10 minutes
- dangerous for the baby bc gets squished. get fetal distress and abnormal fetal HR
components of the passanger (fetus)
- fetal lie
- presentation
- fetal attitude or posture
- fetal position
- changes in shape of the fetal hed (shape to fit the pelvis)
normal fetal lie
- longitudinal (99%)
- in axis of mother midline
uncommon fetal lie
transverse (horizontal)
diff possible fetal presentations
- cephalic (head first)
- breech = bum first (sometimes C section if labour themselves, many babies before, baby not too big)
- transverse lie (C section bc shoulder, arm or column first is dangerous)
- compound (foot stiking out and other foot sticking up, hand over the head)
- face (see part of the face
- brow (forehead of baby)
example of fetal attiudes or postures
- vertex (ovoid shaped mass, fits well in pelvis)
- sinciput (moderate flexion)
- brow (partial extension)
- face (complete extension)
fetus position definition + examples
which way the head is facing (not meaning head downwards but rather A, P lateral, etc.)
- occiput anterior
- occiput posterior
- occiput transverse
best fetal position for delivery
A-left, A-right, P-left or P-right. is called the occiput anterior.*** bc smallest diameter of head passes first
-transverse and posterior less ideal
how to determine fetal position
feel the occipital and frontal fontanelles (widenings of the bone suture in the skull) with your fingers
- occipital fontanelle = 2 sutures
- frontal = 3 sutures
smallest diameter of the head, skull of the baby
suboccipitobregmatic
changes in the shape of the fetal head at delivery
- molding (cone head that resolves after 48 hours)
- caput succedaneum (bump in back of the head)
how to tell the fetal presentation (cephalic, breech, transverse, brow, face, etc.) and position (
- occipitut ant
- occipitut post
- occiput transverse
limiting point in the pelvis for fetus passage
pelvic outlet (ischial spines, coccyx and pubic arches) wide pubic arch and ischial spine = lot of room for delivery
best pelvis shape for delivery
gynecoid pelvis
- wide ischiopubic rami
- wide space between spines
other pelvic shapes (passages)
- android (narrow and close ischial spines)
- platypelloid (flat)
- anthropoid (squashed)
trajectory that the baby will take in the passage
L because the uterus is bent forward
steps (CARDINAL MOVEMENTS) of the second stage of labor
- engagement
- descent
- flexion (fetus flexes head IMPORTANT for smallest diameter of head to fit through*
- internal rotation to look at the back of the mom
- extension (extend head)
- external rotation = turn again to look laterally like before (restitution). to free shoulders and deliver them up down (AP)
- expulsion
baby position during engagement and descent
looking laterally (passes pelvic inlet in occiput presentations)
key thing for labor dx
cervical dilatation
-2-3 cm at first baby and then same thing later is false labor**
+ other things like frequency and strength of contractions increasing
how to detect ruptured membranes
- amniotic pooling of water in vagina (test fluid pH). amniotic is basic vs vagina is acid
- nitrazine dye test
- ferning (amniotic fluid cristallizes on microscopy and causes ferns) IS DIAGNOSTIC
- amniscure, actimprom (test to detect placental alpha microglobulim 1 prot in amn fluid used if premature
how to examine cervical dilation
use two fingers and dilate two fingers and know how much they’re spaced out
first stage of labor 2 parts
- latent phase (contraction varies in intensity and frequency, slow dilation of cervix). primigravida (first child) = lasts over 20 hours. multigravida = lasts > 14 hours
- active phase of labour (contractions progressing rapidly, same for cervical dilation (progressive)
3 phases of dilation in active phase of stage 1 of labor
-acceleration
-linear
-maximum slope and deceleration
(can plot dilation)
plotting dilation speed helps for what
on sheet made for this specifically, if cross a predetermined alert line, be careful (bit slow) and if cross action line (do something: give oxytocin)
how to help 2nd stage of labor (delivery)
- push head a bit bc coming out too phase = tearing
- help baby turn: look at floor and then help turn again
- wait 1 min after delivery and then clamp the cord to avoid anemia
how to help for third stage of delivery
- active management of bleeding from placenta coming off (apply pressure on the cord for it not to break)
- make sure 3 cords on placenta
- make sure no mass on placenta
when to do C section
- severe glaucoma and can’t push
- fibroid obstructing outlet
- labor not progresing, baby not tolerating labor (HR dropping)
fetal monitoring in labor
- intermittent if low risk
- cardiotocography (fetal HR and maternal contractions frequency): 3 possible curves for fetal HR: acceleration, variable deceleration and late decel
late deceleration meaning
lack of oxygen to the baby, have to act
most important thing in pain relief for labour
make sure no respiratory depression (imp risk) because of the meds (opiates, etc.)
possible methods for pain relief during labour
- support, ambulation (=keep moving)
- hydrotherapy
- hyponosis
- entonox (NO, O2)
- opiates
- epidural
most common method for pain relief in labour
- epidural
- anesthesia at T10 and place needle and thread catherer down. (NOT anesthesia in CSF, just on side of spinal canal)
- problem = pts immobile
maternal changes in labour
- increased BP (falling prog)
- increased CO
- higher RR
- increased fluid loss = less urine output
- difficulty voiding
