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Bloc I - Reproduction > Sept12 A1-Labor and delivery > Flashcards

Sept12 A1-Labor and delivery Flashcards

1
Q

labor def

A

regular painful contractions that result in progressive cervical dilation and effacement

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2
Q

3 stages of labor

A
  • 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)
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3
Q

theoris of cause of labor

A
  • progesterone withdrawal = more PGs and uterine activity
  • PG release (drop in P)
  • oxytocin stimulation
  • fetal cortisol levels
  • having sex (sperm has PGs)
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4
Q

3 components of labor (3 Ps)

A
  • powers (contractions)
  • passenger (fetus)
  • passage (pelvis)
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5
Q

how contractions cause cervical dilation

A

put P on fetus head and baby head down presses on the cervix

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6
Q

powers charact

A
  • 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
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7
Q

when to go to hospital

A

contractions every 4-5 minutes for 1-2 hours

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8
Q

tocometry is what

A

labor monitoring of fetal HR and frequency of contractions for specific pts (high risk pregnancies)

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9
Q

how much contraction is too much and why

A
  • uterine hyperstimulation = more than 5 contractions per 10 minutes
  • dangerous for the baby bc gets squished. get fetal distress and abnormal fetal HR
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10
Q

components of the passanger (fetus)

A
  • fetal lie
  • presentation
  • fetal attitude or posture
  • fetal position
  • changes in shape of the fetal hed (shape to fit the pelvis)
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11
Q

normal fetal lie

A
  • longitudinal (99%)

- in axis of mother midline

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12
Q

uncommon fetal lie

A

transverse (horizontal)

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13
Q

diff possible fetal presentations

A
  • 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)
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14
Q

example of fetal attiudes or postures

A
  • vertex (ovoid shaped mass, fits well in pelvis)
  • sinciput (moderate flexion)
  • brow (partial extension)
  • face (complete extension)
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15
Q

fetus position definition + examples

A

which way the head is facing (not meaning head downwards but rather A, P lateral, etc.)

  • occiput anterior
  • occiput posterior
  • occiput transverse
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16
Q

best fetal position for delivery

A

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

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17
Q

how to determine fetal position

A

feel the occipital and frontal fontanelles (widenings of the bone suture in the skull) with your fingers

  • occipital fontanelle = 2 sutures
  • frontal = 3 sutures
18
Q

smallest diameter of the head, skull of the baby

A

suboccipitobregmatic

19
Q

changes in the shape of the fetal head at delivery

A
  • molding (cone head that resolves after 48 hours)

- caput succedaneum (bump in back of the head)

20
Q

how to tell the fetal presentation (cephalic, breech, transverse, brow, face, etc.) and position (

A
  • occipitut ant
  • occipitut post
  • occiput transverse
21
Q

limiting point in the pelvis for fetus passage

A 
pelvic outlet (ischial spines, coccyx and pubic arches)
wide pubic arch and ischial spine = lot of room for delivery
22
Q

best pelvis shape for delivery

A

gynecoid pelvis

  • wide ischiopubic rami
  • wide space between spines
23
Q

other pelvic shapes (passages)

A
  • android (narrow and close ischial spines)
  • platypelloid (flat)
  • anthropoid (squashed)
24
Q

trajectory that the baby will take in the passage

A

L because the uterus is bent forward

25
Q

steps (CARDINAL MOVEMENTS) of the second stage of labor

A
  • 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
26
Q

baby position during engagement and descent

A

looking laterally (passes pelvic inlet in occiput presentations)

27
Q

key thing for labor dx

A

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

28
Q

how to detect ruptured membranes

A
  • 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
29
Q

how to examine cervical dilation

A

use two fingers and dilate two fingers and know how much they’re spaced out

30
Q

first stage of labor 2 parts

A
  • 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)
31
Q

3 phases of dilation in active phase of stage 1 of labor

A

-acceleration
-linear
-maximum slope and deceleration
(can plot dilation)

32
Q

plotting dilation speed helps for what

A

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)

33
Q

how to help 2nd stage of labor (delivery)

A
  • 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
34
Q

how to help for third stage of delivery

A
  • 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
35
Q

when to do C section

A
  • severe glaucoma and can’t push
  • fibroid obstructing outlet
  • labor not progresing, baby not tolerating labor (HR dropping)
36
Q

fetal monitoring in labor

A
  • intermittent if low risk
  • cardiotocography (fetal HR and maternal contractions frequency): 3 possible curves for fetal HR: acceleration, variable deceleration and late decel
37
Q

late deceleration meaning

A

lack of oxygen to the baby, have to act

38
Q

most important thing in pain relief for labour

A

make sure no respiratory depression (imp risk) because of the meds (opiates, etc.)

39
Q

possible methods for pain relief during labour

A
  • support, ambulation (=keep moving)
  • hydrotherapy
  • hyponosis
  • entonox (NO, O2)
  • opiates
  • epidural
40
Q

most common method for pain relief in labour

A
  • epidural
  • anesthesia at T10 and place needle and thread catherer down. (NOT anesthesia in CSF, just on side of spinal canal)
  • problem = pts immobile
41
Q

maternal changes in labour

A
  • increased BP (falling prog)
  • increased CO
  • higher RR
  • increased fluid loss = less urine output
  • difficulty voiding

Bloc I - Reproduction (57 decks)

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