Test 1-Labor, Postpartum, Newborn Flashcards
What are the cardinal movements of labor?
Flexed attitude (chin to chest) Engagement, descent, flexion Internal rotation Extension External rotation Expulsion
How do you assess what position the fetus is in?
Leopold’s procedure
What is/are the most important thing/s to do when a mom comes in with ruptured membranes?
Check for a prolapsed cord if she reported a gush
Put on a FHM and make sure baby is okay
What do you do if you discover there is a prolapsed cord?
Stick your fingers in the vagina to raise the baby’s head and get mom in for a c section
Describe the types of breech positions
Footling-foot first
Frank-butt first
Complete-legs crossed
Shoulder/transverse-shoulder presents first or baby is laying longways across the uterus
What are the stages of labor?
1: cervix is dilating and effacing
2: pushing/delivery of baby
3: delivery of placenta
4: recovery
What are the phases of labor and in what stage do they occur?
Occur in stage one Phases: Latent: 0-3 cm Active: 4-7 cm Transition: 8-10
Describe baby’s station
Negative number is high, positive is low. 0 station means baby is engaged in the true pelvis (opening of the pelvis)
How often do you monitor a low risk mom in labor?
Latent: hourly
Active: q30 min
Transition: q15 mi
How often do you monitor a high risk mom in labor?
Latent: q30 min
Active: q15 min
Transition: q5 min
What are the pros and cons of AROM?
Pro: baby’s head becomes a mechanical dilator to progress labor
Con: cord prolapse, placental abruption, infection
What do we consider true labor?
Contractions every 5 min (10 for a mom with prior births)
Broken water
Contractions radiating from back to belly
What are AROM and SROM?
Spontaneous Rupture of Membranes
Artificial Rupture or Membranes
How do you know if her membranes have truly ruptured?
Nitrogen’s strip
Ferning test
Amnisure test
What is dystocia?
A stop in labor
What is a precipitous labor and why is it bad?
A labor that begins and ends with delivery within 3 hours
Trauma to baby’s head and mom’s vag from being forced out so quickly
What is hydrocephalus?
Water on the brain causing a large head
What is CPD?
Chephalopelvic disproportion-baby’s year is too big to come through mom’s pelvis
What is the position in which a baby can be born vaginally?
Cephalic/vertex
What is a precipitous labor and why is it bad?
A labor that begins and ends with delivery within 3 hours
Trauma to baby’s head and mom’s vag from being forced out so quickly
What is hydrocephalus?
Water on the brain causing a large head
What is CPD?
Chephalopelvic disproportion-baby’s year is too big to come through mom’s pelvis
What is the position in which a baby can be born vaginally?
Cephalic/vertex
What are reasons for postpartum hemorrhage?
Decreased uterine tone
Trauma
Placental fragments
How do you (most accurately) determine blood loss?
Weight anything with blood on/in it
What are blood loss parameters for hemorrhage?
Vaginal birth: >500 mL during delivery
C/S: >1,000 mL during delivery
What is a cause during labor for possible PPH?
Pitocin use
What is the first line drug of choice for PPH and why? Why might you not use pitocin and what are alternatives?
- Pitocin
- It causes the uterus to contract down to stop the bleeding
- If mom was on pitocin for extended time during labor
- cytotec (Misoprostol) or Hemobate (unless cardiac issue or asthmatic)
Best IV gauge for L/D? Why? Which do you never use and why?
18(green) or 20(pink)-neither will lyse a cell if blood is needed
22(blue)-will lyse a cell
How do you give pitocin?
IVPB (never push) diluted in LR
Or
IM injection
What is Ketoralac
To radio-NSAID lain relief
What is Sheehan syndrome?
Pituitary gland damage r/t postpartum hemorrhage
What are reproductive complications from birth and why do they happen?
Uterine displacement because of bladder distention
Bladder distention/urinate retention because of loss of tone
PO Hemorrhage because of tone, trauma, or placental fragments
What can cause a precipitous labor?
4+ births prior to the current one
Cocaine use
What drug relaxes and softens the uterus?
Terbutaline
Describe fetal presentation.
What part of the baby is presenting to you first from the vagina
Describe fetal lie.
How is the baby lying in the womb
Is the spine on the left or right
Is the occipital bone anterior or posterior
What causes variable decels?
Cord cord compression
What causes early decels?
Head compressions
What FHR change is okay?
Accelerations
What causes late decels?
Placental perfusion problems
What does APGAR stand for?
Appearance Pulse Grimace Activity Respiratory Effort
How is APGAR scored? When is it done?
A: 0 for central cyanosis, 1 for acrocyanosis, 2 for full pink color
P: 0 for 0 bpm, 1 for 1-99 bpm, 2 for 100+ bpm
G: 0 for floppy, 1 for barely grimacing with stimulation, 2 for full grimace
A: 0 for floppy and needing resuscitation, 1 for slightly floppy, 2 for screaming and flailing
R: 0 for no effort, 1 for grunting/retractions, 2 for healthy cry
1 min, 5 min and then at 10 if either is <7
When do you do compressions on a baby?
HR <60
What is a respiratory issue r/t labor?
Wet lung sounds from too much pitocin
What medications are given to most (if not all) newborns at birth?
Vitamin K
Hep B vaccine
Erythromycin eye ointment
What helps clear baby’s fluid out of his lungs?
Force from birth canal
CatecholaMines released due to the stress of labor
How much fluid is in a baby’s lungs at birth?
30 mL
What is special about newborn respirations?
They have periods where they stop breathing (not a normal respiratory rate/rhythm but is normal for newborns)
What is vernix?
White substance on a baby-totally normal
What is milia?
White dots across the nose
What is lanugo?
Fine baby hairs (usually on the shoulders and top of back?)
What is erythema toxicum?
Baby acne
What are Mongolian spots?
Birthmarks that may look like bruises
What are Epstein’s pearls?
Calcium deposits in the mouth-totally normal
Describe a postpartum assessment
Breasts Uterus Bowels Bladder Lochia Epesiptomy/perineum
Homan’s sign
Emotional
Status
Rhogam
When is rhogam used?
When mom is Rh - and baby is Rh +
