Test 2 -Labor and Delivery Flashcards
Which pelvis shape is the most favorable for delivery ?
Gynecoid Pelvis
Gynecoid - well ________ most favorable for delivery
Platypoid - Broad, but flat and short; favors ________ fetal presentation (requires _________)
Anthropoid - oval but long and narrow; __________ for vaginal delivery
Android - “________ pelvis” narrow/heart shaped (requires CS or _______)
rounded
transverse, CS
adequate
male, forceps
What are the 5 P’s of Labor?
Passage (pelvis)
Passenger (fetus)
Powers (CTX/pushing)
Position (how the baby is inside/ mother position)
Psyche (how the mother is coping)
How can you tell the baby is in the correct position for delivery?
Sutures in the head palpated
Fetal attitude is the relation of the fetal parts to one another (refers to ________ of fetus during labor)
posture
What is the leopold’s maneuver?
Palpates around the fetus to determine how they are positioned in the uterus
What does a contraction feel like?
firm and globular
What is effacement of the cervix?
Thinning (0-100%)
What factors contribute to the woman’s attitude in labor?
- her perception
- those around her
- Prior experience/ expectations
What factors prepare and support are available to enhance coping effects?
- relaxation of voluntary muscles
- support person/ coach/ doula/ positioning
- distraction
- breathing techniques with each ctx
Nursing should AVOID _______ exams whenever possible on women with PROM/ SPROM
*** never if she had vaginal bleeding
vaginal
What should you document for rupture of membranes
- _______ of fluid
- _______ of fluid
- ______ rupture occurred
*** assess immediately for _________ cord
color
odor
time
prolapsed
What is your primary concern if a woman presents and she is leaking fluid for 4 days? Why?
Infection
Because membrane is open and baby is now exposed
First stage of labor : beginning to complete of ___________ ________ (0-10cm)
cervical dilation
Second Stage of labor : complete dilation to ______ of baby
birth
Third stage of labor : Birth to delivery of _________
placenta
Fourth stage of stage : first ___ hours after delivery of ______
4
placenta
First stage “dilating stage”
Latent (__-__cm) ctx become increasingly stronger and more frequent
Active (__-__cm) more rapid dilation/effacement and descent of fetus
Transition (__-__cm) ctx every 2-3 min and last 60-90 seconds
** maternal symptoms: irritability, restlessness, hyperventilation, N/V, rectal pressure
0-3
4-7
8-10
Braxton Hicks Contractions
_____ labor pains
Feel strong at times
Do _____ change or dilate the cervix
____ pattern
Stop with change in _________
“________” for the marathon
false
NOT
NO
activity
Practice
What is fetal station?
How far down the baby’s head has decreased into the mother’s pelvis
What is the purpose of fetal station?
To tell how far through (or above) the pelvis baby is
What are the risks of pushing before its time?
Retard labor
Failure to progress
Cervical edema
NURSING CARE : FIRST STAGE
- VS, fluid/electrolyte balance
- Contraction monitoring (_________, __________, _________)
- Voiding/bladder: how often pt is voiding, not any ________/________
- Comfort measures : ________, ______ massage, ice chips, relaxation, focal point
- Provide reassurance, explain process/procedures, reinforce teaching
- Assist support person
frequency, duration, intensity
protein/glucose
positioning, back
TOCO is a device for monitoring and recording __________ _________ before and during labor
uterine contractions
Doppler monitor measures :
Fetal HR
SECOND STAGE OF LABOR
- avg __ hrs nulliparous. ___min multiparous
- Complete _________ dilation to delivery of _____
2,20
cervical , fetus
NURSING CARE : 2ND STAGE OF LABOR
- Monitor physical status, progress of labor
- Assist with techniques that foster _________ of fetus
- encourage _________ down
- Discourage ________ _________ for more than 5 seconds
- Positioning: __________ _______, ______ ______, ______ _______
- Comfort measures
- Assist support person
- Monitor FHR and regularity
- Remove foley cath and internal monitors as needed
expulsion
bearing
holding breath
side lying, semi fowler, squatting position
INSTRUMENT ASSISTED VAGINAL DELIVERIES
- Forceps : curved blades to extract the ______ ______
Indicated if mom : can’t _____, fetus is ____________
- Vacuum: delivery with suction device applied to the fetal ______ for traction
Contraindicated: ____/breech presentation
Can be used if mom is ____________ or unable to push ___________
fetal head
push/ compromised
head
face
Exhausted, effectively
Delivery of the placenta should be done within ____ minutes
30
Blood loss of ____-_____ mL occurs as a normal consequence of placental separation
300-500
Contractions of the uterus prevents maternal _________
hemorrhage
_________ __________ occurs when the placental fails to detach from the uterus as it exits, pulls on the inside surface, and turns the uterus inside out
uterine inversion
NURSING CARE STAGE THREE
- Observe for s/s of _____ separation
- Assess _____ loss
- Monitor VS
- Assist with delivery of ______
- Bulb ______ baby
ALWAYS ______ then ______ to avoid aspiration
- Cord is clamped _____ and cut between clamps
- Record time of birth
- ________ infant to mom’s chest first hour
placental
blood
placenta
suction
mouth, nose
twice
stable
What are some benefits of skin-to-skin care?
Regulates:
BS
RR
Temp
Infection
HR
Decreases crying
Better sleep
Better breast feeding
Forth stage of labor is the most critical period for the mother. Why?
To prevent the mother from infection and hemorrhage
It is important to teach the patient the importance of breastfeeding, ambulation, and newborn care during the forth stage of labor (TRUE OR FALSE)
True
Labor induction is the stimulation of uterine contraction during pregnancy ______ labor begins on its own to achieve ______ birth
before
vaginal
HOW IS INDUCTION PERFORMED?
- ________ ripening ( medications or foley bulb)
- ________ _________ of membranes
- ____ medications ( Pitocin, Cervidil, Cytotec)
- Complimentary methods (Resting, prostaglandins)
cervical
Artificial rupture
IV
What are some reasons a woman may be induced?
high BP
Slight abruption
Chronic condition
ROM
Something wrong with baby
Labor dystocia is an abnormal ________ pattern
Can be due to a problem with
-
-
-
labor
the powers
passage
passenger
Labor dystocia is defined as less than ____cm of cervical dilation per hr over a ___ hour period
0.5
4
Labor augmentation refers to the artificial stimulation of ______ ___________ when spontaneous contractions have failed to result in progressive cervical dilation or the descent of the fetus
uterine contractions
Why would you perform labor augmentation?
To speed labor up/ help it progress
What natural ways can you augment a labor?
- walking
- nipple stimulation
- sex
INDUCTION
- Stimulate labor _______ it starts
AGUMENTATION
- labor has ______ but has not lead to cervical _______ so we are going to help it along
BEFORE
started, dilation
An amniotomy is an __________ ________ of membranes
artificial rupture
Amniotomy is used in the _____ stage of labor to shorten the length of labor
first
What are some nursing interventions for an amniotomy?
- FHR _______ and immediately _______
- Assess amniotic fluid _____/_____
- Assess pt’s temp every ___ hrs
BEFORE/AFTER
color/odor
2
An amino infusion is done by having warm sterile NS or LR introduced into the uterus through a _________
IUPC
When is an aminoinfusion used?
- Low fluid (__________________)
- ________ decels, (cord ___________)
- __________ stained fluid
- oligohydraminos
- Variable , compression
- Meconium
Opioid analgesics are use in _____ labor
- They induce _______
early
sedation
What is the number he narcotic used in L&D?
Fentanyl
Morphine lasts a long time and is given during the _____ stage of labor
1st
MORPHINE
- rapidly crossed the _______
- do NOT admin. within __ hours of delivery
- Have ________ available for newborn if overly sedated
placenta
2
Narcan
FENTANYL
- Causes less n/v and __________ depression than other options
- Minimal ________
- Minimal _______ side effects
- Works quickly and ______ off quickly
respiratory
sedation
fetal
wears
HYDROXYZINE
- May increase effectiveness of ______
- May _______ anxiety
- Cannot be given ____
opioids
decrease
IV
PROMETHAZINE
- Can cause ______
- Can contribute to _________ ___________
sedation
maternal hypotension
Prodromal labor is _____ labor with regular ctx but they start and stop and do ______ cause significant cervical change
early
NOT
The cause of prodromal labor is unknown but is thought to prepare the uterus for true labor (TRUE or FALSE)
TRUE
Prodromal labor is different from Braxton Hicks because prodromal labor can be ________ contractions whereas Braxton hicks are ______
regular
irregular
What is the treatment of Prodromal labor?
- Provider may administer a _________ or ____ medication to allow mom to rest and encourage hydration
- ______ labor will usually begin soon
sedative,pain
True
What are the common meds included in a “party pack”?
Phenergan
Vistaril
Oxycodone
Used to give Butisol but no longer in the US
PUDENDAL BLOCK “SADDLE BLOCK”
- local anesthetic injected into __________ nerves
- Provides relief to lower ______, ______, _______
- May diminish ______ ___ _____
pudendal
vagina, vulva, perineum
urge to push
EPIDURAL OPIOID ANALGESIA
- affects T12-S5
- Continuous infusion of anesthetic into the _______ space
- Provides analgesia for approx ___ hours after delivery
epidural
24
What are the HIGH risks that come with epidurals?
Maternal Hypotension (tx with Fluid Bolus 1000mL)
CESAREAN BIRTH
- Birth of an infant through an __________ and _______ incision
abdominal , uterine
Can a woman have a vaginal birth after C-section? (VBAC) If so, who?
YES!
Pts who had previous low transverse incision
What uterine incision is most used and most favorable and allows for a later vaginal birth ?
Low transverse
Success rate of VBAC ?
70-75%
C-section patients are at the highest risks for …
Hemorrhage
Shock
Infection
Patients who received a c-section have what kind of diet?
Ice chips, clears to full
Catheter is removed ___-____ hours after c-section
6-8
Count fetal movements daily (same time) every day beginning at ____ weeks gestation
28
NON-STRESS TEST (NST)
- measure of the FHR in response to its own _________
- Indications: ____ risk pregnancy, _______ fetal movement in norm. pregnancy
- Purpose: Adequate ________ is required for fetal activity ad HR to be within normal ranges
- Results: __________ (Normal) ,____________(Abnormal) ,_____________
movements
high/decreased
oxygen
reactive, non-reactive, unsatisfactory
Healthy babies will respond with an __________ HR during times of movement, and the HR will __________ at rest
increased
decreased
Reactive NST “___________”
- 2 ____________ of at least __bpm above fetal HR baseline that lasts __ seconds
- Monitoring for minimum of ___ minutes, max __ minutes
reassuring
accelerations
15
15
20
40
Non-reactive = “____-___________”
- Criteria for reactive are not met
non-reassuring
_____________ stimulator is applied to the maternal abdomen over the area of the fetal head
Vibroacoustic
If you have a non-reactive NST, there are no further actions (TRUE OR FALSE)
False
Biophysical Profile combines the ____ and fetal ____________ and evaluates the well being of the _____
NST
ultrasound
fetus
Results of a Biophysical profile
- Scores of 8-10 are considered _______
- Scores of 7-5 are neither _________ nor __________
Needs further _________
- Repeat BPP in __-__ hours
- Consider __________
- Scores <4 Immediate __________ plan
normal
reassuring/ nonreassuring
monitoring
12/24
delivery
delivery
CONTRACTION STRESS TEST
- Determines how well the baby will cope with the ___________ of vaginal delivery by stimulating synthetic contractions
contractions
CST RESULTS
- NORMAL result = ________ CST - fetus’ HR did NOT slow during contractions
- ABNORMAL result = _________ CST - fetus’ heart DID decrease during ctx, can determine a more serious problem
negative
positive
BENEFITS OF DELAYED CORD CLAMPING TO THE BABY INCLUDES
- _____ frequency of iron deficiency anemia
- ________ need for blood transfusion
- ______ blood volume
- Neurodevelopment may be _________
** This is currently the standard of practice
lower
reduced
higher
enhanced
An amniotic fluid embolism occurs when ___________ fluid is forced into an open maternal uterine blood sinus. This condition may occur during labor or in the post-partial period
amniotic
UTERINE RUPTURE
S/S: Sudden sharp _______ pain , ______ of ctx, Sudden fetal brady to absence of fetal _____ tone, shock
INTERVENTIONS: deliver the baby via _________ ASAP
abdominal, cessation, heart
c-section
Uterine rupture is a catastrophic tearing open of the ______ into the ________ cavity
uterus
abdominal
ETIOLOGY OF UTERINE RUPTURE
- Rupture of previous _________
- __________ labor
- Injudicious use of Pitocin ( _____________)
- Excessive ________ pressure applied to the __________ during delivery
C-section scar
Prolonged
overstimulation
manual, fundus
A retained placenta is the retention of the placenta beyond ___ minutes after birth
CAN LEAD TO : __________, ___________
*** may require manual removal or placenta via D&C
30
hemorrhage, infection
Pulling on the cord carries a risk of tearing the cord and of causing a rare but life-threatening condition — ______ ___________, in which the organ is pulled indie out or even of the body
uterine inversion
Signs and Symptoms of retained placenta :
Fever
Foul Smelling discharge
Persistent pelvic/ Abdominal pain
Excessive vaginal bleeding
POST-TERM PREGNANCY
- Birth beyond ____ completed weeks of pregnancy
MOST COMMON CAUSES
- poor pregnancy ______
- desire for _______ labor
- no _________ care
42
dating
natural
prenatal
PERINATAL COMPLICATIONS OF POST-TERM PREGNANCY
- ___________ staining
- Asphyxia
- _______ complications
- Fractures
- ________ injury
- ____________ hemorrhage
meconium
cord
nerve
intracranial
Macrosomia is when the baby weighs more than ______ grams at birth
DELIVERY RECOMMEND. = ________ if weight estimated > 4500grams (11lbs)— otherwise vaginal delivery
4000
c-section
Persistent occipital posterior position (POP) is when the baby’s ______ is lying against the maternal ________. (back to back)
RISK of : __/__ degree perineal laceration *** attempt to reposition the baby
LABOR IS :
- ______ labor
- longer
- ______ painful - needs forceps/vacuum
Spine
Spine
3/4
back
more
Shoulder dystocia is an obstructed labor, after the delivery of the head, the anterior _______ of the infant cannot pass below the pubic symphysis
** Most experts agree that this _________ be predicted
shoulder
CANNOT
SHOULDER DYSTOCIA
COMMON SIGN IN LABOR:
- Turtling : occurs when the ______ emerges and then ________ (pulls back) against the perineum, like a turtle in its shell. This causes the baby’s checks to bulge
head
retracts
Cephalopevlvic disproportion is when the fetus is ______- than the mother’s passageway
larger
SHOULDER PRESENTATION “TRANSVERSE LIE”
- _________ for vaginal delivery
- if discovered before term, _____________ is expectant (watchful)
- External cephalon version (ECV) attempt, followed by __________ of labor if successful
impossible
management
induction
