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OB > Test 2 -Labor and Delivery > Flashcards

Test 2 -Labor and Delivery Flashcards

1
Q

Which pelvis shape is the most favorable for delivery ?

A

Gynecoid Pelvis

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2
Q

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 _______)

A

rounded
transverse, CS
adequate
male, forceps

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3
Q

What are the 5 P’s of Labor?

A

Passage (pelvis)
Passenger (fetus)
Powers (CTX/pushing)
Position (how the baby is inside/ mother position)
Psyche (how the mother is coping)

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4
Q

How can you tell the baby is in the correct position for delivery?

A

Sutures in the head palpated

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5
Q

Fetal attitude is the relation of the fetal parts to one another (refers to ________ of fetus during labor)

A

posture

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6
Q

What is the leopold’s maneuver?

A

Palpates around the fetus to determine how they are positioned in the uterus

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7
Q

What does a contraction feel like?

A

firm and globular

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8
Q

What is effacement of the cervix?

A

Thinning (0-100%)

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9
Q

What factors contribute to the woman’s attitude in labor?

A
  • her perception
  • those around her
  • Prior experience/ expectations
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10
Q

What factors prepare and support are available to enhance coping effects?

A
  • relaxation of voluntary muscles
  • support person/ coach/ doula/ positioning
  • distraction
  • breathing techniques with each ctx
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11
Q

Nursing should AVOID _______ exams whenever possible on women with PROM/ SPROM
*** never if she had vaginal bleeding

A

vaginal

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12
Q

What should you document for rupture of membranes
- _______ of fluid
- _______ of fluid
- ______ rupture occurred
*** assess immediately for _________ cord

A

color
odor
time
prolapsed

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13
Q

What is your primary concern if a woman presents and she is leaking fluid for 4 days? Why?

A

Infection
Because membrane is open and baby is now exposed

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14
Q

First stage of labor : beginning to complete of ___________ ________ (0-10cm)

A

cervical dilation

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15
Q

Second Stage of labor : complete dilation to ______ of baby

A

birth

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16
Q

Third stage of labor : Birth to delivery of _________

A

placenta

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17
Q

Fourth stage of stage : first ___ hours after delivery of ______

A

4
placenta

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18
Q

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

A

0-3
4-7
8-10

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19
Q

Braxton Hicks Contractions
_____ labor pains
Feel strong at times
Do _____ change or dilate the cervix
____ pattern
Stop with change in _________
“________” for the marathon

A

false
NOT
NO
activity
Practice

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20
Q

What is fetal station?

A

How far down the baby’s head has decreased into the mother’s pelvis

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21
Q

What is the purpose of fetal station?

A

To tell how far through (or above) the pelvis baby is

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22
Q

What are the risks of pushing before its time?

A

Retard labor
Failure to progress
Cervical edema

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23
Q

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

A

frequency, duration, intensity
protein/glucose
positioning, back

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24
Q

TOCO is a device for monitoring and recording __________ _________ before and during labor

A

uterine contractions

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25
Q

Doppler monitor measures :

A

Fetal HR

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26
Q

SECOND STAGE OF LABOR
- avg __ hrs nulliparous. ___min multiparous
- Complete _________ dilation to delivery of _____

A

2,20
cervical , fetus

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27
Q

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

A

expulsion
bearing
holding breath
side lying, semi fowler, squatting position

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28
Q

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 ___________

A

fetal head
push/ compromised
head
face
Exhausted, effectively

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29
Q

Delivery of the placenta should be done within ____ minutes

A

30

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30
Q

Blood loss of ____-_____ mL occurs as a normal consequence of placental separation

A

300-500

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31
Q

Contractions of the uterus prevents maternal _________

A

hemorrhage

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32
Q

_________ __________ occurs when the placental fails to detach from the uterus as it exits, pulls on the inside surface, and turns the uterus inside out

A

uterine inversion

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33
Q

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

A

placental
blood
placenta
suction
mouth, nose
twice
stable

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34
Q

What are some benefits of skin-to-skin care?

A

Regulates:
BS
RR
Temp
Infection
HR
Decreases crying
Better sleep
Better breast feeding

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35
Q

Forth stage of labor is the most critical period for the mother. Why?

A

To prevent the mother from infection and hemorrhage

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36
Q

It is important to teach the patient the importance of breastfeeding, ambulation, and newborn care during the forth stage of labor (TRUE OR FALSE)

A

True

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37
Q

Labor induction is the stimulation of uterine contraction during pregnancy ______ labor begins on its own to achieve ______ birth

A

before
vaginal

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38
Q

HOW IS INDUCTION PERFORMED?
- ________ ripening ( medications or foley bulb)
- ________ _________ of membranes
- ____ medications ( Pitocin, Cervidil, Cytotec)
- Complimentary methods (Resting, prostaglandins)

A

cervical
Artificial rupture
IV

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39
Q

What are some reasons a woman may be induced?

A

high BP
Slight abruption
Chronic condition
ROM
Something wrong with baby

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40
Q

Labor dystocia is an abnormal ________ pattern
Can be due to a problem with
-
-
-

A

labor
the powers
passage
passenger

41
Q

Labor dystocia is defined as less than ____cm of cervical dilation per hr over a ___ hour period

A

0.5
4

42
Q

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

A

uterine contractions

43
Q

Why would you perform labor augmentation?

A

To speed labor up/ help it progress

44
Q

What natural ways can you augment a labor?

A
  • walking
  • nipple stimulation
  • sex
45
Q

INDUCTION
- Stimulate labor _______ it starts
AGUMENTATION
- labor has ______ but has not lead to cervical _______ so we are going to help it along

A

BEFORE
started, dilation

46
Q

An amniotomy is an __________ ________ of membranes

A

artificial rupture

47
Q

Amniotomy is used in the _____ stage of labor to shorten the length of labor

A

first

48
Q

What are some nursing interventions for an amniotomy?
- FHR _______ and immediately _______
- Assess amniotic fluid _____/_____
- Assess pt’s temp every ___ hrs

A

BEFORE/AFTER
color/odor
2

49
Q

An amino infusion is done by having warm sterile NS or LR introduced into the uterus through a _________

A

IUPC

50
Q

When is an aminoinfusion used?
- Low fluid (__________________)
- ________ decels, (cord ___________)
- __________ stained fluid

A
  • oligohydraminos
  • Variable , compression
  • Meconium
51
Q

Opioid analgesics are use in _____ labor
- They induce _______

A

early
sedation

52
Q

What is the number he narcotic used in L&D?

A

Fentanyl

53
Q

Morphine lasts a long time and is given during the _____ stage of labor

A

1st

54
Q

MORPHINE
- rapidly crossed the _______
- do NOT admin. within __ hours of delivery
- Have ________ available for newborn if overly sedated

A

placenta
2
Narcan

55
Q

FENTANYL
- Causes less n/v and __________ depression than other options
- Minimal ________
- Minimal _______ side effects
- Works quickly and ______ off quickly

A

respiratory
sedation
fetal
wears

56
Q

HYDROXYZINE
- May increase effectiveness of ______
- May _______ anxiety
- Cannot be given ____

A

opioids
decrease
IV

57
Q

PROMETHAZINE
- Can cause ______
- Can contribute to _________ ___________

A

sedation
maternal hypotension

58
Q

Prodromal labor is _____ labor with regular ctx but they start and stop and do ______ cause significant cervical change

A

early
NOT

59
Q

The cause of prodromal labor is unknown but is thought to prepare the uterus for true labor (TRUE or FALSE)

A

TRUE

60
Q

Prodromal labor is different from Braxton Hicks because prodromal labor can be ________ contractions whereas Braxton hicks are ______

A

regular
irregular

61
Q

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

A

sedative,pain
True

62
Q

What are the common meds included in a “party pack”?

A

Phenergan
Vistaril
Oxycodone
Used to give Butisol but no longer in the US

63
Q

PUDENDAL BLOCK “SADDLE BLOCK”
- local anesthetic injected into __________ nerves
- Provides relief to lower ______, ______, _______
- May diminish ______ ___ _____

A

pudendal
vagina, vulva, perineum
urge to push

64
Q

EPIDURAL OPIOID ANALGESIA
- affects T12-S5
- Continuous infusion of anesthetic into the _______ space
- Provides analgesia for approx ___ hours after delivery

A

epidural
24

65
Q

What are the HIGH risks that come with epidurals?

A

Maternal Hypotension (tx with Fluid Bolus 1000mL)

66
Q

CESAREAN BIRTH
- Birth of an infant through an __________ and _______ incision

A

abdominal , uterine

67
Q

Can a woman have a vaginal birth after C-section? (VBAC) If so, who?

A

YES!
Pts who had previous low transverse incision

68
Q

What uterine incision is most used and most favorable and allows for a later vaginal birth ?

A

Low transverse

69
Q

Success rate of VBAC ?

A

70-75%

70
Q

C-section patients are at the highest risks for …

A

Hemorrhage
Shock
Infection

71
Q

Patients who received a c-section have what kind of diet?

A

Ice chips, clears to full

72
Q

Catheter is removed ___-____ hours after c-section

A

6-8

73
Q

Count fetal movements daily (same time) every day beginning at ____ weeks gestation

A

28

74
Q

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) ,_____________

A

movements
high/decreased
oxygen
reactive, non-reactive, unsatisfactory

75
Q

Healthy babies will respond with an __________ HR during times of movement, and the HR will __________ at rest

A

increased
decreased

76
Q

Reactive NST “___________”
- 2 ____________ of at least __bpm above fetal HR baseline that lasts __ seconds
- Monitoring for minimum of ___ minutes, max __ minutes

A

reassuring
accelerations
15
15
20
40

77
Q

Non-reactive = “____-___________”
- Criteria for reactive are not met

A

non-reassuring

78
Q

_____________ stimulator is applied to the maternal abdomen over the area of the fetal head

A

Vibroacoustic

79
Q

If you have a non-reactive NST, there are no further actions (TRUE OR FALSE)

A

False

80
Q

Biophysical Profile combines the ____ and fetal ____________ and evaluates the well being of the _____

A

NST
ultrasound
fetus

81
Q

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

A

normal
reassuring/ nonreassuring
monitoring
12/24
delivery
delivery

82
Q

CONTRACTION STRESS TEST
- Determines how well the baby will cope with the ___________ of vaginal delivery by stimulating synthetic contractions

A

contractions

83
Q

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

A

negative
positive

84
Q

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

A

lower
reduced
higher
enhanced

85
Q

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

A

amniotic

86
Q

UTERINE RUPTURE
S/S: Sudden sharp _______ pain , ______ of ctx, Sudden fetal brady to absence of fetal _____ tone, shock
INTERVENTIONS: deliver the baby via _________ ASAP

A

abdominal, cessation, heart
c-section

87
Q

Uterine rupture is a catastrophic tearing open of the ______ into the ________ cavity

A

uterus
abdominal

88
Q

ETIOLOGY OF UTERINE RUPTURE
- Rupture of previous _________
- __________ labor
- Injudicious use of Pitocin ( _____________)
- Excessive ________ pressure applied to the __________ during delivery

A

C-section scar
Prolonged
overstimulation
manual, fundus

89
Q

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

A

30
hemorrhage, infection

90
Q

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

A

uterine inversion

91
Q

Signs and Symptoms of retained placenta :

A

Fever
Foul Smelling discharge
Persistent pelvic/ Abdominal pain
Excessive vaginal bleeding

92
Q

POST-TERM PREGNANCY
- Birth beyond ____ completed weeks of pregnancy
MOST COMMON CAUSES
- poor pregnancy ______
- desire for _______ labor
- no _________ care

A

42
dating
natural
prenatal

93
Q

PERINATAL COMPLICATIONS OF POST-TERM PREGNANCY
- ___________ staining
- Asphyxia
- _______ complications
- Fractures
- ________ injury
- ____________ hemorrhage

A

meconium
cord
nerve
intracranial

94
Q

Macrosomia is when the baby weighs more than ______ grams at birth
DELIVERY RECOMMEND. = ________ if weight estimated > 4500grams (11lbs)— otherwise vaginal delivery

A

4000
c-section

95
Q

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

A

Spine
Spine
3/4
back
more

96
Q

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

A

shoulder
CANNOT

97
Q

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

A

head
retracts

98
Q

Cephalopevlvic disproportion is when the fetus is ______- than the mother’s passageway

A

larger

99
Q

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

A

impossible
management
induction

OB (5 decks)

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