Unit 19 Labor & Delivery Flashcards
During an admission of a gravida PT what basic things would you assess?
Fetal HR
Mother VS
Contraction status
What do the different amniotic colors mean? Red, Green/Yellow, White and clear.
Red could indicate bleeding
Green/Yellow usually from bile/ meconium staining
White/clear is normal
How and what is assessed for in uterine activity?
Assessed by palpations or electronic monitoring
Assessing for frequency, duration, intensity
In what phase of the first stage of labor would you introduce medications if needed? What happens if Rx is given in transition phase?
The active phase
If given in transition phase, baby will be lethargic, cyanotic, etc.
Describe the contraction frequency and duration during the phases in the first stage of labor and the cervix dilation.
Latent phase: Contractions are 10-30 minutes apart lasting 30 seconds then 5-7 minutes apart lasting 30-40 seconds 1-3cm cervix
Active phase: 2-5 minutes apart lasting 40-60 seconds
4-7 cm cervix
Transition phase: 1 1/2- 2 minutes apart lasting 60-90 seconds 8-10 cm cervix
When does the abdomen become hard in labor?
When woman has contraction
How is frequency timed during labor?
Timed from the beginning of a contraction to the beginning of the next one with no monitor,
With a monitor it’s from one peak to the next.
What will too few rest periods between contractions create?
Fetal hypoxia, which will cause learning disabilities
How is duration timed?
Beginning of a contraction to the end of the same contraction
What is the other word for peak of a contraction?
Acme
What does effacement mean?
To become shorter and thinner [the cervix]
What does each fingertip equal in centimeters and what does the cervix dilate up too?
Each finger is about 2 cm.
Cervix dilates up to 10cm.
What are some medications to soften the cervix when it is just too rigid during labor, their action, and side effects?
- dinoprostone (Cervidil) [Prostaglandin class of meds]
- misoprostol (Cytotec)
- (Laminaria)
they are hydrophilic, bringing water to the area which helps dilate/soften the cervix and stimulate contractions.
Side effects: Maternal nausea, vomiting, diarrhea (usually when stomach is full)
What are signs of true labor?
- Effacing followed by dilating
- Progressive dilation (usually the mother is 10-20% effaced prior to labor pattern
- Contraction that occur regularly, become stronger, last longer, and occur more closely together
- More intense with walking
- Contractions usually felt in lower back radiating to lower portion of abdomen
- Contractions that continue despite comfort measures
Describe the mother behavioral patterns/signs and symptoms during the 3 phases of the first stage of labor.
Latent phase: little descent, irregular contractions, talking and happy, using breathing and focusing techniques.
Active phase: serious, intense, tired, more demanding, using breathing techniques
Transition phase: Effacement complete, fearful, nausea, vomiting, rectal discomfort, shakes from fluid volume shift (not cold), paced breathing desire to have bowel movement
What does the desire to have bowel movement during labor or before labor indicate?
Fetal pressure on bowels and head descent
How would a woman’s bladder be emptied during labor and what is difficult unless bladder is empty?
Foley catheter to relieve full bladder, baby will have difficulty coming with full bladder
Describe the second, third, and fourth stages of labor.
Second stage: Complete effacement/dilation to delivery, the “pushing stage”. Head on vaginal wall. If woman is nullparas (never given birth yet) could take up to 3 hours.
Third stage: Birth to delivery up placenta
Fourth stage: Immediate recovery (offer ice chips, flat ginger-ale instead of water)
What could slow, lazy contraction be from?
Possibly an epidural that was given
Where are the following places in the cervix…anterior, posterior, midposition.
Anterior refers to by the opening of the vagina
Posterior refers to the far back of the vagina
Mid-position is midway
What is an artificial rupture of the membrane (AROM) also known as and what instrument can be used?
amniotomy
amnihook
What tests can be performed to evaluate for amniotic fluid leak/rupture?
Nitrazine strip against cervix, will turn blue/positive when exposed to amniotic fluid
Fern test done by resident- cervix is swabbed side to side and if green like a fern it’s positive/reactive
After amniotic fluid is ruptured what is the first thing assessed?
Fetal HR! (almost always assessed first)
What is the appropriate amount of amniotic fluid at 20 weeks gestation? 36-38 weeks gestation?
20 weeks = 400ml
36-38 = 1000ml
What are the two amounts of amniotic fluid referred as and describe what results of it.
Oligohydramnios- too little fluid, incomplete or absent kidney, obstruction of urethra, fetus cannot secrete(create) or excrete
Polyhydramnios- too much fluid, causes congenital anomalies, anecephalcy
What is the best pelvis for delivery?
gynecoid (heart shaped)
What are the cardinal movements of labor?
- Lightening (baby drops into lowest point of pelvis)
- Engagement (head stays in pelvis)
- Descend
- Flexion (chin flexing)
- Internal rotation
- Extension (looks at floor-anterior delivery)
- Restitution (external rotation, head re-aligns with shoulders)
- External rotation expulsion
Define the following abbreviations. LOA LOP ROA ROP LMA RMA LSA RSA Footling breach RADP RADA LADA LADP
LOA Left occipital anterior LOP Left occipital posterior ROA ROP LMA Left mentrum (facial presentation) anterior RMA LSA Left sacral anterior RSA LSP RSP Footling breach RADP RADA ------- Right and left acromio dorsal (transverse) LADA LADP
Which direction is baby looking during delivery regarding anterior and posterior? What is the best presentation of delivery?
Anterior is baby looking down to floor
Posterior baby is looking up to ceiling
Best way to arrive is LOA
If delivered breech what is an important intervention to be taken? What instrument is used to extract baby?
- Use warmed blankets so fetus does not cry while head is still in vagina
- Use piper forceps
The posterior fontanelle is what shape? anterior?
Posterior- triangle
Anterior- diamond
What is Leopold’s Maneuver?
Using two hands you push on the sides of the belly to see where baby is lying
What is version? What is the worry/issue?
Trying to turn the baby around to head down, issue is you might rip cord?
What/how is station determined and what do the levels mean?
Where the baby is in terms of coming out, each finger is equal to one station. The higher the number (ex: +3) the closer to delivery.
- Feeling just the top of the head during vaginal check is 0 station.
- -1, -2 the baby is high up
What is iatrogenic cause?
Illness caused by the healthcare team
What is fetal hyperactivity a sign of?
Fetal hypoxia, not getting enough blood/oxygen
What is nuchal cord?
Cord wrapped around the neck
How is baseline FHR calculated? What is bradycardic FHR seen in/caused from?
Average of the FHR over 10 minute period
-Seen in cases of maternal hemorrhage, uterine rupture, and narcotics use for pain management
What is an appropriate FHR range and beat to beat variability?
10 below and 10 above the baseline FHR.
1-5 mild beat to beat variability
6-10 moderate beat to beat variability
Where is less beat to beat variability seen?
- Seen in premies
- With the use of Stadol a synthetic pain reliever used in OB
- Also seen with fetal approach to death
When a medication is being pushed, what changes regarding FHR and what doesn’t?
Baseline NEVER changes
Beat to beat variability narrows/changes
Each line on a fetal monitoring strip is how many seconds? What is the top of the strip and the bottom?
10 seconds
Top is FHR
Bottom is UC
Describe the the following fetal monitor pattern: Acceleration
- Baby swimming in 1000 ml :)
- Increase in FHR, reassuring indication of health
- Understand HR rises during intense contraction because it is still in amniotic fluid! Returns to baseline after contraction
- Good pattern
Describe the the following fetal monitor pattern:
Early Deceleration
- Only good deceleration pattern
- Looks like mirror image of contraction
- Rapid return to baseline FHR
-Each contraction the head is pushing up against cervix
in attempt to dilate
Describe the the following fetal monitor pattern:
Late Deceleration
- Non reassuring pattern on distress
- Indicative of fetal hypoxia also known as uteroplacental insufficiency
-Usually result of hemorrhage from uterine rupture or
tear in umbilical cord, too much pressure during contraction,
-Occur AFTER contraction
give fluids and 02
Describe the the following fetal monitor pattern:
Variable
- Combo package of early and late pattern
- Indicative of cord issues
- Occurs suddenly usually with pressure on the cord
-Most often cord around the neck or knot in cord
(remember if someone is strangled they’ll have a bowel movement thus good indicator is green amniotic fluid upon rupture)
- Babies will often have stain umbilical cords at birth
- reposition mother
Why would you see green amniotic fluid during a breech birth with variable fetal pattern?
Each contraction gut in squeezed rather than the baby’s head
What does sinosoidal pattern mean?
Prematurity/fetal death
Where is the external fetal lead placed? External uterine lead?
fetal lead: Placed on the baby’s back just below the head, jelly needed
uterine lead: Consistently placed on the fundus regardless of the presentation and position
no jelly needed
Describe internal leads.
- Require rupture of membranes
- Placed in sterile conditions
- Accurate in determining uterine pressure
- Goes on scalp of fetus
**If forgotten to be taken off prior to delivery and baby comes out with it on, mother places on IV antibiotics post delivery
What is the IV fluid of choice for labor and delivery?
Lactated Ringer
What are simple interventions for increasing fetal profusion?
Place mother on left side
After repositioning administer O2 7-10L by mask if needed
What are non-pharmacological options for pain management during labor?
Dick-Read method: birth without fear by education and environmental control and relaxation
Lamaze: psychophrophylaxis with conditioning and breathing
Bradley: Husband coached childbirth and support by working with pain rather then being distracted from it
**Essentially various breathing techniques, ice packs, warm baths, scented oils
What is a good protocol to follow in hypotension during labor and delivery?
-Give fluids, lay to side, empty bladder
Name and describe effects of some pharmacological treatments for labor discomfort.
morphine: CNS and resp. depression, avoid close to delivery time, usually 1 hour, constipation postpartum
meperidine (Demerol): same as above
butorphanol (Stadol) or nalbuphine (Nubain): stadol affects fetal strip so nubain is preferred
sublimaze (Fentanyl) neonatal CNS depression, hypotension, NandV, FHR changes
promethazine (Phenergan) hydroxyzine (Vistaril): given with narcotics, increases effect
epidural: most common complication is hypotension, others include respiratory depression, alterations in FHR
What is true regarding labor and delivery and urinary retention?
Baby will not deliver with full bladder blocking the way. It is important to empty.
Regarding Rx’s monitor for urinary retention
