Week 3 Flashcards
5 P’s
Passenger
Passageway
Powers
Position
Psychological
closure of A fontanelle
18 mo
closure of P fontanelle
6-8 weeks
in the fetus the occipital bone is larger meaning
when baby is placed flat it pushes head down
- watch airway
sagittal suture can be felt for
direction of fetus
fetal presentation
part of the fetus that lies closest to the internal os of the cervix
what do we normally want to present
head
- occipital
Vertex
head down
breach
butt down
shoulder
shoulder down
proven pelvis
had a vaginal birth before
CPD
cephalopelivc disproortion
- head is not going through pelvis good
fetal lie
relation of the long axis of the fetus to the long axis of the mother
- spines
fetal attitude
relation of the fetal body parts to one another
normal fetal attitude
general flexion with the chin flexes onto chest and the extremities flexed into the abdomen
why do we need to know fetal position
where to put the monitor
Liapolds can determine
lie
attitude
presentation
fetal station
measure of the degree of descent of the presenting part through the birth canal
what is 0 station
at the ischial spine
more engaged
more than 0
+
less engaged
+ 4/5 =
birth is imminent
why is squatting or sitting on a. ball good
open hips and push baby down
4 types of pelvis
gynecoid
android
anthropoid
platypelloid
normal female pelvic shape
gynecoid
effacement
the thinning and shortening of the cervix
dilation
force of contraction and pressure from presenting part make diameter expand from closed <1cm to complete 10 cm
primary vs secondary powers
primary: uterus contractions
secondary: maternal bearing down
Ferguson reflex
feeling the urge to push
why do we like left side lying
takes pressure off main vessels
anxiety and fear in birth
stimulates catacholmines release which causes ineffective contractions and dysfunctional labor
muslim possible culture requests
female only staff
very modest
jewish possible culture requests
kosher diet
Asian possible culture requests
fish and rice prepared by mom
Hispanic possible culture requests
evil eye
touch while giving compliment
TRUE ACTIVE LABOR
DILATION
EFFACEMENT
AND DESCENT OF FETUS
preceding labor
-primips
uterus drops 2 weeks before term
preceding labor
-multips (dropping)
may not happen until true labor is in process
why might we see bloody show
small capillaries on cervix rupture
Braxton hicks
practice contractions
factors involved with onset of labor
oxytocin
pressure on the cervix releases
oxytocin
production of prostaglandins do what
soften the cervix and dilate
labor
process of moving fetus, placenta, and membranes out of the uterus through birth canal
how many stages of labor
4
false vs true labor
true
- increase frequency of contractions
- back pain and radiates to front
- contractions continue with sleep
- walking increases contractions
- PROGRESSIVE EFFACTMENT
false
- decrease in frequency
- lower abdomen pain
- disappears with sleep
- NO CHANGE IN CERVIX
1st stage of labor
onset of contractions to full dilation
1st stage
- latent
0-5 cm
1st stage
- active
6 cm and up
once you get to 6cm
1 cm every hour
2nd stage
cervix is dilated to birth of infant
3rd stage
birth of infant to birth of placenta
4th stage
birth of placenta to 2 hours PP
7 cardinal movements
engagement
descent
flexion
internal rotation
extension
external rotation
expulsion
not coping with pain
crying
moving
can’t focus
jitters
sweating
is coping
eyes closed
rhythmically breathing
rotating hips
fatigue does what
decreases woman’s ability to cope effectively with contraction pain
do we give heat with epidural
no because no sensation
opioids do what to maternal vital signs
decrease HR, RR, BP
why is fent good
short half life
fewer neonatal effects
what do we give 15 to 30 mins before anesthesia
fluid bolus (500cc)
what does fluid bolus do
decrease the potential for hypotension caused by sympathetic blockade
disadvantages to spinal anesthesia
hypotension
impaired breathing
operatie birth more likely
spinal headache caused by
accidentally punctured the dura
“wet tap”
- treatment is blood patch
maternal labs for epidural
platelets
- lesss than 100,000 bad and cannot get epidural
wedge under hip does what
displaces the uterus and gets it off major vessels
cricoid pressure
helps visualize vocal cords for intubation
also helps prevent aspiration
more movement is better because
helps change babies position
side effects of anesthesia
hypotension
N/V
itchy skin
urinary retention
HA
increase temp
fetal wellbeing during labor is measured by
the response of fetal heart rate to the uterine contractions
contractions reduce the blood flow through the maternal vessel which
decrease O2 content in the maternal blood
does FHR monitoring decrease neonatal morbidity
false
abnormal fetal HR
hypoxia
Pitocin does that equal high or low risk mom
high risk
we use intermittent auscultation in a
low risk pt
components of external monitoring
ultrasound transducer
Toco transducer
ultrasound transducer measures
fetal HR
where is the ultrasound transducer placed
on fetal back
- use leipolds to find that
toco transducer measures
contractions
where is the toco transducer placed
on fundus
components of internal monitoring
spiral electrode
intrauterine pressure catheter
spiral electrode
HR
screwed into head
intrauterine pressure catheter
amount of pressure in the uterus
monitors contractions
why do we want moms pulse ox on
so we know we are picking up baby heart tones and not moms
normal fetal HR range
110-160
bradycardia (less than 110) causes
hypoxic
drugs
vasovagal
tachycardia (greater than 160) causes
maternal fever
infection
fetal anemia
variability tells us
if we got good oxygenation during labor
4 categories of variability
absent
minimal
moderate
marked
absent variability
no range
- m acid
- fetal sleep cycle
minimal variability
less than 5 BPM above or below baseline
moderate variability
6-25BPM above or below
normal acid base balance
what type of varaibilty do we want
moderate
marked variability
over 25BPM above or below
- fetal anemia or chorioamnionitis
accerlations indicate
fetal well being/adequately oxygenation
- we want accelerations
accerlation criteria terms and before 32 weeks
at least 15BPm increase for at least 15 sec
32: at least 10 BPM increase for at least 10 sec
decorations
decrease in FHR characterized by their shapes and timing relationship to contractions
early decels
response to vital head compression
late decels
uteroplacental insufficiency
variable decal
umbilical cord compression or prolapse
prolonged deceleration
more than 2 min but less than 10 min
contractions frequency
time from beginning of one cxn to beginning of next cxn, measured in mintues
- cxn in 10 min window averaged over 30 mins
tachysystole
> 5 cxn in a 10 min window, averaged over 30 mins
- bad because HR goes down and the fetus is not being perfused = acidosis
resting tone
normal intrauterine pressure between cxn or in absence of cxn
- allows the uterine vessels to give blood flow to the placental allowing the fetal exchange of repritory gases which enhanced fetal oxygenation
VEAL CHOP
variability
early
accerlated
late
cord
head
okay
perfusion
if we have variable what do we do
the cord is not perufsing enough so we want to slow labor down and stop pit
Category 1
- HR
- Variability
- decels
normal HR (110-160)
moderate variability
absent decels
category 2
- HR
- Variability
- decels
- accelerations
- bradycardia/tachycarida
- minimal or absent variability
- recurrent decels
- no accelerations in response to fetal stimulation
category 3
- HR
- Variability
- decels
- nonreasuring FHR pattern associated with hypoxemia (bradycardia)
- absence of baseline variability
- recurrent or late decels
- sinusoidal pattern
what happens if you have category 3
emergency delivery
where do we draw cord ABG
arterial
intrauterine resuscitation acronym
LIONS PIT
LIONS PIT
stop pit
left side
IV open
oxygen ?
notify MD
stop
PIT
what does stoping pit do
maximize uterine blood flow and placental perfusion
amnioinfusion
due to decrease amniotic fluids and we replace it to help cushion baby
tocolytic therapy is used for
tachysstole
TRUE ACTIVE LABOR
CERVICAL DILATION
EFFACEMENT
DESCENT OF FETUS
first stage of labor
begin with regular contractions and ends with full cervical effacement and dilation
latent: 0-5cm
active: >6cm
- 1cm for every hour after 6
EMTALA
emergency medical treatment and active labor act
- a woman is considered to be in true labor until a qualified provider determines that she is not
- stablize mom and baby and then transport
what do we need to do when membrane is ruptured spontaneously or artificially
time
color: normal is clear
odor: abnormal is foul
FETAL HR if decreased then might be cord issue and have to do C
by the time of rupturing and delivery is how long due to infection risk
18 hours
leopolds determines
lie
attiutde
presentation
3/70%/-2
dilation 3
effacement 70%
staton -2
station of what means birth is imminent
+ 4/5
we need a station of what before we can rupture the membrane
-3
moms should void every
2hours
full bladder can
prevent fetal descent in the labor process
and prevent uterine clamping down in the PP
APGAR
1, 5, 10
nuchal cord
wrapped around neck
