Week 3 (Labor & Delivery) Flashcards
What are the 5 P’s of L&D?
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- Passenger: fetus & placenta
- Passageway: birth canal
- Powers: contractions
- Position of the laboring woman
- Psychology / Psychological Response
What is the passenger of the 5 P’s?
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Fetus & Placenta
What is the Passageway of the 5 P’s?
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Birth Canal
What is the Powers of the 5 P’s?
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Contractions
Anterior Fontanelle
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- Closes at 12 - 18 months
- Diamond Shaped
Posterior Fontanelle
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- Closes by 2 - 3 months
- Triangle shaped
Where is the sagittal suture located?
Between pareital bones
Cephalic
Toward the head
Breech
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Buttocks-first presentation of the fetus at delivery
Shoulder Presentation
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Baby is in transverse position at delivery
- must be turned
Proven Pelvis
Pelvis that has already delivered a baby
Fetal Lie
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Relation of the fetus’ long axis (spine) to the mother’s long axis (spine)
- longitudinal / vertical
- transverse / horizontal
- oblique
Fetal Attitude
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Relation of fetal body parts to one another
- Normal: general flexion with the fetal chin flexed onto the chest & the extremities flexed
What is the normal fetal attitude?
general flexion with the fetal chin flexed onto the chest & extremities are flexed
Fetal Position
The relationship of presenting parts to the 4 quadrants of the mother’s pelvis
- LOA, ROA
- ROP, LOP
- ROT, LOT
Leopolds Maneuvers
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Palpation to determine the fetal lie, fetal attitude, & fetal presentation
Fetal Station
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A measure of the degree of descent of the presenting part of the fetus through the birth canal
-5
-4
-3 Minimum to rupture; risk of prolapsed cord if not at
-2
-1
0 (baby is engaged)
+1
+2
+3
+4
+5 Birth is imminent
Pelvis Shapes
- Gynecoid: typical, common, best for vaginal birth
- Android: round, heart-shaped
- Anthropoid: oval
- Platypelloid: flattened
Pelvic Inlelt
Tip of the pubic bone to tip of the sacrum
Pelvic Outlet
Bottom of symphysis pubis to the tip of the sacrum
Effacement
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Thinning & shortening of the cervix
- turtleneck
- in %
Dilation
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Force of contraction & pressure from presenting part make diameter expand from closed 1 cm to complete 10 cm
- marks the end of the first stage of labor
Labor Numbers (4 / 60% / -3)
4 cm dilation
60% effacement
-3 fetal station
Primary Powers
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Involuntary uterine contractions
* Starts labor
* Results in dilation
* adequate & coordinated
Secondary Powers
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Bearing down efforts
- in addition to involuntary contractions
Ferguson Reflex: pushing down without trying
Ferguson Reflex
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Pushing down without trying
Anxiety
Lead to release of catecholamines = ineffective contractions
Signs of Labor
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- Primips: uterus sinks down “dropped” lightening 2 weeks before
- Multips: drop might not happen until true labor
Bloody Show
A small amount of blood at the vagina from ruptured capillaries when cervix effaces
Braxton Hicks Contractions
Intermittent painless uterine contractions that occur with increasing frequency as the pregnancy progresses
Labor
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Process of moving fetus, placenta, & membranes out of the uterus through the birth canal
- Effacement & dilation of the cervix AND descent of the fetus
When does risk of infection increase?
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If amniotic sac has been ruptured for more than 18 hours
False Labor
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Regular contractions with no cervical change
- activity has no effect on contractions or decreases
- go away when sleeping
- show not present
True Labor
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Contractions that cause cervical change
- progressive in frequency & intensity
- activity increases & continues during sleep
- progressive effacement & dilation
Stages of Labor
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1st: onset of contractions to full dilation
2nd: time of full dilation to birth of intant
3rd: birth of intant to placenta delivered
4th: delivery of placenta till first 2 hours after birth
What is the 1st stage of labor?
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onset of contractions to full dilation
What is the 2nd stage of labor?
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Time of full dilation to birth of infant
What is the 3rd stage of birth?
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birth of infant to placenta delivery
What is the 4th stage of labor?
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delivery of placenta until first 2 hours after birth
7 Cardinial Movements
1.) Engagement
2.) Descent
3.) Flexion
4.) Internal rotation
5.) Extension
6.) External rotation
7.) Expulsion
Fetal Heart Rate
Reliable & predictive information about the condition of fetus related to oxygen
Maternal Adaptation
- ↑ Cardiac output 10 - 15%
- ↑ HR
- ↑ BP during contractions
- ↑ WBCs
- ↑ RR
- ↑ Temperature (might, but not always)
- ↑ Proteinuria (might, but not always)
- ↓ Gastric motility
- ↓ Blood glucose
A —— ——– with an adequate uteroplacental circulation is able to compensate for the stress of uterine contractions.
Healthy fetus
Opioids
Medicatiosn that readily cross the placenta & can have profound effects on the fetus
Narcan
Avoid giving this in women that are opioid dependent
- can cause seizures
Epidural
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- Causes hypotension
- Give fluid bolus of LR 15 - 30 minutes before epidural to prevent hypotentsion
- VS Q5 minutes
Episiotomy
Incision made to widen the vaginal opening during childbirth
Post Dural Puncture Headache (PDPH)
Headache that occurs when the spinal dura is accidentally punctured during an epidural causing a CSF lead
TX: epidural blood patch
Contraindications for Epidurals
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- Active hemorrhage
- Hypotension
- Coagulopathy
- Infection
- ↑ ICP
- Allergies
- Cardiac Conditions
- Refusal
WBC must be > 100,000
What is EFM?
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Electronic Fetal Monitoring
Toco Transducer
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Measures uterine contractions
- placed at the fundus
Ultrasound Transducer
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Measures fetal HR
- placed on baby’s back
Intrauterine Pressure Catheter (IUPC)
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Catheter that measures contraction pressure
- can only use once amniotic sac has been ruptured
External Fetal Monitoring (EFM) Categories
Category I: normal
Category II: indeterminate
Category III: abnormal
Fetal HR Variability
- Absent: none (distress, hypoxic, or sleeping)
- Minimal: < 5 beat difference from baseline
- Moderate: 6 - 25 beat difference from baseline
- Marked: > 25 beat difference from baseline
Accelerations
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Good indicator of fetal well-being
- peaks at least 15 bpm for at least 15 beats
Decelerations
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Decrease in FHR characterized by shapes & timing
VEAL CHOP
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- Variable decelerations = Cord compression
- Early decelerations = Head compression
- Accelerations = OK
- Late decelerations = Placental insufficiency
Explain the first part of VEAL CHOP.
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Variable decelerations = Cord compression
Explain the second part of VEAL CHOP
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Early decelerations = Head compression
Explain the third part of VEAL CHOP
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Accelerations = OK
Explain the fourth part of VEAL CHOP
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Late decelerations = Placental insufficiency
Contraction Palpation (what does the stomach feel like on palpation during a contraction?)
- mild = nose (tip)
- moderate = chin
- strong = forehead
Tachysystole
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5+ contractions in a 10 minute window, over a period of 30 minutes
- too many contractions!!!
Tx: terbutaline
Early Decelerations
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Mirrors contractions
- Cause: Cord compression (V = C in VEAL CHOP)
Late Decelerations
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Dip in the fetal heart rate AFTER the peak of the contraction
- CAUSE: Placental insufficiency (L = P in VEAL CHOP)
Fetal HR Categories
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Category I: normal
* 110 - 160 bpm
* accelerations
Category II: tachy or brady
* absence of baseline
* no accelerations
* episodic decelerations
Category III: emergent delivery
* brady
* hypoxemia
* sinusoidal pattern
Sinusoidal Pattern
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Sawtooth pattern (on fetal heart rate monitor)
- can indicate fetal hemorrhage
What can a sinusoidal pattern on the FHR indicate?
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fetal hemorrhage
Tachycardia (FHR)
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> 160 bpm
CAUSES:
* ↑ fetal activity
* ↑ maternal fever
* chorioaminitis
* ↓ hypothyroidism
* drugs
* ↓ fetal hypoxemia, anemia, HF
Treatment for Intrauterine Resuscitation
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LIONS PIT
- Left side lying
- IV fluid bolus
- Notify physician
- 1.) Stop Pitocin
STOP PITOCIN = FIRST STEP
Bradycardia (FHR)
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< 120 bpm
- mild = 80 - 90 bpm
- moderate = < 80 bpm
Variability (FHR)
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- Short Term: speeds up & slows down
- Long Term: braod swings in FHR, can be stimulated with examination or loud noise
- Reduced: can occur with narcotics, anomalies, & hypoxia
- Persistent: in combination with another type of variability to indicate fetal jeapordy
Short Term Variability (FHR)
Speeds up & slows down
Long Term Variability (FHR)
Broad swings in FHR
* can be stimulated with examination or loud noise
Reduced variability (FHR)
Can occur with narcotics, anomalies, & hypoxia
Persistent Variability (FHR)
In combination with another type of variability to indicate fetal jeapordy
First Stage of Labor
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Latent:
* early phase
* regular, painful contractions
Active:
* cervical dilation occurs
* begins @ 6 cm then increases by 1 cm/hr until 10 cm
Spontaneous Rupture of Membranes (SROM)
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1.) What time?
2.) What color?
3.) Is there an odor?
- did the cord prolapse? – check for FHR immediately
GBS
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Group Beta Strep
- vaginal / rectal culture between 35 - 37 weeks
- Receive 2 doses abx prophylaxis (penicillin) during labor to protect the baby
How often should moms in the 1st stage of labor void?
Every 2 hours
Fetal Hypoxia
Meconium stained amniotic fluid
Second Stage of Labor
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Full dilation (10 cm) to birth
- Latent: delayed pushing, laboring down, passive descent
- Active: Pushing & urge to bear down (Ferguson reflex)
The application of what type of pressure can cause complications after birth?
Fundal
Third Stage of Labor
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Birth of baby to expulson of placenta
- can bolus oxytocin to clamp down uterus
- counter pressure on the cord to pull away placenta
- pieces of placenta left in mom can cause hemorrhage - check surface of placenta
Fourth Stage of Labor
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Expulson of Placenta to 2 hours after birth
- VS Q5 minutes
- checking for bleeding / lochia
- empty bladder
- fundal checks
- if C-section = post-op complications
