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NRSG 328- Maternity > Week 3- Labour and delivery > Flashcards

Week 3- Labour and delivery Flashcards

1
Q

home birth advantages

A
  • control over who is there
  • no risk of acquiring pathogens
  • low technology birth
  • lower rates of interventions
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2
Q

5 P of the birth process

A

power
passageway
passenger
position
psyche

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3
Q

the power are the __________
1.
2.

A

forces that cause the cervix to open and that push the fetus downward through birth canal

  1. uterine contraction
  2. mothers pushing
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4
Q

contractions are the primary powers during

A

1st stage (from onset to full dilation)

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5
Q

phases of contractions

A
  1. increment (increasing in strength)
  2. peak or acme: (greatest strength)
  3. decrement: the period of decreasing strength
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6
Q

contractions described by their

A

frequency
intensity
duration

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7
Q

frequency

A

time from the start of one contraction to the beginning of the next

ex: every 4 1/2 mins

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8
Q

if contractions occur more often than every ___ than they are

A

2 mins too close together and may reduce fetal oxygen supply and should be reported

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9
Q

duration

A

time from beginning of one contraction to the to the end of the same one

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10
Q

contractions lasting longer than ____ may

A

90 sec, reduce fetal O2 supply and should be reported

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11
Q

intensity

A

approximate strength of the contraction
mild, moderate, strong

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12
Q

Mild intensity contractions

A

fundus is easily indented with the fingertips
feels like tip of nose

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13
Q

moderate intensity contractions

A

fundus indented with fingertips but more difficult
feels like chin

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14
Q

strong intensity contractions

A

fundus cant readily be indented,
feels like forehead

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15
Q

resting tone of the uterus should be

A

soft, if firm not enough time between contractions for fetus to recover

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16
Q

the passage way consists of

A

bony pelvis
soft tissues (cervix, muscles, ligaments and fascia)

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17
Q

different pelvis

A
  • gynecoid (rounded anterior and posterior segments, most favorable)
  • android ( wedge-shaped inlet, narrow anterior segment)
  • anthropoid ( anterior posterior diameter that equals or exceeds its transverse diameter, long narrow oval, infant most likely born occiput posterior
  • platypelloid (short anterior posterior diameter and a flat transverse oval shape, unfavorable for vaginal birth
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18
Q

pelvis divided into

A

2 parts
1- false (upper flaring part)
2. true ( lower part)- inlet, mid-pelvis, outlet

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19
Q

biparietal diameter

A

between the points of the two parietal bones on each side of the head

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20
Q

longitudinal, transverse and oblique lie

A

parallel to mothers spine
right angle to spine
between longitudinal and transverse

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21
Q

fetal attitude normally

A

head flexed forward and the arms and legs flexed
most efficiently occupies space

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22
Q

fetal presentation

A

the fetal part that enters the pelvis first

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23
Q

most common presentation

A

cephalic (head down)

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24
Q

vertex presentation (3)

A
  • head is fully flexed
  • most favorable cephalic variation
  • smallest part of head enters first
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25
Q

Sinciput (military) presentation

A

head neither flexed nor extended

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26
Q

brow presentation (3)

A

head partly extended
longest part of head presentation
unstable often convert to vertex of face

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27
Q

face presentation

A

head fully extended and face presents

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28
Q

frank breech

A
  • legs flexed at the hips and extend towards the shoulders
  • most common breech presentation
  • buttocks presents at the cervix
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29
Q

full or complete breech

A
  • a reversal of the cephalic
  • both feet and the buttocks present at the cervix
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30
Q

footling breech

A
  • one of both feet present first at the cervix
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31
Q

transverse lie must be

A

born by c/s

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32
Q

position is

A

how a reference point on the fetal presenting part is oriented within the mothers pelvis

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33
Q

occiput is used to describe how

A

the head is oriented if the fetus is in a cephalic vertex presentation

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34
Q

sacrum is used to describe how

A

the buttocks is oriented within pelvis

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35
Q

abbreviations for fetal presentation

A
  1. R or L side
    - omitted if fetal reference point is directly anterior or posterior such as OA
  2. fetal reference point (occiput for vertex presentation, mentum (chin) for face presentation, sacrum for breech.
  3. front or back of the pelvis
    transverse is neither posterior or anterior
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36
Q

position for shorter labor

A

walking, squatting, sitting, kneeling
gravity helps

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37
Q

anxiety in labour

A

secretion of catecholamines, inhibit uterine contractions and divert blood flow from the placenta

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38
Q

braxton hicks

A
  • irregular contractions
  • begin in early pregnancy may intensify as term progresses
  • play a part in preparing the cervix
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39
Q

lightening

A
  • or dropping
  • fetus settles into true pelvis and fundus no longer pushing on diaphragm
  • increase urge to void but can breathe better
  • can occur 2-4 weeks before birth
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40
Q

vaginal discharge as labour nears

A

may increase
mucous plug is dislodged tearing small capillaries in the process

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41
Q

bloody show

A
  • thick mucus mixed with pink or dark brown blood
  • may begin a few days before labour or until it starts
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42
Q

weight loss before labour

A

may lose 0.5-1.5 kg just before labour begins
hormonal changes cause body to lose more water

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43
Q

descent

A

required for all other mechanisms of labour to occur
- station

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44
Q

engagement

A

presenting part passes the pelvic inlet

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45
Q

internal rotation

A

as the fetus is pushed downward cause head to turn until occiput is directly under the symphysis pubis (OA)

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46
Q

As the fetal head passes under the mother’s symphysis pubis, it must ____________so it can properly negotiate the curve.

A

change from flexion to extension

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47
Q

go to hospital when
1st baby
second or more baby

A

contractions 4-5 min apart for 1 hour
each last 60 sec
5-7 mins apart for 1 hour

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48
Q

The three major assessments performed promptly on admission are

A

1-fetal condition
2- maternal condition
3- impeding birth

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49
Q

how to determine fetal presentation and position

A

Leopold maneuver

helps find back which is best place for hearing FHR

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50
Q

distinction between true labour and false labour

A

changes in the cervix

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51
Q

Women who are GBS positive will be _____ shortly after membranes rupture if not yet in labour

A

induced

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52
Q

stages of labour

A
  • First stage (0-10 cm)
    • Latent (early) (0-3 cm)
    • Active (4-10 cm)
    • Second stage (10 cm to birth of infant)
    • Third stage: Delivery of placenta
    • Fourth stage: 1-2 hours following birth
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53
Q

EFM associated with

A

increase intervention and c/s

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54
Q

pre-labour signs (5)

A
  • contractions are irregular or do not increase in F,I, D
  • walking tends to relieve or decrease contractions
  • discomfort is felt in the abdomen or groin
  • bloody show is usually not present
  • there is no change in effacement or dilation of the cervix
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55
Q

episodic changes are

A

changes in the FHR that are not associated with uterine contractions.

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56
Q

periodic changes are

A

associated with uterine contractions.

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57
Q

Fetal bradycardia occurs when

A

FHR is below 110 beats/ min for 10 minutes or longer.

58
Q

Causes of fetal bradycardia can be

A

fetal cardiac anomalies
hypoxia
maternal hypoglycemia
maternal hypotension
maternal hypothermia
prolonged umbilical cord compression
viral infections.

59
Q
  • Fetal tachycardia is a baseline FHR
A

greater than 160 beats/min that lasts for more than 10 minutes

60
Q

causes of fetal tachycardia

A

maternal infection, fever, medication administration, or maternal dehydration, although it can also be a sign of fetal hypoxemia.

61
Q

When fetal tachycardia occurs along with _____, ________ interventions are required

A

loss of baseline variability or with late decelerations

62
Q

Variability describes

A

fluctuations or constant changes in the baseline FHR above or below the baseline
excluding accelerations and decelerations in a 10-minute window
- Variability causes a recording of the FHR to have a sawtooth appearance.

63
Q

Absent variability is a

A

0-2 bmp change from baseline in a 10 min period

64
Q

absent variability typically caused by

A

uteroplacental insufficiency
maternal hypotension
cord compression
fetal hypoxia

65
Q

Minimal variability is FHR changes of

A

less than 6 bpm

66
Q

minimal variability usually due to

A

medications given to mom, smoking, fetal sleep

67
Q

If minimal variability lasts for ___________ it is considered atypical, but if it lasts longer than __________, it is considered an abnormal finding and the primary healthcare provider should be notified.

A

40 to 80 minutes,
80 minutes

68
Q

Moderate variability is defined as

A

changes of 6-25 beats/min from the baseline FHR.
It is considered normal because it indicates good oxygenation of the central nervous system (CNS) and fetal well-being.

69
Q

Marked variability occurs when there are

A

more than 25 beats/ min of fluctuation over the FHR baseline; the significance of marked variability is uncertain.

70
Q

. Accelerations are

A

temporary, abrupt rate increases of at least 15 beats/ min above the baseline FHR that last 15 seconds but less than 2 min

71
Q

prolonged acceleration.

A

an acceleration that lasts 2 to 10 minutes

72
Q

An acceleration that lasts longer than 10 minutes may be considered

A

a baseline FHR change

73
Q

Early decelerations

A

temporary gradual FHR decreases during contractions; the FHR always returns to the baseline rate by the end of the contraction.

usually good

74
Q

The peak of deceleration occurs at the same time as

A

the peak of contraction

75
Q

Variable decelerations are

A

abrupt decreases of at least 15 beats/min below base-line, lasting 15 seconds to 2 minutes in the full-term fetus.

76
Q

variable decelerations suggest that the

A

umbilical cord is being compressed, sometimes because it is around the fetal neck (nuchal cord) or because there is inadequate amniotic fluid to cushion the cord.

77
Q

Variable decelerations are further classified as

A

Uncomplicated: Deceleration that have acceleration at the beginning or end of contraction.
- Usually they are not clinically significant unless present with other abnormal FHR signs.
Complicated: Deceleration to 70 beats/min for more than 60 seconds, slow return to baseline.
If repetitive (>3) they are considered abnormal.

78
Q

late decelerations indicate

A

that the placenta is not delivering enough oxygen to the fetus (uteroplacental insufficiency), and this could be due to chronic conditions in the mother or placental conditions.

79
Q

Late decelerations that are accompanied by
________, _________ are abnormal and require immediate intervention by the health care provider

A

decreased variability and absent accelerations

80
Q

Prolonged decelerations are

A

abrupt FHR decreases of at least 15 beats/min from baseline that last longer than 2 minutes but less than 10 minutes.

81
Q

prolonged deceleration can be caused by

A

cord compression or prolapse, maternal supine hypotension, or regional anaesthesia.

82
Q

A prolonged deceleration that lasts longer than 10 minutes may be

A

considered a change in the baseline rate

83
Q

Sinusoidal pattern.

A

specific FHR pattern that has a smooth, wavelike appearance or undulating pattern with a wave frequency of 3 to 5 waves per minute and persists for 20 minutes or longer

84
Q

sinusoidal pattern caused by

A

fetal response to medication provided to the mother in labour, such as opioids, or occur in a fetus who is anemic.

85
Q

____________ is usually the first corrective response to a pattern of variable decelerations.

A

repositioning

86
Q

Altered pushing and breathing techniques in the second stage of labour:

A
  1. Changing from Valsalva (holding the breath and pushing) to open glottis pushing
  2. Fewer pushing efforts during contractions
  3. Pushing with every other contraction
  4. Pushing only with the urge to push
87
Q

Umbilical artery gases reflect the _________ and venous gases reflect ______________

A

status of the fetus
how well the placenta functions

88
Q

normal FHR tracing:
baseline
variability
decel
accel

A

Baseline (110-160)

variability:
6-25 bpm (moderate)
<5 bpm for <40 min

decel:
- none or occasional uncomplicated variables or early decel

Accel:
- spontaneous present

89
Q

abnormal FHR

A

baseline:
- <100 bpm
- >160 for >80 mins

variability
- > or equal to 5 bpm for >80 mins

decel
- repetitive complicated variable decel
- late decel > 50% of contractions
- single prolonged decel > 3min but < 10 min

acel
- usually absent

90
Q

nitrazine paper

A

determine amniotic fluid

91
Q

A common cause of a longer labour is a fetus that remains in a

A

OP

92
Q

characterize labour when the fetus is in the OP position.

A

Intense and poorly relieved back and leg pain

93
Q

Good positions to relieve the pain of back labour include the following:

A
  • Sitting, kneeling, or standing while leaning forward
  • Rocking the pelvis back and forth while on hands and knees to encourage rotation
  • Side-lying (on the left side for an ROP position, on the right side for an LOP position)
  • Squatting (for second-stage labour) increases the diameter of the pelvis, facilitating fetal rotation and descent
  • Lunging by placing one foot in a chair with the foot and knee pointed to that side; lunging sideways repeatedly during a contraction for 5 seconds at a time.
94
Q

The signs of rupture include

A

severe pain in the lower abdomen and abnormal FHR

95
Q

The woman should push for a maximum of

A

6 sec s at a time

96
Q

Pushing before full dilation can cause

A

maternal exhaustion, possible swelling of the cervix, and fetal hypoxia, thus slowing labour progress rather than speeding it up.

97
Q

Perineal lacerations and often episiotomies are described by the amount of tissue involved:

A
  • First degree: Involves the superficial vaginal mucosa or perineal skin
  • Second degree: Involves the vaginal mucosa, perineal skin, and deeper tissues of the perineum
  • Third degree: Same as second degree, plus involves the anal sphincter
  • Fourth degree: Extends through the anal sphincter into the rectal mucosa
98
Q

The main complication from an episiotomy is

A

PP pain

99
Q

The fourth stage of labour is the

A

first 1 to 2 hours after birth when the mother and newborn become physiologically stable.

100
Q

Pain threshold

A

also called pain perception,
is the least amount of sensation that a person perceives as painful

101
Q

Pain tolerance

A

the amount of pain one is able to endure.

102
Q

physical factors contribute to pain during labour:

A
  • Dilation and stretching of the cervix
  • Reduced uterine blood supply during contractions (ischemia)
  • Pressure of the fetus on pelvic structures
  • Stretching of the vagina and perineum
103
Q

the stimulation of large-diameter nerve fibres temporarily

A

interferes with the conduction of impulses through small-diameter fibers.

104
Q

signs of hyperventilation

A

dizziness, tingling, and numbness around her mouth and may have spasms of her fingers and feet

105
Q

If she feels an urge to push before her cervix is fully dilated, the woman is taught to

A

blow in short breaths to avoid bearing down.

106
Q

Encouraging women to hold their breath during pushing causes a

A

decrease in blood flow to the uterus and also to the fetus, and is not an effective method of breathing for pushing.

107
Q

meperidine (demerol)

A

given if morphine allergy
otherwise not recommended
IV or IM

108
Q

fentanyl

A

rapid onset an short duration of action
can cause resp depression
often used with epidural

109
Q

nitrous oxide works best when a woman

A

inhales 30 sec before a contraction

110
Q

Resuscitation of a newborn with respiratory depression we use e

A

Epinephrine and volume expanders such as normal saline or O-negative packed red blood cells are used for resuscitation with weight-based dosing

111
Q

all benzos can disrupt

A

the variability of the fetal heart rate and delay the newborn infant’s ability to regulate temperature

112
Q

if epidural injected into subarachnoid space

A

the woman will become hypotensive, experience numbness around the mouth, ringing in the ears (tinnitus), and have jitteriness, which are symptoms that suggest injection into a vein.

113
Q

An epidural block for labour is more accurately termed

A

analgesia than anesthesia

114
Q

The most common adverse effects of epidural block are

A

hypotension and urinary retention

115
Q

subarachnoid block
The effect of anaesthesia occurs

A

more rapidly and is more profound
he woman loses all movement and sensation below the block very quickly
effect lasts longer than that of the epidural block.

116
Q

combined spinal epidural

A
  • medication is inserted using an epidural needle and smaller spinal needle to access the subarachnoid space.
  • The spinal needle is withdrawn and the epidural catheter is threaded through, remaining in place for ongoing top-ups.
  • The advantage is rapid onset of pain relief with less motor block.
  • Women tend to be more satisfied with the use of CSE for pain relief, as ambulation is possible with this technique
117
Q

Local and pudendal blocks

A

administered in the vaginal-perineal area

118
Q

pudendal block most often used

A

for pain relief for women requiring the use of vacuum or forceps for the birth in the absence of an existing epidural.

119
Q

advantage to a pudendal nerve block

A

lack of effect on maternal cardiovascular system
no effect on fetal heart rate

120
Q

GA adverse effects to mother

A

aspiration of gastric contents leading to rep problems

121
Q

GA adverse effects to fetus

A

resp depression
keep cord clamping short

122
Q

with opioids resp depression is most likely to occur

A

in the fetus

123
Q

Augmentation

A

stimulation of contractions after they have begun already

124
Q

induction is avoided

A

before 39 weeks and ideally after 40 weeks

125
Q

readiness for labour induction when

A

The presence of increased fetal fibronectin at the cervix and a Bishop score above 6

126
Q

induction indications

A
  • Gestational hypertension (GH) or pre-eclampsia
  • Ruptured membranes without spontaneous onset of labour, particularly with group B streptococcus (GBS) colonization
  • Infection within the uterus (chorioamnionitis)
  • Medical problems in the woman that worsen during pregnancy, such as diabetes or renal or pulmonary disease
  • Fetal concerns, such as intrauterine growth restriction, prolonged pregnancy, or incompatibility between fetal and maternal blood types
  • Placental insufficiency
  • Intrauterine fetal death
127
Q

CONTRAINDICATIONS TO INDUCTION

A
  • Placenta previa (placenta grows and covers the cervix opening)
  • Umbilical cord prolapse
  • Abnormal fetal lie or presentation (e.g., footling breech)
  • Active herpes infection externally or in the birth canal, which the infant can acquire during birth
  • Pelvic structural deformities
  • Suspected fetal macrosomia
  • Previous classic (vertical) Caesarean incision or inverted T incision
  • Previous uterine rupture
128
Q

induction is more effective it

A

the cervix has ripened (effaced and dilated)

129
Q

cervical ripening methods

A

prostaglandins - dissolve collagen network

E2= gel or insert Dinoprostone (cervidil)
E1= misoprostol, orally or intravaginally, more effective after 24 hours, associated with uterine tachysystole and FHR abnormalities

130
Q

signs of tachysystole

A

10 or more uterine contractions in 20 minutes with or without alteration of FHR or pattern.

131
Q

mechanical methods to stimulate contractions

A
  • hydrostatic dilators: dilate cervix, placed in lower uterine segment, stimulates release of prostaglandins
  • transcervical balloon dilators: 16fr and 30 ml balloon, traction, FHR monitoring before and after for 20-30 mins
  • amniotomy: AROM
    stimulates prostaglandins secretion, which stim labour
132
Q

Three complications associated with amniotomy may also occur if a woman’s membranes rupture spontaneously

A
  1. prolapse of umbilical cord
  2. infection
  3. placental abruption
133
Q

most common complications related to the use of oxytocin to stimulate contractions are

A

decreased fetal circulation from tachysystole
uterine rupture

134
Q

AMNIOFUSION

A
  • injection of warmed sterile saline or lactated Ringer’s solution into the uterus via an intrauterine pressure catheter during labour after the membranes have ruptured.
  • increase amniotic fluid
135
Q

indications for forceps or vacuum

A

cervix fully dilated
membranes ruptured
bladder empty
fetal head engaged at +2 station

136
Q

signs of vaginal hematoma

A
  • severe and poorly relieved pelvic or rectal pain
    -
137
Q

3 types of uterine incisions

A
  1. low transverse (preferred)
  2. low vertical (minimal blood loss and birth of large fetus)
  3. classic (most blood loss, most likely to rupture during another pregnancy, could be the only option)
138
Q

Dystocia

A

labour that is progressing slowly.

139
Q

RF for dysfunctional labour

A
  • Advanced maternal age (>35 years of age)
  • Obesity or high BMI (>40)
  • Overdistention of uterus (polyhydramnios or multiple gestation)
  • Abnormal fetal presentation
  • Cephalopelvic disproportion (CPD)
  • Overstimulation of the uterus
  • Maternal fatigue, dehydration, fear
  • Lack of analgesic assistance or extended analgesia/ anaesthesia
140
Q

problems with the powers of labour

A
  1. hypertonic labour: increased uterine muscle tone usually in the latent first stage
  2. hypotonic labour: contractions are too weak to be effective, more likely with overdistended uterus
  3. ineffective maternal pushing
141
Q

problems with the passenger

A
  1. fetal size: CPD, shoulder dystocia
142
Q

how to manage shoulder dystocia

A
  • apply firm pressure just above the symphysis pubis (suprapubic pressure) to push the shoulders towards the pelvis
  • squatting or sharp flexion of the thighs against the abdomen

NRSG 328- Maternity (4 decks)

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