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48 Cards in this Set

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First stage of labor
starts with onset of contractions and lasts until complete cervical dilation
(includes latent phase, active phase, and transition phase)
Second stage of labor
begins with complete dilation of cervix and ends with the delivery of the baby
(the pushing stage)

this time is variable depending on primips and multips
Third stage of labor
starts with delivery of fetus and lasts until delivery of placenta

sudden shift in volue of uterus causes shearing of the placenta away from the wall of the uterus (can take 30 min. to an hour to deliver placenta)

watch for hemorrhage
Fourth Stage of labor
starts with delivery of placenta and lasts for four hours
(recovery stage)

Immediate recovery period (VS and fundal check Q 15 min. X 4, Q 30 min. X 4, and hourly until stable)
latent phase

(1st phase in 1st stage in labor)
early labor, dilation of 0-3 cm, excitement from parent

can last a couple of hours up to 24 hours
active phase

(2nd phase in 1st stage in labor)
more intense labor, cervix dilation of 4-7 cm, serious and inward focus from mom
transition phase

(3rd phase in 1st stage in labor)
transition between first stage and second stage, cervix dilation of 8-10 cm, inward focus and irritabiltiy from mom,
(vomitting may begin, partner is blamed)
Vaginal laceration classification
1st degree
vaginal mucosa, no muscle
Vaginal laceration classification
2nd degree
vaginal mucosa and some perineal muscle
Vaginal laceration classification
3rd degree
vaginal mucosa, muscle but not including the rectal sphincter
Laceration degree classification
4th degree
laceration through all layers including sphincter
transducer
external fetal monitor
visualizes the opening and closing of cardiac chambers and translates it into written pattern
tocodynamometer
external fetal monitor
measures frequency and duration of contractions but not intensity; this must be palpated manually to determine intensity
Fetal scalp electrode
internal fetal monitor
picks up fetal heart rate by ECG; more accurate

goes under skin of head
intrauterine pressue catheter (IUPC)
internal fetal monitor
actually measures the intensity of contraction in mmHg
(this is the only way to measure intensity accurately)
Normal Fetal heart rate range
110-160 bpm and it is measured inbetween contractions
considered tachycardia for Fetal heart rate
above 160 bpm
considered bradycardia for fetal heart rate
below 110 bpm
fetal malposition

passenger complication during labor
most difficult is OP (occiput posterior)
fetal malpresentation

passenger complication during labor
shoulder, breech, face, or any other part besides the vertex (head) is the presenting part
fetal distress

passenger labor complications
persistent late decelerations, or variables
prolapsed umbilical cord

passenger labor complications
occurs when cord comes before the presenting part; may be very obvious; can frequently be concealed
(usually means C-section)
multiple gestation

passenger labor complications
is all are cephalic or head down, the vaginal birth is probable
most are doen by C-section
passageway labor complications
abnormal size or shape of pelvis
cephalopelvic disproportion (CPD): the head does not fit, or shoulder dystocia (shoulders do not deliver; treat with McRobert's maneuver: knees back to ears)
risk factors for
Preeclampsia
primagravida, age extremes (<17, >35), diabetes, preexisting HTN, multiple gestation, fetal hydrops, hydatiform mole, previous preeclampsia, family hx, obesity, immune factors, genetic disposition, envrionment, renal disease, Rh incompatibility, African-American ethnicity, donor insemination or donation
Chronic HTN
present before pregnancy or before 20 wks, lasts from <1st trimester and extends beyone 84th day postpartum
Gestational HTN or Pregnancy Induced HTN or transient HTN
blood pressure elevation detected for the first time during pregnancy, without proteinuria, preeclampsia does not develop and BP falls to a normal range by 12th wk. postpartum, dx after 20 weeks above 140/90 on 2 occasions within 6 hours
Preeclampsia
increase of BP after 20th week gestation (140/90), accompanied by proteinuris (300 mg in 24 hours), may have a sudden onset of edema with other symptoms
Chronic HTN with superimposed preeclampsia
pt. has HTN and proteinuria prior to 20th week gestation, then has a subsequent new onset of proteinuria (sudden increase of protein), has no evidence of UTIs, a sudden increase of BP, thrombocytopenia (<100,000 platelet count), and an increase in liver enzymes
HELLP syndrome
Hemolysis, Elevated Liver Enzymes, Low Platelets

Tx: improve platlet count, transfuse of plasma and platelets, deliver baby and placenta
Presumptive signs of pregnancy
menstrual suppression, N/V, frequent urination, tender breast changes, Quickening, linea negra, chloasma, striae, darkening areola, fatigue and drowsiness
Probable signs of pregnancy
Pos. Chadwick, Hegar, and Goodell signs, enlarged abdomen, fetal outline, ballottement, Braxton Hicks, Pos. HCG test
Positive signs of pregnancy
fetal heart rate heard, fetal movement observed by examiner, ultrasound
Nagele's Rule
add 7 days to first day of LMP and then subtract 3 months and add one year
MSAFP (maternal serum alpha fetal protein)
tested between 14-22 wks, tests genetic information like Down syndrome
Gestational Diabetes screening
done between 24-28 weeks by glucose tolerance test
Rh retest and screen for antibody conversion
done at 24-28 weeks prior to receiving Rhogam shot
if antibodies are neg. pt get a shot then another by 72 hours postpartum
GBS screen
tested at 34-37 weeks
if pos. get 2 doses of antibiotics 2 hours apart at delivery
normal weight gain
20-25 pounds
under weight weight gain
25-35 pounds
over weight weight gain
15 - 20 pounds
Threatened spontaneous abortion/miscarriage
intrauterine bleeding before 20 weeks, w/o dilation of cervix or expulsion of any POC
Inevitable spontaneous abortion/miscarriage
no expulsion of POC, bleeding and dilation of cervix, incompatible for pregnancy
incomplete spontaneous abortion/miscarriage
partial expulsion of some but not all POC, before 20 weeks and retained something (bleeding present) pt must get POC out
complete spontaneous abortion/miscarriage
complete expulsion of all POC, before 20 weeks
septic spontaneous abortion/miscarriage
an infection of the POC and the endometrial lining, resulting in abortion
missed spontaneous abortion/miscarriage
death of the embryo or fetus before 20 weeks and complete retention of POC
recurrent or habitual spontaneous abortion/miscarriage
pt has had 3 or more consecutive spontaneous abortions