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122 Cards in this Set

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Why does labor start?
The baby is physically mature enough to adjust to extra-uterine life.

Baby also not too big to cause mechanical difficulties
What is the physiological definition of labor?
-Process of moving the fetus, placenta and membranes out of the uterus and through the birth canal
What is the clinical definition of labor?
Progressive contractions resulting in progressive CERVICAL CHANGE

-Must have both to be in labor
What are the 5P's?
1. Passenger
2. Passageway
3. Powers
4. Position
5. Psychological respoonse of the mother
Who is the passenger?
The fetus and the placenta
What is the passageway?
The birth canal
What are the powers? List the two types
Contractions
-Involuntary uterine
-voluntary pushing powers
Define the Fetal Lie
Relationship between the long axes of the fetal and materal spines.

-the position of the fetus
What is the longitudinal fetal lie?
Baby's spine and mom's are parallel.

-Good position
What fetal lie usually results in a C-section?
Transverse:

fetus is horizontally oriented in uterus.

-fetal spine is at a right angle to mom's
Describe the oblique fetal lie.
Baby comes down on an angle.

-Not best but the baby will usually adjust to parallel to deliver
What are the 3 fetal presentations?
1. cephalic (vertex)
2. breech
3. shoulder
What is the most common fetal presentation?
Cephalic
List the 3 cephalic presentations.
1. Occiput
2. Brow
3. Mentum (chin comes out first)
What percentage of women have baby's in breech position?
3%
Which presentation is an obstetric emergency?
Shoulder
What is the presenting part?
the first aspect of the fetus felt on exam
Which fontanel has 3 openings?
the anterior
What feature on the skull of the fetus helps the provider know the position in the canal?
the fontanels
What is the fetal attitude?
the relationship of the fetal body parts to eachother
What are the 3 possible fetal attitudes?
1. Flexion (chin to chest)
2. Extension (chin up in the air)
3. Military(straight neck)
What fetal attitude provides the smallest diameter of the head to fit perfectly into the pelvis?
Flexed
Define the fetal position
Relationship of the denomenator (landmark) of the presenting part to the 4 quadrants of the mother's pelvis
What is the most common fetal position?>
LOA
How do you determine if the position is posterior or anterior?
The direction of the butt
What are the 3 letter abbreviations of position?
1. R/L
2. assigned denominator (occiput, mentum etc)
3. Anterior/posterior/transverse
The relationship of the presenting part to the ischial spines of the maternal pelvis is called the?
Fetal Station
What is zero station?
Baby is at the ischial spine
When does engagement occur?
When baby is at the ischial spine
As the baby is delivered does the fetal station values become more + or -?
More positive
What two aspects of the passageway can be changed during labor?
The Birth canal: it stretches, swelling can go back down etc

The Soft tissues: swelling, bleeding, cysts or tumors can be removed etc
What aspect of the passageway cannot be changed?
The bony pelvis
What is the most common female pelvis structure?
Gynecoid: round
What percentage of women have an android pelvis? Who is this pelvis most common in?
23% of all women
-Known as the male pelvis
What % of women have an anthropoid pelvis? What is its structure? Is it a good or bad prognosis for vaginal delivery?
-24% of all women
-Oblong shape with a large AP diameter
-Great prognosis for vaginal
What pelvis structure is the worst for vaginal delivery? What % of women have this pelvis?
Platypelloid
-Short AP diameter
-3% of all women
-usually have a C-section
What do all positive positions of labor have in common?
They all use gravity to help with the delivery
What are the 4 common positions for pushing?
1. Lithotomy position
2. Semirecumbent: partner behind pt
3. lateral recumbent (on their side)
4. squatting
What are the primary powers?
involuntary uterine contractions causing cervical change
What are the secondary powers?
Voluntary pushing powers
How do we characterize primary powers?
1. Duration
2. Frequency
3. Intensity
What 2 changes in the cervix are a result of primary powers?
1. Dilation
2. Effacement
Which women have effacement occur prior to full dilation?
Pritips
When do effacement and dilation occur in multips?
They occur at the same time!
Multips multitask
What is effacement?
The thinning and shortening of the cervix in the first stage of labor
How to we express effacement and dilation?
Effacement is in %s

Dilation is in cm's
In true labor, what is the location of the Ctx's?
They start in the back and come around to the lower abdomen
Where do Ctx's occur in false labor?
Middle abdomen down to the groin
How are contractions characterized in false labor?
Are inconsistent in frequency, duration and intensity. Do not change or may decrease with activity (walking)
In true labor, how are contractions characterized?
Progressing

-Getting stronger, longer and closer together
In true labor, does walking minimize the pain of contractions?
No, it can actually exasperate them
What is true about the cervix in false labor?
It is not progressively changing. No dilation is occurring
In a primip, when the baby drops how long does delivery usually follow?
10-14 days
In a multip, what is the earliest delivery can occur once baby has dropped?
They same day!
What physiological response does dropping induce?
Increased urination
What are the 8 SxS of impending labor?
1. lightening
2. stronger braxton-hicks
3. Mucus Plug
4. bloody show
5. cervical ripening
6. burst of energy
7. SROM
8. GI upsets
What is lightening?
As the baby descends or drops it "lightens" the load and makes breathing easier for mom

-But when it drops it can hit the sciatic nerve and cause sharp pain
What are braxton-hicks contractions?
painless intermittent contractions of the uterus.

-Helps the uterus prepare for labor
What is the purpose of the mucus plug?
to stop infection from entering the uterus
What is the bloody show?
The passing of the mucus plug and the baby dropping can cause some blood
Describe cervical ripening?
The cervix becomes soft and malleable so that the baby can pass through easily
What is nesting?
the burst of energy that the mother feels at the beginning of labor.

-They usually clean the house or prepare the baby's room.
What two tests can be done to see if SROM has occurred?
1. Nitrozene paper: pH test because amniotic fluid is less acidic than urine
2. Use a slide: will see small cells that look like christmas trees: called ferning
What 2 techniques can you tell a term woman to do at home to bring about labor?
1. Have heterosexual sex: prostaglandins encourage oxytocin release
2. Make a cocktail of castor oil, orange juice and vodka
What is the first stage of labor?
-From the onset of regular uterine contractions to full dilation
What are the 3 phases of the 1st stage of labor?
1. Latent
2. Active
3. Transition
Describe the Latent stage of labor?
- 0-3cm
- Ctx are mild to moderate in intensity
- Duration is 30-60 seconds
- Frequency: 5-30 mins
- Mother is happy, excited and talkative
- effacement 0-40%
What are the characteristics of the active stage of labor?
- 4-7cm
-Ctx moderate to strong
-Duration: 60 seconds
-Freq: every 2-5 mins
-Efface: 40-80%
-Mom wants involved! Wants pain management
-use breathing techniques and relaxation
what is the average rate of cervical change for primips and multips?
Pri: 1.2 cm/hour
multi: 1.5 cm/hour
What is the shortest part of the Stage 1?
The transition phase
Describe the transition phase?
- 8 10cm
- Ctx are intense!
- 80-100% efface
- Duration: 60-90 sec
- Freq: every 90secs - 2mins
- women become exhausted
- "I can't do this!"
- coping mechs no longer work
- can last anywhere from 15 mins to 1 hour
How long can the 1st stage be delayed with an epidural?
1 hour
What is the 2nd stage of labor? How long does it last?
the pushing stage

-can last under 30 mins or up to 2 hours
What is the physiological reason to begin pushing>?
Ferguson's Reflex is being engaged by the baby's head and signal the need to push
List the Cardinal Movements in order!!
1. Engagement
2. Descent
3. Flexion
4. Internal Rotation
5. Extension
6. Restitution
7. External Rotation
8. Lateral Flexion
Where does engagement take place?
when baby is at zero station
Why does the baby drop?
1. pressure of amniotic fluid
2. Pressure of the fundus
3. Contraction of abdominal muscles
4. extension and straightening of fetal body
During internal rotation which direction does the fetal head rotate?
From Left to right
What movement causes the head to start to emerge?
Extension

-resistance of the pelvis floor and vulva starts to open up
What is restitution?
The movement where the shoulders of the fetus enter pelvis obliquely and remain oblique when head rotates to the AP diameter
What is the 3rd stage of labor?
From birth newborn to birth of the placenta
-spontaneous separation and expulsion
-May have manual removal
-Placental parts may remain in the uterus causing bleeding
What are the 4 signs of placental separation?
1. Change in shape
2. Sudden gush of blood
-blood vessels @ top of uterus burst when placenta detaches and you get a gush of blood
3. Lengthening of the cord: appears to lengthen
4. change in position of the uterus: 1/2 between umbilicus and uterus
What is the maternal side of the placenta called?
Duncin/ corion
What is the fetal side of the placenta called?
The amnion side
What is Warton's jelly?
the substance around the cord that protects it
What can be a possible problem if only 2 vessels are detected in the cord
Possible kidney problem because they develop at the same time
What is the 4th stage of labor?
-Maternal stabilization/homeostasis
-Initial bonding with baby
-initiate feeding
-can last up to 4 hours
what is the most critical/dangerous time for the mother?
the first hour after delivery

-chance of hemorrhage
What factors influence a mother's perception of pain?
1. Culture
2. Anxiety and fear
3. previous birth experience
4. childbirth preparation
What are the non-pharmacological pain relief methods?
1. relax techniques
2. breathing techniques
3. imagery
4. music
5. touch
6. hydrotherapy
7. TENS
8. Accupressure
9. Heat and cold
10. hypnosis
11. Biofeedback
12. aromatherapy
Why do the systemic analgesics provide central effects?
Because they can cross the BBB
Why are systemic analgesics not used as much?
have an extensive half life and they stay with baby b/c they cross the placenta
What are some examples of systemic analgesics?
1. opioids
2. ataractics
3. Barbituates
4. Benzos
What is important to do when administering a narcotic?
MUST have NARCAN available in case of overdose or respiratory distress
What effects to opioid antagonists have?
No amnesia effect but creates euphoric effect
LIst the 5 nerve block/analgesics
1. Local infiltration
2. Pudendal block
3. Spinal anesthesia
4. epidural block
5. general anesthesia
What is a local infiltration?
injection of local anesthetic to area to numb the area
When is a pudendal block used?
to repair an episiotomy.

-It blocks the perineal nerve
Which block only requires one dose?
the spinal anesthesia
How does the spinal anesthesia have its effect? what drug is used most often
It mixes with the CSF.

-fentanyl
Describe and epidural block.
Use duramorph that is long acting and short acting for pain

-insert a catheter into the spine and can give more amounts if needed
-effects can last up to 16 hours and must be monitored for RDS
-may cause itchiness or headache
When is general anesthesia used?
When a spinal and epidural block are not an option or for an emergency surgery
What are the risks of systemic analgesia?
1. Fetal Depression
2. Prolonged Labor
3. Nausea/Vomiting **
What risks are involved in neuraxial analgeisa
1. Maternal hypotension***
2. Fetal bradycardia
3. prolonged labor/ 2d stage
How do you treat maternal hypotension?
-Increase fluids
-turn to the left side
-give face mask of O2
What are the three major steps to take during admission to L&D?
1. Obtain & review prenatal record
2. Evaluate emotional status/support
3. Pertinent "review of systems" (ROS)
What aspects go into the pertinent review of systems?
1. estimated date of birth
2. onset, freq, duration, intensity of ctx
3. fetal movement
4. vaginal bleeding/bloody show
5. membrane status
6. previous childbirth outcomes
What aspects go into the abdominal exam during the admission assessment?
1. Fundal height: should be at umbilicus at 28 weeks and up 1cm every week after
2. Leopold's Maneuver
3. Palpate for Ctxs
What is leopold's Maneuver?
Feel baby by feeling belly
What should you do if meconium is in the amniotic fluid?
Prepare suction for birth
What does a foul smell from amniotic fluid indicate?
infection of the membranes
During the active stage how often should you check the pt?
15-30 mins
How often are FHR and CTx documented during active phase?
every 15-30 mins
How often do you document the BP, Temp and voiding during active phase?
BP: Q1-2 hours
Temp: Q4 hour if mem intact
Q1-2 hours if ROM
Voiding: Q 2 hours
What should the nurse do and documented during the pushing stage at in what intervals?
FHR: Q 5 mins or btn ctxs
BP: Q 5-15 mins
Support and encourage
Position changes
room prep
What are the 3 possible perineal outcomes from birth?
1. intact
2. laceration
3. episiotomy
What are the degrees of lacerations and their definitions?
1st: perineal skin/vaginal mucosa
2nd: superficial muscles
3rd: Deep muscle to anal capsule
4th: rectal sphincter
Other than the degreed lacerations, where else can lacerations occur during labor?
-Urethral
-Labial
-Cervical
What are the 2 types of episiotomies?
1. Midline
2. Mediolateral: gluteal muscle
--healing is longer more painful but with less of a chance of getting a 4th degree
What must be done at time and place of placental birth?
1. Palpate/massage fundus until firm
2. administer pitocin
3. Document
How often should the nurse assess bleeding in the 3rd stage?
Q 15 mins
What is given to the PP nurse in report?
1. Age, G/P
2. Type and time of birth/labor, gender, APGARS
3. Time of placenta
4. pain management?
5. condition of perineum
6. events since birth
7. Condition of NB
8. Feeding methods
9. Relevant info from History
10. IV (pitosin)
11. Social factors