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122 Cards in this Set
- Front
- Back
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Why does labor start?
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The baby is physically mature enough to adjust to extra-uterine life.
Baby also not too big to cause mechanical difficulties |
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What is the physiological definition of labor?
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-Process of moving the fetus, placenta and membranes out of the uterus and through the birth canal
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What is the clinical definition of labor?
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Progressive contractions resulting in progressive CERVICAL CHANGE
-Must have both to be in labor |
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What are the 5P's?
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1. Passenger
2. Passageway 3. Powers 4. Position 5. Psychological respoonse of the mother |
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Who is the passenger?
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The fetus and the placenta
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What is the passageway?
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The birth canal
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What are the powers? List the two types
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Contractions
-Involuntary uterine -voluntary pushing powers |
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Define the Fetal Lie
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Relationship between the long axes of the fetal and materal spines.
-the position of the fetus |
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What is the longitudinal fetal lie?
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Baby's spine and mom's are parallel.
-Good position |
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What fetal lie usually results in a C-section?
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Transverse:
fetus is horizontally oriented in uterus. -fetal spine is at a right angle to mom's |
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Describe the oblique fetal lie.
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Baby comes down on an angle.
-Not best but the baby will usually adjust to parallel to deliver |
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What are the 3 fetal presentations?
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1. cephalic (vertex)
2. breech 3. shoulder |
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What is the most common fetal presentation?
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Cephalic
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List the 3 cephalic presentations.
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1. Occiput
2. Brow 3. Mentum (chin comes out first) |
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What percentage of women have baby's in breech position?
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3%
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Which presentation is an obstetric emergency?
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Shoulder
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What is the presenting part?
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the first aspect of the fetus felt on exam
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Which fontanel has 3 openings?
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the anterior
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What feature on the skull of the fetus helps the provider know the position in the canal?
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the fontanels
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What is the fetal attitude?
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the relationship of the fetal body parts to eachother
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What are the 3 possible fetal attitudes?
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1. Flexion (chin to chest)
2. Extension (chin up in the air) 3. Military(straight neck) |
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What fetal attitude provides the smallest diameter of the head to fit perfectly into the pelvis?
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Flexed
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Define the fetal position
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Relationship of the denomenator (landmark) of the presenting part to the 4 quadrants of the mother's pelvis
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What is the most common fetal position?>
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LOA
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How do you determine if the position is posterior or anterior?
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The direction of the butt
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What are the 3 letter abbreviations of position?
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1. R/L
2. assigned denominator (occiput, mentum etc) 3. Anterior/posterior/transverse |
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The relationship of the presenting part to the ischial spines of the maternal pelvis is called the?
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Fetal Station
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What is zero station?
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Baby is at the ischial spine
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When does engagement occur?
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When baby is at the ischial spine
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As the baby is delivered does the fetal station values become more + or -?
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More positive
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What two aspects of the passageway can be changed during labor?
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The Birth canal: it stretches, swelling can go back down etc
The Soft tissues: swelling, bleeding, cysts or tumors can be removed etc |
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What aspect of the passageway cannot be changed?
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The bony pelvis
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What is the most common female pelvis structure?
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Gynecoid: round
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What percentage of women have an android pelvis? Who is this pelvis most common in?
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23% of all women
-Known as the male pelvis |
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What % of women have an anthropoid pelvis? What is its structure? Is it a good or bad prognosis for vaginal delivery?
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-24% of all women
-Oblong shape with a large AP diameter -Great prognosis for vaginal |
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What pelvis structure is the worst for vaginal delivery? What % of women have this pelvis?
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Platypelloid
-Short AP diameter -3% of all women -usually have a C-section |
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What do all positive positions of labor have in common?
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They all use gravity to help with the delivery
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What are the 4 common positions for pushing?
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1. Lithotomy position
2. Semirecumbent: partner behind pt 3. lateral recumbent (on their side) 4. squatting |
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What are the primary powers?
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involuntary uterine contractions causing cervical change
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What are the secondary powers?
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Voluntary pushing powers
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How do we characterize primary powers?
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1. Duration
2. Frequency 3. Intensity |
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What 2 changes in the cervix are a result of primary powers?
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1. Dilation
2. Effacement |
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Which women have effacement occur prior to full dilation?
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Pritips
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When do effacement and dilation occur in multips?
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They occur at the same time!
Multips multitask |
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What is effacement?
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The thinning and shortening of the cervix in the first stage of labor
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How to we express effacement and dilation?
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Effacement is in %s
Dilation is in cm's |
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In true labor, what is the location of the Ctx's?
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They start in the back and come around to the lower abdomen
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Where do Ctx's occur in false labor?
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Middle abdomen down to the groin
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How are contractions characterized in false labor?
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Are inconsistent in frequency, duration and intensity. Do not change or may decrease with activity (walking)
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In true labor, how are contractions characterized?
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Progressing
-Getting stronger, longer and closer together |
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In true labor, does walking minimize the pain of contractions?
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No, it can actually exasperate them
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What is true about the cervix in false labor?
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It is not progressively changing. No dilation is occurring
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In a primip, when the baby drops how long does delivery usually follow?
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10-14 days
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In a multip, what is the earliest delivery can occur once baby has dropped?
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They same day!
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What physiological response does dropping induce?
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Increased urination
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What are the 8 SxS of impending labor?
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1. lightening
2. stronger braxton-hicks 3. Mucus Plug 4. bloody show 5. cervical ripening 6. burst of energy 7. SROM 8. GI upsets |
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What is lightening?
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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 |
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What are braxton-hicks contractions?
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painless intermittent contractions of the uterus.
-Helps the uterus prepare for labor |
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What is the purpose of the mucus plug?
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to stop infection from entering the uterus
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What is the bloody show?
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The passing of the mucus plug and the baby dropping can cause some blood
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Describe cervical ripening?
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The cervix becomes soft and malleable so that the baby can pass through easily
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What is nesting?
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the burst of energy that the mother feels at the beginning of labor.
-They usually clean the house or prepare the baby's room. |
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What two tests can be done to see if SROM has occurred?
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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 |
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What 2 techniques can you tell a term woman to do at home to bring about labor?
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1. Have heterosexual sex: prostaglandins encourage oxytocin release
2. Make a cocktail of castor oil, orange juice and vodka |
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What is the first stage of labor?
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-From the onset of regular uterine contractions to full dilation
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What are the 3 phases of the 1st stage of labor?
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1. Latent
2. Active 3. Transition |
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Describe the Latent stage of labor?
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- 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% |
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What are the characteristics of the active stage of labor?
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- 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 |
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what is the average rate of cervical change for primips and multips?
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Pri: 1.2 cm/hour
multi: 1.5 cm/hour |
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What is the shortest part of the Stage 1?
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The transition phase
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Describe the transition phase?
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- 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 |
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How long can the 1st stage be delayed with an epidural?
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1 hour
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What is the 2nd stage of labor? How long does it last?
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the pushing stage
-can last under 30 mins or up to 2 hours |
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What is the physiological reason to begin pushing>?
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Ferguson's Reflex is being engaged by the baby's head and signal the need to push
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List the Cardinal Movements in order!!
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1. Engagement
2. Descent 3. Flexion 4. Internal Rotation 5. Extension 6. Restitution 7. External Rotation 8. Lateral Flexion |
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Where does engagement take place?
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when baby is at zero station
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Why does the baby drop?
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1. pressure of amniotic fluid
2. Pressure of the fundus 3. Contraction of abdominal muscles 4. extension and straightening of fetal body |
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During internal rotation which direction does the fetal head rotate?
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From Left to right
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What movement causes the head to start to emerge?
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Extension
-resistance of the pelvis floor and vulva starts to open up |
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What is restitution?
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The movement where the shoulders of the fetus enter pelvis obliquely and remain oblique when head rotates to the AP diameter
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What is the 3rd stage of labor?
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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 |
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What are the 4 signs of placental separation?
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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 |
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What is the maternal side of the placenta called?
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Duncin/ corion
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What is the fetal side of the placenta called?
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The amnion side
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What is Warton's jelly?
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the substance around the cord that protects it
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What can be a possible problem if only 2 vessels are detected in the cord
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Possible kidney problem because they develop at the same time
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What is the 4th stage of labor?
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-Maternal stabilization/homeostasis
-Initial bonding with baby -initiate feeding -can last up to 4 hours |
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what is the most critical/dangerous time for the mother?
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the first hour after delivery
-chance of hemorrhage |
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What factors influence a mother's perception of pain?
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1. Culture
2. Anxiety and fear 3. previous birth experience 4. childbirth preparation |
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What are the non-pharmacological pain relief methods?
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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 |
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Why do the systemic analgesics provide central effects?
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Because they can cross the BBB
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Why are systemic analgesics not used as much?
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have an extensive half life and they stay with baby b/c they cross the placenta
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What are some examples of systemic analgesics?
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1. opioids
2. ataractics 3. Barbituates 4. Benzos |
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What is important to do when administering a narcotic?
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MUST have NARCAN available in case of overdose or respiratory distress
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What effects to opioid antagonists have?
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No amnesia effect but creates euphoric effect
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LIst the 5 nerve block/analgesics
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1. Local infiltration
2. Pudendal block 3. Spinal anesthesia 4. epidural block 5. general anesthesia |
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What is a local infiltration?
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injection of local anesthetic to area to numb the area
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When is a pudendal block used?
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to repair an episiotomy.
-It blocks the perineal nerve |
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Which block only requires one dose?
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the spinal anesthesia
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How does the spinal anesthesia have its effect? what drug is used most often
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It mixes with the CSF.
-fentanyl |
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Describe and epidural block.
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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 |
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When is general anesthesia used?
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When a spinal and epidural block are not an option or for an emergency surgery
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What are the risks of systemic analgesia?
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1. Fetal Depression
2. Prolonged Labor 3. Nausea/Vomiting ** |
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What risks are involved in neuraxial analgeisa
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1. Maternal hypotension***
2. Fetal bradycardia 3. prolonged labor/ 2d stage |
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How do you treat maternal hypotension?
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-Increase fluids
-turn to the left side -give face mask of O2 |
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What are the three major steps to take during admission to L&D?
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1. Obtain & review prenatal record
2. Evaluate emotional status/support 3. Pertinent "review of systems" (ROS) |
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What aspects go into the pertinent review of systems?
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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 |
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What aspects go into the abdominal exam during the admission assessment?
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1. Fundal height: should be at umbilicus at 28 weeks and up 1cm every week after
2. Leopold's Maneuver 3. Palpate for Ctxs |
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What is leopold's Maneuver?
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Feel baby by feeling belly
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What should you do if meconium is in the amniotic fluid?
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Prepare suction for birth
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What does a foul smell from amniotic fluid indicate?
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infection of the membranes
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During the active stage how often should you check the pt?
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15-30 mins
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How often are FHR and CTx documented during active phase?
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every 15-30 mins
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How often do you document the BP, Temp and voiding during active phase?
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BP: Q1-2 hours
Temp: Q4 hour if mem intact Q1-2 hours if ROM Voiding: Q 2 hours |
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What should the nurse do and documented during the pushing stage at in what intervals?
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FHR: Q 5 mins or btn ctxs
BP: Q 5-15 mins Support and encourage Position changes room prep |
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What are the 3 possible perineal outcomes from birth?
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1. intact
2. laceration 3. episiotomy |
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What are the degrees of lacerations and their definitions?
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1st: perineal skin/vaginal mucosa
2nd: superficial muscles 3rd: Deep muscle to anal capsule 4th: rectal sphincter |
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Other than the degreed lacerations, where else can lacerations occur during labor?
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-Urethral
-Labial -Cervical |
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What are the 2 types of episiotomies?
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1. Midline
2. Mediolateral: gluteal muscle --healing is longer more painful but with less of a chance of getting a 4th degree |
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What must be done at time and place of placental birth?
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1. Palpate/massage fundus until firm
2. administer pitocin 3. Document |
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How often should the nurse assess bleeding in the 3rd stage?
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Q 15 mins
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What is given to the PP nurse in report?
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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 |
