Maternal Child Nursing Aquinas College

Front 1

The process of moving the fetus, placenta and membranes out of the uterus and through the birth canal.

Back 1

Labor

Front 2

Signs preceding labor

Back 2

lightening, braxton hicks contractions, ripening, bloody show, ROM or SROM, sudden burst of energy, weight loss, diarrhea n/v, and indigestion

Front 3

ripening

Back 3

softening of cervix

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bloody show

Back 4

mucous plug is expelled resulting in a small amount of blood loss from exposed cervical capillaries. Sign of labor in 24 to 48 hours.

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Causes of onset of labor:

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1. Estrogen stimulates uterine muscle contractions which lead to softening of cervix. 2. Decrease in progesterone 3. Increase of prostaglandins. 3. Increase in corticotrophin releasing hormone (CRH)

Front 6

Effacement

Back 6

with each contraction, the cervix then shortens and thins pulling up into the uterus and becoming part of the lower uterine wall.

Front 7

First stage of labor?

Back 7

lasts from the onset of regular uterine contractions to full dilation (10 cm) of the cervix. Can be hard to determine actual time of onset. Usually longer than second and third stages combined. In a first pregnancy can take up to 20 hours; in some multips, may be less than 1 hour. Made of three phases: latent, active, and transition

Front 8

Latent-1st stage

Back 8

begins with onset of contractions, more effacement of contractions with little increase in decent

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Active- 1st stage

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when mom's anxiety increases and discomfort. Dilation from 4 to 7 cm.

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Transition- 1st stage

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even more anxiety and tiredness. Dilation from 8 to 10cm but at a very slow rate. Increased rate of descent.

Front 11

Second Stage

Back 11

lasts from the time that cervix is fully dilated (10cm) to the birth of the fetus. Average of 20 to 50 minutes, but may take as long as 3 hours (with epidural anesthesia). Two phases: 1. Latent 2. Active

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Latent- 2nd stage

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complete dilation of cervix, but contractions are weak and no urge to push (more effective if they feel the earge to push!! Do not force pushing)

Front 13

Active - 2nd stage

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contractions resume, the woman is making strong bearing-down efforts and fetal station is advancing (moving from 2-1-0)

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Crowning

Back 14

etal head is encircled by the external opening of the vagina and means birth is imminent

Front 15

Third Stage

Back 15

"from the birth of the fetus until the placenta is delivered (if placenta is not delivered in at least one hour she has a risk for hemorrhage) Placenta normally separates after third or fourth strong contraction – will deliver with the next strong contraction. Can be as short as 3-5 minutes; up to 1 hour is considered within normal limits

Front 16

Schultze mechanism

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shiny" placenta separates from the inside to the outer margins first, fetal side presents as it comes out

Front 17

Cardinal Movements

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"(7) Engagement, Descent, Flexion, Internal rotation, Extension, External rotation (restitution), Expulsion

Front 18

Duncan mechanism

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"dirty" placenta separates from the outer margins inward presents sideways showing the maternal side first.

Front 19

Decent

Back 19

4 forces: 1. Pressure of the amniotic fluid 2. Direct pressure of the fundus of the uterus on the breech of the fetus. 3. Contraction of stomach muscles. 4. Extension and straightening of the fetal body. Head enters inlet.

Front 20

Flexion

Back 20

as fetal head descends and meets resistance for the muscle pelvic floor and cervix, the fetal chin flexes downward into chest

Front 21

Internal rotation

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as the occiput meets resistance from the levator ani muscles, the occiput rotates left to right and the sagittal suture aligns with the anterposterior pelvic diameter.

Front 22

Extension

Back 22

from resistance of the pelvic floor and movement of the vuvla opening anteriouly and forward, assist ____ of head as it passes under the symphysis pubis.

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referred pain

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Usually only during contractions- – radiates from uterus to the abdominal wall, lumbosacral area, iliac crests, gluteal area and thighs

Front 24

somatic pain

Back 24

"during second stage. Described as intense, sharp, burning and well-localized. Caused by stretching and distention of perineal tissues and the pelvic floor, distention and traction on the peritoneum and uterocervical supports during contractions and from lacerations of the soft tissue (cervix, vagina and perineum). from expulsive forces and pressure on bladder, bowel and other sensitive structures.

Front 25

Sedatives

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may be used in prodroma labor, but not in active labor b/c they can cause respiratory depression in fetus – drug of choice is morphine (use with caution in patients with asthma)

Front 26

Analgesia

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relieving perception of pain or raising pain threshold without loss of consciousness

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Systemic

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"the major method in labor, when regional anesthesia not available. Effects on fetus and newborn can be profound (respiratory depression, decreased alertness, delayed sucking). IV preferred to IM because onset faster and more predictable

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Opioid (narcotic):

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meperidine (Demerol) and fentanyl – can decrease gastric emptying, promoting N/V, inhibit bowel/bladder emptying, affect HR, BP and respiratory rate – need safety precautions (sedation/dizziness)

Front 29

positive pregnancy Test

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measures the beta subunit of human chorionic gonadotropin (hCG) hormone in urine or serum.

Front 30

hCG

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hormone secreted by the trophoblast to encourage progestrone and estrogen production by the luteum to maintain the pregnancy until the placentas fully develops and takes over production

Front 31

high levels of hCG and inhibin-A and low UE

Back 31

risk of down syndrome

Front 32

AFI index

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Measure depth of fluid volume in all four quadrants around mother’s umbilicus, and add the measurements together

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Anencephaly

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neural tube defect where a portion of the fetal brain is abscent

Front 34

Maternal Serum Alpha-fetoprotien (MSAFP)

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checks AFP, hCG, diameric inhibin-A, and estriol to screen for NTD, trisomy 21 (DS), and trisomy 18. Can be done at 15 to 22 wks gestation, ideally at 16wks.

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Amniocentesis

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used for genetic dx, done btwn 15 and 20 wks for NTD, AFP levels, blood type, DNA. Later done btwn 30 to 35 wks dor lung maturity tests

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Recommended weight gain in pregnancy, based on maternal BMI:

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"Low (<19.8) 28-40 lbs.--Normal (19.8-26) 25-35 lbs.--High (27-29) 15-25 lbs.--Obese (>29) 15-20 lbs.--4 to 6 lbs a month to gain in weight during pregnancy.

Front 37

How many lbs a month to gain in weight during pregnancy?

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4 to 6 lbs a month (the text states 3.5 to 5lbs during 1st trimester then 1lb per week in 2nd and 3rd trimester)

Front 38

weight of fetus, placenta, amniotic fluid

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11 lbs. (5kg)

Front 39

weight of uterus

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2 lbs. (0.9kg)

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weight of increased blood volume

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4 lbs. (1.8kg)

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weight of breast tissue

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3 lbs. (1.4kg)

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weight of maternal stores

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5-10lbs. (2.3 to 4.5kg)

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Antepartum

Back 43

time btwn conception and onset of labor, used interchangeably with prenatal

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Intrapartum

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time from onset of labor to birth of infant and placenta

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Postpartum

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Time from birth until women's body returns to prepregnancy state

Front 46

Nagele's rule

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1st day of LMP, subtract 3 months, and add 7 days

Front 47

Drug of choice in the prevention and treatment of convulsions caused by preeclampsia or eclampsia?

Back 47

Magnesium sulfate

Front 48

Intravenous antiHTN agent of choice for the treatment of HTN that occurs w/ severe preeclampsia?

Back 48

Hydralazine

Front 49

AntiHTN agent of choice for treatment of chronic HTN during prego?

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Methyldopa

Front 50

Antiemetic medication that is commonly used to treat hyperemesis gravidarum?

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Metoclopramide

Front 51

Synthetic prostaglandin E analog administered orally or intravaginally as part of the medical management of a miscarriage?

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Misoprostol

Front 52

Antimetabolite and folic acid antagonist that is used to destroy rapidly dividing cells; it is used for the medical management of an unruptured ecotopic prego?

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Methotrexate

Front 53

Prostaglandin derivative that can be administered intramuscular to contract the uterus and treat excessive bleeding following evacuating the products of conception when a miscarriage has occured?

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Carboprost tromethamoine