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53 Cards in this Set
- Front
- Back
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What are the 3 phases of the 1st stage of labor?
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1) Latent phase (0-3cm)
2) Active phase (4-7cm) 3) Transition (8-10cm) |
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Definition of Labor
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The process of moving fetus, placenta, and membranes out of the uterus and through the birth canal.
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Characteristics of the 1st stage of labor?
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Lasts from the onset of regular uterine contractions to full dilation of the cervix.
Longest stage |
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Latent phase characteristics
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(0-3cm)
Begins with the onset of reg contractions (mild) Progress in effacement and little increase in descent 8hrs for 1st labor, not to exceed 20hrs 6 hrs for multi, not to exceed 14hrs |
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Active phase characteristics
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3-6hr duration
More rapid dilation of the cervix (1.2 cm/hr in null & 1.5 cm/hr in multi) Increased rate of descent |
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Transition phase characteristics
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8-10 cms
Approx 20-40 min Increased anxiety, force, and fear of being torn open Descent 1cm/hr in null and 2cm/ hr in multi Once 10 cm is reached increase in bloody show, uncontrollable desire to bear down, and rupture of membranes |
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2nd stage of labor characteristics
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Begins with complete dilation and ends with birth of infant.
Average of 20-50 min in multi Up to 2 hours considered normal (null) |
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3rd stage of labor characteristics
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Birth to delivery of placenta
Placenta usually seperates after 3-4 stong contraction after birth 3min to an hour normal, with an increase risk of hemorrhage as time passes |
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4th stage of labor characteristics
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Arbitrarily lasts 2 hours after placenta
Observe for complications Homeostasis reestablished |
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Ultrasound transducer
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External FHR
Reflects sound waves to measure FHR |
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Tococtransducer
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Placed over fundus above the uterus
Measures uterine contractions transabdominally |
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What must be present for the use of internal monitoring?
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Membranes must be ruptured
Cervix sufficiently dilated Presenting part low enough for placement of the electrode |
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Spiral electrode
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Internally measures FHR
Screwed into scalp Carefull not to apply to face, suture lines, or fontanelles (perineum if breach) |
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IUPC
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Intrauterine pressure catheter
Solid or fluid filled catheter No farther than beyond the fingertips, used when closer uterine monitoring or amniofusion is indicated |
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What are the 3 types of decels that are encountered during labor
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1) Early
2) Late 3) Variable |
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Early deceleration characteristics?
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Decrease in FHR in response to fetal head compression
Begins at or after contraction and returns by time contraction is over (mirrors) Benign, no interventions necessary Occur in vaginal exams, 2nd stage pushing, application of internal monitors,etc... |
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Late deceleration characteristics?
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Transitory decrease in HR caused by uteroplacental insufficiency (decreased blood flow)
Baby is not tolerating labor well Persistent is usually indicative of hypoxemia |
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Variable deceleration characteristics?
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Transitory decrease in FHR caused by umbilical cord compression
Decrease is >=15/min, lasts at least 15 sec, and returns to baseline in less than 2 min. Occur transiently cord compression (baby grabs etc..) May be u or v shaped 50% monitored babies experience Only problem if prolonged or persistent |
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How is the placenta attached?
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To the basal plate in the endometrium by numerous fibrous anchor villi
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If the uterus is relaxed, can the placenta detach?
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No because the placental side is not reduced in size
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5 signs of placental seperation
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1) Change in the uterus from discoid to globular shape
2) Rise of fundus in the abdomen 3) Sudden gush or trickle of blood 4) Further protrusion of umbilical cord out of vagina 5) Vaginal fullness |
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Shultze mechanism
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Shiny
Placenta seperates from inside to outside. Expelled with fetal side presenting |
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Duncan mechanism
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Placenta seperates from outer edges inside
Rolls up and presents sideways with maternal side delivering 1st |
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Characteristics of true labor
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Contraction intensity increases
Intensify when walking Contractions regular and intervals shorten Cervix dilates and becomes effaced Show is usually present and sedation does not stop |
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Characteristics of false labor
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Contraction intensity remains unchanged
No intensification with walking Irregular and intervals do not shorten Cervix does not dilate or efface Show is not present and sedation tends to stop |
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What is the most dangerous pontential complication of labor
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Hemorrhage
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What is the most common cause of PPH (hemorrhage)?
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Uterine Atony- loss of muscle tone
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What conditions are important to access for that could predispose mom to hemorrhage?
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Precipitous, very long, or induced labor
Large baby, grand multiparity etc... |
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What are some other factors that could lead to hemorrhage?
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Retained placenta
Cervical or genital lacerations Hematomas Uterine rupture or inversion Infections Clotting disorders |
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What are interventions for hemorrhage?
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Medications
Uterine massage Uterine tamponade (pressure) D & C Hysterectomy |
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What is the intitial managemnt of PPH
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Firm massage of the fundus
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What role does the bladder play with the uterus?
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A full bladder displaces the fundus and prevents the uterus from contracting
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What medications cause uterine contrractions?
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Oxytocin
Methergine Prostglandin |
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What is postpartum involution?
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Return of the uterus to the non-pregnant state following birth
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At what rate does te uterus return to its pre-pregnant
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Fundus descends 1-2 cm every 24 hours
By 2 weeks the uterus lies in the true pelvis |
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What are the factors that enhance involution
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Uncomplicated labor
Complete expulsion of the placenta and membranes Early ambulation Breastfeeding |
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What are the factors that impede involution
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Anasthesia
Grand multiparity Prolonged labor Difficult birth Full bladder Incomplete expulsion of the placenta and membranes Infection |
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What is subinvolution?
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Failure of the uterues to return to the non-pregnant state
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What are causes of subinvolution?
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Retained placental fragments
Polyhydraminios Intauterine infection Large gestational age baby |
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What is the most common complication of epidural?
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Maternal hypotension (20% drop from pre, or less than 100 systolic)
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What are treatment of hypotension after anesthesia?
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Vasopressors (ephederine)
May increase IV rate (protocol) Turn on side |
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BUBBLE HEP?
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Breasts
Uterus Bladder Bowels Lochia Episiotomy / Lacerations Homan's sign Emotional Pain |
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Breasts?
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Encourage comfortable bra,
Assess breasts and nipples |
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Uterus?
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Check frimness and position
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Bladder?
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Full bladder displaces uterus and prevents contractions (cath only when necessary)
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Bowels?
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Tend to be sluggish
Stool softeners |
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Lochia?
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Assess while massaging fundus
Scant= blood only with wiping or 1" on peripad/ hr Light/small= 4"/hr Moderate= 6"/hr Heavy= saturated in hr Heavy may be problem, lots of large clots is not normal. Continuous may indicate lacerations |
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Normal amniotic fluid
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Pale, straw colored
May contain white flex of vernix, lanugo, or scalp hair Watery with no strong odor |
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Abnormal amniotic fluid
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Meconium stained may be greenish brown
thick, cloudy, and foul smell |
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What are the 5 p's that influence labor
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Passenger
Passageway Powers Position (of mom) Psychological response |
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Passenger?
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Fetus and placenta
Size and position of fetus primarily |
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Passageway?
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Birth canal
Types of pelvis: Gynecoid- classic female Android- resembles male Anthropoid- resembles ape Platypelloid- flat |
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Powers?
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Contractions
Primary powers include: Effacement, dilation. ferguson reflex Secondary powers- valsalva |
