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126 Cards in this Set
- Front
- Back
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Gravida
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a woman who is or has been pregnant
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Para
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the number of pregnancies that reached viability (20 weeks)
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Primigravida
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a woman who is pregnant for the first time
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Primipara
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woman who has delivered one viable fetus
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Multigravida
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a pregnant woman who has been pregnant before
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Multipara
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a woman who has delivered more than one viable fetus
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Nulligravida
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woman who has never been pregnant
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Nullipara
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a woman who has not carried a fetus to variability
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G.T.P.A.L
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a. G= gravida (pregnancies)
b. T= term births or pregnancies delivered (37+) c. P= premature births (20-36.6 weeks) d. A= abortions (spontaneous or induced) e. L= number of living children |
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Presumptive Signs
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those that suggest but do not positively indicate pregnancy
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Probable Signs
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strong indicators of pregnancy, short of confirmation. Two or more are highly suggestive of pregnancy. Detected at about 12th week
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Positive Signs:
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absolute confirmation of pregnancy
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What are the Presumptive Signs of Pregnancy
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Amenorrhea: absence of menstruation
Nausea/vomiting: due to metabolic and hormonal changes Breast changes: enlargement, tingling, increased sensation to touch, darkening of nipples and areola Urinary frequency: due to pressure on bladder from uterine enlargement v. Fatigue: due to increased metabolism vi. Quickening: fluttering sensation when fetus moves (16-20 weeks gestation) |
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What are the Probable Signs of Pregnancy
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Pigmentation changes: linea nigra, chloasma (mask of pregnancy)
Abdominal enlargement: as uterus rises out of the pelvis (after 12 weeks) Chadwick’s Sign: purplish color of cervix Hegar’s Sign: softening of the lower uterus v. Ballottement: detection of fetus floating in amniotic fluid vi. Braxton Hicks contractions: irregular, painless uterine contractions vii. Goodell’s Sign: softening of a normally-firm cervix Positive pregnancy test: Maternal blood or urine test for human chorionic gonadotropin (hCG). (Testing one week after a missed period usually provides more accurate information) Hegar’s Sign: A Softening of the Lower Uterus Mask of Pregnancy (chloasma) |
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What are the Positive Signs of Pregnancy
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Detection of fetal heart tones
Palpation of fetal movement Ultrasonic evidence of a fetus |
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First trimester
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First day of LMP to week 13
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Second trimester
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14 weeks to 27 weeks
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Third trimester
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27 weeks to 40 weeks
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Hegar’s Sign
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softening of the lower uterus
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Goodell’s Sign
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softening of a normally-firm cervix
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Braxton Hicks contractions
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irregular, painless uterine contractions
A Probable Sign of Pregnancy |
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Ballottement
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detection of fetus floating in amniotic fluid
A Probable Sign of Pregnancy |
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Chadwick’s Sign
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purplish color of cervix
A Probable Sign of Pregnancy |
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Rh Sensitization
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May occur when mother is Rh negative but fetus is Rh positive
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RhoGAM
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Treats Rh Sensitization
given prophalactally at 28 weeks gestation and again within 72 hours of childbirth. Remember this second dose is only given if the infant is Rh+ |
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T.O.R.C.H. Infections
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a. T= Toxoplasmosis
b. O= Other* c. R= Rubella d. C= Cytomegalovirus e. H= Herpes *Other includes gonorrhea, syphilis, varicella, Hepatitis B, Group B strep and HIV |
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What are the 3 things that the L&D RN need to assess to differentiate between true and false labor
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a. Uterine contractions
b. Status of cervix c. Status of membranes (bag of water) |
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What are the characteristics of contractions in TRUE labor
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May be irregular at first, usually become regular, longer, and closer together
Walking makes them stronger Lying down does not makes them go away Usually felt in lower back and radiates to front |
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What are the characteristics of contractions in FALSE labor
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Usually irregular and short, don’t get longer, stronger or closer
Walking does not make them stronger Lying down may make them go away Usually felt in upper uterus and groin |
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What are the characteristics of the cervix in FALSE labor
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The cervix may soften but there is little thinning or opening
NO change in position for the baby |
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What are the characteristics of the cervix in TRUE labor
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The cervix softens , thins and opens
Baby begins to move into the pelvis |
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What are the preliminary signs of TRUE labor
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a. Lightening
i. Baby “drops.” Relief of pressure on the diaphragm and stomach, increased pressure on the bladder b. Increased vaginal secretions c. Slight weight loss d. Mucous plug, bloody show e. Thinning and softening of cervix f. Persistent backache g. Increased Braxton-Hicks i. (intermittent painless uterine contractions) |
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What is COAT and what does it stand for?
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The tool used to assess the BOW
Color of fluid Odor Amount of fluid Timing of rupture |
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How are ruptured membranes confirmed?
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Nitrazine Paper test - If paper turns blue, fluid is alkaline which confirms amniotic fluid
OR ii. Fern Test 1) Vaginal fluid swabbed and placed on microscope slide. Fern pattern confirms amniotic fluid. Used if further confirmation is needed. |
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What are the 5 P's of the Labor Process?
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Passenger (fetus) Passageway (pelvis)
Powers (contractions) Position of mother Psychological factors (psyche) |
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Engagement
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the widesst diameter of the presenting part that has passed through the pelvic inlet
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Molding
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reshaping of the fetal head to facilitate birth
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Station
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relationship of the widest diameter of the preseting part and the ischial spines of the pelvis
Graded on a 1-5 scale |
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Attitude
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relationship of the fetal parts to one another
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Lie
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relationship of the longitudinal axis of the fetus to the longitudinal axis of the mother
*think L in Lie is L for LONGITUDE! |
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Presentation
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fetal part entering the pelvis first
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Position
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relatinship of the fetal presenting part to the maternal pelvis
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What are four methods used to determine fetal postion
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Leopold’s Maneuvers
Vaginal exam Ultrasound Auscultation of fetal heart rate (FHR) |
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What are the cardinal movements
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descent
engagement fexion internal rotation extension external rotation expulsion |
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Descent
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Continues throughout labor
If this does not occur, none of the other mechanisms can occur |
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Engagement (cardinal sign of labor)
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level of ischial spines into the pelvic inlet
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Flexion
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must occur now (after descent and engagement) for other mechanisms to follow.
Head and neck flex, allowing the smallest diameter of the head to come first |
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Internal Rotation
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may be prolonged, head must rotate up to three times in order to pass navigate the pelvic canal e. :
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Extension
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allows head to pass under pelvic arch
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External Rotation
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involves two movements allowing shoulders to position
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Expulsion
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rest of the body follows the anterior shoulder
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What do the cardinal movements depend on?
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Passenger
Passageway Powers Psyche |
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How many stages of Labor are there
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4
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What are the 3 phases in the 1st stage of labor
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latent
active transitional |
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What cervical changes happen in the 1st stage of labor
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The cervix dialtes from 0-10cm
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What cervical changes happen in the 2nd stage of labor
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Complete dilation
the baby is born |
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What cervical changes happen in the 3rd stage of labor
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Placenta is delivered
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What cervical changes happen in the 4th stage of labor
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Immediate recovery period
2 hours |
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When is an epidural given
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during the active phase in the 1st stage of labor
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What is the mother doing in the 2nd stage of labor
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PUSHING
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What actions take place in the 3rd stage of labor
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Cord clamped; delivery of placenta
Vagina, cervix and perineum inspected and repaired if needed Assess fundal height, firmness Massage fundus (manually contracts the uterus) v. Give oxytocin (chemically contracts the uterus) Promote family bonding/breastfeeding |
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What is the most important RN implication in the fourth stage of labor
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Monitoring the mother for hemorrhage
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When do perineal lacerations usually occur
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When the head is being delivered
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What is a 1st and fourth degree laceration
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1st is skin
4th is through the rectal wall |
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Episiotomy
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an Incision made in the perineum to enlarge the vaginal opening
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Effacement of the Cervix
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a. Shortening and thinning of the cervix, measured in percentages (25%,50%,75%,100%)
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What is the greatest amount the cervix will dialate
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10cm
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What are the three ways the fetus can present?
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cephalic - vertex, brow, face, mentum (chin)
breech - complete, frank, footling shoulder |
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Define station and Engagement and how it is measured
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When fetal head is level with the ischial spines, fetus is engaged
Level of engagement is zero (0) station |
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Define Induction of Labor
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initiation of labor by artificial means
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what drug is used to induce labor
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Oxytocin
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What are some indications for inducing labor
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dysfunctional labor
fetal demise post term pregnancy elective maternal complications - diabetes, hypertension |
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What is the Bishop score used for
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to assess cervical ripeness
takes into account amount of dilation, effacement, station, cervical consistency and cervix position. scored 0-3 0=closed 1=1-2 2=3-4 3=>5 |
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What does a high Bishop score indicate?
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the greater the success of induction of labor
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What are two things that can be used to assist in ripening the cervix
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Prostaglandin gel
Evening primrose oil |
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What does oxytocin assist with
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contractions
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When the membrane has been ruptured either through AROM or SROM what is essential to confirm and how?
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fetal well-being by assessing fetal heart tones
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Why is it essential to confirm fetal well being after membrane rupture?
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Risk of prolapsed cord when fluid gushes out of vagina
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Amniotomy
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The physician reaches up and nicks the membrane which is followed by a gush of amniotic fluid.
ESSENTIAL to assess fetal well being after r/t prolapsed cord |
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What are the 4 purposes of giving oxytocin
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Induction of labor
Augmentation of labor Contraction stress test (CST) Prevention of hemorrhage |
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What is the drug of choice for labor pain
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Stadol
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What is the major complication of giving Stadol or demerol too close to delivery
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significant respiratory depression in the infant
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What drug is given to counteract the effects of Stadol or demerol
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Narcan IM
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What is a local anesthetic used for in labor
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episiotomies
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Pudendal block
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Anesthesia used for major perineal repair
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Lumbar epidural block is used for
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vaginal births
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spinal (subarachnoid) block is used for
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C sections
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General anesthesia is used for
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ER C sections
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What are the advantages of an epidural
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Mother alert, cooperative, relaxed
Airway and reflexes intact, only motor paralysis Gastric emptying not delayed Fetal distress rare Can be modified quickly to allow mother to push Provides rest period for long labors |
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What are the disadvantages of an epidural
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IV required
Occasional dizziness Weakness of legs, not able to ambulate Difficulty emptying bladder Hypotension, convulsions or parasthesias Increased C-sections due to inability to bear down Occasional high spinal anesthesia resulting in depressed/arrested respiration |
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What are the two major complications/adverse reactions to a spinal block
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1) Respiratory depression
rate must be assessed EVERY hour for the first 24 hours after birth 2) Spinal headache Lie flat 8-12 hours after injection. Treated with spinal blood patch. |
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What are some RN interventions to facilitate bonding/attachment
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1. Skin-to-skin (kangaroo care)
2. Breastfeeding 3. Father cutting the cord 4. Family-centered care |
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What are some methods to give to the pt to prepare for childbirth?
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1. Lamaze
2. International Childbirth Education Association 3. Breastfeeding 4. Sibling 5. C-Section Teaching 6. Baby care 7. Daddy Boot Camp |
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What are the 3 problems that can occur with the passenger
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fetal malpostion/malpresentation
prolapsed umbilical cord fetal distress |
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What is the cause of a prolapsed umbilical cord
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1) fetus is not firmly engaged, allowing room for the cord to move beyond (prolapse) or along the presenting part
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What will display on the FHM in the event of a prolapsed cord
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Variable decels
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What are the 3 types of prolapsed cord
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Partial - trapped beside the presenting part
Hidden - Complete - cord is visible in vagina, comes out first |
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What RN interventions should be done in the event of a prolapsed cord
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knee to chest / trendelenburg position
examiner (RN) pushes presentin part upward to relieve pressure on the cord if cord protrudes throug the vagina applice sterile saline soaked dressing O2 by face maske at 8-10L prepare for rapid delivery |
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Define fetal distress
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insufficient O2 supply to meet the demands of the fetus
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What are 2 causes for fetal distress
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umbilical cord compression
uteroplacental insuffieciency |
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What adverse reaction can decreased oxygenation to the fetus cause and how can it be treated
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relaxation of anal sphincter, passage of meconium stool and gasping
amnioinusion to dilute meconium |
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Where should pressure be applied in the event of shoulder dystocia
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suprapubic. - a) Allows the sholder to pass below the pubic bone
NEVER fundal - Forcing can cause the uterus or bladder to rupture |
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McRoberts positioning
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used in the event of shoulder dystocia
The thighs are flexed up to the abdomen. Helps to enlarge the pelvic outlet |
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Define Cephalopelvic Disproportion (CPD)
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Fetal head is too large to pass through the bony pelvis
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Shoulder Dystocia
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An obstetrical emergency resulting from difficulty/inabilitity to deliver the shoulders
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Oligohydramnios
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Inadequate amount of amniotic fluid
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What is a normal amount of amniotic fluid
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800-1000mL
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How much fluid is requred for vaginal birth
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a 2cm pocket
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An inadequate amount of amniotic fluid may be r/t ?
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problems with fetal renal development
may also be caused by some NSAIDS |
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Polyhydramnios/Hydramnios
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Excessive amounts of amniotic fluid
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An excessive amount of amniotic fluid may be r/t ?
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problem with GI fetal development
Baby is not drinking / using fluid therefore there is too much |
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What risk to the mother can polyhydramnios cause?
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postpartum hemorrhage
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How can excess fluid be removed?
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amniocentesis or ibuprofen therapy
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Labor dystocia
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Difficult labor that is prolonged or more painful
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What can labor dystocia cause?
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maternal dehydration, infection, fetal injury or death
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What are th 2 types of contractions that can occur in labor dystocia
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hypertonic
hypotonic |
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Define premature labor
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contrations occuring between 20-37 weeks gestation
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What are the s/s of Preterm Labor
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Contractions occurring q 10 minutes or less
Dilated to 1 cm or more 80% or more effacement Low abdominal cramping with or without diarrhea Intermittent pelvic pressure, urinary frequency Low back ache (constant or intermittent) Increased vaginal discharge Leaking amniotic fluid Positive biochemical marker (fetal fibronectin) |
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What is fetal fibronectin
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a protien detected in maternal blood.
. A negative fFN has a high predictive value (up to 95% accurate) that the woman will not deliver in 7-14 days better at detecting who will not deliver preterm than who will deliver preterm |
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What are the RN interventions that need to be taken with preterm labor
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bedrest
monitor uterine activity and FHR admnin tocolytic agent admin corticosteroids |
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tocolytic agent
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Stops contractions
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Why and when is corticosteroids ( betamethason or dexamethasone adminstered
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between 28-24 weeks
can cross the placenta and stimulate fetal lung maturity and production of surfactant |
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What are some problems with the psyche r/t risks during labor
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Fear and anxiety
Perception of the problem Self-image Preparation for childbirth Support systems Coping ability |
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What is the purpose of doing a C section
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to preserve the health of the mother and fetus
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Major Indications for C/Sections
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Dystocia or CPD
Fetal distress Breech presentation Previous cesarean birth |
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What are the risks to the mother with a C section
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i. Aspiration, hemorrhage, infections, injury to bladder/bowel, thrombophlebitis, pulmonary embolism
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