Repro: Ortmann Labor; Kct & Nsv

Front 1

What are 3 signs that mom's body is preparing for labor?

Back 1

1. Lightning-fetal head settles into pelvis making it easier for mom to breathe.
2. Braxton Hick contractions--false labor. These help w/ initial effacement, softening, & dilation of uterus.
3. Blood show--effacement & early dilation of cervix. Bloody smear w/ mucus indicating mucus is starting to pull away and cervix is starting to dilate

Front 2

If mom has excess of protein in urine, she could be at risk for what?

Back 2

pre-eclampsia

Front 3

When would you not want to do dilation and effacement?

Back 3

w/ known placenta plevia

Front 4

Braxton Hicks contractions occur in which pt of normal labor?

Back 4

latent phase, (during latent phase you also get dilation up to 4 cm)

Front 5

What occurs during the active phase of labor?

Back 5

Dilation of cervix at 4 cm to 10 cm; head descends in 2nd stage;

Front 6

How long does the 1st stage of labor take for a primi? For a multiparous mom? How mast does the cervix dilate?

Back 6

-6-8 hrs primipara; 2-10 hrs for multip; 1.2-1.5 cm/hr.

Front 7

How long does the 2nd stage of labor take for a primi?multip?

Back 7

30min-3hrs; 5-30 min for multipar;

Front 8

What occurs during the 3rd stage of labor? How long does it take? Is it faster for multiparous mom?

Back 8

placenta is delivered, 5-30 min for any mom

Front 9

What do you evaluate during the 1st stage of labor?

Back 9

cervical dilation, effacement, and descent;

Front 10

When does the 2nd stage of labor begin? How is progress measured?

Back 10

AFTER full dilation; descent, flexion, rotation of presenting part.

Front 11

When does the 3rd stage of labor begin?

Back 11

after delivery of baby until placenta is delivered.

Front 12

What is the patient still allowed to do during the 1st stage of labor?

Back 12

she can ambulate, take sips of fluid, and can have minor pain relief.

Front 13

During the 1st stage, what should be monitored on the mom?

Back 13

use external monitor to get VS every hour, fetal heart rate every 15-30 min, and contraction s every 30 minutes--best to watch these continuously.

Front 14

How do you measure the progress of the 2nd stage?

Back 14

descent of baby's head. When baby's head feels ischial spines, you're at the 0 station and then as head continues to descend, you go to +1, +2.

Front 15

What are the components of the mechanism of labor in vertex presentation?

Back 15

engagement (of head) or presenting part, flexion of fetal head--has to flex so vertex (top of head) goes out first, internal rotation (head rotates around b/c it starts in horizontal plane), extension (once head is out, head turns back into same position it started out w/), external rotation & expulsion

Front 16

When does head drop into pelvis to prepare for pregnancy?

Back 16

2 weeks before labor

Front 17

What are the four types of pelvises?

Back 17

1. Gynecoid: nl, most room for delivery
2. Android: heart shaped, normal variation & delivery
3. Platypalloid Flat:creates problems, head comes down sideways since it goes to area of greatest room
4. Anthropod:very narrow pelvis, brow or face presentation, problems in delivery

Front 18

What affects the descent of the baby?

Back 18

forces of labor (how strong uterine contractions are) & thinning of uterine segments (as head descends out, lower uterine segment stretches upwards causing thinning)

Front 19

What is a PLATYPELLOID PELVIS and why is it a problem?

Back 19

"flat pelvis"- inhibits head flexion leading to DEFLEXION which MAY CAUSE FACE OR BROW PRESENTATION

Front 20

WHat factors effects baby's descent out of the uterus

Back 20

• DESCENT IS AFFECTED BY FORCES OF LABOR & THINNING OF LOWER UTERINE SEGMENT- as the head descents down, the lower segment stretched upward thining of the area. PELVIS AND SIZE OF PRESENTING PART PLAY A MAJOR ROLE

Front 21

Why does the baby's head rotate internally while it descents?

Back 21

• INTERNAL ROTATION- USUALLY OCCURS AT MIDPELVIS. ROTATION OCCURS SO THAT SAGITAL SUTURE OCCUPIES A.P. DIAMETER OF PELVIS- the rotation allows the head to occupy the larges AP diameter of the pelvis

Front 22

Whats is Erbs palsy and when can it occur and what can it cause?

Back 22

Damage to Brachial plexus. Occurs during delivery of the shoulders. . If you pull downward on the head you can damage the brachial plexus and the infant will have a floppy arms.

Front 23

Normaly blood even after delivery blood is infulsed from the placenta to the baby. Why do you this process to be as short as possible

Back 23

the normal delivery you don’t want this process to go on for too long b.c it wont be able to get rid og products of break down of RBC and baby turns yellow. You want to clamp the cord as soon as the delivery happens. DELAYED CLAMPING OF CORD CAN RESULT IN HYPERBILIRBINEMIA. CLAMP CORD & PLACE INFANT ON MOTHER’S ABDOMEN, CORD CAN THEN BE CUT.

Front 24

When is the ideal time to inspect the vagina post-partum

Back 24

• 3RD STAGE OF LABOR- AFTER DELIVERY INSPECT CERVIX & VAGINA, MAKE REPAIRS,- after delivery until the delivery of the placenta. Ideas time to inspect the vagina, repair any episiotomy etc. Reason you want to do it now is b.c there is very little bleeding b.c the placenta is still in there

Front 25

How long does it take placenta to seperate after the baby had been delivered?

Back 25

2-10 min

Front 26

What are the 4 sings of Placental seperation?

Back 26

1. FRESH SHOW OF BLOOD- gush of blood
2. LENGTHNING OF CORD
3. FUNDUS RIZES UP
4. UTERUS BECOMES FIRM& GLOBULAR

Front 27

How do you prevent excessive bleeding post partum

Back 27

Uterine Massage and IV oxytocin

Front 28

What are three disorders of labor?

Back 28

• PROLONGED LATENT PHASE
• PROTRACTION DISORDERS
• ARREST DISORDERS

Front 29

What are some causes of Prolong laten phase disorder?

Back 29

CAUSES INCLUDE;
-SEDATION (#1)- labor fades away,
-CONDUCTION ANESTHESIA BEFORE ACTIVE PHASE STARTS- you can cause a prolong latent phase b/c the contraction will fade away,
-UNFAVORABLE CERVIX AT START OF LABOR- if its is thick and barely dilated  it will take a long time for it to get ready,
- UTERINE DYSFUNCTION- monitor contraction  if the pt gets a strong contraction and then dosen’t get one leads to utering dysfunction, AND
-RELATIVE CEPHALOPELVIC DISPROPORTION- too big for delivery, rest and sedation and hydration is a way to deal with it.

Front 30

How do we define laten phase

Back 30

LATENT PHASE STARTS WITH ONSET OF CONTRACTIONS & ENDS WITH START OF THE ACTIVE PHASE OF CERVICAL DILATION- time dilation starts

Front 31

How do you mamange prolong laten phase disorder

Back 31

• MOST PATIENTS WILL RESPOND TO REST AND HYDRATION, CAN ALSO USE ACTIVE MANAGEMENT OF LABOR – titrating a dilute dose of oxytocin and pt will progress

Front 32

What are Protraction disorders

Back 32

• PROTRACTED DILATION IN ACTIVE PHASE, LESS THAN 1.2CM/HR IN NULLIP & LESS THAN 1.5 CM/HR IN MULTIPS

Front 33

What are some caused of Protraction disorders

Back 33

-CAUSES; 1/3 DUE TO CPD (CEPHALOPELVIC DISPROPORTION)- the smallest part is not what is coming down,
-THE REMAINDER CAUSED BY MALPOSITION OF FETAL HEAD,
-IMPROPER CONDUCTION ANESTHESIA- anesthesia- gone too high that it takes away all the urge for the pt to push or feel anything, -EXCESSIVE SEDATION- causes same problem- no urge to push, -PELVIC TUMORS- eg fibroid tumors will grow during pregnancy, if one is sitting next to cervix, it will impede labor

Front 34

How do you treat protraction disorders?

Back 34

• TREATMENT DEPENDS ON PRESENCE OR ABSENCE OF CPD (CEPHALOPELVIC DISPROPORTION)- c-section is the only answer because giving this pt oxytocin will not help with the delivery, ADEQUACY OF UTERINE CONTRACTIONS & FETAL STATUS in absence of CPD- can aid with using Oxytocin
• Monitor pt very closely

Front 35

What kind of dilvery can a CPD pts have?

Back 35

Only C-section

Front 36

What are arrest disorders?

Back 36

• ARREST DISORDERS- 2ND ARREST OF DILATION- NO CHANGE in dilation or descent IN 2 HRS IN ACTIVE PHASE; NO DESCENT FOR 1 HR OR MORE  indicate and Arrest

Front 37

How do we diagnose arrest disorders?

Back 37

– Diagnosed by doing a vaginal exam- notice no change in active phase

Front 38

What are some causes of arrest disorders

Back 38

•CAUSES- 50% OR MORE DUE TO CPD. IF ADEQUATE CONTRACTIONS PRESENT with good frequency and strength and no descent, it tells you that its likely due to CPD
•Others are DUE TO MALPRESENTATION, ANESTHESIA OR SEDATION

Front 39

How do you treat arrest disorders

Back 39

• TX- RE-EVAL PELVIS, FETAL WT- , USE OXYTOCIN IF CONT. INADEQUATE
• IF everything is ADEQUATE- then you can use oxytocin to push the baby down

Front 40

What are precipitate labor disorders

Back 40

• PRECIPITATE LABOR DISORDERS - DEFINED AS DELIVERY LESS THAN 3 HRS FROM ONSET OF LABOR.

Front 41

What are some causes of precipitate labor disorders

Back 41

•CAN BE RESULT OF VERY STRONG CONTRACTIONS OR VERY LOW RESISTANCE OF BIRTH CANAL
•STRONG CONTRACTIONS MAY BE DUE TO OXYTOCIN – stop immediately, the contraction will fade in ~5 min OR PLACENTAL ABRUPTION- most of the time it is partial placental – large blood clot behind, acting like and irretant causing placenta to contract to expel it

Front 42

What are some effects of Fast delivery?

Back 42

•EFFECTS – MATERNAL- IF INADEQUATE DILATION –CERVICAL& VAGINAL LACERATIONS COMMON,
•POSSIBLE UTERINE RUPTURE- if cervix is not dilated completely,
•POST PARTUM HEMORRHAGE RISK INCR.- the faster the delivery the greater the risk.
•EFFECTS- FETAL-a) INCR. MORTALITY & MORBIDITY DUE TO DECREASED OXYGENATION, b) BRACHIAL PLEXUS INJURIES IN 1/3 OF CASES, c) sometime no one is around if the pt delivers to quickly the baby fall on the floor

Front 43

What kind of treatments can you give to slow down labor?

Back 43

• TREATMENT- STOP OXYTOCIN, CONSIDER TOCOLYTIC AGENTS IE, TERBUTALINE OR RITODRINE- they sometime work by slowing down contraction but they wont be all that helpful. These are Beta-mimetic- thing used to help stop uterine contractions