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28 Cards in this Set
- Front
- Back
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Define "labor"
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BOTH cervical effacement and dilation resulting from REGULAR uterine contractions that occur at least EVERY 5 minutes and LAST 30-60 seconds.
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How do you know if it is "false" labor usually?
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1. Key is contraction patterns (less intense and less regular) and go away when patients lay down
2. No progressive cervical changes 3. More associated with abdominal discomfort |
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Describe the 3 stages of labor...
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1st - from onset till complete dilation and effacement features:
latent phase: early labor active phase: as soon as 4 cm dilation 2nd- complete dilation to birth 3rd- delivery of fetus to expulsion of placenta |
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What type of monitoring needs to occur during the three stages
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1st- monitor every 30 mins for changes
2nd- every 15 mins for changes |
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Is the "show"
What is an abnormal sign? |
- sign of impending labor blood tinged mucous dishcharge from vagina
- labor hrs to days after - IF HEAVY BLEEDING = ABNORMAL |
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What is fetal lie?
What lie is never to be vaginally delivered? |
Long axis of fetus in relation to th mother...
i.e. head down= longitudinal - transverse is never to be vaginally delivered |
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When is it appropriate to admit pt for labor?
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contractions every 3-5 mins for at least 45secs (confirmed on monitor)
- 3-4 cm dilation and 50% effacement of cervix - confirmation of ruptured membranes from fern test - ANY HEAVY BLEEDING! |
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What do you advice pt before they arrive for labor and what is diet/IV status?
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Advice not to eat...
pt is NPO with IV NS and D5 |
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Normal rate of cervical dilation during active phase?
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1 cm/hr and 1.2cm/hr in later labors
- stage one in multiparas is 2-10 hrs compared to 6-18 in primaparas |
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Management of 1st stage of labor?
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Ambulation- may walk until uncomportatible
- Lateral L recumbent- less blockage of vessals |
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How long does 2nd stage last in the following...
a. primapara (and w/epidural) b. multipara |
a. 30 mins- 2hrs and (3hr with epidural)
b. 10 mins- 1 hr (2hr with epidural) |
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What are the 6 cardinal movements of labor?
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1. engagement- widest diameter of baby's head reaches inlet of pelvis
2. flexion 3. Descent 4. Internal rotation 5. extension 6. external rotation (restitution) |
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If presentation is face what do you do?
What are the three main presentations? |
only deliver if face is under pubic bone
3 main presentations (cephalic, breech, and shoulder/hand) |
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how is position of baby defined?
Two Most common positions? |
relation of given portion of the presenting part to the maternal pelvis
a. LOA b. ROA |
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What is "station" and at what station do you see fetal head?
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Used to describe the descent of fetus (distance in cm from ischial spines) during 2nd stage evaluated by measuring the relationship of the boney portion of the fetal head to level of the maternal ischial spine
= +3 when see baby's head |
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What is typical management of stage 2 of labor and what occurs during this stage?
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RN/physician in room, six movements of labor occur, crowing (fetal head at vulva)
- possible episiotomy and delivery occurs |
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At delivery what needs to be done...?
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1. support head and mom's perineum
2. suction mouth first then nose 3. deliver anterior shoulder and then apply downward traction at the head 4. dry and stimulate 5. clamp and cut cord (obtain cord blood specimen) 6. Deliver placenta w/ gentle traction to avoid uterine collapse 7. Repair genital lacerations, assess bleeding and fundal tone |
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Types of perineal lacerations?
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4 degrees
1st- tear of vaginal or perineal skin 2nd- tear extending into the subepithelial tissue of vagina or perineum 3rd tear involving anal sphincter 4th- involves rectal mucosa |
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What if stage three is longer than 20 mins?
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Beware of hemorrhage
- Look for lacerations of cervix, vagina, vulva - look for increased bleeding - inspect placenta - repair episiotomy or lacerations |
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Augmentation vs induction of labor?
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Induction - artificial means of initiating labor
augmentation- artificial stimulation of already started labor |
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When is induction allowed by patient request?
What score do you use for assessing induction? What score is indication of induction? |
If after 39 wks and no labor otherwise must have problem for induction to occur.
- Use bishop score to assess likelihood of successful induction of labor - 8 or higher |
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C/i to induction of labor?
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1. Transverse fetal lie
2. Vasa precia or placenta previa 3. Umbilical cord prolapse 4. Previous transfundal uterine surgery |
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What does the bishop score factor into its rating?
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Cervix
1. position 2. consistency 3. effacement % 4. dilation (cm) Fetal head 1. station |
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Cervical ripening methods
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1. PGE2
2. cytotec (PGE1) 3. Foley Bulb catheter |
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Induction methods using pitocin?
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Synthetic oxytocin causes uterine contractions
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What is the post partum period?
What could occur during this period and when? |
6 wks after delivery
a. post partum blues- first two weeks b. post partum depression after 2 wks c. return of menstration |
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What is ideal epidural?
Why are narcotics dangerous? |
no pain plus maintain movement of extremities (meds dont pass to baby)
- narcs could cause respiratory depression in mom and baby |
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Where is epidural given?
What are A/E |
Lumbar is regional anesthetic given between L2-3, 3-4 or 4-5 and catheter is placed over needle and left in place to provide continuous anesthesia throughout
A/E - Hypotension- give ephedrine - spinal headache- give fluids and caffeine |
