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76 Cards in this Set
- Front
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Define labor
List the stages and phases of labor describe the cnanges of the 3 stages of labor describe mechs of labor discuss the eval of the labor pt discuss the mangmt of a labor pt in each stage of labor Describe adequate contractions and patterns. Be knowledgeable of medications used in labor. |
objectives
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definition of labor
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cervical dilation with uterine contraction
spontaneous, induced, term or preterm |
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anything after ___ weeks is full term
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38
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changes prior to labor
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1. uterine contractions with no cervical dilation (Braxton Hicks contractions)
2. Lightening = fetal head descends into the pelvis 3. Blood tinged mucous = effacement (thinning of cervix) with extrusion of mucous from the endocervical glands |
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What are the cardinal movements?
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the changes of the position of the fetus as it passes through the birth canal.
"Mechanisms of Labor" |
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What are the 7 mechanisms of labor?
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1. Engagement
2. Descent 3. Flexion 4. Internal Rotation 5. Extension 6. External rotation 7. Expulsion |
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Usual presentation is vertex, where the _______ of the head is in the lower most part with regard to the longitudinal axis of the mother
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occiput
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Pelvic inlet = from the sacral promontory to the ______
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symphysis pubis
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Biparietal diameter = largest part of the ____.
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head
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Engagement – biparietal diameter of the head is below the _____
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pelvic inlet.
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Descent - movement of the fetus downward. Greatest rate occurs during _____
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the latter portions of the 1st and 2nd stage of labor
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What mechanism of labor is the following:
– the fetal head flexed with chin to chest. Allows for the smallest diameters of the fetal head into the pelvis |
Flexion
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What mechanism of labor is the following:
– occiput of the head rotates toward the maternal symphysis pubis or sacrum. |
Internal rotation
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Extension - as the fetal head reaches the ______, it extends to accommodate the upward curve of the birth canal
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introitus
(An opening or entryway, especially the opening into the vagina.) |
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External rotation – after delivery of the head, the head rotates to the shoulders. Also called ______
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restitution
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What mechanism of labor is the following:
– delivery of the fetus. |
Expulsion
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1st stage of labor = onset of labor to _____
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full cervical dilation
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The 1st stage is Further divided by Friedman into phases. Friedman’s curve plots dilation against ______
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time and station
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2 phases (Friedman's) of 1st stage of labor:
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Latent and active
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Latent phase is from ______ cm.
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0 – 3 or 4
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Latent phase May last 20 hrs in a primiparous or ___ hrs in a multiparous. Change of the slope on the curve
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14
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Factors that affect latent phase:(3) ____
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sedation, epidurals , unripe cervix.
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Active phase – also called the ______ phase
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maximal
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Active phase – also called the maximal phase. Rapid change in cervical dilation. From 3-4 cm to ___ cm. Usually about 4-6 hrs. Primips dilates about 1 cm / hr. Multips dilate about 1.5 cm / hr
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10
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Active phase:
Usually about 4-6 hrs. Primips dilates about 1 cm / hr. Multips dilate about ___ cm / hr |
1.5
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2nd stage of labor =
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full dilation to delivery of the baby
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How long does 2nd stage last?
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2 hours usually
May be prolonged due to sedation, epidural, persistent occiput posterior |
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3rd stage of labor =
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immediately after delivery of the baby to delivery of the placenta
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How long does the 3rd stage last?
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May last 30 mins or longer
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Which stage of labor contains most of the mechanisms of labor?
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2nd
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4th stage of labor =
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immediate post partum period to 2 hrs after delivery of placenta
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During which stage of labor is most likely to have complications of post partum hemorrhage or uterine atony during this time
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4th stage
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With what 3 complaints do labor pts come to the hospital?
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1. Uterine contractions
2. Rupture of membranes 3. Bleeding |
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When the labor pt initially comes to the hospital, you should initially evaluate what things?
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Prenatal records – looking for complications, gestational age, labs *GBS* status.
Focused history - nature and frequency of contractions, membranes intact (Fern), bleeding, fetal movement. Limited P.E. – Uterine contractions ; observe and palpate. FHT’s Leopold's maneuvers, Vaginal exam; checking effacement, position, consistency, dilation, station |
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Fern test?
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To see if the membrane is intact
dip a q-tip look on microscope looks like a fern = urate crystals from baby |
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FHT’s?
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140-160
(fetal heart tones) |
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Leopold's maneuvers?
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feel the head to evaluate descention
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What is the word for the level of presenting part in relation to the ischial spines?
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Station =
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Head at what station means the biparietal diameter has negotiated the pelvic inlet.
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0
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How often do you check the vital signs of the 1st stage labor pt?
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q 30 mins
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What do you feed a 1st stage labor pt?
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NPO (except ice)
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What labs do you run on the 1st stage labor pt?
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Labs : CBC, Blood type and screen, U/A (looking for glucose and protein), RPR
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Do you put in an IV in a 1st stage labor pt?
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IV line for hydration and access to the intravascular space
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Do you catheterize the pt?
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Foley if you need it
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How often do you check the vital signs of the 1st stage labor pt?
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q 30 mins
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What do you feed a 1st stage labor pt?
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NPO (except ice)
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What labs do you run on the 1st stage labor pt?
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Labs : CBC, Blood type and screen, U/A (looking for glucose and protein), RPR
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Do you put in an IV in a 1st stage labor pt?
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IV line for hydration and access to the intravascular space
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Do you catheterize the pt?
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Foley if you need it
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What are we forgetting to do for 1st stage labor pt?
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External fetal monitor. Assess fetal tolerance of labor.
Analgesics and/or anesthetics Pelvic exams May perform artificial rupture of membranes, note color of fluid, Monitor contraction pattern |
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What kind of pain meds do you give?
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: Demerol, Stadol, Nubain, Fentanyl, epidural blocks, spinal blocks, pudendal or local blocks.
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You don't want to do too many pelvic exams. Why is that?
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risk of chorioamnionitis
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Adequate pattern is contractions every _____(mins) lasting ____(how long?).
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Adequate pattern is contractions every 2 min lasting 60 sec.
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How can you measure the strength of contractions?
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with internal monitor of adding Montevideo units.
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Need contractions ___ mmHg or 180 MVU to dilate the cervix.
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50-60
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Why note the color of the fluid if you rupture the membrane?
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blood = bad
meconium = suck it out of baby's mouth, etc |
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In the 2nd stage of labor, Begin pushing (____ maneuver) to increase intraabdominal pressure to aid in fetal descent.
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valsalva
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In the 2nd stage of labor, Patient in _____ lithotomy position
a) dorsal b) ventral c) lateral |
dorsal
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_______ if needed to enlarge the vaginal outlet.
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Episiotomy
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delivery of the fetal head should be:
a) Slow and controlled b) Swift and controlled c) Fast and uncontrolled |
Slow and controlled
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What if the baby has a nuchal cord?
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reduce or cut
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Restitute. Shoulders rotate to the what position in pelvis?
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A-P
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Hands on chin and vertex and apply gentle downward pressure to deliver the anterior shoulder. ______ traction to deliver the posterior shoulder.
a) downward b) upward c) lateral d) firm e) light |
Upward
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After expulsion what do you do?
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Suction mouth and nose.
Clamp and cut cord. Baby to warmer. Obtain cord blood. Repair episiotomy and any lacerations |
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3rd stage of labor = delivery of what?
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placenta
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How do you deliver a placenta?
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Suction mouth and nose.
Suprapubic pressure and gentle traction on cord to deliver placenta. |
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Why suprapubic pressure?
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to keep the uterus from inverting
don't use fundus pressure |
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Do not pull on cord. Why?
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Causes inversion of uterus, tear cord
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May take ___ min to deliver.
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30
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Check cord for _____, inspect placenta to check intact
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vessels
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Inspect vaginal canal and cervix, and _____
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rectum
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First 1-2 hrs after delivery is the ___ stage of labor.
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4th
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During 4th stage of labor, Watch for post partum hemorrhage and uterine _____.
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atony
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How often do you check vital signs and fundal and bleeding checks
during 4th stage? |
every 15 min.
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Can you feed the pt during 4th stage?
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Keep NPO and IV access
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Why might the uterus be above the umbilicus after delivery?
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full bladder ... (maybe twins, etc)
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