Antepartum And Labor And Delivery

Front 1

Stages of Labor

Back 1

Stage 1: Dilation
*Beginning: onset of regular contractions
*End: Complete dilation and effacement
Stage 2: Expulsion
*Beginning: complete dilation and effacement
*End: Birth of baby
-Stage 3: Placenta
*Beginning: Birth of baby
*End: expulsion of placenta
-Stage 4: Physical Recovery
*Beginning: expulsion of placenta
*End: 1-4 hours postpartum

Front 2

Phases of Stage 1: Dilation

Back 2

-Latent
-Active
-Transition

Front 3

Phase 1

Back 3

-Phase 1: Latent
*Cervix: begin - 4cm
*Contraction freq: 10-20 then 5" regular
*Intensity: Mild to mod
*Duration: 30 sec

Front 4

Phase 2

Back 4

-Phase 2: Active
*Cervix: 4 - 7cm
*Contraction freq: 3 - 5"
*Intensity: mod to strong
*Duration: 45sec

Front 5

Phase 3

Back 5

-Phase 2: Transition
*Cervix: 8 - 10cm
*Contraction freq: 2 - 3"
*Intensity: strong
*Duration: 60 - 90 sec

Front 6

Stages of Labor

Back 6

-Dilation (w/3phases)
-Elpulsion
-Placenta
-Physical Recovery

Front 7

Indications of Pregnancy

Back 7

-Presumptive
-Probable
-Positive

Front 8

Presumptive

Back 8

-Amenorrhea
-N&V
-Fatigue
-Urinary frequency
-Cervical color changes
-Brease and skin changes
-Quickening

Front 9

Probable

Back 9

-Abdominal enlargement
-Braxton-Hicks Contractions
-Palpation of fetal outline
-Positive pregnancy test
-hCG: human chorionic Gonadotropin

Front 10

Positive

Back 10

-Auscultation of fetal heart sounds (18-20 wks)
-Doppler 10-12 wks
-Fetoscope 18wks
-Fetal movement
-Visualization of fetus by ultrasound

Front 11

Terms

Back 11

-Hegar's Sign: softening of the uterus
-Goodell's sign: softening of the cervix
-McDonald's sign: Uterus flexed
-Chadwick's sign: color change in the cervix, vagina, and labia (bluish)
-Ballottement: during vaginal exam the cervix is tapped, fetus floats upward and then returns to cervical area

Front 12

Routine Lab Tests for Pregnancy

Back 12

-CBC, UA, BG
-ABO and Rh typing
-Hgb electrophoresis
-VDRL/FTA: syphilis
-Rubella Titer
-TB skin test
-Cervical culture
-Pap
-HIV
-Hep B
-AFP: alpha fetoprotein to detect for fetal anomalies

Front 13

Luteinizing Hormone

Back 13

-Anterior Pituitary Gland
-Target organs: ovaries and testes
-Action: Stimulated final maturation of follicle
-Causes ovulation
-Stimulates transformation of graafin follicle into corpus luteum

Front 14

Follicle Stimulating Hormone

Back 14

-Anterior Pituitary
-Ovaries
-Stimulates production of estrogens, progesterone
-Stimulates growth and maturation of graafin follicles before ovulation

Front 15

Progesterone

Back 15

-Ovary, corpus luteum, placenta
-Acts on uterine and breasts
-Stimulates secretion of endometrial glands, in preperation for possible embryo
-Pregnancy induces growth of cells of fallopian tubes and uterine lining to hourish embryo
-Decreases contraction of uterus
-Prepares breasts for lactation but inhibits prolactin secretion

Front 16

Prolactin

Back 16

-Anterior Pituitary
-Female breasts
-Stimulates secreion of milk
-Sucking of breast by infant stimulates prolactin production
-Estrogen and progesterone from placenta have inhibiting effect on milk production

Front 17

Oxytocin

Back 17

-Posterior Pituitary
-Uterus, female breasts
-Stimulates in uterus contractions during child birth and postpartum contractions to compress uterine vessels and control bleeding
-Stimulates let-down or milk ejection reflex during breast feeding

Front 18

Dip Stick Urine

Back 18

-Protein: for PIH
-Glucose: for Diabetes
-UTI

Front 19

hCG

Back 19

-Used to determine early pregnancies
-Released from the trophoblastic cells

Front 20

Metabolic Changes

Back 20

-Average wht gain is 30lbs
-Caloric needs: 2500 a day
-Protein: 60g per day
-Vitamins: B6, D, E & folic acid

Front 21

Negal's Rule

Back 21

-Subtract 3 months and add 7 days to 1st day of last normal menstral period

Front 22

Umbelical Cord

Back 22

-2 veins
-1 artery

Front 23

GTPAL

Back 23

-Gravida, term, preterm, abortions, and live births

Front 24

Gravida

Back 24

-Number of pregnancies

Front 25

Para

Back 25

-Number of pregnancies that have progressed past 20 weeks

Front 26

Umbilicus Cord

Back 26

-Contains:
*2 arteries
*1 vein

Front 27

PIH

Back 27

-Pregnancy Induced Hypertension
-BP > 140/90 OR > 30 baseline SBP OR > 15 DBP
-S/S:
*seizures
*headaches
*spots in front of eyes
*pariorbital edema
*stroke and other complications

Front 28

Nursing Priorities with PIH

Back 28

-PEACE
-P: promote bedrest
-E: ensure high protein diet
(d/t proteinuria)
-A: antihypertensives drug (Apresoline does not cross placenta barrier)
-C: convulsion (prevent w/Mg sulfate, antidote calcium gluconate)
E: evaluate physical parameter (complications of mg sulfate)

Front 29

Bleeding Conditions

Back 29

-Spontaneous Abortion: termination of the pregnancy prior to 20wks gestation
-Inevitable abortion: vaginal bleeding with cramping, cervical changes and rupture of membranes (not reversible)
-Incomplete abortion: D&C usually needed (<6wks >14wks)
-Habitual abortion: SAB in >3 consecutive pregancies

Front 30

Differential Diagnosis

Back 30

-Ectopic pregnancy
-Implantation bleeding
-Molar pregnancy: hydatidiform mole proliferation of the chorionic villi

Front 31

Placenta Previa

Back 31

-Placenta implants in the lower part of the uterus
-S/S: painless. bleeding, sometimes found by ultrasound
-Types include:
*Total
*Partial
*Marginal
-C-section must be preformed

Front 32

Abruptio Placenta

Back 32

-Seperation of the placenta before delivery
-Can be caused by cocaine use, trauma
-S/S: sometimes vaginal bleeding, abdominal pain, board-like abdomen, uterine tenderness, concealed bleeding, may be noted by pain, fetal distress and shock symptoms in the mother
-DIC: disseminated intravascular coagulation
*may occur as a sequela to abruptio
-C-section required

Front 33

Toxoplasmosis

Back 33

-Protozoan found in cat liter that can cause severe fetal damage

Front 34

Amniocentesis

Back 34

-Aspiration of amniotic fluid for exam
-Usually done at 15-18wks

Front 35

Midtrimester Amniocentesis

Back 35

-To examine fetal cells for any chromosomal abnormalities

Front 36

Third trimester Amniocentesis

Back 36

-Done to determine fetal maturity or to diagnose fetal hemolytic disease

Front 37

Eary Amniocentesis

Back 37

-Usually done between 11-14wks

Front 38

Non Stress Test

Back 38

-To assess fetal well being
-Assess ability of fetal heart to speed up in response to fetal movement
-Requires 30 - 40 minutes
-Response is a good thing

Front 39

Gestational Diabetes vs DM

Back 39

-GD:
*multiple risk factors
*FBG > 140
*Obesity, high birth wght, previous preg. or birth
-DM:
*no oral insulin
*Mom Type 1 is at risk for DKA or SAB
*Pt education for hyper/hypo glycemia

Front 40

Magnesium Sulfate Toxicity

Back 40

-BURP
-B: blood pressure decreased
-U: Urine output decreased
-R: Respirations decreased
-P: Patella reflex absent

Front 41

Danger Signs of Pregnancy

Back 41

-CABS
-C: Chills and fever, cerebral disturbances
-A: Abdominal pain
-B: Blurred vision, blood pressure, bleeding
-S: Swelling, sudden escape of fluid

Front 42

Auscultation of Fetal heart sounds

Back 42

-18-20weeks
-Doppler: 10-12weeks

Front 43

Preterm Labor

Back 43

-Labor that occurs between 20 and 37 weeks of gestation
*may be due to DES exposure which will cause birth defects
-Fetal factors:
*multiple pregnancy
*hydraminos: too much amniotic fluid
*fetal infection
*plecenta previa
*abruptio placenta

Front 44

Tocolysis

Back 44

-Medication to stop labor
-Examples:
*Mag sulfate
*Beta-adrenergic: yutopar
*Prostaglandin synthesis inhibitors
*Calcium channel blockers
-

Front 45

Magnesium Sulfate

Back 45

-6-8mg/dl is effective range

Front 46

Betamethasone

Back 46

-An antenatal corticosteroid
-Used to promote fetal lung maturation

Front 47

Onset of Labor: True

Back 47

-**Cervix progressive effacement and dilation (most important sign)**
-Contractions are consistent and increase in intensity and frequency
-Discomfort in lower back to abdomen
***Contractions start in the fundus and do down the uterus

Front 48

Dilation

Back 48

Cervix progresses from 0-10cm in diameter

Front 49

Effacement

Back 49

The thinning of the cervix

Front 50

S/S of Labor and Delivery

Back 50

-WORLD
-W: wgt loss
-O: observe change in sensations
-R: rupture of membranes (baby should be delivered in 24 hours to prevent infection)
-L: lightening: baby droppin
-D: dilation & effacement
-S: show bloody (mucous plug)

Front 51

Stage 1

Back 51

-Latent phase:
*mild and frequent contractions
*every 5min lasting 30-40"
-Active phase:
*increase in FID (freq. inten. dura.)
*2-5min frequency
*lasting 40-60"
-Transition phase:
*very strong contractions
*1.5-2min frequency
*lasting 60"

Front 52

Hypertonic Contractions

Back 52

-Contractions that
*have 1-2min frequency
*last 90sec
-No time for the uterus to relax and allow blood to flow back to the placenta and fetas

Front 53

Lacerations

Back 53

-1st degree: vaginal mucousa, skin of perineum
-2nd degree: vagina, perineum, fascia muscle
-3rd degree: all perineum, external anal sphincter
-4th degree: all perineum, rectal sphincter, some rectal mucus membrane

Front 54

Morphine

Back 54

-Can be reversed by 0.4mg narcan via IVP

Front 55

Epidural

Back 55

-Can only be give during 2nd phase of labor
-Local: for perineum repair and pudendal block for vaginal/forceps delivery
-Regional:
*Epidural: outside the dura mater
*Intrathecal: into the subarachnoid space
*Spinal: subarchnoid space with loss of motor and sensory function
-General: usually used for life threatening emergencies

Front 56

Anesthesia

Back 56

-REGION
-R: respiratory paralysis
-E: elimination
-G: gastrointestinal
-I: inform of procedure
-O: observe for hypotension
-N: no trauma (prevent trauma to extremeties

Front 57

Mechanics of Labor

Back 57

-4Ps
-Power of uterine contraction
-Passenger: size, lie, presentation, attitude, postion, station
-Passage: pelvic inlet, midcavity and outlet
-Pstchy of mother

Front 58

Active Phase

Back 58

-4-7cm dilated
-Contractions every 3-5min
-Lasting 30-60"
-MAD
-M: medication (can only be given in this phase
-A: assess and anticipate needs
-D: dry lips (ointment) and dry linens

Front 59

Transition Phase

Back 59

-8-10cm dilated
-Contractions every 2-3min
-Lasting 45-90"
-TIRED
-T: Tires (needs support)
-I: Inform of progress
-R: Restless
-E: Encourage and praise
-D: Discomfort (no pain meds)

Front 60

Dysfunctional Labor

Back 60

-Problems with: power, passage, passenger, psyche
-Problems of: presentation, position, effacement, dilatoin, and descent

Front 61

PROM

Back 61

-Prolonged premature rupture of membranes
-Hypovolemic shock???
-Nitrazine or fern test on fluid (will be blue if amniotic fluid is present)

Front 62

Preterm labor

Back 62

> 20th week but < 38th week

Front 63

Prolapse Cord

Back 63

Compression of cord can happen after water breaks

Front 64

Uterine Rupture

Back 64

Hypertonic dysfunction

Front 65

Amniotic fluid embolism

Back 65

-in baby's circulatory system

Front 66

Early Decelerations

Back 66

-Fetal head compression
-Intracranial pressure
-Cause vagus nerve to slow HR
-HR > 100 BPM
-Return to baseline at end of contraction
-Mirror images of contractions
-Are not associated with fetal compromise and require no added interventions

Front 67

Late Decelerations

Back 67

-Decrease in oxygen
-Less water exchange
-Indicates danger d/t uterus/placenta insufficiency
-Variable HR due to stimuli are ok
-Late decelerations are not good
-Begin well after the contraction begins (right shift)
-Return to baseline after contraction ends
-Reflect impaired placenta exchange
-Placenta blood flow and fetal oxygen supply needs to be addressed

Front 68

Variable Decelerations

Back 68

-Shape like a v or flat u
-can occur at any time and may be non-repetitive
-Cause: cord compression
-Nursing care: change position of the mother
-Mother may need oxygen to help the fetus

Front 69

Nursing Intervention for Late Deceleration

Back 69

-COIL
-C: change position (left lateral position)
-O: oxygen (admin oxygen to morther to correct fetal insufficiency, if oxytocin is infusin stop infusion)
-I: IV fluids (will increase the maternal blood pressure and the uteroplacenta circulation)
-L: lower head of bed (to encrease perfusion to uterus)

Front 70

Side Effects of Pitocin

Back 70

-PITOCIN
-P: pressure elevated
-I: intake and output (watch)
-T: Tetanic contractions
-O: Oxygen decrease in fetus
-C: Cardiac arrhythmia
-I: Irregular fetal HR
-N: N&V
-Stop the pitocin drip

Front 71

hCG

Back 71

-Human chorionic gonadotropin
-Causes the corpus luteum to persist and secrete estrogens and progesterone

Front 72

H&H

Back 72

-RBC mass and Plasma volume increases during pregnancy
-The resulting dilution of RBCs (d/t greater and earlier increase in plasma volume) causes a decline in maternal hematocrit
-Hmg: >10.5
-Hct: >33%

Front 73

Nausea and Vomiting Causes

Back 73

-Generally beginning about 6wks after last period
-Believed to be caused by the increased levels of hormones hCG, estrogen..., decreased gastric motility and relative hypoglycemia

Front 74

Rhogam

Back 74

-Admin to women who are Rh- at 28 wks gestation and 72 hours after delivery

Front 75

Chorionic Villus Sampling

Back 75

-Removal of a small sample of chorionic tissue
-Dx for genetic disorders
-9-ll wks optimal time
-Indications:
*family history of genetic abnormalities
*Advanced maternal age
*mother is carrier for x-linked disease
*parents known carriers of autosomal recessive disorders
*History >3 successive SAB

Front 76

Precipitate Labor

Back 76

Labor that lasts <24 hours???

Front 77

Macrosomia

Back 77

Unusually large fetal size, infant birth > 4000g

Front 78

Shoulder Dystocia

Back 78

-Delayed or difficult birth of the fetal shoulders after the head is born

Front 79

Ritodrine

Back 79

-Beta-adrenergic drug
-Yutopar
-S/S: tachycardia (M and F), decreased BP
-May be given: IV, SC, oral

Front 80

Betamethasone

Back 80

-Corticosteroid
-Acceleration of fetal lung maturation
-12mg IM for 2 doses, 24 hours apart
-Up to 34wks

Front 81

Nitrazine Paper

Back 81

-Paper to determine pH
-Helps to determine whether the amniotic sac has ruptured

Front 82

Fern Test

Back 82

-Microscopic appearance of amniotic fluid that resembles fern leaves when the fluid is allowed to dry on slide

Front 83

Fetal Heart Rate

Back 83

110-160 BPM

Front 84

Fetal head engagement

Back 84

-Descent of the widest diameter of the fetal presenting part to at least zero station

Front 85

Fundal Height

Back 85

-22wks roughly when fundus reaches the umbilicus