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Flashcards in 4. Labor Deck (90):
1

Definition of Labor: Physiologcal

The process of moving the fetus, placenta and membranes out of the uterus and through the birth canal

2

Definition of Labor: Clinical

Progressive contractions resulting in progressive cervical change

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Contractions without change is ____, change (cervical) without contractions is ______.

• Contractions without change is false labor • Change (cervical) without contractions is nothing.

4

Factors affecting Labor (5)

o Passenger (the baby)

o Passageway (the birth canal)

o Powers (contractions)

o Position (Mom’s position)

o Psychological Response (Mom’s psych response)

5

Fetal lie (def):

Relationship between the long axes of the fetal and maternal spines

6

3 categories of fetal lie

• Longitudinal

• Transverse

• Oblique

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Fetal presentation (def)

Refers to the part of the fetus that would / will enter the pelvis first

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3 Presentations

• Cephalic

• Breech

• Shoulder

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Presenting Part (def)

First aspect of the fetus felt on the (vaginal) exam

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How can you feel if the presenting part is the head?

Anterior part of skull has THREE lines. If you reach in to feel the head and feel 3 lines, the baby is face down.

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Fetal Position (def)

Relationship of the denominator of the presenting part to the mother's pelvis. Listed as a 3 letter abbreviation

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Position: What does the 3-letter abbreviation mean?

1) Right / Left

2) Assigned denominator (Presenting Part)

3) Anterior / Posterior / Transverse

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What does "Anterior" mean in terms of positioning?

It means the baby's BACK is facing forward

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What does "Posterior" mean in terms of positioning?

It means the baby's BACK is facing the mom's BACK

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What does "transverse" mean in terms of positioning?

It means the baby's BACK is to the side

16

Fetal Station (def)

The relationship of the presenting part of the baby to the ischeal spines of maternal pelvis

17

How is fetal station measured?

Measured in cm above (-) or cm below (+) the ischeal spines

18

3 / 30 / -1 : MEANING

3 cm dilation

30% effacement

-1 station (just above the ischeal spine)

19

Components of the bony pelvis (7)

- Iliac crest

- Iliac fossa (flat face)

- ASIS (tubercle)

- Ala

- Sacrum

- SI joint

- Pubis

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Basic female pelvis types (4)

- Gynecoid - Android - Anthropoid - Platypelloid

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Gynecoid Pelvis - Incidence - Shape - Prognosis

- 50% of women - Best for childbearing - Circular. "Female shaped pelvis"

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Android Pelvis

- Incidence

- Shape

- Prognosis

- 23% of women

- Not ideal for birth

- Male shaped pelvis (gave your heart to a man)

23

Anthropoid pelvis

- Incidence

- Shape

- Prognosis

- 24% of women

- 2nd best for childbirth

- Vertical oval

24

Platypelloid Pelvis

- Incidence

- Shape

- Prognosis

- 3% of women

- WORST for childbearing

- Horizontal oval

25

What maternal position is good for back labor?

Kneeling and leaning forward with support

26

8 positive positions for labor

- Walking

- Sitting / leaning

- Tailor sitting

- Semirecumbant

- Hands and knees

- Standing

- Squatting

- Kneeling, leaning forward with support

27

4 positions for pushing /birth

- Lithotomy

- Semirecumbant

- Lateral recumbant

- Squatting

28

What are primary powers?

Uterine contractions causing cervical change. Involuntary

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Primary powers cause:

CERVICAL CHANGE. Effacement and dilation

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Effacement:

- Def:

- How measured

- Non-effaced cervix is ____

- Elongation and thinning of the cervix

- Measured as a percentage

- Non effaced cervix: 2cm

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Dilation

- Def:

- How measured

- Def: Opening of the cervis

- Measured in cm (0-10cm)

32

What are secondary powers?

Expulsive (involuntary) uterine contractions in conjunction with voluntary maternal pushing efforts

33

False Labor vs. True Labor: Ctx Quality

FALSE: Inconsistent in frequency, duration and intensity TRUE: Longer, stronger and closer together

34

False Labor vs. True Labor: How ctx change with activity

FALSE:Slow with movement TRUE: Progress with movement

35

False Labor vs. True Labor: Location of ctx

FALSE: Felt in the abdomen and groin

TRUE: Begin in lower back and gradually sweep around to the abdomen

36

False Labor vs. True Labor: Discomfort

FALSE:May be more annoying than truly painful

TRUE: Sometimes persists as back pain; often resembles menstrual cramps during early labor.

37

False Labor vs. True Labor: Cervix

FALSE: Does not significantly change in effacement or dilation

TRUE: Includes progressive effacement and dilation.

38

What is the most important factor that differentiates true labor from false labor?

Cervix undergoes progressive effacement and dilation

39

Six Sxs of impending labor

- Light(e)ning

- Stronger Braxton Hicks

- Mucus Plug

- Bloody Show

- SROM

- GI upset

40

Sxs of impending labor: Lightening

1) “Lightening”: Mom’s “load” is lightened: Baby drops, mom can breathe again.

2) “Lightning”: Electrical, shooting pain is another sign

41

Sxs of impending labor: Braxton Hicks

Braxton Hicks: Painless Contractions. Uterus is “warming up.”

42

Sxs of impending labor: Mucus plug

Drop of plug

43

Sxs of impending labor: Bloody show

Might come along with the mucus plug

44

Sxs of impending labor: SROM

Trickle or gush. Positive firning

45

Sxs of impending labor: GI upset

Vomiting, diarrhea. Body moves bowels to get things moving.

46

How does the mucus plug form?

Excess hormones (esp estrogen) causes excess discharge (Lukarrhea): Forms mucus plug (wine cork)

47

How do you know if substance is amniotic fluid? (Lab)

“Positive firning:” means substance is positive for amniotic fluid.

(Why? Because under a microscope, the fluid looks like little fir trees.)

48

Four stages of labor (summary):

1) 0-10 cm

2) Pushing and birth

3) Placental separation and expulsion

4) Initial PP period

49

Four stages of labor (duration):

1) 14 - 20h

2) 10m - 3 h

3) 5m - 1h

4) 1 - 2h

50

1st stage of labor: Multiparous v Primiparous

• Multiparous = multitasks. Several steps can happen at the same time.

• Primiparous = takes longer.

51

1st stage of labor:

- Onset:

- Conclusion:

Onset: Regular uterine contractions

Conclusion: Full dilation

52

3 phases of 1st stage of labor (list)

- Latent -

Active

- Transition

53

Latent stage of labor:

- cm dilated

- CTX Intensity

- CTX duration

- 0-3 cm dilated

- CTX mild to moderate in Intensity

- CTX last for 30-60 seconds

54

Active stage of labor

- cm dilated

- CTX Intensity

- CTX duration

- 4-7 cm dilated

- CTX moderate to strong in Intensity

- CTX last 60 seconds

55

Transition

- cm dilated

- CTX Intensity

- CTX duration

- 8-10 cm dilated

- CTX INTENSE. Stronger, longer, closer together.

- CTX last 60-90 seconds

56

2nd stage of labor:

Onset:

Conclusion:

- Onset: Full dilation

- Conclusion: Birth of the fetus

57

CARDINAL (8)

- Engagement

- Descent

- Flexion

- Internal Rotation

- Extension

- Restitution

- External Rotation

- Lateral Flexion

58

Describe ENGAGEMENT

Presenting part / widest diameter is at the ischeal spines: 0 station. You're committed!

59

Describe FLEXION

Flexion of the fetal head, allowing the smallest head diameter to align with the smaller diameters of the mid-pelvis as the fetus descends

60

Describe INTERNAL ROTATION

Allows hte largest fetal head diameters to align with the largest maternal pelvic diameters

61

Describe EXTENSION

Extension of the fetal head as the neck pivots on the inner margin of the symphysis pubis, allowing the head to align with the curves of the pelvic outlet

62

Describe RESTITUTION

The shoulders of the fetus enter the pelvis obliquely, and remain like that when the head rotates to the AP diameter through internal rotation

63

Describe EXTERNAL ROTATION

As the shoulders rotate to the AP diameter, the head is turned further to one side. Allows head to align with curves of the pelvic outlet.

64

Describe LATERAL FLEXION

- Baby bends at waist

65

3rd stage of labor

- Onset:

- Conclusion:

- Onset: Birth of newborn

- Conclusion: Birth of placenta

66

When will a HCP do a manual removal of the placenta?

Usually after 1 hour

67

Signs of placental separation (4)

• Change in shape – uterus becomes lobular

• Sudden gush of blood

• Lengthening of cord (appears to lengthen)

• Change in position of uterus

68

Placenta

- Name of maternal side

- Name of fetal side

- Maternal: DUNKIN

- Fetal: SCHULTZ

69

How would a smoker's placenta differ from a non-smoker?

Smokers have larger placentas because it has to grow larger to get enough oxygenation (due to vasoconstriction)

70

What covers the umbilical cord?

WHARTON'S JELLY

71

What happens during the 4th stage of labor?

- Maternal stabilization and homeostasis

72

System Analgesics: Types (4)

* Opioids

* Atarctics

* Barbituates

* Benzos

73

System Analgesics: Risks (3)

* Fetal Depression

* Prolonged Labor

* N / V

74

Opiate antagonist

Narcan

75

What are Atarctics?

Analgesics Potentiators

76

Nerve Block (Neuraxial) Analgesia / Anesthesia: Types (5)

* Local infiltration

* Pudendal block

* Spinal anesthesia

* Epidural block

* General anesthesia

77

Pudendal Block: Indication

Used for sewing up

78

Nerve Block (Neuraxial) Analgesia / Anesthesia: Risks (3)

* Maternal Hypotension

* Fetal bradycardia

* Prolonged labor / 2nd stage

79

What is the difference between analgesia and anesthesia?

• Analgesia: Relief of pain without the total loss of feeling or muscle movement. Lessening of pain.

 

• Anesthesia: Blockage of all feeling, including pain

80

What are Leopold's Maneuvers?

Vaginal exam to determine presentation and position of fetus and to aid in location of fetal heart sounds

81

What labs would you do on admission for L&D?

Dip urine for glucose, protein, ketones

82

What is the name for an artificial rupture of membranes?

Amniotomy

83

What do you note for the ROM?

- Time

- Color

- Odor

- Amount

84

What do you do if there is meconium in the amniotic fluid?

PREPARE SUCTION FOR BIRTH

85

First stage of labor management (5)

- FHR & CTX check Q14-30 m

- BP Q 1-2 h

- T Q4 if membranes intact, Q1-2 if ruptured

- Void Q2h

- Frequent position changes

86

Second stage of labor management (5)

- FHR Q5 minutes or between CTX

- BP Q 5-15 min

- Support and encourage position changes / optimize position

- Room prep

- Document

87

Third stage management (4)

- Vitals Q15

- Palpate fundus til firm

- Pitocin

- Document

88

Perineal Lacerations (4 levels)

1) Perineal skin / vag mucosa

2) Superficial muscles

3) Deep muscle to anal capsule

4) Rectal sphincter

89

Other laceration locations (3):

- Labial

- Urethral

- Cervical

90

Episiotomies (3)

- Midline (MLE)

- Mediolateral (RML, LML)