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4. Labor Flashcards

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1
Q

Definition of Labor: Physiologcal

A

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

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2
Q

Definition of Labor: Clinical

A

Progressive contractions resulting in progressive cervical change

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3
Q

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

A

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

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4
Q

Factors affecting Labor (5)

A

o Passenger (the baby)

o Passageway (the birth canal)

o Powers (contractions)

o Position (Mom’s position)

o Psychological Response (Mom’s psych response)

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5
Q

Fetal lie (def):

A

Relationship between the long axes of the fetal and maternal spines

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6
Q

3 categories of fetal lie

A
  • Longitudinal
  • Transverse
  • Oblique
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7
Q

Fetal presentation (def)

A

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

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8
Q

3 Presentations

A
  • Cephalic
  • Breech
  • Shoulder
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9
Q

Presenting Part (def)

A

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

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10
Q

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

A

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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11
Q

Fetal Position (def)

A

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

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12
Q

Position: What does the 3-letter abbreviation mean?

A

1) Right / Left
2) Assigned denominator (Presenting Part)
3) Anterior / Posterior / Transverse

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13
Q

What does “Anterior” mean in terms of positioning?

A

It means the baby’s BACK is facing forward

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14
Q

What does “Posterior” mean in terms of positioning?

A

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

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15
Q

What does “transverse” mean in terms of positioning?

A

It means the baby’s BACK is to the side

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16
Q

Fetal Station (def)

A

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

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17
Q

How is fetal station measured?

A

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

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18
Q

3 / 30 / -1 : MEANING

A

3 cm dilation

30% effacement

-1 station (just above the ischeal spine)

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19
Q

Components of the bony pelvis (7)

A
  • Iliac crest
  • Iliac fossa (flat face)
  • ASIS (tubercle)
  • Ala
  • Sacrum
  • SI joint
  • Pubis
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20
Q

Basic female pelvis types (4)

A
  • Gynecoid - Android - Anthropoid - Platypelloid
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21
Q

Gynecoid Pelvis - Incidence - Shape - Prognosis

A
  • 50% of women - Best for childbearing - Circular. “Female shaped pelvis”
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22
Q

Android Pelvis

  • Incidence
  • Shape
  • Prognosis
A
  • 23% of women
  • Not ideal for birth
  • Male shaped pelvis (gave your heart to a man)
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23
Q

Anthropoid pelvis

  • Incidence
  • Shape
  • Prognosis
A
  • 24% of women
  • 2nd best for childbirth
  • Vertical oval
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24
Q

Platypelloid Pelvis

  • Incidence
  • Shape
  • Prognosis
A
  • 3% of women
  • WORST for childbearing
  • Horizontal oval
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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
29
Primary powers cause:
CERVICAL CHANGE. Effacement and dilation
30
Effacement: - Def: - How measured - Non-effaced cervix is \_\_\_\_
- Elongation and thinning of the cervix - Measured as a percentage - Non effaced cervix: 2cm
31
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)

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