8/20/13 Lecture Flashcards by Meg Dolohanty

WHat are 3 maternal changes before onset of labor?

Braxton Hicks Contractions
Lightening
Increase cervical &/or Blood-tinged mucus “bloody show”

How well did you know this?

Not at all

Perfectly

What three things are included in the initial evaluation?

Prenatal record review
Vitals signs (maternal and fetal heart tones)
Focused history

How well did you know this?

Not at all

Perfectly

What are the 4 keys things of a focussed history for intrapartum care?

UC’s- how often, how long?
ROM/LOF- how much fluid leaking
VB- vaginal bleeding
Decreased FM (fetal movement)

How well did you know this?

Not at all

Perfectly

What is presentation?

Presenting part of the fetus in maternal pelvis. (usually the occiput)

How well did you know this?

Not at all

Perfectly

What is the most typical positions for a baby to be delivered in?

left occiput transverse

right occiput transverse

How well did you know this?

Not at all

Perfectly

What do you look at on a SVE (sterile vaginal exam)?

Effacement (shortening of the cervical canal)

Dilation

How well did you know this?

Not at all

Perfectly

What is the longest journey in a new mom?

Effacement

How well did you know this?

Not at all

Perfectly

What happens at the same time in a multigravida mom?

cervix effaces and dilates at the same time

How well did you know this?

Not at all

Perfectly

Where is 0 station?

Where baby is at the ischial spines

How well did you know this?

Not at all

Perfectly

What is anything above the spines?

A negative number

How well did you know this?

Not at all

Perfectly

What are the 2 stages of the first stage of labor?

Latent phase

Active phase

How well did you know this?

Not at all

Perfectly

What is the latent phase of the first stage of labor?

Cervical effacement to 4 cm

How well did you know this?

Not at all

Perfectly

What is the active phase of the first stage of labor?

Starts at 4-5 cm to 10 cm

How well did you know this?

Not at all

Perfectly

What is the transition part of active phase?

Where they get to 8 cm to 10 cm

How well did you know this?

Not at all

Perfectly

What is the second stage of labor?

Pushing and birth of the infant

How well did you know this?

Not at all

Perfectly

What is the third stage of labor?

Placenta expulsion

How well did you know this?

Not at all

Perfectly

What is the fourth stage of labor?

Recovery 2 hours after placenta

How well did you know this?

Not at all

Perfectly

What time frame should the placenta come out within?

30 minutes

How well did you know this?

Not at all

Perfectly

What are the 7 mechanisms of labor?

Engagement
Flexion
Descent
Internal rotation
Extension
restitution/ external rotation
explusion

How well did you know this?

Not at all

Perfectly

In order for the baby to descend what must the baby do?

Flex their head

How well did you know this?

Not at all

Perfectly

What is the mechanism of labor for descent beyond pelvic inlet?

Engagement

How well did you know this?

Not at all

Perfectly

What is the mechanism of labor where the small diameter of vertex presents into pelvis?

Flexion

How well did you know this?

Not at all

Perfectly

What is the mechanism of labor where the vertex goes deeper into the pelvis?

Internal rotation

How well did you know this?

Not at all

Perfectly

What is the mechanism of labor where the vertex reaches the introitus?

Extension

How well did you know this?

Not at all

Perfectly

What is the mechanism of labor that occurs after delivery of the head. Rotation of shoulders are aligned with pelvic outlet?

Restitution/ external rotation

What is the mechanism of labor where there is birth of the anterior then posterior shoulder and then rest of the body?

Expulsion

What can occur in supine maternal position?

Supine hypotension | Obstructs venous return

What maternal position allows gravity to facilitate descent?

upright position

What maternal position is where the uterus is off teh vena cava and allows for improved cardiac output and uteroplacental blood flow?

Left lateral position

What is the most common position used in the US for spontaneous vaginal births (NSVD)?

Dorsal lithotomy (tilted to the left)

How is fetal heart rate monitored?

Intermittently by doppler (not as common) | or continuous EFM

What is a doulas?

"female servant" birthing coach helps a women relax and focus

What is a common nonnarcotic analgesia?

``` Nubain Stadol (not as common) ```

Is it better to give morphine or fentanyl for labor?

Fentanyl | morphine has a longer 1/2 life and can lead to respiratory depression in mom and baby

In the first stage where is pain coming from?

Contraction of uterus and dilating cervix

In the second stage where does the pain come from?

Vagina and perineum stretching | compression of rectum

What are the three things you do in the 1st stage of labor?

Serial pelvic exams Observing for ROM (clear, meconium, or blood) Support and encouragement

What is meconium that you are worried about the baby aspirating?

Lentil-like soup

What begins during the 2nd stage of labor?

Pushing

If a women is pushing, which is better- an open glottis or valsalva (holding breath)

Open glottis- more oxygen to baby

What is caput succedaneum?

edema that crosses the suture line

Are episiotomys common?

No, not a common intervention (get more 3rd and 4th degree extension, lacerations)

What is a ritgen maneuver?

Rare intervention | during extension- apply pressure and lifting baby's chin

What are 3 signs of placenta separation? (all of these are reassuring)

uterus rises in the abdomen becomes globular Gush of blood Lengthening of cord

When is there the highest risk of PPH?

within the first hour

What are some uterotonins given? These help the uterus contract?

Oxytocin misoprostol methergine hemabate

What degree laceration is skin, vaginal, subcutaneous, and muscles?

second degree

What degree laceration has anal and rectal spincter

third degree

what degree laceration involves vaginal mucosa, skin of the perineum, small labial and periurethral tear

First degree

What degree is there injury to the rectal mucosa?

fourth degree laceration

what are some maternal reasons for labor induction?

HTN Pre-ecclampsia GDM

What are some fetal reasons for labor induction?

IUGR potterm Oligohydramnios (small amount of amniotic fluid)

What are 3 methods used for induction?

1. ROM or "stripping/sweeping" manipulate amniotic sac 2. Cervical ripening: Cook's catheter or foley bulb;(mechnaically dilates, helps release prostaglandins) misoprostol (potent E2 medication) 3. Oxytocin: incremental dose increases (cervix must first be ripened)

What are the two types of cesarean delivery?

LTCS | Classical Cesarean Section

What is LTCS?

Incision through the thin lower uterine segment allows for subsequent trials of VBAC (most common)

What is a classical cesarean section?

Incision through the thick, muscular upper portion of the uterus, risk of uterine rupture. TOLAC not recommended

Is TOLAC successful?

Usually 60-80% are. will have decreased success with dystocia, ARA (advanced reproductive age), obesity

What are the requirements for TOLAC?

One previous LTCS | 24 hour availability of continuous EFM, OBGYN, anesthesia, and blood bank in case of emergency

What are the three factors involved in normal labor? (Three P's)

Power= UC's Passenger- Fetal factors Passage- Maternal factors

What is the biggest reason for not making progress in labor?

Baby positioning (posterior is harder)

What are some more P's?

``` Preparation Psyche Pain Partner Position ```

For a nulliparous women, if it taken how many hours before reaching 4 cm when is dystocia considered?

Duration of over 20 hours in nulliparous | Duration of greater than 14 hours in multiparous

What is a protracted labor?

Making changes, but very slowly | <1 cm an hour

What is active phase arrest?

Several hours with no change

What is protracted descent?

Women making change with baby coming down, but its slow

What is an amniotomy (AROM)

Artificial rupture of membranes

What is direct traction on the fetal head with forceps or traction to the fetal skull with a vacuum extractor?

Operative delivery

When can you not do VAD?

Under 34 weeks fetal head not in pelvis position of fetal head unknown suspected fetal bone demineralization or bleeding disorder

What are some risks with forceps?

Perineal trauma, hematoma, pelvic floor injury | Fetal brain spine, musculoskeletal, coreeal abrasion

What are some VAD risks?

Minimal compared to forceps | Fetal- hyperbilirubinemia, cephalohematomas, intracranial hemorrhage

what are some risks that can lead to breech presentation?

``` prematurity multiple pregnancy polyhydramnios hydrocephaly anencephaly uterine anomalies and uterine tumors ```

What is the most common breech?

Frank breech (butt first)

wHat is a complete breech?

Sitting almost yoga style

What do you do for external cephalic version (ECV)?

pressure to the mother's abdomen to turn the fetus to vertex

Whom does ECV not work well on?

nulliparous women

What are some risk of ECV?

premature ROM placental abruption cord accident uterine rupture

What are some risks factor for shoulder dystocia?

``` multiparity obesity postterm gestation h/o macrosomic fetus previous h/o shoulder dystocia ```

What is the turtle sign? What does it indicate?

Baby starts to come out then retracts | sign of shoulder dystocia

What is the McRobers manuever, what does it help?

Put legs to ears (as far up as possible) | improve diameter of pelvis, can help should dystocia

What are four manuevers to help with shoulder dystocia?

McRoberts Supra pubic pressure Rotational Zavanelli

What is a maneuver where you have tried to get the baby out, doesn't work. So you push the baby back up then call for a C-section?

Zavanelli

What can happen with shoulder dystocia?

brachial plexus injury (90% resolve)