Exam 4 Flashcards by Morgan Sowder

Factors factors that affect the process of labor and birth - the 5 P’s

Passenger: Fetus and Placenta
Passageway: Birth canal
Powers: Contractions
Position (of mother)
Psychologic Response

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Frank breach

Legs folded ankles to head

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Single footling breach

One foot sticking out

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Complete breach

Legs crossed, butt first

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Shoulder presentation

Type of breach
Shoulder coming out first

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Fetal lie

How spine of fetus and mother line up

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Longitudinal fetal lie

Most common
Fetus aligned with mother

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Transverse fetal lie

Fetus positioned across mother’s pelvis
Most common early in pregnancy

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Oblique fetal lie

Baby turned sideways
Spine facing laterally

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Vertex presentation

Chin tucked
Type of fetal attitude

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Sinciput presentation

Chin neutral position
Type of fetal attitude

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Brow presentation

Chin up
Type of fetal attitude

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Types of fetal positions

ROA
ROT
ROP
LOP
LOT
LOA
Right/Left
Occipito
Anterior/Posterior/Transverse

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Best fetal positions

ROA and LOA
Facedown

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Fetal station

Measures the decent of the baby
In relation to ischial spine

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x/x/x

dilation/effacement/station
ex. 8/100/0

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Types of bony pelvis’

Gynecoid
Android
Anthropoid
Platypelloid

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Gynecoid

Optimal pelvis type
Round, wide bone structure

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Android

Wedge- or cone-like shape, with a wider top and narrower bottom

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Anthropoid

Narrow, oval-shaped pelvis that’s deeper than it is wide

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Platypelloid

Flat, wide, and shallow pelvis that’s the least common type. It’s more bean-shaped than heart-shaped

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Lower uterine segment

Where contraction occur
Pushes baby down, putting pressure on cervix
Type of soft tissue

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Introitus

Vaginal opening

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Primary powers

Contractions

Secondary powers

Bearing down

What to measure during contractions

Frequency, duration, intensity

Where to measure contraction

From beginning of one to the beginning of the next

How much time is between the dark lines of the fetal monitoring strip

1 minute Each box is 10 seconds

Phases of contractions

Increment: Increasing Acne: Peak Decrement: Decreasing

Signs preceding labor

Lightening - fetal head drops into pelvis Bloody show Losing mucus plug Persistent low back pain Braxton Hick's contractions - no cervical change Wt loss - 1-3lbs, fluid/electrolyte shifting Nesting - surge to prepare for baby

Phases in first stage of labor

Latent: 0-3cm Active: 4-7cm Transition: 8-10cm

First stage of labor

Events preceding full dilation

Second stage of labor

Time from fully dilated to baby coming out

Third stage of labor

Pushing stage

Fourth stage of labor

Delivery of placenta until mom is stable

Things that initiate the onset of labor

Sex Nipple stimulation - releases oxytocin

7 Cardinal movements of mechanisms of labor

Engagement Descent Flexion Internal rotation Extension External rotation (also called Restitution) Expulsion

Normal fetal HR

Monitor during labor 110-160

What factors affect fetal HR

Reduction of blood flow d/t HTN (gestational or chronic), hemorrhage, hypotension, anemia

Factors that alter fetal circulation

Compressed of umblilical cord Fetal head compression Reduction in blood flow to intervillous space of placenta

Ways to monitor fetal HR

Intermittent auscultation - Usually Q30mins, with doppler, fetoscope, fetal monitor ultrasound - Does not detect patterns Electronic fetal monitoring (EFM) - External or internal

What must happen before internal EFM is used

Water broken Dilated 1-2cm Monitors uterine contractions IUPC - Intrauterine pressure catheter FSE - Fetal scalp electrode

Sinusoidal pattern

Sawtooth FHR pattern Not good

When can you determine FHR is brachy or tachy

After 10 minutes

Periodic changes in FHR

Occur in reaction to uterine contractions

Episodic changes in FHR

Not related to uterine contractions

Normal acel for 32+ wk

15x15 acels For at least 15 seconds 1 box up and over

Cause of early decels

Good thing, indicates progression of labor Head compression d/t contractions Peak of contraction should mirror decel (Periodic) More than 30 seconds

Cause of late decels

Poor oxygenation Uterine tachysystole, hypertonus Hypotension Postterm date Maternal diabetes IUGR - small baby Occurs right after contraction (Periodic) More than 30 seconds

Nursing interventions for late decels

Turn patient Oxygen - nonrebreather at 10L Fluid bolus Turn off Pitocin Administer Terbutaline - slow contractions

Cause of variables/variablity

Cord compression Abrupt onset For less than 30 seconds

Nursing intervention for variability

Turn pt Fluids Turn of Pitocin Amnioinfusion: Fluid into uterus, more cushioning Notify HCP

Prolonged decel

Gradual or abrupt At least 15 beats below baseline, more than 2 mins but less than 10 (after 10 min is considered baseline change)

FHR category 1

HR WNL Moderate variability Absent late or variables Early decels present or absent Acels present or absent

FHR category 2

Anything between 1 and 3 No acels after stimulation

FHR category 3

Absent baseline variability Recurrent late decels Recurrent variable decels Bradycardia Sinusoidal pattern

How often to document assessment of pt with epidural vs not

Q15mins Q30mins

When is fetal monitoring required

When receiving Pitocin

Interuterine rescucitation

Top 3 interventions: Turning pt, oxygen, and fluids