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Flashcards in Final Deck (41)
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1

Placental Shearing begins where? Which part detaches last?

begins at caudal part... the upper area detaches last

2

Definition of Labor

- regular uterine contractions that increase in intensity
- progressive cervical effacement
progressive uterine dilation
("false" labor is when is there is no change in cervical dilation)
- delivery

3

Term Pregnancy timeline

37-42 weeks

4

First Stage of labor - Latent Phase:

"early labor"
- bet onset of labor and point at which rate of cervical dilation increases
- slow dilation*
- contractions 5-10 min apart, 30-45 sec*

5

First Stage of labor - Active Phase:

"active labor"
faster rate of dilation
-begins at ~4cm*
- contractions 2-4 min apart, 60 sec; more intense

6

First Stage of labor - "Transition"

mix of cervical dilation and descent of fetus

7

At onset of labor, what hormones are involved?

- PG's
- Progesterone
- Estrogen
- Oxytocin
- Hypothalamic-pituitary-adrenal factors (cortisol, PG's)

8

At onset of labor, what do Prostaglandins do?

soften cervix and help cause contractions

9

At onset of labor, what does Progesterone do?

mb progesterone withdrawal

10

At onset of labor, what does Estrogen do?

up regulates receptors on uterus increasing contractility

11

At onset of labor, what does Oxytocin do?

stimulates uterine contractions - stronger contractions

12

fetal secretion of cortisol does what?

increases placental CRH, corticotropin-releasing hormone which then enhances PG production in placenta and primes uterine myometrium

13

What is the first stage of labor?

interval bet onset of labor and full cervical dilation (10cm)

14

What is the Second Stage of labor?

ave 1-2 hrs
interval bet full cervical dilation and delivery of infant

15

What are cardinal movements?

changes in the position of the fetal head during the passage thru the maternal pelvis:
1. head floating
2. engagement, flexion, descent
3. descent, internal rotation
4. complete rotation, beg extension
5. complete extension
6. restitution (external rotation)
7. delivery of ant. shoulder
8. del. of post. shoulder

16

Definition of Restitution

the spontaneous realignment of the fetal head with the fetal body, after delivery of the head

17

What are the Mechanics of Labor?

1. Power - strength of uterine contractions
2. Passenger - the fetus (presentation, attitude (flex/ext of head), position)
3. Pelvis

18

First Stage of Labor - what should you evaluate?

- cervical status, hx of medical conditions and new disorders, fetal status
- Vitals, Fetal heart rate, Freq. and Duration of contractions
- labs - urine for protein, CBC for hgb

19

Upon cervical exam, what are you looking for?

- ruptured membranes
- dilation
- effacement (%)
- station of fetal head
- status of amniotic membranes, presence of meconium
- fetus presentation and position

20

How often should you monitor vitals?

every 4 hrs if normal
- if abN, 1-2 hrs

21

What 3 things should you monitor during labor?

1. vitals
2. uterine contractions
3. cervix
4. fetal heart rate

22

How often should you monitor the cervix?

cervix exam:
- on admission
- 1-4 hr intervals during 1st stage
- 1 hr intervals during 2nd stage
- when pt feels urge to push
- w any fetal heart rate abN

23

How often should you monitor fetal heart rate? what is a normal rate?

- every 15-60 min during 1st stage
- every 5 min during 2nd
- listen during and after contractions
NORMAL: 110-160 bpm

24

How to augment labor?

- hydration
- calories
- position changes
- acu
- homeo
- herbs
- breast pump
- amniotomy

25

What does an amniotomy do?

artificial rupture of membranes -> release of amniotic fluids
- increases contraction strength
- improve contact of fetal head to cervix
- expose cervix to PGs in amnio fluid

26

All pregnant pts should be screened for what?

Group B beta hemolytic strep
- tx w intrapartum IV penicillin 4 hrs before delivery

27

When is an Episiotomy indicated?

- fetal distress at +4 station
- prolonged crowning
- need for instrumentation

(this is when the vagina is cut)

28

What is the third stage of labor? How long?

interval bet fetal delivery and complete expulsion of placenta
- ave is 5-6 min
- 97% within 30 min
* PPH increases w length

29

benefits of delayed clamping

- higher hgb
- halved rate of anemia
- imp. in babies whose mothers have low ferritin, will be breastfed wo iron supplementation, low birth weight
- if preterm, decrease anemia, lowers risk of necrotizing enterocolitis, less intraventricular hemorrhage

30

what are some positions the woman can be in during labor?

standing, sitting, side-lying, squatting, hands and knees, kneeling

31

What are signs of placental shearing?

- gush of blood
- umbilical cord lengthens
- uterus becomes firmer and globular
- uterus moves upward

32

Tx for retained placenta?

1. angelica
2. homeopathics - pulsatilla, sabina

33

How much is normal blood loss during labor?

250-500ml

34

PPH is blood loss of how much?

500 ml or greater

35

What is uterine atony?

Uterine atony is a loss of tone in the uterine musculature. Normally, contraction of the uterine muscle compresses the vessels and reduces flow. This increases the likelihood of coagulation and prevents bleeds. Thus, lack of uterine muscle contraction can cause an acute hemorrhage.

36

What are some causes of PPH?

- uterine atony
- episiotomy
- vaginal/cervical lacerations
- ruptured or inverted uterus
- retained products of conception
- placenta accreta
- maternal coag defects

37

SSx of PPH

rising fundus
vaginal bleeding
tachycardia before BP drop
shock

38

How to Tx PPH?

1. pharm - oxytocics
2. uterine massage or bimanual pressure
3. IV
4. belladonna, lachesis, sabina, aletri
5. cinnamon/erigeron
- after mother is stable, collonsonia

39

how to deliver in emergency situation

baby crowns: counter pressure, pant, flex head
head delivered: cord around neck? lift over baby’s head
Restitution
Shoulders come out
1st thing to do w baby: warm it up, dry off
If baby is not crying: rub back, KD 1, mouth to mouth
leave cord attached
once you deliver placenta: rub tummy, get clots out

40

What are some abN placenta variations?

- infarcts
- meconium staining
- pale
- dark red
- edema

41

A cause of prolonged labor

cephalopelvic disproportion
(occurs when a baby's head or body is too large to fit through the mother's pelvis. It is believed that true CPD is rare, but many cases of “failure to progress” during labor are given a diagnosis of CPD.)