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Leslie CNM > Intrapartum > Flashcards

Intrapartum Flashcards

1
Q

What factors combined cause the onset of labor

A 
Oxytocin, estrogen, progesterone, prostiglandins, CRH, and relaxin
Progesterone withdrawal (increase in E1)
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2
Q

What changes happen in they myometrium to bring on adequate ctrx

A

Myomentirum (smooth muscle) is usually electromagnetical with increasing intracellular Ca through changes in membrane potential or receptor mediated

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3
Q

Neurotransmitted innervations of the uterus

A

sympathetic = alpha adrenergic
parasympathetic = beta adrenergic
all receptors are subject to influences of agonists or antagonists

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4
Q

Alpha adrenergic agonist used to stimulate contractions (3)

A

used to stimulate contractions
Oxytocin/Pitocin
Ergots
Prostiglandins

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5
Q

Beta adrenergic agonists (7)

A 
tocolytics; decrease uterine contractions 
Inhibits myosin/actin and moves Ca out of the cell causing smooth muscle relaxation
ETOH
Mag SO4
Prostaglandin synthesis inhibitors
Beta 2 Adrenergic Drugs (Terbutaline)
Calcium Channel Blockers
Aminophylline
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6
Q

ABCs of Labor Assessment

A 
Amniotic Fluid leakage
Bleeding Vaginally
Contractions
Dysuria
Evidence of Preeclampsia
Fetal movement
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7
Q

Vital signs during labor (4)

A

Temp: slight elevation throughout labor, highest during and after childbirth (rule out infection)
BP: During contx an increase systolic= 15; diastolic = 5-10 mmHg
Pulse and respirations slightly increased

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8
Q

Intermittent monitoring recommendations (8)

A 
30 minutes in first/active stage of labor
5 minutes in 2nd stage
Additional assessment needed for the following
ROM
sudden change in contx pattern
before/after vag exams
before ambulation
any indication of complications.
(listen through contrx)
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9
Q

3 main types of fetal presentation

A

Cephalic (vertex), breech, shoulder (transverse)

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10
Q

Longitudinal lies

A

cephalic (vertex, brow, face)
Breech
Complete=flexion at hips and knees butt presents
Frank = flexion at hips extension at knees; butt presents
Footling = extension at hips and knees; one or both feet presents
Kneeling = extension at hips, flexed knees; knees presents
Transverse/oblique; shoulder presents

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11
Q

Diagnosis of ROM (2)

A

Sterile Spec exam
visualizing pooling in the posterior fornix (most definitive diagnosis)
Nitrazine paper test (pH of amniotic fluid = 7.0-7.5; pH of vagina 4.5-5.5)

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12
Q

Monitoring contractions (manual)

A

Palpation (contx start in fundus and move down toward cervix)
Frequency (begininning of 1 contrx to the beginning of the next)
Intensity (mild, moderate, firm)

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13
Q

Monitoring contractions (electronic)

A

Intensity (in early labor) approx 25mmHg increasing to 50mmHg by the end of labor

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14
Q

IUPC

A

provides only electronic method of mearuing uterine resting tone, intensity/strength of ctrx
in MVU
Contraindicated in HIV

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15
Q

Clinical Labor

A

80-120 MVU, 3 contrx in 10 min, each approx 40 mmHg in intensity

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16
Q

Uterine activity normal/abnormal

A 
normal = 5 or less contx in  10 mins, over 30 min
abnormal = 6 or more in 10 min, over 30 min (tachysystole)
17
Q

Purpose of EFM

A

to determine if the fetus is well oxygenated

18
Q

EFM Baseline:

A

Baseline: rounded to increments of 5bpm during 10 min segment
Normal: 110 to 160 bpm
Brady: < 110bpm
Tachy: >160 bpm

19
Q

EFM Variability

A 
fluctuation in FHR baseline hat are irregular in amplitude and frequency
Absent: Undetectable
Minimal: = to or < 5 bpm
Moderate: 6- 25 bpm
Marked: > 25 bpm
20
Q

EFM Accelerations

A

an abrupt increase of at least 15 bpm above baseline
Onset to peak < 30 secs and duration is = to or > 15 secs and < 2 mins from onset to baseline
Accelerations that are 10 mins or more are considered baseline changes.

21
Q

EFM Decelerations

A

Late: Onset to nadir is = to or > 30 secs. The nadir of decels usually occurs after peak of contraction
Early: Onset to nadir is = to ro > 30 secs and usually occurs at same time of peak of contrx
Variable: an abrupt decrease below the baseline which may or may not be associated with UCs
Prolonged: decreased FHR > 15 bpm lasting at least 2 min but < 10 min. If sustained for 10 min or more is a baseline change.

22
Q

Indications for internal EFM

A 
Inability to monitor externally
Fetal distress
High Risk pregnancy
meconium stained fluid
Contraindicated in HIV
23
Q

Fetal Tachy and causes

A 
FHR >/= 160 bpm x 10 min
Mild: 161-180 bpm
Severe: >180 bpm
Causes:
1. fever
2. infection
3. medications (beta adenergics)
4. chronic fetal hypoxia
5. cardiac prob
24
Q

Fetal brady and causes

A 
FHR < 110 bpm x 10 min
Mild: 100-109 bpm (mostly positional)
Moderate: 80 - 100
Severe: < 80 bpm for 3 min or greater
Causes:
1. anestesia
2. head compressions with posterior positions
3. cord compressions
4. placental insufficiency
5. medications (beta blockers)
6. cardiac probs
7 terminal fetal condition

Leslie CNM (7 decks)

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