Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NURS3038 - Maternal Care > Intrapartum Care > Flashcards

Intrapartum Care Flashcards

1
Q

Stages of Labour

A
  1. The onset of regular contractions (increasing in length and frequency) to full dilation of the cervix (10cm); process of cervix softening, opening and thinning out.
  2. Full dilation of the cervix to delivery of the neonate; process of pushing the foetus out of the birth canal.
  3. Birth of infant to delivery of placenta; process of gentle uterine contractions to loosen and push out placenta and to stop bleeding.
  4. Delivery of placenta and control of bleeding until 1hour post-birth.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Stage 1
Signs & Symptoms (6)

A
  1. Discomfort progressing to pain (incl. lower-back pain)
  2. Lightening – movement of infant in maternal pelvis
  3. Braxton Hicks contractions – intermittent period-like cramps
  4. Bloody show – blood-stained discharge of mucous (operculum)
  5. Waters breaking – spontaneous rupture of amniotic membrane; clear-pink water.
  6. GIT discomfort - nausea/vomiting and/or diarrhoea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Stage 1
Duration & Factors

A

Approx. 12-14 hours (primigravida) or 6-10 hours (multigravida).
Factors:
1. Passenger – foetal size, position and HR pattern.
2. Power – strength, frequency and duration of contractions,
3. Passage – pelvic anatomy and measurements.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Stage 1
Stages

A
  1. Latent - cervix dilates to 3cm; contractions are mild and irregular.
  2. Active (est. labour) - cervix dilates 7-8 cm; contractions become stronger, more regular and more painful (approx. 30-60sec/3-4min)
  3. Transition - cervix dilates to 10cm; continuous painful contractions and rectal pressure.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Stage 1
Speeding-up Labour

A

A. Artificial rupture of membranes
B. Oxytocin infusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Stage 1
When to transfer to hospital?

A
  1. Contractions <3-5min apart
  2. Waters break
  3. Bright red bloody discharge
  4. Spontaneous labour if planned c-section
  5. Changes in foetal movement pattern
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Stage 1
Midwifery Care (9)

A
  1. Maternal observations
  2. Foetal observations
  3. Encourage upright/active movement
  4. Pain-relief
  5. Psychosocial support
  6. Nutrition and hydration
  7. Education
  8. Involve support person
  9. Review birth plan
  10. Encourage 2-3hrly voiding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Non-Pharmacologic Pain Relief

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pharmacologic Pain Relief

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Stage 1
Initial Assessment (10)

A
  1. Emotional/psychological state
  2. Foetal movements in past 24hrs
  3. Vaginal losses - colour, volume, odour, blood.
  4. Contractions - time of onset, frequency, strength, duration, resting tone.
  5. Pregnancy care record - parity/gestation, antenatal events/complications, PMHx.
  6. Maternal vital signs
  7. Urinalysis - ketones, flucose, protein.
  8. Palpate abdomen - foetal size, foetal presentation/position, symphyseal-fundal height.
  9. Foetal heart rate
  10. Vaginal examination - cervical dilation.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Stage 1
Signs of Progress

A
  1. Cervical dilatation
  2. Cervical effacement
  3. Descent of the presenting part (confirmed by abdominal or vaginal examination)
  4. Increasing strength and duration of contractions.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Stage 1
Maternal Observations

A

Every 30min:
1. Palpate uterine activity and contractions
2. HR
3. Vaginal losses
Every 4hours (or as indicated)
1. Vital signs
2. Vaginal examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Stage 1
Foetal Observations

A

A) CTG only if indicated - e.g. prolonged labour, maternal fever, abnormal foetal HR, bleeding; OR
B) Intermittent auscultation toward end of contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Stage 2
Foetal Observations

A

A) CTG ; OR
B) Not actively pushing - 15min; OR
C) Active pushing - 5min or post-contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Stage 2
Maternal Observations

A
  1. HR - 15min
  2. Palpate uterine activity and contractions - 30min
  3. Vital signs - 60min
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Urinary Catheterisation (in/out)
Indications

A

Pregnant woman:
1. Has not passed urine for 2-3 hours
2. Has difficulty passing urine
3. Has a palpable bladder

17
Q

Stage 2
Perineal Care

A
18
Q

Stage 2
Directed Pushing

A
19
Q

Stage 2
Self-directed Pushing

A
20
Q

Stage 2
Birth & Hands-on Technique

A
  1. Call for second-clinician
  2. Support perineum
  3. Apply gentle counter-pressure on foetal head
  4. Apply gentle traction to release anterior shoulder (if required) and allow posterior shoulder to be released
  5. Place baby skin-to-skin with mother immediately post-birth
  6. Delayed cord clamping (>1min)
21
Q

Stage 2
Episiotomy - Indications

A
  1. First vaginal birth requiring forceps/ventouse
  2. Suspected or confirmed fetal compromise
  3. Delayed second stage
  4. A severe perineal tear is judged to be imminent (‘button-holing’, significant blanching).
22
Q

Assisted Birth
Definition & Indications

A

The use of instruments to assist in delivery of foetus.
Indications:
- failure to progress
- maternal exhaustion in 2nd stage,
- foetal distress
- awkward positioning of infant
- vaginal delivery of premature infant.

23
Q

Assisted Birth
Methods

A

A. Ventouse – vacuum cap attached to infant’s head by suction; clinician assists to deliver infant during maternal contraction/pushing.
B. Forceps – positioning of forceps around infant’s head; clinician gently pulls to assist delivery; may be specially designed to turn the infant to particular sides.
*Administration of local anaesthetic to perineum/vagina +/- episiotomy

24
Q

Induction
Definition & Indications

A

Assisting commencement of labour using artificial methods.
Indications
- Maternal hypertension
- Pre-eclampsia
- Miscarriage
- Enlarged foetus
- Cephalon-pelvic disproportion
- Diabetes.
- Intra-uterine growth restriction
- Mild foetal distress
- Foetal post-maturity.

25
Q

Induction
Methods

A
  1. Prostin E2 (prostaglandin) – administered as pessary or gel to ripen cervix; requires careful monitoring of mother and infant.
  2. Balloon catheter – inserted into cervix and inflated with water to apply pressure; left in situ for approx. 12hours.
  3. Artificial rupture of membranes – use of amnihook/amnicot to break membranes per vagina.
  4. Synoticinon IV infusion – stimulates uterine contractions; requires careful dosing and monitoring; midwife increases dose every 30min until labour commenced; foetal heart rate monitored via CTG.
26
Q

Stage 3
Active Management

A

Complete within 30min of birth:
1. Administer uterotonic agent - 10iu IM/IV oxytocin
2. Cut umbilical cord once pulsations cease
3. Perform controlled cord traction WITH conter-pressure to uterus (guarding)
4. Post-delivery check fundus for uterine tone and perform fundal massage if active bleeding
5. Monitor blood loss
*Recommended method

27
Q

Stage 3
Physiological Management

A

Completed within 60min of birth:
1. Leave cord intact until pulsation ceased and/or placenta birthed
2. Encourage skin-to-skin and breast-feeding
3. Encourage upright maternal position
4. Monitor signs of separation

28
Q

Stage 4
Placental Examination

A
  1. Completeness and deviation from normal
29
Q

Stage 4
Maternal Care (9)

A
  1. Uninterrupted skin-to-skin contact for min 1hr
  2. Encourage breast-feeding and educate about secure attachment
  3. Ensure warmth and comfort
  4. Encourage food, fluids and rest
  5. Assess emotional/psychological response to labour/birth
  6. Encourage presence of support person
  7. Regular maternal observations
  8. Perineal care
  9. Bladder care
30
Q

Stage 4
Postpartum Maternal Observations

A

Immediately post-birth and 15min for 1hour:
1. Vital signs
2. Uterus tone and height (firm and central
3. Blood loss
Immediately post-birth and 1hr
1. Perineum
2. Pain/discomfort

31
Q

Stage 4
Neonatal Care

A
  1. Clean and dry infant
  2. APGAR score - 1 and 5min.
  3. Uninterrupted skin-to-skin contact for first hour (thermoregulation)
  4. Explain importance of positioning for patent airway
  5. Observe and support initial feed
  6. Weight, height and head circumference
  7. Administer Vitamin K (Konakion)
  8. Administer HepB vaccine
32
Q

Stage 3
Signs of Separation

A
  1. Uterus rises in the abdomen
  2. Uterus becomes firmer.
  3. A trickle or gush of blood from the vagina
  4. Lengthening of the cord
  5. Cord does not retract with supra-pubic pressure.

NURS3038 - Maternal Care (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions