Intrapartum Obgyn Flashcards
(34 cards)
- Uterine contractions regular, before 37 weeks gestation , and associated with cervical changes
- Can result in premature birth
Preterm Labor
Birth types
spontaneous - intact membranes or PPROM
indicated - d/t maternal or OB complications (eclampsia)
Preterm Labor
Risk Factors: multifetal gestation and prior preterm birth
Causes:
1. Maternal or fetal stress trigger HPA axis (maternal substance abuse, short interpregnancy)
2. Decidual-chorioamniontic inflammation/infection
3. Decidual hemorrhage
4. Patho uterine distention
Causes of Preterm Labor
Signs and Symptoms (6)
- Menses like cramps
- Abdominal / pelvic pressure
- Change in vaginal discharge
- Abd pain with or without diarrhea
- Dull low back pain
- Painless contractions
s/s of Preterm Labor
Evaluation of :
US - cervical length, location of placenta
GBS culture, STD culture
Amniocentesis (check for infxn)
Evaluate pre term labor
Management
STOP UC- use of tocolytic therapy and prolong pregnancy for 48 hours (BETHAMETHASONE, or DEXAMETHASONE)
- C/I in : advanced maternal age, vaginal bleed, severely anomalous fetus, severely pre -eclamptic, chorioamnionitis
- MgSO4
- ABX prophlyaxis of GBS or PPROM
Manage of Pre term labor
Preterm 42 weeks
Classify pregnancy
Relates to immediate and extended maternal care after delivery (puerperium)
- From end of L&D through first 6 weeks after delivery
- Postnatal care = neonatal concerns after birth
Post partum care
sensation felt when “baby drops” = time when presenting (lowermost) part of the fetus descends into maternal pelvis
- aka engagement
- 2-3 weeks before labor
lightening - intrapartum care
False UC, NO cervical dilation
Braxton hicks - intrapartum care
increase cervical mucus and or blood-tinged mucus
Bloody Show
Call doc if
- UC q 5 min x 1 hour
- vaginal fluids: sudden gush or continuous leakage
- Vaginal bleeding
- Decreased FM
intrapartum care
PN record review - confirm GA week, day
aware problems/ risk during pregnancy
review lab results
focused maternal hx: UCs, ROM, LOF (leak of fluid), bleeding, decreased FM, focal sx
va: maternal
Abdomen - UCs (mild moderate severe), fetal lie, presentation, position
initial eval for labor
- The relation of the long axis of the fetus to the maternal long axis, longitudinal 99% of time.
- the portion of the fetus lowest in the birth canal, palpated during the exam (most common: head is sharply flexed onto the fetal chest such that the occiput or vertex shows)
- relation of the fetal presenting part to the Right or Left side of the maternal pelvis
- Fetal Lie
- Presentation
- Position
The OCCIPUT-ANTERIOR POSITION is deal for…..
BIRTH!!
- fundal component
- fetal back and extremities
- presenting part/ symphysis
- direction and degree of flexion of head
Leopold Maneuvers - intapartum care
Cervical consistency - soft or firm
- Cervical effacement - shortening of cervical canal = % of thinning
- Cervical dilation= opening of cervix
PE/ vaginal/ digital exam - intrapartum care
Fetal station : fetal presenting part in relation to ischial spines
- Spines separate pelvic inlet from outlet
- -> FETAL PART AT THE SPINES = STAGE 0 (ZEROO)
Intrapartum care - initial eval for labor
Stage 1.
The interval between onset of labor and full dilation of cervix
- Latent phase –> cervical effacement up to 4cm
- Active phase –> cervical effacement starting at 4-5cm to 10 cm
- Transition –> 8-10 cm
Stage 2
Starting from full dilation through delivery of the baby
Stage 3
Starting from delivery of baby through delivery of placenta
Stage 4
Immediate 2 hours after delivery of placenta
Stages of Labor - intrapartum care
Changes of fetal position thru birth canal.
1. Engagement
descent of biparietal diameter into pelvic outlet
- Flexion:
smaller diameter of vertex presents into pelvis - Descend
vertex reaches ischial spine - Internal rotation
Vertex deeper into pelvis (anterior or posterior presentation of head) - Extension
vertex reaches introitus
- Flexed head extends to fit upward curve - External rotation
head rotates to “face forwards” to align with shoulders and pelvic outlet (Restitution) - Expulsion
delivery of body
Mechanisms of labor - Cardinal movements
Management - normal L&D
- Maternal ambulation and position
- -> allow to ambulate or assume any position
- > left lateral position if recumbent
Dorsal Lithotomy position - most commonly used in US for spontaneous vaginal births
intrapartum -care management
why minimize maternal fluids?
give - ice chips /clear fluids , parenteral : IV w/ 1/2 NS or D5 1/2 NS
because d/t decrease GI peristalsis, aspiration can occur during admin of anesthesia
Labor pain
- 1st stage d/t contraction of uterus and dilating cervix
- 2nd stage d/t vagina and perineum stretching; compression of rectum
Maternal analgesia
No pharm - breathing, hypnosis, ball, peanuts, rocking chairs, hydrotherapy
Pharm: NUBAIN, STADOL, MORPHINE, FENTANYL
Regional blocks : anesthetic or narcotic in epidural or subarachnoid space
- combined spinal-epidural = rapid initial relief
Local block - to vagina or perineum (pudendal block)
General anesthesia - IV or inhaled
Maternal analgesia , normal L&D
