Intrapartum Part 1 Flashcards
(79 cards)
1
Q
Intrapartum
A
During labor until a few hrs after delivery
2
Q
Clinical Pelvimetry
A
False pelvis (above pelvic brim) True pelvis represents bony limits of birth canal: most important in childbirth
3
Q
3 subdivisions of true pelvis
A
Bony limits of birth canal:
pelvic inlet
midpelvis
pelvic outlet
4
Q
Pelvic types
A
Gynecoid: prognosis good, best pelvic type for delivery
Anthropoid: good prognosis
5
Q
female bony pelvis
A
four bones: 2 innominate (hip bones) ilium, ischium, pubis sacrum coccyx
6
Q
pelvic floor
A
musculature to overcome force of gravity
pelvic diaphragm
-dilation during pregnancy
-returns after birth
7
Q
Premonitary signs of labor
A
braxton hicks lightening increased vaginal secretions bloody show/ mucous plug energy spurt
8
Q
phone triaging a pt
A
- what is your EDD
2. what time did the membranes rupture
9
Q
True vs. False labor
A
progressive dilation and effacement
10
Q
false labor management
A
pain can be relieved by ambulation, changes of position, resting or hot bath or shower
11
Q
RN responsibilities admission to the birth center
A
therapeutic relationship
imminence of birth
fetal and maternal status
admission assessments
12
Q
ROM
A
ferning
nitrazine paper turns blue if amniotic fluid is present
vaginal pH < 4.5
amniotic fluid pH 7.0-7.5
13
Q
uterus changes during birth
A
contractions
14
Q
Cervical changes during birth
A
effacement
dilation
15
Q
cardiovascular changes during birth
A
check vitals between contractions
remember about positioning
16
Q
respiratory changes during birth
A
hyperventilation
17
Q
GI changes during birth
A
motility decreased
thirst
18
Q
GU changes during birth
A
reduced sensation of full bladder
19
Q
hematopoietic system changes during birth
A
SVD 500 ml, C/S 1000 ml
H/H
WBC increased up to 25000/mm3
increased clotting factors
decreased fibrinolysis
20
Q
psychosocial considerations
A
readiness preconceived ideas about birth birth plan factors associated w/ positive birth support system
21
Q
4 P’s of birth process
A
powers passage passenger psyche the 4 P's are interrelated and must all work together
22
Q
powers
A
physiologic forces of labor- uterine muscular contractions
-frequency & intensity
pushing during second stage of labor
23
Q
passage
A
size of maternal pelvis
type of maternal pelvise
ability of cervix to dilate, efface
ability of vaginal canal to descend
24
Q
Passenger
A
fetal head
fetal lie
fetal attitude
fetal presentation
25
fetal head
overlapping bones- molding
| sutures- allow for molding
26
fetal lie
longitudinal- vertical
| transverse- horizontal
27
fetal attitude
posture of fetus to conform to uterine cavity
| normal attitude: head flexed, chin on chest, arms crossed over chest, legs flexed at knee, thighs on abdomen
28
Fetal presentation
b
29
fetal malpresentation
```
breech (frank, footling, complete)
transverse lie (shoulder presentation)
```
30
Station
presenting part vs. imaginary line between the ischial spines
presenting part moves from negative to positive
31
psyche
```
culture
individual values
education/ support
birthing experiece
impact of technology
pain, fatigue and fear
```
32
Stages of Labor
1. Cervical dilation: 0-10 cm
2. Birth of baby "pushing"
3. placental delivery
4. Recovery
33
1st stage- 1st phase
| cervical dilation
latent phase:
- beginning cervical dilation and effacement
- no evident fetal descent
- contractions increase, mild-regular intensity
- excited, talkative, smiling
34
1st stage-2nd phase
| cervical dilation
active phase
- dilation 4-7 cm
- progressive fetal descent
- contractions increase in freq and intensity
- increased anxiety
35
1st stage- 3rd phase
| cervical dilation
transition phase
-dilation 7-10 cm
progressive fetal descent
-contractions increase in freq and intensity
-woman more likely to withdrawal into self
36
second stage
| "pushing"
```
complete dilation 10 cm
ends with birth of baby
spontaneous birth
positional changes of fetus
"urge to push"
```
37
recommendation time for 2nd stage
2 hrs for mulitparous woman w/ anesthesia and 3 hrs for nullipara w/ anesthesia
-after this time period, c-section is recommended
38
open glottis pushing
grunt without holding breath and bear down spontaneously
| push no more than 8 seconds, no more than 3 times per contraction
39
closed glottis
valsalva manuver
| no longer recommended
40
3rd stage
| "placental"
begins with birth of baby, ends with expulsion of placenta
placental separation
- signs!!
- delivery
- retained (placenta breaks in pieces)
- schultz and duncan mechanisms
41
Uterine Inversion
Medical Emergency
| placenta doesn't detach or is ripped from cervix
42
4th stage
| "recovery"
```
begins with delivery of placenta, ends when mother is stable
1-4 hrs after birth
physiologic readjustment
thirsty and hungry
shaking
bladder is hypotonic
uterus remains contracted
```
43
Amniotomy
Sterile procedure- rupture of membranes
Have ready: amnio-hook, sterile gloves and lubricant, clean chux, blankets, washcloth
when the membranes are rupture the mother feels pain, baby's head is no longer cushioned
44
RN assesments before and after amniotomy
assure the presenting part is engaged prior to procedure to prevent cord prolapse
monitor FHR before and after
monitor color, amount and smell of the fluid
45
Prolapsed cord
medical emergency
| when a cord comes out before the baby
46
Prolapsed cord management
priority is to relieve pressure off the cord
birth by stat C/S unless vag birth is imminent
position hips higher than head
with gloved hand, push fetus upward
give O2
47
RN care during labor
promote placental functioning
-maternal position, IV fluids, relaxation and pain relief
provide comfort measures
-lighting, temp, mouth care, bladder (empty q 2 h)
48
Pain during labor
...
49
Non-pharmacologic pain relief
```
relaxation techniques
visualization
thermal stimulation
focal point
massage
music
```
50
Breathing Techniques
...
51
Pharmacologic pain management
remember any drug taken by the woman is taken by the fetus
| ....
52
Common drugs used in labor
1. Opioids-
2. Adjunctive drugs-
3. Narcotic Antagonists-
53
Labor induction
the chemical or mechanical initiation of uterine contractions
* bishop score is used to assess readiness and predict success of induction augmentation
54
Labor Augmentation
improving the quality of uterine contractions once labor has started
* bishop score is used to assess readiness and predict success of induction augmentation
55
Factors of Bishop Score
```
cervical dilation
cervical effacement
fetal station
cervical consistency
cervical position
```
Max score 13
56
cervical ripening
| Prostaglandin E2
intravaginal insert
left in posterior vagina-slow release
easily removed
57
cervical ripening
| Misoprostol
...
58
contraindications to cervical ripening
...
59
Pitocin
used to induce contractions
| Assess maternal pelvis and fetal position before starting infusion
60
RN responsibilities during induction or augmentation
Observe the uterine response for hyper-stimulation and high resting tone (we don't want these sxs)
observe the fetal response
pain assessment
documentation
61
Monitoring uterine contractions (UC)
palpation
external- tocodynamometer
internal- intrauterine pressure catheter
62
Internal EFM
```
Fetal scalp electrode (FSE)
cervix must be dilated at least 2 cm
membranes ruptured
electrode attached to presenting part
continuous recording
infection risk
```
63
FHR patterns
```
interval between heartbeats (continually monitored)
baseline
variability
accelerations
decelerations
```
64
baseline FHR
```
the rate at which the baby stays while at rest between UCs
mean FHR during 10 min period
rounded to 5 bpm
must be observed for 2 mins
FHR decreases w/ gestational age
```
65
FHR Variability
most important indicator of an adequatley oxygenated fetus
| moderate 6-25 bpm (normal)
66
episodic changes in FHR
not associated w/ uterine contractions
67
periodic changes in FHR
associated w/ uterine contractions
68
FHR Accelerations
a breif temp increase of at least 15 beast above baseline, lasting 15 seconds
usually associated w/ fetal movement, vaginal exams, contractions, fetal scalp stem, etc.
considered a sign of well being
69
FHR decelerations
a periodic decrease in FHR below the baseline
70
FHR early decelerations
normally reassuring, the onset and return of deceleration coincide with the start and end of the contraction
71
FHR variable changes
variable in duration, intensity and timing, not usually concerning UNLESS:
less than 70 bpm
lasts > 60 seconds
slow return to baseline
72
FHR late decelerations
```
immediate interventions:
position change
increase IV fluids
O2 face mask
stop IV Pitocin in infusing
notify MD, CNM
```
73
Guidelines for management: prolonged decelerations
perform vag exam to r/o cord prolapse
maintain maternal position on L side
d/c oxytocin
report findings and document, provide explanation to pt
increase IV fluids
administer tocolytic as ordered
anticipate intervention if FHR previously abnormal, deceleration lasts > 3 min
74
Reassuring FHR patterns
Baseline 110-160
moderate variability
accelerations > 15x15
no concerning decelerations
75
Non reassuring FHR patterns
```
tachycardia
bradycardia
decreased or absent variability
late decelerations
severe variable decelerations
any prolonged decelerations
```
76
RN interventions for non reassuring FHR
1. identify the cause
2. stop or decrease oxytocin infusion per unit policy
3. increase placental perfusion (L side then increase IV fluids)
4. increase maternal O2 sat (face mask, 8-10 L/min)
5. reduce cord compression
6. Call MD
77
what are factors that might cause minimal variabiliy and lack of accels on a FHR?
hypoxia
maternal narcotic admin
magnesium sulfate
CNS abnormalities
78
RN actions for minimal variability and lack of acels on FHR
MAXIMIZE PLACENTAL PERFUSION
lateral position
oxygen
maintain BP
79
testinf to determine abnormal FHR significance
fetal scalp stimulation
vibroacoustic stimulation
fetal oxygen saturation monitor
fetal scalp blood sampling
