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Flashcards in L & D Deck (39):
1

Stage 1

Onset of labor to 10 cm dilation
- Longest part of labor
- Time spent in contractions

2

Stage 2

- Full dilation (10 cm) to birth of neonate
- May take hours
- Pushing signals beginning

3

Stage 3

- Birth to delivery of placenta

4

Stage 4

First hour of birth when risk of maternal hemorrhage is greatest

5

Stage 1: Early labor

0-4 cms dilation
- Longer part of stage 1
- Stay at home
- Beginning of contractions
- Eat and drink

6

Stage 1: Active labor

- 4 - 7 cms
- Active contractions 5 min apart 1 min in length
- shorter period of time
- Time to go to hospital
- Changes in ability- mood
- Anesthesia

7

Stage 1: Transition

- 8-10 cms dilation
- transition between contractions and pushing
- Stormy, relentless with early peak
- Short time between contractions

8

Puerperium

Delivery of placenta to 6 wks postpartum
- Involution of uterus
- Changes in lochia (vaginal flow of uterine remnants- rubra, serosa & alba)
- CV changes (diuresis, wt loss, freq urination, sweating)
- Mentration & ovulation
- Psychosocial changes

9

Leopold manuvers

- Assessment of fetal presentation in early labor
- Palpalte fundus to determine postion
- Palpate sides to determine extremities
- Palpate lower abdomen above symphysis
- Pressure on uterus to determine head flexion

10

Cardinal movements

Progression of labor in vertex position
- Engagement
- Flexion
- Descent
- Internal rotation
- Extension
- External rotation

11

Cesarian section

- Major abd surgery
- Requires anesthesia
- Thrombus formation
- Uterine rupture
- Longer post partum recovery: VTE, bowel disruption, pain
- Fetal/ neonatal risks- increased injury & respiratory morbidity

12

Uterine rupture- Eti

- Complete or incomplete
- Separation through thickness of uterine wall including visceral serious (with to without fetal placental unit) or uterine muscle separation
- Due to trauma, obstruction, congenital anomaly, previous surgery

13

Uterine rupture- Sx

- Severe FHR deceleration
- Uterine pain
- Sometimes chest pain
- Loss of station
- No external bleeding

14

Uterine rupture- Risk

- Perinatal death rate high
- Cesarian section (low 3/1000)
- Admin of oxytocin
- Hysterectomy
- Perinatal death

15

Uterine rupture- Tx

- Immediate c-section
- Tx of shock

16

Postpartum hemorrhage- Eti

- Excessive blood loss following vaginal delivery
- > 500ml
- Due to uterine atony (most common),
- obstetric lacerations
- retained placental tissue
- coagulation defects.
- 3rd leading cause of maternal death

17

Postpartum hemorrhage- Sx

- Excessive blood loss immediately or up to 6 weeks postpartum
- Evidence of shock in VS

18

Postpartum hemorrhage- Tx

- Active management of 3rd stage of labor
- Prevention of know issues
- Fundal massage/ bimanual compression for placental delivery
- Administer uterotonic
- Blood transfusion

19

Fetal distress- Eti/ sx

- Variable fetal heart rate
- Persistent drop in fetal HR during contractions

20

Fetal distress- Tx

- Prolonged bradycardia = c-section
- Halt contractions
- Improve maternal hydration & blood flow to fetus

21

Failure to progress- Eti/ sx

- Lack of cervical dilation or descent
- Prolongation of normal labor progression curve
- Due to power, passenger & pelvis

22

Failure to progress- Tx

- Assess contractions, strengthen
- Assess passenger- rotate or change delivery position
- Asses pelvis- c-section if needed

23

Cephalopelvic disproportion- Sx/tx

- Head too large for canal
- C-section

24

Cord prolapse- Eti

- Descent of umbilical cord into lower uterine segment
- Causes compression compromising fetal circulation
- Cord palpable or visible

25

Cord prolapse- Tx

- Knee chest position to keep fetus away from cord
- C-section

26

Abruptio placentae- Eti

- Premature separation of normally implanted placenta
- After 20 wks gestation
- Trauma, HTN, increased parity

27

Abruptio placentae- Sx

- Bleeding from vagina
- Uterine activity
- Fetal HR abn
- Maternal hemodynamic changes

28

Abruptio placentae- Tx

- > 37 weeks, induction of labor
- < 34 weeks- corticosteroids x 48 hrs then induction
- Tx hemodynamic status

29

Placenta previa- Eti

- Leading cause of 3rd trimester bleeding
- Placental implantation adjacent or overlying cervical os

30

Placenta previa- Sx

- Painless vaginal bleeding
- 3rd trimester
- US findings

31

Placenta previa- Tx

- Hemodynamic stabilization
- Delivery if fetal distress or >37 wks
- Stabilization & conservative mgmt (hydration, HR monitoring)
- Corticosteroids

32

Malpresentation- Sx

- Leopold manuvers to dx
- Presentation other than cephalic
- Shoulder, footing, frank (most common)

33

Malpresentation- Tx

- External cephalic version after 36 wks
- C-section if complicated, sign of fetal distress
- Vaginal delivery very complicated

34

Precipitous labor- Eti

- L & D < 3 hrs
- Rate of dilation > 5 cm/ hr

35

Precipitous labor- Tx

- Rarely complications
- Avoid meds that cause additional contractions
- Uterine atony- postpartum hemorrhage

36

Systemic analgesia

- Opioids to relieve pain sx
- SE: N/V/cough suppression, constipation
- Used during first stage of labor

37

General anesthesia

- c-section when regional techniques contraindicated
- coagulopathy, infection, hypovolemia

38

Regional anesthesia

Injection of anesthetic to modulation perception and sensation of pain
- Epidural- establishment of labor
- Caudal block- 2nd stage of labor

39

Psychological support

- Better pain outcome
- Relaxation, breathing & concentration techniques to coach mom through process