L & D Flashcards by Melissa Ring

What is labor

Painful, repetitive uterine contractions causing cervical effacement and dilation

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What properties make up ‘true labor’

Regular contractions
interval decreases
walking makes worse
abdomen / back pain
mild sedation has no effect

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What properties make up ‘false labor’

irregular contractions
interval remains the same
walking helps
abdominal cramping
mild sedation helps

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If group B strep is present and the mom is not allergic, how do you treat them

pen G for at least 2 doses 4hrs apart until delivery

*IV cefazolin if allergic

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How do you assess fetal wellbeing

Fetal heart rate
presentation/position/attitude
Size

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What is the goal of fetal wellbeing assessments during labor

to maintain optimal oxygenation to the brain

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How do you monitor the fetus during labor

external and internal methods

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What is an internal method of monitoring the fetus

fetal scalp electrode

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What is an external method of monitoring the fetus

Intermitten auscultation
continuous electronic monitoring

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What is the purpose of electronic fetal monitoring

to continuously record heartbeat of fetus and contractions of the uterus through labor

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how is an internal electric fetal monitoring preformed

an intrauterine pressure catheter

less effected by birthing person/fetal movement

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What is the upper tracing on the fetal monitoring screen

Fetal heart rate

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What is the lower tracing on fetal monitoring

contractions

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What does the fetal heart rate tell us

Whether or not its safe to continue labor if no other problems are present

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What things may effect the fetal heart rate during labor

Fetal conditions
tests done during labor
birthing person condition
medication in labor
uterine contractions
pushing
*doesnt mean something is wrong

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What are the 5 components of fetal heart rate tracing

baseline
variability
accelerations
deceleration
changes/trends over time

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What is a normal fetal heart rate

110-160 bpm

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What is a moderate beat to beat variability

amplitude of 6-25 over a 10-20 minute period

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What is beat to beat variability a measure of

fetal pH

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What are early decelerations associated with

head compression

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What are variable decelerations associated with

cord compression

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What are accelerations associated with

oxygenation

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What are late decelerations associated with

placental insufficiency

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What is the most common form of deceleration

Variable (cord compression)

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What do the presence of accelerations predict

Absence of metabolic anemia at the time of observation

How are uterine contractions measured

the number of contraction occurring in 10 minutes, averaged over 30 minutes

What is tachysystole contractions

>5 contractions in 10 minutes over 30 minutes

What is normal uterine activity

<5 contractions in 10 minutes averaged over 30

How is contraction strength measured

by Montevideo units *the sum of intensity of each contraction in 10 minutes

What indicated accurate uterine activity

a contraction pattern that generates >200MVUs

What are the 3 Ps of labor

passenger power passage

What is felt on the first Leopold maneuver

Determines shape and consistency of the fundus and if fetal part is head or butt

What are the descriptors used to describe the passenger

Lie (how are they in relation to mom) Presenting part (Breech, shoulder, etc) position attitude (How high in the birth canal)

What is the second Leopold maneuver

Determines where the back is

What is the third Leopold maneuver used for

identifies presenting part and its mobility

What is the fourth Leopold maneuver

Determines fetal attitude and degree of extension into pelvis

What determines the babies position

Where the back is on mom

What is the normal presenting part in delivery

Facing backwards, head first

What is the cord presentation

umbilical cord falls between present part and crevice with or without membrane rupture

What is a cord prolapse

umbilical cord falls through cervic next to or before presenting part WITH membrane rupture *STAT C-section

What are the 3 configurations of breech presentations

Frank complete footling

What are some risk factors for breech presentations

Gestational age before term hydramnios multiple fetuses hydrocephaly pelvic tumor uterine anomalies placenta previa

what is placenta previa

When the placenta is low in the uterus and blocks some of the cervical opening

What is fetal station

Station refers to how far down fetal head is in pelvis

What is considered the 'zero station'

Geometric plane that extends through ischial spine up to the pubic bone (mid-pelvis)

What is placenta accreta

When the placenta grows too deeply into the uterine wall and cannot be separated

What properties make up a GOOD contraction

covers entire uterus all parts reach peak at same time intrauterine pressure 55-60 frequency every 2-4min Complete relaxation between

What is cervical effacement

Thinning of cervix

What is cervical dilation

Enlargement of cervical opening

When does effacement occur in first time births

before dilation

When does effacement occur in experienced mothers

After dilation

What is Bishops score used for

Determine favorability / ripening of cervix in vaginal examination

What does it mean is the Bishop score is <6

Cervical ripening is needed before labor induction

How can you 'ripen' the cervix

Balloon Osmotic amniotomy prostaglandins

What is cervical ripening

collagen chains fracture, more hydrophilic glycosaminoglycans, increased H2O

What occurs in the first stage of labor

From beginning of labor until full cervical dilation

What occurs in stage 2 of labor

From full dilation ends with delivery of baby

What occurs in stage 3 of labor

from delivery of baby ends with delivery of placenta and membranes

What is the 4th stage of labor

Recovery period after delivery of placenta uterus contracts and regains

What occurs in the prodrome of labor

Passing mucous plug lightening (dropping into pelvis) Cervical ripening

What are the cardinal movements of labor

Engagement Descent Flexion Internal rotation extension external rotation expulsion

What are the signs of the third stage of labor

Gush of blood cord appears to lengthen uterus is globular uterus rises anteriorly

What are the 2 methods for managing the 3rd stage of labor

Active: admin oxytocin, apply fundal pressure, controlled umbilical traction Expectant: Spontaneous placenta expulsion

What is uterine involution

Fundus is about the size of a grapefruit immediately rises to umbilicus for about 12 hours drops 1cm each day for 10 days until back in pelvis

When do mothers have their post partum visit

Between 21 and 56 days post delivery

What conditions require Cesarean section or expedited delivery

Fetal distress birthing person distress arrest of dilation arrest of descent placenta previa malpresentation