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OB > L&D, Fetal Monitoring > Flashcards

L&D, Fetal Monitoring Flashcards

1
Q

what are some critical factors in labor?

A
  • birth passage
  • fetus (passenger)
  • relationship b/w the passage and fetus (proportion)
  • physiologic forces of labor (powers)
  • psychological factors (psyche of mother)
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2
Q

vertex presentation

A

occiput presentation; crown of head is presenting first; fetal head is completely flexed and chin is to chest

most common and this is what we want to see!

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3
Q

cephalic presentation

A

head is partially flexed

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4
Q

brow presentation

A

baby’s head is beginning to lift up and the brow/forehead is the presenting parts

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5
Q

facial presentation

A

fetal head hyperextended, babies can come out w/ very bruised faces

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6
Q

fetal sutures

A

membranous spaces between cranial bones

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7
Q

fetal fontanels

A

intersections of cranial sutures; molding

anterior (diamond shape), posterior (triangle shape)

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8
Q

what is the purpose of sutures and fontanels?

A

during vaginal delivery process, sutures can override themselves to make the head a little smaller for the birthing process

as a developing human child and the brain grows, these allow the skull to grow with it

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9
Q

engagement in presenting part to pelvis

A

largest diameter of the presenting part passes through the pelvic inlet (BPD; biparietal diameter)

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10
Q

station in presenting part to pelvis

A

relationship of the presenting part to the ischial spine

ex: - 5 = high up; + 5 = baby’s ready to come out; 0 = at ischial spine

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11
Q

how do we confirm spontaneous ROM?

A

ferning & nitrazine/amnio indicator

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12
Q

ferning

A

obtain fluid, put on slide, dry, and look at microscope = looks like fern plant

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13
Q

nitrazine/amnio indicator

A

exposed to amniotic fluid = turns dark blue/black color = positive ROM, ruling out urine or other vaginal secretions

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14
Q

what is the key to true labor?

A

progressive dilation and effacement

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15
Q

what is pitocin?

A

chemically manufactured oxytocin which is used to augment or induce labor

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16
Q

what does pitocin do?

A

promotes increased uterine tone following delivery = to prevent some bleeding as well

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17
Q

first stage of labor

A

0-10 cm dilated

3 phases

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18
Q

second stage of labor

A

10 cm dilated –> deliver of baby

  • pushing, counting w/ pushes
  • nullipara: lasts 2 hrs
  • multipara: lasts 15 min
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19
Q

third stage of labor

A

expulsion and delivery of placenta

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20
Q

fourth stage of labor

A

first few hours (1-4 hrs) postpartum

  • prime time for breast feeding and bonding
  • drop in BP, increase in pulse d/t blood loss
  • firm fundus and should be measured
  • hypotonic bladder
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21
Q

phases within the first stage of labor

A
  • early/latent phase
  • active phase
  • transition phase
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22
Q

first stage of labor: early/latent phase

A
  • starts with onset of contractions (mild)
  • able to cope w/ pain
  • excited!
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23
Q

first stage of labor: active phase

A
  • contractions intensify
  • anxiety increases
  • 4-7 cm and fetal decent (coming down)
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24
Q

first stage of labor: transition phase

A
  • increasing force and intensity of contractions
  • significant anxiety
  • dilation slows and decent increases

nullipara: lasts < 3 hrs
multipara: lasts < 1 hr

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25
Q

cardinal movements of labor

A
  1. descent
  2. flexion
  3. internal rotation
  4. extension
  5. restitution
  6. external rotation
  7. expulsion
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26
Q

pro of perineal laceration

A

tissue tears where it’s weakest

27
Q

con of perineal laceration

A

may be difficult to repair if it’s jagged, may extend to 4th degree laceration (where tissue b/w vagina and rectal area tears completely), labia, or urethra

28
Q

how can we prevent a perineal laceration?

A

perineal massage (scooping tissue to stretch it out to allow for deliver)/mineral oil

29
Q

what is an episiotomy?

A

lengthening the vaginal opening to allow for delivery by cutting the tissue

30
Q

pro of an episiotomy

A

controlled (don’t risk tearing into rectum, urethra, or labia), repair is cleaner

may have less chance for infection

31
Q

con of episiotomy

A

may be unnecessary

32
Q

what is a retained placenta?

A

placenta that hadn’t been delivered within 30 minutes following delivery of baby

33
Q

pain management in labor

A
  • relaxation techniques
  • narcotics
  • epidural
  • spinal
34
Q

how can nurses be supportive in pain management for a woman in labor?

A
  • massage or counter pressure (using tennis balls into back, use of light touch)
  • breathing
  • meditation
  • focal point
  • sip and chips
  • hygiene
35
Q

what is the most concerning possible side effect of an epidural?

A

hypotension

monitor every 2-3 min then every 15 during epidural

36
Q

criteria for epidural

A
  • pt PLT count must be at least 100,000
  • fluid bolus must be given to decrease change of drop in BP
  • monitor BP
37
Q

why is hypotension concerning when given an epidural?

A

this affects the fetus because there’s less pressure perfusing to the placenta = fetal HR to bottom out = fetus gets less O2 during this time

38
Q

how do we position a patient with an epidural?

A
  • left lateral tilt, pressure of pregnancy off abdominal aorta
  • frequent repositioning to avoid pressure –> epidural works w/ gravity
  • straight cath q2
39
Q

contraindications for epidurals

A
  • PLT < 100,000
  • coagulation disorders/hemorrhage
  • severe spinal abnormalities = makes placement difficult
  • infection or septic
  • uncooperative pt
40
Q

common indications of a c-section

A
  • prior c/s
  • breech presentation
  • failure to progress
  • fetal distress
  • placental complications
41
Q

nursing care following c-section

A
  • encourage mom to breast feed in recovery room w/in 1hr
  • continue to provide emotional support
42
Q

what orders do we expect following c-seciton?

A
  • pitocin to ensure uterus remains firm
  • DVT prophylaxis (ambulate 4 hrs post op)
  • advance diet
  • pain management
43
Q

external fetal monitor

A

toco & EFM on monthers abdomen

44
Q

toco

A

looks for uterine muscle tone, cx strength placed on fundus

only tells us duration of cx

45
Q

EFM

A

place over where baby’s heart would be, graphical representation of cardiac movement

46
Q

what is a drawback of external fetal monitoring?

A

inability to precisely determine how strong cx is

if mother moves or baby moves = may not have accurate reading

47
Q

methods of internal fetal monitoring

A

scalp electrode and IUPC

48
Q

scalp electrode

A

small spiral placed into layer of skin on baby’s scalp

reassurance for accurate HR

49
Q

IUPC (internal uterine pressure catheter)

A
  • determine intensity of uterine cx
  • mmHg muscle tone of uterus is doing
  • resting tone in b/w cx as well as during cx –> how effective cx’s are
50
Q

indications of internal fetal monitoring

A
  • when not getting a good reading w/ external
  • baby must be vertex
51
Q

what’s a major drawback of internal fetal monitoring?

A

risk for infection

52
Q

what are the risks of using internal fetal monitoring?

A
  • AROM
  • uterine perforation –> going through uterus
  • baby may have small mark on scalp
53
Q

how can we accurately determine if a fetus is tachycardic or bradycardic?

A

HR must last > 10 min

54
Q

what does variability indicate?

A

fetal wellbeing, it’s the interaction b/w sympathetic and parasympathetic

55
Q

nursing interventions for non-reassuring variability

A
  • give mom something to wake baby up
  • acoustical stimulator (buzzer) –> lil apparatus on belly to startle baby
56
Q

accelerations in FHR

A

elevation > 15 bpm lasting at least 15 seconds; indicates fetal wellbeing

57
Q

early decelerations in FHR

A
  • “mirror” cx
  • d/t head compression
58
Q

nursing interventions for early decels

A
  • vaginal exam, check mom
  • perhaps progressing and moving along
  • potentially change positions
59
Q

late decelerations in FHR

A
  • start at peak of cx and then resume to baseline
  • non-reassuring!!
  • indicates placental insufficiency
60
Q

what are we most concerned about with late decels?

A

most concerned about the brain, hypoxia

61
Q

nursing interventions for late decels

A

“5 turns”
1. turn pt on left side
2. turn fluids on
3. turn pitocin off
4. turn O2 on
5. turn call light on (for additional assistance!)

62
Q

variable decelerations in FHR

A
  • can happen whenever
  • d/t cord compression
63
Q

nursing interventions for variable decels

A
  • sometimes it’s positional
  • move so there’s not as much pressure
  • continue to monitor
64
Q

prolonged decelerations

A

decel is > 15 bpm and > 2min but < 10 min

OB (8 decks)

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