Labor and Delivery (1) Flashcards
(126 cards)
1
Q
what is the birth passage?
A
from uterus through cervix into vagina
2
Q
what are physiologic forces of labor
A
contractions
3
Q
what is cephalic presentation?
A
head first
4
Q
what is breech presentation?
A
butt first
5
Q
what are the types of cephalic presentation?
A
vertex!!
cinisput??, brow, facial
6
Q
what type of presentation is where you can see the face coming out?
A
occiput posterior
7
Q
what is the most common/ideal presentation?
A
right occiput anterior (head to the right of pelvis and forward)
8
Q
what is frank breech?
A
butt first
9
Q
what is footling breech?
A
a foot coming out
10
Q
what is transverse presentation
A
sideways, shoulder first
11
Q
is flexed or extended preffered?
A
flexed inward
12
Q
what are the 3 major parts of the fetal head?
A
face, base of skull, vault
13
Q
describe the fusion of the face, base of skull, and vault
A
-face: bones well fused
-base of skull: 2 temporal bones well fused
-vault: NOT FUSED, held by sutures
14
Q
what are the membranous spaces between cranial bones
A
sutures
15
Q
what are the intersections of cranial sutures
A
fontanels
16
Q
the anterior fontanel is ____ shaped and the posterior is _____ shaped
A
diamond, triangle
17
Q
what is the ideal shape of the maternal pelvis?
A
gynecoid
18
Q
what is the gradual thinning, shoertening, and drawing up of the cervix measured in percents from 0-100
A
effacement
19
Q
what is the gradual opening of the cervix measures in cm from 0-10
A
dilation
20
Q
what is dilation caused by?
A
fetal axis pressure (uterus contracts, pushes fetus down)
21
Q
what is complete dilation
A
cerviz is fully dialted (10cm), cant feel cervix
22
Q
what do 0% and 100% effacement mean?
A
0 = thick cervix
100 = paper thin
23
Q
what is when the largest diameter of the presenting part passes through the pelvic inlet (BPD=bi-parietal diameter)
A
engagement
24
Q
what is the relationship of the presenting part to the ischeal spines
A
station
25
what is zero station
baby is at the presenting part of the ischial spines
26
what is the strength of contractions called?
intensity
27
what is the frequency of contractions described as
the start of one contraction to the start of the next
28
what is duration of a contraction described as
start of one contraction to the relaxation of that same ocntraction
29
what is lightening
engagement, baby drops and settles
30
what are premonitory signs of labor? (feeling that something is going to happen)
-lightening
-increased frequency/duration of cont.
-vaginal bleeding - mucus plug
-cervix ripening (soft/thin)
-back pain
-SROM
-sudden energy burst (nesting)
31
what is done to confirm rupture of membranes?
ferning test (test amniotic fluid appearance)
nitrazine / amnio indicator (to r/o other secretions)
32
what are characteristics of true labor
* regular contractions
* inc. frequency, duration, strength
* progressive dilatation and effacement!!!!
* discomfort starts in back and radiates around body
33
what are characteristics of false labor?
* irregular contraction
* do not increase in frequency, duration, and strength
* do not lead to dilatation and effacement
* "hardening"sensation
34
what is pitocin, what is it used for, and what does it promote
-chemically manufactured version of oxytocin
-used to augment or induce labor
-promotes increased uterine tone following delivery
35
what is the cardiovascular response to labor?
* increase in cardiac output
* increased BP during contractions
36
what are fluid and elec responses to labor?
* diaphoresis
* hyperventilation
* inc. temp from muscle activity
37
respiratory responses to labor
* increased O2 demand
* mild metabolic acidosis compensated by respiratory alkalosis
38
renal responses to labor?
* increased renin & angiotensin to control uterine blood flow
* bladder pushed forward and up
39
GI responses to labor?
* motility reduced
* gastric emptying prolonged
* increased acidity of gastric contents
40
immune responses to labor?
* increased WBC (25-30,000) due to stress
* decreased blood glucose
41
what is a birth plan?
plan for the mother and the team for the best outcomes
42
name and describe the stages of labor/birth?
* 1st stage: 0-10cm dilated
* 2nd stage: 10cm dilated-delivery of the baby
* 3rd stage: delivery of the placenta
* 4th stage: first few hours postpartum
43
what are the phases within the first stage of labor?
* early/latent phase
* active phase
* transition phase
44
what phase of the first stage of labor starts with the onset of contractions?
early/latent phase
45
how are pain/contractions during the early/latent phase
mild contractions, able to cope with pain
46
what phase of the first stage of labor is where contractions intensify and anxiety increases?
active phase
47
how far is fetal descent during the active phase?
4-7cm
48
what is the typical pattern/distance of descent for nullipara and multipara?
nullipara: 1.2cm/hour
multipara: 1.5cm/hour
49
what phase of the first stage of labor is where dilation slows but descent increases, force and intensity of contractions increase, and there is significant anxiety?
transition phase
50
how much is dialted during the transition phase?
8-10 cm
51
how long does the transition phase last for nullipara and multipara?
nullipara: less than 3 hours
multipara: less than an hour
52
what stage of labor involves pushing with the urge to push?
second stage
53
how long does the secong stage of labor last for nullipara and multipara?
null: 2 hr
multi: 15 min
54
what are some tops for coaching the mother through pushing?
* reassurance
* encouragement
* birthing bar
* pulling
* open glottis pushing (don't hold breath)
55
what is the sign that birth is imminent
crowning
56
what are the 7 cardinal movements of labor?
* descent
* flexion
* internel rotation
* extension
* restitution
* external rotation
* expulsion
57
describe the cardinal movement of descent
head enters the inlet d/t
1. pressure from amniotic fluid
2. pressure from uterus
3. contraction of abd muscles
4. extension of fetus
58
describe the cardinal movement of flexion
chin flexes downward onto chest d/t resistance from soft tissues in pelvis
59
describe the cardinal movement of internal rotation
occiput rotates from left to right in order to fit the diameter of the pelvic cavity
60
describe the cardinal movement of extension
fetal head extends as it passes under the symphysis pubic d/t resistance of the pelvic floor and opening of vulva
61
describe the cardinal movement of restitution
head emerges and turns to one side and aligns with position of the back (neck became twisted through process of shpuldrs entering pelvis)
62
describe the cardinal movement of external rotation
head turns farther to one side becasue the shoulders are rotating to the anterior/posterior position in the pelvis
63
describe the cardinal movement of expulsion
anterior shoulder moves under the symphysis pubis. flexion of the shoulder and head occur
-anterior shoulder born, followed by posterior shoulder and body
64
what is where the vaginal tissue tears where it is weakest to allow greater opening for delivery?
perineal laceration
65
what are the pros/cons of perineal laceration
pro: tears where it is weakest
con: may be difficult to repair, may extend to 4th degree, labia, or urethra
66
how to prevent perineal lacerations
massage/mineral oil
67
what is lengthening the vaginal opening to allow for delivery by cutting the tissue
episiotomy
68
what are the pros and cons of episiotomy
pro: controlled, repair is cleaner
con: may be unnecessary
69
placental separation, delivery of the placenta, and retained placenta happen during what stage of labor?
third stage
70
why does placental separation begin?
d/t inc. uterine tone and dec. surface area
71
how is the placenta delivered?
pushing, don't pull cord
72
what are the guidelines for a retained placenta
placenta is not delivered within 30 mins following delivery of the baby
73
what stage of labor/birth is prime time for breastfeeding, mother may be shaking, and has hypotonic baldder
4th stage
74
the 4th stage of L/D is __-__ hours after delivery
1-4
75
how should the fundus feel in the 4th stage of L/D
firm and between the umbilicus and symphysis pubis
76
what do BP and pulse look like during the 4th stage
drop in BP and increase in pulse
77
what narcotics are used during L/D?
stadol, nubain, demerol, morphine
78
what is an epidural?
local anesthetic and narcotic into epidural space
79
what is a spinal
local anesthetic into the spinal fluid in the spinal canal (often for c/s birth)
80
what are the pros/cons of epidural?
pros:
* fully awake
* can be adjusted
* allows urge to push
cons:
* skilled procedure
* takes 30 mins
* no ctrl of mvmt below waste
* costly
81
what are possible side effects of epidural?
* HYPOTENSION
* seizures (rare)
* meningitis (rare)
* arrest (rare)
* spinal HA
82
for a patient wanting an epidural, platelets must be at least ___
100,000 mm3
83
what should be monitored during an epidural
* BP (might be low)
* position
* effectiveness
* bladder, straight cath q2h
84
how can a low BP from epidural effect fetus
can cause fetal HR to decrease, less o2
85
what are contraindications for epidural?
* platelets less than 100,000 mm3
* coag disorder
* spinal abnormality
* infection
* uncooperative
86
what are indications for c section
* prior c/s
* breech
* failure to progress
* fetal distress
* placental complications
87
what is the most common c/s incision
low transverse, allows for VBAC too
88
what is done for prep for c/s
* shaving
* foley
* SCDs
* prep for spinal
89
what are usual orders during a c/s
* pitocin
* DVT prevention/SCD
* advance diet
* pain management
90
what does a TOCO measure?
muscle tone or contraction strength on fundus
91
what does an EFM (external fetal monitor) show?
placed where fetal heartbeat is, shows heartbeat on graph
92
when should external monitors (TOCO and EFM) be used?
when things are well! only shows duration
93
what are pros/cons of EFM?
pro: external, not invasive
con: con't show contraction strength, might not be accurate with movement
94
what are the internal monitors?
-IFM (scalp electrode)
-IUPC (intra uterine pressure catheter)
95
what does an IUPC measure?
intensity in cintractions in mg
96
when are internal monitors used?
when the externals are inaccurate
97
what are drawbacks of internal monitors?
needs ROM, baby needs to be vertex, infection, perforation
98
how is frequency of contractions measured?
beginning of one contraction to beginning of the next, OR peak to peak
99
how is duration of contraction measured
from beginning to end
100
how does the fundus feel during mild contractions?
like pressing on your nose, easily indented
101
how does the fundus feel during moderate contractions
like ppressing your chin, difficult to indent
102
how does the fundus feel during string contractions?
like pressing your forehead, hard
103
what are contractions recorded in?
MVUs
104
how to calculate contraction MVUs?
its recorded by measuring each contraction over a 10 min span.
-make sure to measure contraction strength by subtracting the baseline from the reading at the top of the peak, add all contractions within 10 mins together
105
what is the normal fetal HR
110-160, slows with increased gestational age
106
what is fetal tachycardia?
greater than 160 (lasting longer than 10 mins)
107
what is fetal bradycardia
less than 110 (lasting longer than 10 mins)
108
what is jaggedness of FHR called?
variability
109
is variability good or bad?
good!!
110
what does variability represent?
interaction between sympathetic and aprasympathetic NS
111
what does absent variability mean and what should we do?
potentially nonreassuring, give mom a sugary drink to stimulate, use buzzer to startle baby
112
what is fetal elevation of greater than 15 bpm lasting at least 15 sec?
accelerations
113
are accelerations good?
yes!!! reassuring
114
what is shown with a "flat line" on fetal heart rate tracings?
lack of variability
115
nursing interventions for lack of variability
reposition, stimulate
116
what is important to look at for decelertions
where they begin in relation to contraction
117
what causes early decelerations?
head compression
118
what are interventions for early decelerations
reposition, vaginal exam!!!!!
119
what causes late decelerations?
uteroplacental insufficiency, sign of stress and hypoxia
120
what are nursing interventions for late decelerations?
5 Ps
* turn pt to left side
* turn fluids on
* turn pitocin off
* turn o2 on
* turn call light on
121
what are variable decelerations like?
abrupt onset and abrupt return to normal, vary in timing of contraction
122
what causes variable decelerations?
cord compression
123
what are interventions for variable deceleration?
positioning
124
what is the time calssification of a prolonged deceleration?
greater than 2 minutes
125
what are indirect methods of fetal assessment?
-scalp stimulation
-cord blood analysis at birth (bllod gasses, pH)
126
what are some pain management techniques used during L/D?
nonpharm: relax techniques, comfort measures, distraction, massage, effleurage (finger mvmt on abd), position
pharm: narcotics, epidural, spinal
