Labor and delivery Flashcards
(44 cards)
spontaneous uterine contractions late in pregnancy NOT associated with dilation, no more than 1-2x an hour, do not increase in frequency/intensity, resolve with change of activity
braxton-hicks contractions
fetal head descending into pelvis causing change in abdomen shape and sensation
lightening
gush of liquid, constant leakage
ruptured membranes
cervical mucus with cervical thickening
bloody show
what are the general signs of labor?
lightening, ruptured membranes, bloody show
contractions with radiation to lower back and abdomen with progressive pain and dilation
(softening → effacement → dilation → position)
true labor
onset of labor with true regular contractions → dilation of cervix up to 10 cm
stage 1 –
→ prodromal phase: frequent but irregular contractions with no cervical change
→ latent phase: contractions regular + painful, slow cervical changes
→ active phase: strong, frequent contractions with fast progress, rapid dilation starting at 6cm
what is a normal stage 1 timing?
Normal <20h nullipara and <14h multipara for the latent phase
Normal .5-.7/hr nullipara and .5-1.3 multipara for the active phase
What do you do with abnormalities in the latent phase?
Abnormal = balloon, amniotomy, misoprostol, oxytocin
What do you do with abnormalities in the active phase?
Abnormal = >6cm dilated with failure of progression after at least 4 hours and 6 hours w/oxytocin⇒C-section
complete cervical dilation to delivery of baby
stage 2
→ passive phase: complete cervical dilation to active maternal expulsive efforts
→ active phase: expulsive efforts to delivery
What is normal for stage 2 of labor, and what do you do if it stalls?
Normal: ~50min primigravida and 20min multigravida
Arrest = 4+ hours of inadequate contractions or 6+ hours of previous and no cervical change – try oxytocin ⇒ c section if failure and - position, vacuum or forceps if +
What is considered an arrest in stage 2 of labor?
4+ hours of inadequate contractions or 6+ hours of previous and no cervical change
from delivery of baby to delivery of placenta
stage 3 of labor
Normal <30 min
What signs are you looking for in regards to placenta separation?
fresh blood, lengthening of cord, fundus of uterus rises, uterus firm and globular
When should you admit a patient for labor and delivery?
active labor with regular contraction, significant effacement, 4-5cm dilation with documented cervical change, rupture of membranes, abnormal bleeding, maternal or fetal health issues
When should you discharge a patient to go home and wait?
intact membranes, cervical dilation <4cm, no cervical change or contractions at end of 2 hours observation with normal fetal heart rate tracing
What are the four mechanisms of labor?
Vaginal birth
Assisted vaginal (forceps, vacuum delivery)
C-section
Vaginal birth after C-section
What are the 3 Ps of labor?
POWER: ability of uterus to push the baby out with frequency, duration, intensity, resting tone
PASSAGE: pelvis + soft tissue where the baby will pass (if uncontrolled → C section)
PASSENGER: baby size, presentation, position (if uncontrolled → C section)
Whats the general labor timeline?
Nulliparous - 10.1h
Multiparous - 8.2h
what are the cardinal movements of labor?
-head floating
-engagement: entering pelvic inlet
-descent: passage of head into pelvis
-flexion: flexion of head to allow entrance to pelvis
-internal rotation: sagittal suture parallel to anteroposterior diameter
-extension: vertex extends as it is passed beneath symphysis
-external rotation: fetus externally rotates after head is delivered to deliver shoulder
-expulsion: anterior shoulder → posterior shoulder
What should you be testing when someone comes in for labor?
Hgb/hct (especially if low!)
Type + screen (Rh typing)
HIV
Hep B
Syphilis
Group B strep
largest diameter of fetal head fits into largest diameter of maternal pelvis
engagement
relationship of long axis of fetus to long axis of uterus, normally longitudinal
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