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Labor & Delivery Flashcards

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1
Q

1st stage of labor

A

True labor to complete cervical dilation (10 cm)

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2
Q

Complete cervical dilation

A

10 cm

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3
Q

In which labor stage do the phases of labor occur?

A

First stage

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4
Q

Latent phase of labor

A

0-5 cm, longest, begins w/ onset of regular contractions which become established and increase in frequency/duration/intensity but usually remain mild

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5
Q

Active phase of labor

A

6-10 cm, faster, esp multiparous

Contractions more frequent & intense (moderate to strong per palpation)

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6
Q

Transition phase of labor

A

8-10 cm, quickest, may vomit shake, become anxious

Intense, frequent contractions

aka deceleration phase

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7
Q

Second stage of labor

A

Cervical dilation to 10 cm in preparation for birth; seen with cervical effacement

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8
Q

Cervical effacement

A

Thinning of cervix

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9
Q

Cervical dilation

A

Opening of cervix

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10
Q

Third stage of labor

A

Birth to placental separation/expulsion

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11
Q

Fourth stage of labor

A

First 4 hours after delivery

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12
Q

In what stage of labor does crowning occur?

A

Second stage

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13
Q

What position should the fetus be in during the latent phase of labor?

A

Head at the internal cervical os but cervix is still closed to maintian integrity of amniotic sac

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14
Q

What causes cervical dilation?

A

Rippling effect from repetitive uterine contractions pulling it and stretching it open

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15
Q

What may be a sign of transition from the latent to active phase of labor in the birthing person?

A

Contractions become more intense and they’re breathing deeply/having difficulty speaking

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16
Q

How can you gauge the strength of a contraction?

A

Palpate abdomen at tip of fundus and compare to other body parts

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17
Q

What does palpating a mild contraction feel like?

A

Tip of nose

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18
Q

What does palpating a moderate contraction feel like?

A

Tip of chin

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19
Q

What does palpating a strong contraction feel like?

A

Forehead consistency

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20
Q

How long between contractions is needed to reperfuse/reoxygenate fetus?

A

60 seconds

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21
Q

What may happen to fetal heart rate as contractions increase in frequency/intensity?

A

Decelerate

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22
Q

After 5-6 cm, which birthing persons dilate quickly?

A

Primi- or multiparous

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23
Q

After 5-6 cm, which birthing persons dilate slower & at what rate?

A

Nulliparous; 1 cm q1-2 hours

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24
Q

What are the 6 P’s of birth?

A 
Passageway (birth canal)
Passenger (fetus, placenta)
Powers (contractions) 
Position (maternal)
Psyche
Pain
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25
Define pelvimetry
Measure between ischial spines
26
4 pelvic shapes
Gynecoid (optimal) Platypelloid Android (resembling male) Anthropoid
27
What pelvic shape favors the occiput posterior position?
Anthropoid
28
What makes gynecoid pelvis optimal for vaginal delivery?
It's wider side-to-side than front-to-back, parallel sides, dull ischial spines, pubic arch 90 degrees or wider
29
What is a posterior occiput (OP) birth?
Baby born face up
30
What are potential complications of OP birth?
Fetal elongation altering FHR Apneic episodes causing low APGAR scores
31
Why is android pelvis problematic?
Too narrow, usually does not progress to vaginal birth; if so, may have occipital bruising
32
Why is platypelloid pelvis not conducive to vaginal delivery?
Fetus has to pass through pelvis with head in a transverse/sideways position
33
How is cervical effacement measured/documented?
By percentage; 0% (long/thick, 40 mm) to 50% (20 mm) to 100% (paper thin)
34
Where is an incision made for a C-section?
In the lower 1/3 of uterus w/ direction of muscle fibers
35
What is the dividing line of the upper 2/3 and lower 1/3 of uterus called?
Physiologic retraction ring
36
What happens to the upper uterus during labor contractions?
Thickens
37
What happens to the lower uterus during labor contractions?
Thins and is pulled upward
38
Why does amniotic rupture cause pain?
Loss of cushion and fetal head begins pressing directly on cervix
39
How do dilation & effacement differ in nulli- vs multiparous birthing persons?
Nulliparous - complete effacement before dilation Multiparous - effacement & dilation may occur simultaneously
40
What are important aspects of the fetus to assess/monitor?
Fetal: head, attitude, lie, presentation, position, station, engagement
41
3 major parts of the fetal head
Face (well fused) Base of skull (well fused) Vault of cranium) (not fused)
42
How can a fetus head squeeze through the birth canal?
Sutures can override one another, allowing caput molding to pass through
43
Which is larger, anterior or posterior fontanelle?
Anterior
44
How might you be able to determine which direction the fetus is looking?
Location of fontanelles
45
Define fetal attitude
Relation of the fetal parts to one another
46
Normal fetal attitude
Chin flexed to chest, extremities flexed into torse
47
Non-normal fetal attitude
Chin extended away from chest, head tilted to one side, extremities extended
48
Define fetal lie
Relationship of fetal long axis to maternal long axis
49
Longitudinal lie
Fetal spine is parallel to maternal spine
50
Transverse lie
Fetal spine is perpendicular to maternal spine
51
Transverse lie complications
Shoulder presenting so may require C-section if fetus does not spontaneously rotate
52
Define fetal presentation
Part of fetus entering pelvic inlet first & leading through birth canal during labor
53
Possible fetal presentations
Vertex/occiput (normal head first), breech (feet or sacrum first), shoulder (scapula), face, brow, chin (mentum)
54
Which fetal presentation is optimal for vaginal birth?
Vertex/occiput
55
Which fetal presentation(s) likely require C-section?
Face, breech, shoulder
56
What is a clue it may be a face or breech presentation?
If you can put your finger in a hole --> mouth (face) or anus (breech)
57
What are some signs of a brow, face, or undiagnosed breech presentation?
Higher FHR, abnormal contractions
58
Define compound presentation
Presentation of extra body part near presenting fetal part such as a hand or foot
59
Types of breech presentations
Complete, incomplete, frank
60
Why can breech births be complicating for the fetus?
When a fetus' limb feels cold, it wants to take its first breaths which can lead to apnea
61
Which position can a face presentation be delivered in?
Mentum/chin anterior only
62
Define fetal position
Relationship of presenting part of fetus to four maternal pelvic quadrants
63
How is fetal position documented?
By 3 letters: 1) R or L side of maternal pelvis 2) O, S, M, Sc (presenting fetal part) 3) A, P, T (transverse) (part of maternal pelvis)
64
What is the most common fetal position?
OA = occiput anterior
65
Define fetal station
Relationship of presenting fetal part to reference line at ischial spines of maternal pelvis Measurement of fetal descent in cm
66
Where is station 0 in terms of fetal station?
At ischial spines
67
What indicates a minus station?
Fetal station above ischial spines
68
What indicates a plus station?
Fetal station below ischial spines
69
What is the range of fetal station?
-5 to 0 to +5
70
Define fetal engagement
Largest diameter of presenting fetal part reaches/passes through pelvic inlet; cannot be moved out of it
71
What measurement is used for fetal engagement in vertex/occiput presentations?
Biparietal diameter
72
What is a term biparietal diameter and what does it indicate?
9.25 cm; fetal head size
73
What measurement is used for fetal engagement of a breech presentation?
Intertrochanter diameter
74
What is the smallest and most critical anteroposterior diameter?
Suboccipitobregmatic diameter (nl = 9.5 cm)
75
Define contractions
Rhythmic tightening & shortening of uterine muscles during labor
76
Define contraction duration
Beginning to completion of one contraction
77
Define contraction frequency
Time between beginning of one contraction & beginning of next contraction
78
Define contraction intensity
Strength of uterine contraction in mmHg
79
How is contraction intensity measured?
Mild, moderate, strong
80
Early labor contractions
25-40 mmHg
81
Active labor contractions
50-70 mmHg
82
Transition phase contractions
80-100 mmHg
83
Second (pushing) stage contractions
>100 mmHg
84
Second stage of labor characteristics
Complete cervical effacement & dilation Contractions q1-2mins, 90 sec, strong Fetal descent stimulates urge to push Lasts 2 hrs (primi) or 30-40 min (multi)
85
What type of pushing is recommended for birthing persons?
Open glottis pushing (grunting, yelling, exhaling)
86
How long can a birthing person hold their breath before O2 delivery to the fetus declines?
7 seconds
87
What station should the fetus be at before pushing begins?
+2
88
What may crowning feel like for the birthing person?
Burning, tearing, pressure, pain
89
What might the birthing person feel during second stage of labor?
Relief to be able to push & birth is near Pain w/ pushing Helpless, fearful, irritable Accomplished *Provide reassurance & encouragement
90
What device is used to measure contractions?
Intrauterine pressure catheter
91
Characteristics of contractions
Increment (buildup) Acme/Peak Decrement (regression)
92
At what contraction intensities does uterine blood flow stop?
40-60 mmHg
93
Define cardinal movements/mechanisms of labor?
How a fetus navigates the birth canal
94
Define fetal descent
Progress of presenting fetal part through the pelvis
95
How is fetal descent measured?
By station
96
Define fetal flexion
Fetal head meets resistance at pelvis/cervix causing flexion to decrease diameter
97
Define internal rotation of the fetus
Fetal occiput rotates to lateral anterior position in corkscrew motion to pass through pelvis
98
Define fetal extension
Fetal occiput passes under symphysis pubis and head extends anteriorly as it is born
99
Define external rotation of the fetus
After head is born, rotates to position it occupied in pelvic inlet in alignment w/ fetal body and then does a 1/4 turn to transverse position as anterior shoulder passes under symphysis pubis
100
Define fetal expulsion
After birth of head/shoulders, trunk is born by flexion toward symphysis pubis
101
What are some common maternal positions?
Lithotomy - feet up in stirrups Semi-sitting w/ pillows underneath knees, arms, back Lateral/side-lying w/ curved back & upper leg supported by partner Hydrotherapy - shower, tub
102
What maternal positions can gravity assist w/ fetal descent?
Upright, sitting, kneeling, squatting
103
Advantages of birthing stool
Opens pelvis, gravity, helps pushing
104
Advantage of squatting
Gives birthing person sense of control
105
Why are frequent position changes helpful?
Increase comfort, relieve fatigue, promote circulation
106
What determines position during second stage of labor?
Maternal preference, provider preference, condition of birthing person & fetus
107
What are some things to avoid with water births?
Do not put baby back into water once out as it is breathing independently Do not deliver placenta into water
108
How can the birthing person's emotional state influence labor?
Catecholamines can affect uterine contractions, slowing labor, due to decreased uterine blood flow
109
Types of labor pains & when they occur
Visceral - 1st stage (T10-L2, fundus of uterus level) Somatic - late 1st/2nd stage (S2-S4)
110
Factors influencing labor pain
Young maternal age, hx of dysmenorrhea, fetal position, large maternal and/or fetal weight, nulliparity
111
At what spinal level is an epidural typically given?
L3-L4; higher needs different meds to avoid respiratory complications
112
What are characteristics of labor analgesics to consider?
Maternal/fetal safety, ease of admin, consistent/predictable/rapid onset, allowing maternal movement, retention of maternal expulsive efforts
113
Types of labor analgesics
Opioids - fentanyl, morphine (need to give at certain time b/c affects fetus) Antagonist-agonist opioids - nubain Epidural - pain med + anesthetic Spinal - similar to epidural Pudendal block - lidocaine Local anesthesia - lidocaine
114
Where is the pudendal nerve located?
Ischial spines
115
Where is the epidural space relative to the spinal space?
Inferior to spinal space
116
What is a common complication of an epidural?
Headache, may require blood patch
117
What are Leopold maneuvers?
Abdominal palpation of fetal presenting part, lie, attitude, descent, and probable location where fetal heart tones can be best auscultated
118
What are two types of external fetal monitors?
External electronic monitoring (tocotransducer) External fetal monitor
119
What does an external electronic monitor (tocotransducer) do?
Applied over fundus to display contraction patterns Must be repositioned w/ maternal movement
120
What does an external fetal monitor measure?
FHR patterns during labor, birth
121
Advantages of external fetal monitors?
Easy to apply, quicky evaluation
122
Disadvantages of external fetal monitors
Difficult in birthing persons with more adipose tissue or fetus is in awkward position
123
Advantage of internal fetal monitors
More accurate than external monitors
124
Disadvantages of internal fetal monitoring
Increases risk of infection for birthing person & fetus Fetal scalp electrode (FSE) must avoid soft spots (fontanelles), eyes, etc
125
Characteristics of true labor
Regular & increase in duration, intensity Discomfort begins in back and radiates to front of abdomen Intensified by walking Resting/relaxing in warm water does not decrease intensity Cause cervical dilation Fetal engagement
126
What does progesterone do during labor/delivery?
Relaxes smooth muscle tissue
127
What does estrogen do during labor/delivery?
Stimulates uterine contractions
128
What hormones mostly stimulates uterine contractions?
Oxytocin
129
What do prostaglandins do during labor/delivery?
Contract smooth muscle | Cervical ripening
130
When estrogen drops after delivery, what hormone sharply increases?
Prolactin for milk production
131
Why is it important to not skip feedings overnight if breastfeeding?
Can cause estrogen increase which inhibits PRL and decreases milk production Can also cause ovulation and possible pregnancy so effective contraception use is vital
132
When is the placenta typically delivered?
~30 minutes after delivery of fetus
133
What is uterine tamponade?
Intense contraction to push out placenta
134
What is uterine atony?
Lack of uterine contraction
135
How much blood can a birthing person lose per minute during delivery?
1000 mL/cc
136
What can be used to assist in placental delivery?
IV oxytocin
137
How often should maternal temperature be checked?
q2hrs if membranes ruptured
138
How do you assess fetal wellbeing during L&D?
FHR
139
What is assessed during a vaginal exam during L&D?
Dilation & effacement Fetal descent & station Fetal position, presentation, & lie Membranes - intact or ruptured
140
Nursing assessments during labor
``` Maternal health hx Physical assessment Fetal assessment Labs Pysch assessment ```
141
Labs collected during labor
GBS - IV penicillin if (+) Urinalysis (clean catch) - dehydration, ketonuria, proteinuria, glucosuria, UTI Blood tests - CBC, ABO/Rh typing
142
Signs of symptomatic hemorrhage
SOB, orthostatic hypotension
143
1st stage assessments
``` Review prenatal hx/labs Labor status Fetal status Maternal status Culture, language, religion VS Labs Weight at last prenatal visit Edema, proteinuria Fundus Hydration status Level of fatigue ```
144
Active phase assessments
See L&D admission assessment Birthing person & support person may need more direction, encouragement, confirmation Comfort measures
145
3rd stage assessments & interventions of birthing person
``` Meet newborn Placental delivery Fundus tone Answer questions, educate Relax abdomen Prepare meds if PP hemorrhage anticipated ```
146
3rd stage assessments & interventions for newborn
Resuscitation as needed - ABCs! 1 & 5 min Apgar scores Ensure warmth, skin-skin contact Initiate breastfeeding Get acquainted w/ parents/family
147
If fundus is boggy in 3rd stage, what should the nurse do?
Massage to express clots ``` If not responding, give meds -IM or IV Pitocin -IM methergine (not w/ HTN) IM hemabate -Rectal, vaginal Cytotec ```
148
4th stage assessments for birthing person
q15mins for 1st hour - pain, VS (esp BP), fundus, lochia, bladder, perineum, hemorrhage, bonding & breastfeeding BP drops to pre-pregnant level HR 60-90, slightly lower than labor RR 12-20, easy, quiet
149
4th stage interventions for birthing person
Educate, answer questions Assist parents in exploring newborn Assist w/ breastfeeding Assist w/ elimination Comfort measures/position, perineum, pain meds Fluids, nutrition Allow birthing person/family to debrief L&D experience
150
When should BP & HR be assessed after delivery?
q15mins for 2 hrs after birth
151
When should temp be assessed after delivery?
q4hrs for first 8 hrs then at least q8hrs

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