Labor, Etc. Flashcards by Monica Schoenbaum

What is the definition of “labor”?

Contractions WITH cervical change.

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What are the stages of labor?

First (latent, active, transition)
Second
Third
Fourth

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What is considered the first stage of labor (dilation measurement)

latent: 0-3 cm (5.3 - 8.6 hours)
active: 4-7 cm (2.4 - 4.6 - 1 cm/hr)
transition: 7-10 cm (3.6 for nullipara and variable for multipara per book)
Got this from chart on pg 457

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what is the second stage of labor? How long?

active pushing (Can be two hours, may allow 4 hours if have epidural).

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what is the third stage of labor? How long?

placenta delivery (should be no more than 30 minutes)

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what is the fourth stage of labor?

period of time 1-4 hours after birth

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what is Placenta previa?

Placenta is implanted in the lower uterine segment

Complete, partial, marginal or low-lying

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what are the Risk factors for placental abruption?

Increased maternal age
Increased parity
Smoking
Cocaine use
Trauma – including domestic violence
Maternal hypertension
Rapid uterine decompression
PPROM
Uterine malformation or fibroids
Placental anomalies
Previous abruption – 10 times higher
Inherited thrombophilia

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What are the levels of Abruptio placentae?

A - Marginal abruption with external hemorrhage
B - Central abruption with concealed hemorrhage
C - Complete separation.

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s/s of abruptio placentae

May or may not have vaginal bleeding
May or may not have pain
If severe then
   *pain greater than labor would indicate
   *Board-like abdomen
   *Increased size of uterus

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care for pt with abruptio placentae

Delivery: vaginal versus cesarean
IV
DIC workup – fibrinogen and platelets drop, PT &amp; PTT are prolonged
Maintain maternal cardiovascular status
Occasionally a hysterectomy

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maternal risks from abruptio placentae

Mortality is uncommon
DIC
Hemorrhagic shock
Renal failure
hysterectomy

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fetal risks from abruptio placentae

25% mortality
Anemia
Hypoxia
Prematurity 
Neurological deficits

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factors associated with previa

Previous previa
Multiparity
Increasing age
Placenta accrete (placenta invades the uterine wall and move to other organs and becomes very high risk). 
Prior cesarean birth or other uterine surgery
Abnormal uterus
Abnormally large placenta
Smoking

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levels of previa

A - Low placental implantation
B - Partial placenta previa
C - Total placenta previa (covers full cervical opening)

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care in labor with previa

If low lying allow labor unless significant bleeding; monitor fetal response
If marginal probable c/s
If complete then c/s is scheduled
BR with BRP
Monitoring blood loss, pain, and uterine contractility
Fetal monitoring externally
NO VAGINAL EXAMS
Labs
IV fluids
Blood on hold

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what are the concerns with previa?

Maternal blood-loss decreases oxygen-carrying capacity.

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risks to mom with previa

Affects oxygen delivery to maternal organs

Increases risk of hypovolemia, anemia, infection, preterm labor, multiorgan dysfunction (pituitary, kidneys, lungs)

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risks to fetus with previa

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Decreased placental blood flow

Oxygenation decreases proportionately to changes in maternal cardiac output

why is previa a concern for mom and baby?

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Fetal blood loss
The degree of fetal compromise correlates with total blood loss and duration of the bleeding episode
Maternal blood loss
Can occur rapidly d/t the amt of blood in the uterine vasculature and placenta
Exsanguination (severe loss of blood) can occur w/in 8-10 minutes
d/t overall blood volume expansion a woman can lose a significant amount of blood and remain asymptomatic
Compensatory mechanism (vasoconstriction) less effective after 20% blood loss

what is the first indicator that previa is becoming an issue?

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A change in fetal status may be the first indicator that something is wrong

what are some ways you can prepare for a woman with previa?

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Watch for Signs and symptoms of hemorrhage and shock
Quickly minimize blood loss
Assess hemodynamic status
Mom’s compensatory mechanism shunts blood from uteroplacental unit back to maternal systemic circulation

What is the difference between bleeding from a previa and bleeding from an abruption?

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Previa blood is bright red; abruption blood is dark
Previa is slow; abruption is sudden
Abdomen is soft in previa but hard and firm (guarding) in abruption.
Pain is r/t to labor in previa but constant and severe in abruption.

symptoms of uterine rupture

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Depends on type and timing:
Dehiscence can be asymptomatic
Contractions without dilatation; IUPC may show little pressure
Pain unrelieved by analgesia/anesthesia
Symptoms may develop insidiously: pain, nausea,
vomiting, vaginal bleeding, maternal or fetal
tachycardia, pallor, lack of cervical progress, and
eventually absent FHT

symptoms of complete uterine rupture

``` Symptoms are immediate. Sharp, tearing pain Contractions stop Fetal parts palpable through abdominal wall No fetal presenting part Tense, acute abdomen with shoulder pain ```

Risks of and from uterine rupture

*Can occur in an unscarred uterus *asymptomatic scar dehisence *Risk with VBAC (Trial of labor post c) is 0.2-1.5%; risk is higher with interdelivery intervals <18 months *Increased risk with use of pitocin: induction or augmentation *Controversial studies on prostaglandin use *High mortality risk to infant

Nursing management with pt with uterine rupture

Maternal stabilization Immediate delivery VBAC recommendations from ACOG: One previous LTCS Adequate pelvis No other uterine scars or previous rupture A MD immediately available throughout active phase Anesthesia and personnel available for emergency C/S

what is the purpose of leopold manuever?

determine fetal head position, presentation and lie.

What are some things that can be assessed with leopold maneuver?

is fetal lie transverse or longitudinal; what is in the fundus (head or buttocks?); where is fetal back; where are the small parts of extremities; is there fetal movement; is there more than one fetus; is fundal height proportionate to fetal age?

where is fetal heartbeat best heard?

fetal back (which is one reason leopold is helpful)

what are normal features of fetal HR during labor?

Accelerations are normal. 110-160 BPM.

in normal labor should uterine contractions decrease O2 supply to baby?

No, they should NOT.

characteristics of the "passenger" during labor

passenger (fetus) a) attitude (relation of fetal body parts to one another and describes posture the fetus assumes as it conforms to shape of uterine activity b) lie (position of baby) c) presentation (relation of baby to pelvis) d) engagement (where they are in pelvis) (+ station means baby is moving down)

what are some nonpharmacologic methods of reducing pain during labor?

* position changes; *paced breathing; * relaxation techniques; *touch, distraction techniques; *encourage rest b/w pushing during second phase of labor; *cool clothes to face; *warm perineal, abdominal and back compresses to increase muscle relaxation; perineal massage and stretching with lubricant; sips of fluid or ice chips (i think we'll know this when we see it :) )

Three notations to describe fetal position (head, face or breach):

1. R or L (side of maternal pelvis) 2. O (occiput) M (mentum) S (sacrum) A or Sc (acromion or scapula, process): landmark of the presenting part. 3. Anterior (A); Posterior (P) or transverse (T) depending on whether landmark is front, back or side of the pelvis

when is term dorsal (D) used when discussing fetal presentation?

shoulder presentation

normal cardiovascular changes in labor

CO and BP increase

normal oxygen changes in labor

oxygen demand and consumption increase

Common changes during normal labor:

polyuria, gastric motility and absorption are reduced, WBC count increases and blood glucose levels decrease.

What is the significance of fFN

it is found is amniotic fluid and a positive test can indicate ruptured membranes. If NEAR term, it is normal for fFN to appear in vaginal secretions.

If the physician indicates a shoulder dystocia during the delivery of a macrosomic fetus, how would the nurse assist?

Assist the woman into McRoberts maneuver (yank knees as close to ears as you can to open the pelvis)

what does it mean when a baby is "engaged"

The biparietal diameter of the fetal head is at the level of the ischial spines

signs of shoulder dystocia

* Turtling | * Head out but shoulder isn’t which can lead to hypoxia

things to document with shoulder dystocia

manipulations, procedures, time from head to body

what is Anaphylactoid syndrome:

amniotic fluid enters maternal circulation resulting in blockage of the pulmonary vasculature and tissue destruction. Death can result as quickly as 10 minutes to 32 hrs

symptoms of anaphylactoid syndrome

``` Presentation: Sudden dyspnea Cyanosis Respiratory distress Cardiopulmonary arrest Seizures ```

Labor, Etc. Flashcards

(46 cards)