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NURS3112 > M7.1: Stages of Labour > Flashcards

M7.1: Stages of Labour Flashcards

(46 cards)

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1
Q

what are signs of labour?

A
  • lightening
    -sudden burst of energy
  • braxton hicks contractions
  • bloody show
  • ROM
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2
Q

What is lightening?

A

effects that occur when the fetus begins to settle into the pelvic inlet (engagement)

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3
Q

What may lightening lead to?

A
  • Leg cramps or pains
  • Increased pelvic pressure
  • Increased venous stasis = edema in lower extremities
  • Increased urinary frequency
  • Increased vaginal secretions
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4
Q

Define: Membranes ruptured by physician using amniohook

A

amniotomy or artificial rupture of membranes (AROM)

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5
Q

What is PROM?

A

Premature rupture of membranes

SROM before the onset of labour at any gestational age

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6
Q

What is the risk of ruptured membranes before engagement?

A

prolapsed cord: umbilical cord expelled with fluid

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7
Q

What is PPROM?

A

Preterm premature rupture of membranes (PPROM)

Rupture occurs before 37 weeks of gestation

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8
Q

What is SROM?

A

Occurs at height of intense contraction with gush of fluid out of vagina

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9
Q

What should we assess if ROM occurs?

A

assess the FHR because of the risk of prolapsed umbilical cord (would show decelerations & drop in HR),

assess the color of the amniotic fluid, because meconium-stained fluid can indicate fetal distress

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10
Q

What is the risk if there is ROM but no labour within 12-24 hours?

A
  • Rupture = open pathway into uterine cavity = infection
  • Note: induction done only if pregnancy is near term
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11
Q

Is this a characteristic of true or false labour?
contractions produce progressive dilatation and effacement of the cervix

A

True labour

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12
Q

Is this a characteristic of true or false labour?
discomfort of contractions starts in the back and radiates around to the abdomen

A

True labour

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13
Q

Is this a characteristic of true or false labour?
irregular and do not increase in frequency, duration, and intensity

A

False labour

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14
Q

Is this a characteristic of true or false labour?
discomfort may be relieved by ambulation, changes of position, resting, or a hot bath or shower

A

False labour

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15
Q

Is this a characteristic of true or false labour?
contractions may be perceived as a hardening or “balling-up” without discomfort or discomfort may occur mainly in the lower abdomen and groin.

A

false labour

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16
Q

What is the 1st stage of labour?

A

beginning of true labour and ends when cervix is 10 cm dilated

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17
Q

What is the 2nd stage of labour?

A

begins with complete dilation and ends with birth of neonate

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18
Q

What is the 3rd stage of labour?

A

begins with birth of neonate and ends with expulsion of placenta

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19
Q

What are the phases of the 1st stage of labour?

Study These Flashcards
A
  • latent phase
  • active phase
  • transition phase
20
Q

Dilation and contractions of latent phase

Study These Flashcards
A
  • cervical dilation: 0-3

Contractions:
- Frequency: 10-30 mins
- Duration: 20-30 secs
- Intensity: mild-moderate

21
Q

Dilation and contractions of active phase

Study These Flashcards
A

cervical dilation: 4-7 cm

Contractions:
- Frequency: 2-3 mins
- Duration: 40-60 secs
- Intensity: moderate - strong

22
Q

Dilation and contractions of transition phase

Study These Flashcards
A
  • cervical dilation: 8-10 cm

Contractions:
- Frequency: 1.5-2 mins
- Duration: 60-90 secs
- Intensity: strong by palpation

23
Q

What are the potential priorities for care in first stage?

Study These Flashcards
A
  • Pain
  • Anxiety
  • Fatigue
  • Knowledge deficits
  • Potential for fluid deficits
  • Promotion of labour progress
  • Safety
24
Q

What are factors that influence labour pain?

Study These Flashcards
A
  • Cervical dilation: primary source
  • Perineal distension
  • Intensity and duration of contractions
  • Fetal position
  • Fetal size
  • Other
25
Where is the pain located in the 1st stage of labour?
Lower abdominal wall and areas over lower lumbar region and upper sacrum (around the lower back and lower stomach)
26
What fetal position can cause back pain?
posterior
27
What are interventions we can do for pain?
- Encourage regular position change - Assist with personal comfort measures - Decreasing anxiety - Providing information - Use specific supportive relaxation techniques - Back pain = firm pressure on lower back or sacral area and warm compress - Encourage paced breathing - Nurse presence - Give medications as requested by woman
28
Why is fluid deficits an issue during labour?
- Profuse perspiration/diaphoresis occurs during labour - Hyperventilation also occurs = changing electrolyte and fluid balance from insensible water loss -Muscle activity increases temp = inc sweating and evaporation
29
How do you know a woman is becoming dehydrated?
Poor skin turgor, fever, tachycardia
30
What are potential priorities in 2nd stage of labour?
- Pain - Ineffective coping and fatigue - Promotion of progress in labour (pushing!)
31
What is the pain caused by in the 2nd stage of labour?
- Hypoxia of contracting uterine muscle cells - Distention of vagina and perineum - Pressure on adjacent structures including lower back, buttocks, and thighs
32
What is crowning?
fetal head is encircled by external opening of vagina and means birth is imminent
33
Should woman push through pain and burning?
Yes.
34
What happens if woman is pushing and cervix is not completely dilated?
cervical edema = slows dilation = possible tearing and bruising of cervix and exhaustion
35
What is the valsalva maneuver?
natural, preprogrammed instinct. “When you hold your breath and tense, you create an air pressure “ball” inside your abdominal cavity. This pressure ball serves to stabilize your spine by acting as a support beam (more like a pillar) for your spine, minimizing anterior stress when you’re trying to lift something”
36
T or F: Directed pushing uses valsalva maneuver
True
37
Difference between directed and spontaneous pushing
Directed pushing involves taking a deep breath at the beginning of a contraction, holding it and bearing down throughout the contraction. Conversely, spontaneous pushing allows women to follow their own instincts
38
What is directed pushing associated with?
- Lowers maternal BP and therefore placental flow - Lower fetal pH and PO2 - Lower Apgar scores - Can cause structural and neurologic injury to pelvic floor - Increase in maternal stress and fatigue - Increase in perineal tears
39
What is spontaneous pushing associated with?
- Allowing the woman to follow her body’s directions - Generally push for 5-7 seconds, followed by several breaths for 2 seconds each and push approximately 3-5 times per contraction - Prevents fetal hypoxic effects - Reduces perineal traumas - Fewer risks of adverse maternal, fetal and neonatal outcomes - Less maternal fatigue
40
What are some positions for pushing?
- lithotomy (recumbent) - side lying (left lateral sims) - squatting - hands and knees
41
What are the advantages of squatting positiong for pushing?
- Size of pelvic outlet is increased. - Gravity aids descent and expulsion of newborn. - Second stage may be shortened
42
What are advantages and disadvantages of sidelying position for pushing?
Advantages: - Does not compromise venous return from lower extremities. - Increases perineal relaxation and decreases need for episiotomy. - Appears to prevent rapid descent. Disadvatage: difficult for woman to see birth
43
What are advantages and disadvantages of lithotomy position for pushing?
Advantages: - Enhances ability to maintain sterile field. - May be easier to monitor FHR. - Easier to perform episiotomy or laceration repair Disadvantages: - May decrease blood pressure. - It is difficult for the woman to breathe due to pressure on the diaphragm. - increased risk of aspiration. - May increase perineal pressure, making laceration more likely. - May interfere with uterine contractions.
44
What are the signs of placental separation?
- usually within 5-30 mins after birth - Globular-shaped uterus - Rise of fundus in abdomen - Sudden gush or trickle of blood - Further protrusion of umbilical cord our of vagina
45
When is the placenta considered retained?
Considered retained if more than 30 minutes have passed from completion of second stage of labour
46
What is a nursing priority in the 3rd stage of labour?
postpartum hemmorhage

NURS3112 (10 decks)

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