Maternity 2 - Intrapartum Care

Question 1

Hormonal Activation of Labor
Promotes uterine contractility

Answer 1

Estradiol
Oxytocin - pressure
Prostaglandins - stretching

Question 2

What does the upper uterine segment do?

Answer 2

Contracts and pulls up

Question 3

What does the lower uterine segment do?

Answer 3

expands and thins out

effacement and dilation

Question 4

Lightning?

Answer 4

Baby drops
presenting part settles into the pelvis

leg cramps
increased vag discharge
increased pelvic pressure

Question 5

Rupture of Membranes
ROM

Critical event - do what?

Answer 5

Make sure baby is not in distress

Fetal Heart tones

Note time

Question 6

Rupture of Membranes
ROM

Assess FLuids:

Answer 6

Color
Amount
Odor

Question 7

Rupture of Membranes
ROM

Confirm with

Answer 7

nitrazine
fern test

amnisure

Question 8

True Labor

Answer 8

1. Progressive dilation and effacement
2. regular ctx - increasing frequency, duration, intensity
3. Pain in back and radiates to abdomen
4. Pain not relieved by ambulation or rest

Question 9

When to go to hospital?
511 rule

Answer 9

UC 3-5 minutes

q 5 min
1 min
for 1 hour

Question 10

False Labor pain relieved or decreased by:

Answer 10

1. ambulation
2. change position
3. resting
4. hot bath or shower

Question 11

Focused assessment once admitted to hospital

Answer 11

for mom and baby

cervical dilation & membrane status

fetal well being (20 min continuous monitoring

Question 12

Cervical checks and risk of infection

Answer 12

keep to a minimum - ROM

Question 13

Cervical exam checks:

Answer 13

1. dilation
2. effacement
3. station - level of lowest presenting part in relation to ischial spines
4. position - pelvis - feet, head, bum
5. presentation - cephalic, breech
6. amniotic fluid assessment - blue yes
7. Bleeding assessment

Balatbole - head float back up?

Question 14

Station measurements

Answer 14

station 0 = level with ischial spines

station -1 to -5 = above ischial spines (early)

station +1 - +5 = below ischial spines (closer to delivery)

Question 15

Stages of Labor

Answer 15

1. First Stage
   cervical dilation stage
2. Second Stage
   10 cm to birth
3. third stage
   birth to delivery pf placenta
4. Fourth Stage
   after delivery of placenta to 2 hour PP

Question 16

Phases in first stage

Answer 16

1. Latent - longest phase
   0-5 cm
   ctx irreg. mild
   q 5-30 min (30-45 sec)
   12 hours
2. Active
   6-10 cm
   ctx reg. moderate
   q 3-5 min (40-90sec)
3. Transition -fastest phase
   8-10 cm
   ctx reg. most intense

Question 17

NURSING CARE:

First Stage - Mom

Answer 17

1. VS q hr
2. Temp -
   q 4hr membranes intact
   q 2hr ROM <12 hrs
   q 1hr ROM >12 hrs
3. UC
4. Pain
5. Cervical changes

Question 18

NURSING CARE:

First Stage - Fetal

Answer 18

Fetal Monitoring
continuous monitoring during active phase:

low risk q 15-30 min

high risk q 15 min

ROM = 20 min FHR strip
assess amniotic fluid - cushioning squeeze

Question 19

What is the single most important indicator of adequately oxygenated fetus?

Answer 19

VARIABILITY

moderate is great!!!

Question 20

FHR Variability ranges

Answer 20

absent = o

Minimal = <5 bpm

moderate = 6-25 bpm

marked = >25 bpm

Question 21

Marked variability suggests:

Answer 21

acute hypoxia
or
compression of umbilical cord

Question 22

Veal Chop

Answer 22

V variable
E early
A accel
L Late

C cord compression
H head compression
O Okay
P Placenta insufficiency

Variable & Late = resuscitation

Question 23

Accelerations =

Answer 23

increase FHR over baselin for 15 bpm x 15 sec

fetal well-being

Question 24

POISON for decelerations

Answer 24

P position
O oxytocin off
I iv fluids
S sterile vaginal exam
O oxygen
N notify provider

Question 25

ROADI for decelerations

Answer 25

R reposition O oxygen 8-10 ml A alert HCP D discontinue Oxytocin I IV fluids

Question 26

5 Ps affecting Labor progress

Answer 26

P power - ctx P passage - pelvis shape P passenger - baby P psyche - mom coping P position mom

Question 27

Measurement of UC

Answer 27

toco frequent length IUPC strength and intensity mmHg

Question 28

What is considered adequate labor in MVU when measuring ctx with IUCP? MVU = montevideo units

Answer 28

normal progression 200 MVU q10 min for 2 hrs

Question 29

Fetus Fetal Lie relationship to

Answer 29

mom's spine baby spine parallel longitudinal vertex position (head down) Breech position transverse lie shoulder presentation

Question 30

Most common fetal position

Answer 30

LOA Left occipital anterior

Question 31

Induction

Answer 31

starting labor before it begins on its own. artificial means to open cervix and start contractions

Question 32

Augmentation

Answer 32

stimulating labor that has already began, slow, stalled. mechanical or pharma