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ACP226 Obstetrics > Module 4: Process Of Labour And Delivery > Flashcards

Module 4: Process Of Labour And Delivery Flashcards

(50 cards)

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1
Q

Recommended number of prenatal visits for average obstetrical risk patients

A

8-10:
First visit 6-10wks
Every 4wks up to wk 28
Every 2wks for wk29-36
Every wk from 37wks to birth

Fetal assessment begins between 12-14wks

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2
Q

3 methods used to monitor contractions

A

Palpation
External
Internal

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3
Q

3 phases of uterine contraction

A

Increment (building - longest)
Acme (peak)
Decrement (letting up)

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4
Q

Assessment of uterine contractions includes

A

Frequency
Duration
Intensity/strength
Resting tone

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5
Q

Rupture of membranes

A

Usually about 1L
Most women begin labour within 12-24hrs after

Note time, colour, odour, amount, consistency, FHR on rupture.

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6
Q

Bloody show (mucous plug)

A

Occurs with softening and effacement of cervix.
Sign of impending labour (24-48hrs)

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7
Q

Longitudinal lie

A

Uterus is positioned up/down.

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8
Q

Transverse lie

A

Uterus shape left to right

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9
Q

Leopold maneuver

A

4 maneuvers to evaluate uterus.
1) palpate upper abdomen/fundus
2) palpate Sagittal (L and R) to determine fetal back
3) palpate above pubic symphysis to determine presenting part
4) palpate inguinal area to determine descent

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10
Q

Effacement

A

Drawing up of cervical os and cervical canal into uterine side walls.

Primips: effacement usually occurs before dilation

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11
Q

Dilation

A

Cervical os and can widen from less than 1 cm to approx 10 cm.

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12
Q

Factors affecting the labour process

A

Passageway (birth canal)
Passenger (fetus and placenta)
Powers (contractions)
Position (of labouring client)
Psych response

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13
Q

Five additional P’s of labour

A

Philosophy
Partners
Patience
Patient preparation
Pain management

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14
Q

Factors affecting passenger in labour

A

Fetal head
Fetal attitude
Fetal lie
Fetal presentation
Fetal position
Fetal station
Fetal engagement

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15
Q

Passenger - fetal attitude

A

Refers to relationship of fetal body parts to one another.
Normal attitude is termed general flexion

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16
Q

Passenger presenting part

A

Cephalic.
Breech
Shoulder

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17
Q

Cephalic presentations

A

Vertex (occiput. Most common. Head flexed to chest)
Military (top of head. Head partially flexed)
Brow (head partially extended)
Face (head hyperextended)

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18
Q

Fetal breech presentation

A

Frank (buttocks first)
Complete (cross legged)
Footling (1 or both legs presenting)

Frank can result in vaginal birth. Complete, footling, and incomplete generally require C section.

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19
Q

Shoulder presentation

A

Transverse lie
1/300 births

Associated with: previa, premature, high parity, PROM, multiple gestation, fetal abnormality

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20
Q

Passenger fetal position

A

Relationship of presenting feral part to maternal pelvis.
Pelvis related in 4 imaginary quadrants.
Left anterior
Right anterior
Left posterior
Right posterior

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21
Q

Notations used to describe fetal position

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A

L or R (side of pelvis)
Vertex (occiput), mentum (face) sacrum (breech) shoulder (Acromion)
Anterior, posterior, or transverse.

22
Q

Most common and most favourable passenger position for birthing

Study These Flashcards
A

LOA
Left
Occiput
Anterior

23
Q

Passenger engagement/station

Study These Flashcards
A

Engagement occurs when the largest diameter of presenting part passes through pelvic inlet.

Station is relationship of presenting part to line drawn between ischial spines of maternal pelvis.

24
Q

Fetal position cardinal movements of labour

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A

Engagement
Descent
Flexion
Internal rotation
Extension
External rotation (restitution)
Expulsion

25
Power (contractions)
Primary (uterine contractions) Secondary (intra-abdominal pressure from mother pushing)
26
Premonitory signs of labour
Lightening Braxton-hicks Ripening Mucous plug ROM Sudden burst of energy Weight loss Backache/pelvic pressure increase Diarrhea Indigestion N/V
27
Maternal cardiovascular response to labour
CO increase 30% BP increase HR increase CO peaks immediately after birth and starts to decrease in first 10 minutes. CO remains elevated approx 24hrs
28
Maternal respiratory response to labour
50% of increased O2 used by placenta. Mild metabolic acidosis/respiratory alkalosis
29
Maternal renal response to labour
Polyuria (due to CO) Slight proteinuria Edema May occur
30
Maternal GI system response to labour
Motility reduced Gastric emptying prolonged
31
Stages of labour
1st: beginning of true labour. Ends with complete cervical dilation 2nd: complete dilation and ends with birth of baby 3rd: after birth of baby and ends with placental delivery 4th: 1-4 hrs after birth
32
1st stage of labour
Divided into latent, active, and transition phases.
33
Latent or early phase of 1st stage of labour
Begins with onset of regular contractions. May be little or no fetal descent. Cervix dilates 0-3cm Membranes May rupture Contractions q5-10 lasting 40-45 seconds (NP: 9hrs, MP 5-6hrs)
34
Active phase of 1st stage of labor
Anxiety increases Cervix dilates 4-7cm and effaces. Progressive fetal descent. Contractions q2-5 lasting 45-60s. Contraction begins and moderate and progresses to strong. Show present NP up to 6hr, MP up to 4hr.
35
Transition phase of 1st stage of labor
Short but intense Cervix progresses from 8-10cm Increase in show Contraction q1-2min lasting 60-90s NP up to 1hr, MP 30min
36
2nd stage of labor
Contraction q2-3m lasting 60-90s. NP up to 1hr, MP up to 30m Pelvic phase (fetal descent) Perineal phase (active pushing)
37
3rd stage of labor
Delivery of placenta Signs of separation usually appear around 5 minutes after birth but can take up to 30 minutes. 500ml blood loss normal Over 1L considered severe.
38
Dystocia
Delay or arrest in the progress of labor. Most common cause is dysfunctional or uncoordinated uterine contractions
39
Precipitous labor
Labor completed in less than 3 hours from the start of contractions to birth. Risk of injury to both mother and fetus.
40
Causes of dystocia
Dysfunctional uterine contractions Precipitous labor Cephalopelvic disproportion Passenger orientation and presentation
41
Cephalopelvic disproportion
Occurs when there is a size mismatch between mother’s pelvis and fetus’ head.
42
McRoberts maneuver
Application of suprapubic pressure to relieve shoulder dystocia
43
Compound presentation
Occurs with 2 presenting parts. Can happen when the presenting part doesn’t completely fill the inlet.
44
Non reassuring fetal status (fetal distress)
O2 supply doesn’t meet demand of fetus. Most common cause is cord compression or uteroplacental insufficiency
45
Prolapsed cord
Occur when cord falls and lies with or ahead of presenting part. 50% occur in 2nd stage of labor.
46
Retained placenta
Diagnosed if placenta hasn’t been delivered after 30 minutes
47
Amniotic fluid embolism
Occurs when amniotic fluid, fetal cells or hair, or other debris enters maternal circulation.
48
Fetal arrhythmias and dysrhythmias
Normal: Predictive of normal fetal acid-base status Atypical: Not predictive of abnormal fetal acid base. Abnormal: Predictive of abnormal fetal acid-base
49
Fetal tachycardia
Baseline FHR greater than 160bpm lasting 10 mins or longer
50
Fetal bradycardia
FHR below 110 lasting 10 mins or longer.

ACP226 Obstetrics (3 decks)

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