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BCIT Perinatal Theory One > Module Five > Flashcards

Module Five Flashcards

(64 cards)

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1
Q

Defining sign of labour

A

presence of regular uterine contractions that become progressively stronger, frequent, and longer

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2
Q

Positive sign of labour

A

regular contractions with cervical changes - cervix moving from posterior –> anterior, shortening, thinning (effacing) and dilating

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3
Q

Maternal Prep for Labour

A
  • inc estrogen activates uterus
  • inc oxytocin and prostaglandin –> cervical ripening
  • inc inflm activates cervix & uterus
  • inc uterine oxy receptors
  • inc central receptors (brain) for beta-endorphins continuing to endogenous analgesia in labour
  • inc mammary & central oxytocin and prolactin receptors
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4
Q

Fetal Prep for Labour

A
  • Pre-Labour lung and organ maturation
  • develop. of oxy neuroprotection
  • inc epinephrine and norepinephrine receptors to protect from hypoxia
  • preservation of blood supply to <3 and brain via catecholamine surge and neuroprotection effects
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5
Q

Oxytocin

A

produced by posterior pituitary gland, optimizes rhythmic contractions, promotes calm, reduces fear and stress, promotes attachment

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6
Q

Beta-Endorphins

A

secreted by posterior pituitary gland, provides analgesia and adaptive responses to stress and pain

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7
Q

Catecholamines

A

epinephrine, norepinephrine, dopamine- released in response to fear, stress and perceived danger. Supports newborn transition to extrauterine life. Primary mediators that prepare fetus for birth and support multi-organ transition.

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8
Q

Cortisol

A

Stress hormone, elevated during labour, may promote contractions, increase central oxytocin effects on mat adaptations, attachment, postpartum mood. Prepares fetus for birth- promotes lung maturation and clearance of fetal lung fluid

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9
Q

True Labour

A
  • Regular contractions that become stronger, longer, and more frequent
  • Contractions become more intense with walking
  • Contractions felt in lower back and radiates to lower abdomen
  • Contractions continue despite use of comfort measures & rest
  • Cervix softens, moves from post–> ant position, thins and dilates
  • Presenting part of fetus is engaged in pelvis
  • Bloody Show
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10
Q

False Labour

A
  • Contractions continue irreg or stop/start
  • Contractions may stop with activity or stop with rest
  • Contractions can be felt in low back or abdomen above umbilicus
  • Contractions stop/slow with comfort measures
  • Cervix does not change
  • Fetus may not be engaged
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11
Q

5 Ps of Labour

A 
Passenger
Passage
Powers
Position
Psyche
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12
Q

Passenger

A

Fetus- size, presentation, lie, attitude, position

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13
Q

Passage

A

Mat pelvis- bones, soft tissues, cervix, pelvic floor, vagina

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14
Q

Powers

A

Contractions, voluntary bearing down efforts

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15
Q

Position

A

Woman’s position as she labours

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16
Q

Psyche

A

Woman’s strength, PMHx, ability to cope, perception of pain, level of fear/anxiety, values & beliefs, intentions

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17
Q

6 bones of fetal skull

A

two parietal, two temporal, occipital, frontal

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18
Q

fontanelles

A

anterior- diamond shaped, posterior - triangular

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19
Q

Primary powers

A

uterine contractions

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20
Q

Secondary powers

A

maternal pushing efforts

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21
Q

Position changes

A

relieve fatigue, increase comfort, improve circulation, gravity, opening pelvic diameters

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22
Q

7 Cardinal movements

A
  1. Engagement
  2. Flexion
  3. Descent
  4. Internal Rotation
  5. Extension
  6. Restitution and External Rotation
  7. Expulsion
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23
Q

First Stage

A

onset of regular contractions and ends when cervix fully dilated

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24
Q

Latent Phase (First Stage)

A

Starts when contractions become regular and painful, cervical effacement and dilation commences, complete at 3cm. Lasts 6-8h, contractions q5-30mins

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25
Active Phase (First Stage)
time when labour is well established, contractions more painful, frequent, longer - cervix dilates from 4-7cm. Lasts 3-6 hours, contractions q3-5mins
26
Transition (Accelerated) Phase (First Stage)
cervix 8-10cm, signals approach of 2nd stage, contractions more expulsive in nature
27
Second Stage
Commences with full dilation and ends with birth of baby Expulsive contractions and maternal efforts, gravity enhancing positions. Fetal head descends under public arch, gradually thinning and stretching the vaginal opening.
28
Crowning
Widest diameter of the head distends the opening
29
Restitution
Once head is born it rotates briefly to position it was in when entering the pelvis
30
Latent Phase (Second Stage)
Cervix fully dilated, fetus continues to descend, no urge to push
31
Active Phase (Second Stage)
Stretch receptors in pelvic floor trigger a strong urge to push - Ferguson's reflex
32
Third Stage
Birth of a baby --> delivery of placenta and membranes
33
Signs of Placenta separation
- firmly contracted fundus - change in uterine shape - sudden gush of blood - apparent lengthening of cord - Feeling of vaginal fullness
34
Fourth Stage
One - Four hours postpartum | - physiologic adjustment & stabilization, uterus well contracted, moderate amount of vaginal bleeding
35
Assessing Fetal Well-being
FHR- 110-160 bpm | Assess q 15-30 min in active phase, q5min in 2nd stage
36
Assessing Contractions
palpate before, during, after contraction - resting tone - strength, duration, frequency
37
Non-pharmacological pain management
- intradermal sterile water injection - music - hypnosis - relaxation - breathing techniques - massage - heat/cold application - acupressure & acupuncture - transcutaneous electrical nerve stimulation - water therapy - position changes
38
Pharmacologic
- Inhalation - Nitronox and Entonox - Narcotics- Opioids in early stages - Regional Analgesia/Anesthesia - Epidural
39
Assessments during Second Stage
``` Mat VS q1h FHR q5min Contraction strength, freq, dur Descent Pushing strength, effectiveness Pain and Coping Position Changes- q20mins Spontaneous Pushing ```
40
Risk of PPH
10 IU Oxy @ delivery Cord Clamped within 3 mins Controlled traction to help with placental delivery
41
Maternal Assessment
signs of placental separation VS q15mins for first hour fundus and flow Q15 mins assess pain
42
Newborn Assessment
``` Apgar 1+5 mins VS within 15mins VS hourly until temp stable Head to Toe Readiness to feed ```
43
Labour Dystocia
long, difficult, abnormal labour - variance in one of the 5Ps --> leading cause of c/s Increased risk: obesity, short stature, advanced mat age, infertility, uterine abn, malpresentation, malposition, overstimulation of uterus with oxy, mat fatigue, dehydration, fear, use of epidural
44
Dysfunctional Labour
alteration in characteristics of uterine contractions - lack of progress in cervical dilation, lack of progress in fetal descent and expulsion
45
Passenger Variations
fetal size, fetal presentation, multifetal pregnancy, fetal anomalies
46
Cephalopelvic Disproportion
fetal head too big to move through pelvis - may result from malposition
47
Macrosomia
SFH measures larger than wk gest. Excess wt gain, partner above average height and weight
48
Shoulder Dystocia
Obstetrical Emergency*** head is born but ant shoulder cannot pass under pubic arch - asphyxia, fractures to humerus/clavicle, brachial plexus nerve injury, trauma, rectal injuries, PPH
49
Malpresentation
something other than head is presenting part
50
External Cephalic Version
OB attempts to turn fetus from breech --> cephalic
51
Malposition
most common- persistent occiput posterior position - OP, ROP, LOP - irreg contraction pattern, long and slow labour, back pain - Upright forward leaning, lunging, rocking --> fetal descent and rotation
52
Deflexed Head
presents a wider diameter of the head and is associated with a longer, slower labour
53
Asynclitism
Head is tilted to one side or other instead of in alignment with the shoulders
54
Persistent Cervical lip
thin ribbon or lip of cervix at front or side
55
Oxytocin for Induction
RISKS: uterine hyperstimulation, Placental abruption, uterine rupture, unnecessary c/s d/t abn FHR, PPH, poor fetal oxy, hypoexmia, acidosis
56
hyperstimulation
6 or more contractions in 2 consecutive 10 min windows OR contractions lasting >120s
57
tachysystole
more than 5 contractions per 10 min period over 30 mins
58
hypertonus
contraction lasting greater than 120s
59
Vacuum Assisted Delivery
Trauma to perineum, vagina, cervix, cephalhematoma, scalp lacerations, subdural hematoma
60
Forcep Assisted Birth
Trauma to vagina, cervix, perineum, PPH, lacerations, bruising, facial palsy, subdural hematoma
61
Conditions for Vac & Forcep deliveries
- Fully dilated cervix - Ruptured Membranes - Empty Bladder - Engagement - Maternal Pelvis Assessment - Maternal Consent
62
C/S complications
``` Anesthesia issues Hemorrhage Bowel/Bladder injury Amniotic Fluid Embolism UTI Abd Wound Hematoma Wound Dehiscence Infection Thromboembolism ``` Preterm Birth Inc incidence of resp distress and tachypnea separation of mum and babe affecting attachment
63
Contraindications to VBAC
"T' Classic scar from prev C/S prev uterine rupture presence of contraindication to labour
64
Uterine Rupture- S&S
- atypical/abn FHR pattern - cessation of contractions - constant abd pain - vag bleeding - hematuria - mat shock

BCIT Perinatal Theory One (4 decks)

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