Normal Labor Flashcards
(76 cards)
1
Q
progressive cervical effacement and dilation from regular uterine contractions occurring at least every 3 minutes and last 30-60 sec each
A
labor
2
Q
Braxton Hicks (false labor)
A
common during weeks 4-8 - irregular/unpredictable uterine contractions
3
Q
signs of false labor
A
- Braxton Hicks contractions - irregular, more in abdominal region, repositioning can alter
- no progression of labor
- not associated w/ cervical dilation or effacement
- membranes not ruptured (no bloody show)
4
Q
hormones that inhibit labor
A
progesterone and relaxin
5
Q
hormones that stimulate growth
A
estrogen and prostaglandins
6
Q
hormones that stimulate contractions
A
oxytocin and prostaglandins
7
Q
most important anatomic factor in labor
A
fetal skull size
8
Q
largest part of fetal skull
A
supraoccipitomental (13.5cm)
9
Q
structures of true pelvis
A
pubis anterior, sacrum, coccyx, ischium laterally
10
Q
false pelvis
A
above true pelvis - supports uterus
11
Q
fetal head enters this plane 1st
A
pelvic plane
12
Q
largest plane
A
plane of greatest diameter
13
Q
MC site of low transverse arrests
A
plane of least diameter
14
Q
ischial tuberosities B/L - site of low pelvic arrest
A
pelvic outlet
15
Q
pelvic shapes
classic shape, 50% of women, spacious and cylindrical, widest transverse diameter
A
gynecoid
(most favorable)
16
Q
pelvic shapes
long narrow inlet w/ wide AP diameter, 20% of women, fetal head traverses in AP diameter
A
anthropoid
“oval shaped”
17
Q
pelvic shapes
bases on dimensions, most limited for fetal descent, side walls converge, arrest of descent common, 30% of women
A
android
“heart shaped”
18
Q
pelvic shapes
“flattened” gynecoid pelvis, narrow AP - fetal head must engage in transverse diameter, 3% of women
A
platypelloid
“wider than taller shape”
19
Q
3 P’s of Labor Determining Transit Time
A
- Power - uterine activity
- Passenger - size, lie, presentation, attitude, position, station
- Passageway - female pelvis types
20
Q
2 exam types during labor
A
- obstetric
- fetal position and lie
- Leopold maneuvers, US
- cervical
- determine phase of labor/progression
- 5 items
- dilation
- effacement
- station
- cervical position
- cervical consistency
21
Q
dilation
A
how open cervix is at internal os
(closed - 10cm)
- nulliparous: effacement before dilation
- multiparous: dilation before effacement
- rate of dilation
- nullliparous 1-1.2 cm/hr
- multiparous 1.5 cm/hr
22
Q
effacement
A
how thin cervix is between internal and external os
(normally 3-5cm)
measured in % - 100% is paper thin/ready to deliver
23
Q
station
A
relationship of head to ischial spines
- zero station - presenting part level w/ spines
- neg. station - above
- pos. station - below
- ranges -5 to +5 (but typically -3 to +3)
24
Q
cervical position
A
posterior, mid, anterior
25
cervical consistency
firm / soft / in-between
26
measurement to determine if cervix favorable for spontaneous delivery
Bishop score
| (8 is favorable)
27
intervening to increase the already present contractions
augmentation
28
attempt to begin labor in a non-laboring patient
induction
29
maternal indications for induction
* pre-eclampsia
* hypertension
* deteriorating/uncontrolled diabetes
* placental abruption
* previous still birth
30
fetal indications for induction
* post dates (usually T+10)
* IUGR
* rhesus disease
* intrauterine death
* placental insufficiency
31
induction contraindications
* cephalopelvic disproportion
* malpresentation (unless face or breech)
* fetal distress
* placenta previa
* cord presentation
* vasa praevia
* pelvic tumor
32
cautions for induction
* grand multiparity (6+)
* previous c-section (risk of uterine rupture)
* previous precipitate labor (risk of hyperstimulation)
33
First state of labor
onset true labor to complete dilation of cervix
34
Second state of labor
complete dilation of cervix to birth of baby
(if prolonged may require operative delivery -
forceps or vacuum)
35
Third state of labor
birth of baby to delivery of placenta
| (oxytocin to reduce blood loss)
36
Fourth stage of delivery
delivery of placenta to stabilization of patient
37
2 phases of stage 1 labor
* latent - cervical effacement and early dilation (3-4cm)
* active - rapid cervical dilation beginning at 4cm w/ active uterine contractions
* 1cm/hr primiparous
* 1.2cm/hr multiparous
38
duration of stage 2 labor
30min - 3hours
39
normal changes in babies head d/t delivery
* molding - alteration of cranial bones d/t compression
* caput - localized edema
40
6 cardinal movements of labor
1. engagement
2. descent
3. flexion
4. internal rotation
5. extension
6. external rotation
41
6 cardinal movements
widest presenting part drops into pelvic inlet
engagement
42
6 cardinal movements
dropping of fetal presenting part further into pelvis
descent
43
6 cardinal movements
dropping of chin toward fetal chest to present smallest diameter to maternal inlet
flexion
44
6 cardinal movements
presenting parts rotate to AP diameter
internal rotation
45
6 cardinal movements
occiput reaches symphysis/vaginal canal shifts upward - crowning when head encircled by vulvular ring
extension
46
6 cardinal movements
delivered head returns to original position to align w/ back and shoulders
external rotation
47
6 cardinal movements + 1
delivery of rest of fetus - anterior shoulder follows similar rotation under pubis
expulsion
48
management of first stage
* patient ambulation or lateral recumbent position
* IV fluids
* labs
* maternal monitoring
* analgesia
* fetal monitoring
* uterine activity
* vaginal examinations
* amniotomy
49
management of second stage
* maternal position- avoid supine
* bearing down
* fetal monitor: HR continuously or every 5 min
* vaginal exam: every 30 min
* delivery:
* supine or left lateral position
* episiotomy
* Ritgen maneuver
* clear airway when head delivered
* umbilical cord check
* anterior shoulder then body delivered
* cord clamping delayed 1-2 min
50
Ritgen Maneuver
upward pressure to chin by posterior hand covered
w/ sterile towel
while suboccipical region of head held against symphasis
51
management of third stage
* inspect vagina and cervix for lacerations & repair
* IV Pitocin - prevent hemorrhage
* deliver placenta
* signs of separation
* fresh show of blood
* umbilical cord lenghthens
* fundus rises
* uterus becomes firm & globular
* **uterine massage** - prevent atonicity
* examine placenta for full removal and abnormalities
52
management of fouth stage
* monitor HR, BP, uterine blood loss to prevent post-partum hemorrage
* patient massaging uterus
53
period following delivery of baby and placenta to 6 weeks postpartum
puerperium
54
normal aspects of puerperium
* organs and physiology return to pre-preg. state
* uterus involution - cervix firms
* uterine discharge
* lochia rubra
* lochia serosa
* lochia alba
* r/o endometriosis if foul-smelling lochia
* menstrual flow returns in 6-8 weeks
55
APGAR
* appearance (color)
* pulse (HR)
* grimace (muscle tone)
* activity (reflex irritability)
* respirations (RR)
56
APGAR scoring scale
_0 1 2_
color blue centerpink all pink
HR 0 \<100 \>100
resp. none weak cry vigorous cry
tone none some flex all flexed
reflex none some motion crying, withdrawal
57
APGAR score interpretation
scored at 1 and 5 minutes
* 8-10: no concerns
* 4-7: watch closeley and repeat at 10 min\*\*
* 0-3: resuscitate
58
how to stimulate breathing after delivery
flick soles or rub back
59
procedure if evidence of meconium passed
intubate and suction trachea before stimulating baby
60
when do you initiate positive pressure ventilation
gasping, apnea, HR \< 100 bpm
descision made in first 30-60 seconds after birth
61
fetal heart rates during labor
| (normal, tachycardia, bradycardia)
110-160
\>160
\<110
62
steps in fetal monitoring baseline assessment
* determine baseline FHR
* variability - changes in freq/amp w/ baseline
* normal short-term variability 6-25/min
* below 5 - fetal distress
* changes related to contractions
* no change
* acceleration
* deceleration (early, late, variable, prolonged)
63
fetal heart rate monitoring -
prolonged flat baseline indicates
short term variability
fetal acidosis
64
fetal heart rate monitoring -
normal is 3-10 cycles per min, abnormal indicates
long term variability
metabolic derangement
65
fetal heart rate monitoring -
early deceleration indicates
fetal head engagement
66
fetal heart rate monitoring -
late deceleration indicates
uteroplacental insufficiency
(repeated represents fetal hypoxia and acidosis)
67
fetal heart rate monitoring -
variable decelerations indicate
umbilical cord compression
68
non-pattern signs of fetal distress -
prolonged fetal tachycardia indicates
maternal fever and infection
69
non-pattern signs of fetal distress -
early meconium passage (before membrane rupture) increases risk of
fetal aspiration
70
non-pattern signs of fetal distress -
late meconium passage (2nd stage of labor) indicates
umbilical cord compression or hypertonic uterus
71
amniocentesis
when performed and what it tests
16-20 weeks via 22ga needle w/ US guidance
* fetal chromosome abnormalities
* AFP for neural tube defects
* prenatal infections
* 3rd trimester to assess lung maturity
* remove excessive fluid in polyhydramnios or twins
20mL fluid used
72
similar to amniocentesis
what it is, when it's done
chorionic villus sampling
* week 10 (earlier than amnio)
* sample from placenta through cervix or abdomen
* slightly less sensitive for genetic abnormalities
73
procedures to close cervix
* cerclage
* circumferential suture at 13-16 weeks
* McDonald
* simple purse-string suture near cervicovaginal junction
74
4 indications for operative vaginal delivery
(forceps, suction, c-section)
* prolonged 2nd stage labor
* suspicion of immediate impending compromise
* stabilize head after breech delivery
* shorten 2nd stage for mom's benefit
75
birth via laparotomy then hysterotomy
cesarean section
1' - first time hysterotomy
2' - uterus w/ 1+ prior hysterotomy incisions
76
reasons for increasing c-section
1. fewer children - more nulliparas births
2. avgerage maternal age rising
3. more electronic fetal monitoring
4. more breech fetuses
5. decrease in forcep and vacuum deliveries
6. more inductions
7. rise in obesity
8. increases for preeclampsia
9. VBAC has decreased
10. more elective c-sections
