OB: Labor and Delivery

Question 1

what is cephalic presentation

Answer 1

baby comes out head first

Question 2

Types of cephalic presentation
1. RAO
2. ROT
3. ROP

Answer 2

1. ROA- the baby face is facing the moms back, the baby back is to the left (most common)
2. ROT- The babys face is facing the right hip, babys back is to the left
3. ROP- the babys face is facing the moms abdomen, back is facing toward the left

Question 3

Types of cephalic presentation
4. LOA
5. LOT
6. LOP

Answer 3

1. LOA- The babys face is facing the moms back, the babys back is facing the right
2. LOT- the bays face is facing the left hip, the babys back is toward the right
3. LOP- the babys face is facing the mom abdomen, back is facing toward the right

Question 4

What is breech presentation

Answer 4

baby comes out butt or feet first

Question 5

Dilation

Answer 5

cervix opening to allow for delivery r/t fetus axis pressure
- expressed at: closed = -10

Question 6

Effacement

Answer 6

thinning of the cervix
- expressed as: 0% ( thick cervix) – 100% (paper thin cervix)

Question 7

Engagement

Answer 7

largest diameter of the presenting part passes through the pelvic inlet (BPD)

Question 8

Does dilation and effacement happen simultaneously

Answer 8

yes

Question 9

Station

Answer 9

measure how high or low the baby is
- negative numbers means the baby is high (-5 being the highest)

• positive numbers means the baby is low (+5 being the lowest)
• 0 station = presenting part at ischial spines

Question 10

True labor

Answer 10

• regular contractions
• increased frequency, duration, and strength for contractions
  ++ PROGRESSIVE DILATION and EFFACEMENT++
• discomfort starts in back then radiates around body

Question 11

False labor

Answer 11

• irregular contractions
• dont increase frequency, duration, and strength for contractions
• dont lead to dilation and effacement
• “hardening sensation”

Question 12

Premature signs of labor

Answer 12

• baby drops
• increase frequency of contractions
• vaginal bleeding
• cervix softens
• back pain
• spontaneous rupture of membranes (water breaks)
• sudden burst of energy

Question 13

First stage of labor:
A. Early/latent phase
B. Active phase
C. Transition phase

Answer 13

A. onset of contractions (pt able to cope)
B. contraction intensify (pt dilated 4-7cm +fetal decent)
C. increase force and intensity of contractions (pt. dilated 8-10cm)

Question 14

Second stage of delivery

Answer 14

• pt 10 cm dilated, pushing w/ urge to push
• baby does 8 cardinal mvt- then baby comes out
• Epiostomy: cutting the vaginal opening to allow for delivery ( CON: may be unnecessary)

Question 15

Third stage of delivery

Answer 15

Delivery of the placenta- DONT PULL ON CORD
retained placenta: placenta that not delivered within 30 mins after baby is born

Question 16

Fourth stage of delivery

Answer 16

1-4 hours after delivery
- prime time for bonding
- drop in BP + tachycardia ( r/t blood loss)
++ FUNDUS should be firm and measured between the umbilicus and symphysis pubis

Question 17

Epidural + side effects and nursing interventions

Answer 17

local anesthetics + narcotics into epidural space

SE: HYPOTENSION

NI: monitor BP, fluid bolus

Question 18

Contraindications for epidurals

Answer 18

• plt less than 100,000
• coagulation disorders/ hemorrhage
• severe spinal abnormalities
• infection
• uncooperative pt

Question 19

Cesarean birth

Answer 19

• transverse abdominal incision is the most common
• after procedure: Pitocin ( for uterine firmness), DVT prevention, advance diet, pain management

Question 20

Fetal Monitoring: TACO

Answer 20

tells the duration of the contractions ( as hills) - cant tell the intensity

Duration: measure form beginning of contraction to the end of contraction

Frequency: measure form peak to peak

Question 21

Normal fetal HR

Answer 21

normal= 110-160
greater than 160= tachy
less than 110= brady

Question 22

Variabilty

Answer 22

jaggedness of FHR monitor = GOOD

Question 23

Absent variability

Answer 23

FHR monitor lacks jaggedness= BAD
NI: 1. consider situation ( is mom getting morphine)
2. can give mom juice

Question 24

Accelerations

Answer 24

Fetal HR elevation greater than 15 bpm lasting at least 15 sec = GOOD

Question 25

Decelerations

Answer 25

drop in fetal HR

Question 26

Early decelerations

Answer 26

happens early in contractions r/t head compression ( vasovagul) - mirrors contractions NI: check mom (vaginal exam)

Question 27

Late decelerations

Answer 27

BAD - starts at peak of contraction - sign of stress and hypoxia - caused by uteroplacental insufficiency NI: 5 TURNS 1. turn pt to the left side 2. turn fluids on 3. turn pitocin off 4. turn O2 on 5. turn call light on

Question 28

Variable decelerations

Answer 28

- abrupt onset and abrupt return to baseline - r/t umbillical cord compression ( blood flow is compromised) NI: 1. adjust position 2. give O2 3. monitor 4. Tell provider

Question 29

VEAL CHOP (for fetal HR)

Answer 29

V: variables = C: cord compression E: early = H: head compression A: acceleration= O: ok L: lates = P: placental insufficiency Treatments = 5 TURNS 1. turn pt to the left side 2. turn fluids on 3. turn pitocin off 4. turn O2 on 5. turn call light on

Question 30

Prolonged decelerations

Answer 30

last longer than 2 min but less than 10 CONCERNING TELL THE PROVIDER