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Flashcards in OB Mod IV Review Deck (98):
1

The passage, the fetus, the relationship between the passage and the fetus, the physiologic forces of labor, and the psychosocial considerations.

Five factors of critical importance in the process of labor and birth.

2

Four types of pelvis as classified by the Caldwell-Moloy system

gynecoid (most common)
android
anthropoid
platypelloid

3

The true pelvis consists of....

the inlet, pelvic cavity, and the outlet

4

Frontal suture

located between the two frontal bones, becomes the anterior continuation of the sagittal suture

5

Sagittal suture

located between the parietal bones, divides the skull into left and right halves

6

coronal sutures

located between the frontal and parietal bones, extend transversely left and right from the anterior fontanelle

7

lambdoidal suture

located between the two parietal bones and occipital bone, extends transversely left and right from the posterior fontanelle

8

2 pelvic types favorable for vaginal birth

gynecoid, anthropoid

9

2 pelvic types not favorable for vaginal birth

android, platypelloid

10

Skull landmark Mentum

fetal chin (face presentation; head is hyperextended)

11

Skull landmark Sinciput

anterior area known as the brow (brow presentation)

12

Skull landmark Bregma

diamond-shaped anterior fontanelle (sinciput presentation; no head extension or flexion)

13

Skull landmark Vertex

area between anterior and posterior fontanelles

14

Skull landmark Occiput

occipital bone (vertex presentation; most common type)

15

Primary physiologic force of labor

uterine muscular contractions

16

Secondary physiologic force of labor

use of abdominal muscles to push

17

Each contraction has three phases progressively:

increment, acme, decrement

18

Progesterone relaxes smooth muscle tissue, estrogen stimulates uterine muscle contractions, connective tissue loosens

identified factors at the onset of labor

19

Three phases of the first stage of birth

Latent, active, transition

20

Cardinal movements of labor

1. descent
2. flexion
3. internal rotation
4. extension
5. restitution
6. external rotation
7. expulsion

21

Two phases of the third stage of birth

placental separation, placental delivery

22

Two presentations of the placenta

shiny Schultze, dirty Duncan

23

Under what circumstances should the mother come to the birthing unit?

ROM, regular and frequent uterine contractions, vaginal bleeding, decreased fetal movement

24

Contraction frequency 2-5 minutes, duration 40-60 seconds, moderate to strong intensity.

Active phase

25

Contraction frequency 1.5-2 minutes, duration 60-90 seconds, intensity strong.

Transition phase

26

Systemic medication considerations

1. cross the placental barrier by simple diffusion
2. action depends on liver enzyme metabolism
3. high doses remain in fetus for long periods (fetal liver enzymes and kidney function insufficient)

27

Maternal assessment with medication administration

1. willing to receive
2. vital signs stable
3. contraindications not present

28

Fetal assessment with medication administration

1. FHR between 110 and 160
2. Variability present
3. fetal movement/ accelerations present
4. fetus is at term

29

Labor assessment with medication administration

1. documentation of contraction pattern
2. cervical status (position, consistency, effacement, dilatation, station)

30

Butorphanol tartrate (Stadol)

Synthetic agonist-antagonist opioid analgesic agent.
1. respiratory depression, mother and fetus
2. drowsiness, dizziness, fainting, hypotension
3. urinary retention; not common
4. protect med from light/ store at room temp
5. has a ceiling effect

31

nalbuphine hydrochloride (Nubian)

Synthetic agonist-antagonist opioid analgesic
1. crosses placenta/ nonreassuring fetal heart rate & respiratory depression
2. IV infusion/ 10 mg over 3-5 minutes
3. Has a ceiling effect
4. choice over Stadol/ less nausea & vomiting and increased maternal sedation

32

Fentanyl (Sublimaze)

Short-acting opiate
1. relives pain/ induces sedation
2. 50-100 more potent than morphine
3. does not cross placenta (less neonatal neurobehavioral depression than Demerol)
4. less sedation, nausea, vomiting, pruritus compared with Demerol

33

Potentiate the effects of opioid analgesics permitting lower doses of opioids

analgesic potentiators: promethazine (Phenergan), hydroxyzine (Vistaril), propiomazine (Largon), and promazine (Sparine)

34

Used to counter opioids; reverse respiratory depression

Naloxone (Narcan)
1. if unresponsive to treatment may be readministered every 2-3 minutes

35

Two types of local anesthetic agents

1. esters [procaine hydrochloride (Novocain), chloroprocaine hydrochloride (Nesacaine), Ropivacaine (Naropin), and tetracaine hydrochloride (Pontocaine)]
2. amides [lidocaine hydrochloride (Xylocaine), mepivacaine hydrochloride (Carbocaine), and bupivacaine hydrochloride (Marcaine)]. More powerful than esters

36

Preferred treatment for mild toxic reaction to anesthetics

oxygen and IV injection of a short-acting barbiturate to diminish anxiety

37

Given to counter hypotension of 1-2 minutes after epidural regional block (after initial repositioning efforts to counter hypotension)

ephedrine 5-10 mg IV

38

Pruritus associated with an epidural infusion is treated with administration of what

diphenhydramine hydrochloride (Benadryl)

39

Given at 30-32 weeks gestation to facilitate growth of alveoli

corticosteroids

40

Cyclooxygenase (prostaglandin synthetase) inhibitors, calcium channel blockers such as nifedipine (Procardia), terbutaline sulfate (Brethine), and magnesium sulfate are used for what?

Tocolytics

41

These tocolytics should not be used concurrently due to their calcium blockage potential

Nifedipine/ magnesium

42

Five "P's" of labor

Powers: contractions
Passageway: birth canal
Passenger: fetus and placenta
Position of the Mother
Psyche: psychologic response

43

Percent increase in circulating blood volume when pregnant

40-50%

44

Normal placental implantation

Upper part of the uterus (1st stage of development)

45

Infectious agents (teratogens) and possible effects on pregnancy

Rubella
Parovirus-chance of miscarriage or hydropsfetalis
Toxoplasmosis-cat feces
STD

46

Cervical cerclage

Treatment for cervical incompetence (purse-string stitch)

47

2 types of maternal fetal monitoring

Intrauterine pressure catheter
Internal fetal scalp monitor

48

Premonitory signs of labor

Braxton Hicks contractions
Lighteining (2-3 weeks b4 labor)
Increased vaginal mucous secretion
Bloody show
Energy spurt
Weight loss

49

Theories of the causes of labor

Primarily hormonal changes
Increase in oxytocin receptors
Fetal production of oxytocin, cortisol, prostins
Increase stretching, pressure, irritation of uterus cervix

50

Primary hormone changes during labor

estrogen to progesterone ratio increases
progesterone decreases
prostaglandins increase
oxytocin increases

51

True Vs. False labor contractions

consistent pattern increasing frequency, duration, and intensity/ inconsistent change in activity

52

True Vs. False labor discomfort

begins lower back and moves anterior/ annoying not painful

53

True Vs. False labor cervix changes

effacement and dilation/ no change

54

Uterine rupture (causes, S&S, nursing management, treatment)

Hemorrhage/ fetal anoxia/ fetal hemorrhage/ neonatal morbidity and mortality/ increased risk of maternal death
C-section birth/ hysterectomy

55

Placenta previa (causes, S&S, nursing management, treatment)

Hemorrhage/ uterine atony
increase incidence of C-section/ fetal hypoxia/ acidosis/ fetal exsanguination/ increased prenatal mortality

56

Chorioamnionitis (causes, S&S, nursing management, treatment)

Intra-amniotic infection resulting from bacterial invasion before birth/ PROM/ retained placenta and hemorrhage/ maternal sepsis/ maternal death

57

First stage of labor

onset of true labor until full effacement and dilation of cervix (15-20 hours)

58

First phase (latent)/ First stage of labor

0-3 cm dilated
Uterine contractions 5-20 min/ 30-45 sec
Mild tone
Nose

59

Second phase (active)/ First stage of labor

4-7 cm dilated (Dr. will tell mom to come in)
Uterine contractions 2-5 min/ 45-60 sec
Moderate tone
Chin

60

Third phase (transition)/ First stage of labor

8-10 cm dilated
Uterine contractions 1.5-2.5 min/ 60-90 sec
Firm tone
Forehead

61

Nursing care interventions First Stage of Labor

I/O; Temperature; Vital Signs

62

HCL

nuccal; cord around neck

63

Nursing diagnoses during first stage of labor

dehydration
risk for falls

64

Second stage of labor

Full effacement and dilation until birth

65

Second stage of labor nursing responsibilities

Blood pressure q15min/ FHR q15min
Comfort measures (positioning is important, rest, prepare for delivery, reassure, significant other or self involvement/ present to coach)

66

Second stage of labor concerns

Pushing efforts
Descent
Birth of baby
Amniotic fluid appearance

67

Third stage of labor

From birth of baby to birth of placenta

68

Third stage of labor nursing responsibilities

Prevent fluid loss/ maintain safety/ prevent trauma/ basic care and comfort
Prevent trauma (do not pull on cord: hemorrhage/ cramping before placental delivery)

69

Fourth stage of labor

1-4 hours after birth for physiological and psychological stabilization and family attachment

70

Fourth stage of labor nursing responsibilities

Teach about baby care (i.e. cord care, etc.)
Monitor HR, cardiac output, respiratory rate)
Gastrointestinal and urinary systems are affected

71

Importance of relaxation between contractions

Tense muscles increase resistance to the descent of the fetus and contribute to maternal fatigue.

72

Positional changes during labor (very important)

Encourage mom to move
Walking, rocking, chair, birthing ball, toilet assistance, moving side-to-side

73

Most common type pelvis (50%) that is favorable for vaginal childbirth; wide and deep

Gynecoid

74

Type of pelvis favorable for vaginal childbirth (25% white, 50% non-white); narrow and deep

Anthropoid

75

Type of pelvis not favorable for vaginal childbirth (30%); heart shaped

Android

76

Type of pelvis not favorable for vaginal childbirth (3%); wide and shallow

Platypelloid

77

Consists of the inlet, mid (pelvic cavity measured in the U.S.), and outlet.

True pelvis

78

True pelvis

Portion of the pelvis below the line terminalis (consists of the inlet, midpelvis, and outlet)

79

The flared upper portion of the bony pelvis

False pelvis

80

Soft tissue of the cervix and vagina

Birth canal

81

Released by the placenta, this hormone influences pelvic relaxation

Relaxin

82

How to increase pelvic diameter to facilitate the birth process

during labor squat and lie in a lateral Sims position

83

Most common risks of VBAC

Hemorrhage/ uterine scar separation/ uterine rupture/ surgical injuries/ fetal death/ neurologic complications

84

Aspects to consider with VBAC

Debate regarding safety
ACOG guidelines
Common risks

85

ACOG guidelines

American College of Obstetricians and Gynecologists
The College guidelines state that women with two previous low-transverse cesarean incisions and women carrying twins may be considered
appropriate candidates for a TOLAC

86

Injection of anesthetic into the epidural space between dura and spinal cord.

Epidural block; all drugs injected into epidural or subarachnoid space are preservative free

87

Performed to determine placement of an epidural block

3 mL test

88

Should be monitored before injection through an epidural block

Platelets should be high/ watch vitals/ 3 mL test/ I&O/ **always monitor BP every 15 min.

89

Possible side effect of maternal narcotic analgesia

Newborn respiratory depression

90

Adverse effects of an epidural block

Maternal hypotension/ bladder distension/ prolonged 2nd stage/ nausea and vomiting/ pruritus/ decreased RR for up to 24 hrs dura puncture (headache, fluid leakage)/ contraindicated if allergic to anesthetics.

91

Intrathecal injection (spinal anesthesia)

Injection of preservative free opioid analgesic into subarachnoid space. May have to re-inject.

92

Advantages of spinal anesthesia (intrathecal)

small doses, reduces pain, less sedation, no motor block, no hypotensive effects

93

Disadvantages of spinal anesthesia (intrathecal)

Limited duration of action, inadequate relief for late labor and birth, has to be timed "right" for maximum effect

94

Adverse effects of spinal anesthesia (intrathecal)

Nausea and Vomiting (N/V)/ pruritus (itching)

95

Three types of C-section

Scheduled/ emergent (not a true emergency but must be done)/ emergency

96

Indications for a C-section delivery

PIH (pregnancy induced hypertension), maternal disease, active genital herpes, HIV positive mom, previous uterine surgical procedure, fetal distress, prolapsed umbilical cord, fetal malpresentation, hemorrhagic conditions

97

Contraindications for a C-section delivery

Conditions that are not desirable, intrauterine fetal demise (IUFD), preterm fetus (that wont survive), maternal coagulation defects

98

Three types of breech presentation

Frank breech: bottom first, feet crossed
Complete breech: bottom first, feet crossed in front of the face
Single footing breech: one foot delivering first, second foot over abdomen