OB Module 3: Labor and Delivery Flashcards
(210 cards)
1
Q
___ is one of the most vulnerable periods in a woman’s life
A
labor
2
Q
What are two things you need to respect in a labor and delivery situation
A
- Respect vulnerability in the situation they are in
2. Respect the way that woman is coping with the situation they are in
3
Q
What are the 5 factors that effect the duration, success, and intensity of labor and delivery?
A
The 5 “P”s:
Passenger Passageway Powers Position of the Laboring Woman Psychological Response
4
Q
Who is the “Passenger”
A
the infant
5
Q
What is the “Passageway”
A
Both the bony pelvis and the soft tissues
6
Q
What are the “Powers”
A
the intensity of the contractions and the ability to push in the second stage of labor
7
Q
Passenger
A
The fetus
there are several variables related to the fetus that can impact and influence the labor and delivery
8
Q
What variables of the Passenger can influence the labor and delivery
A
- Size of the fetus
- Fetal presentation
- Fetal Lie
- Fetal Attitude
- Fetal position
9
Q
The head is not like soft tissues. What does this mean
A
it cannot allow total manipulations, but if can elongate and narrow to allow delivery and also rapid brain growth once born
10
Q
What is the largest and hardest part of the body
A
the head
11
Q
What is the skull composed of and why
A
the skull is composed of a series of plates with sutures and fontanels between them to allow for shifting and overlapping during labor and rapid infant brain growth in the first year and a half of life
12
Q
Fetal shoulders can also create ____
A
dystocia
13
Q
Dystocia
A
Seen in very larger babies and diabetic mothers
the babies have taken on a lot of body fat, and this disproportion makes it difficult to deliver the babies shoulders after the head has come out
14
Q
Fetal Presentation
A
refers to the PRESENTING PART of the infant in the birth canal
What is the lowest part of the infant
15
Q
What is the most common fetal presentation
A
Most infants have head first (cephalic) and usually it is the occiput vertex
So this is the occiput and then vertex that present first anteflexed to the neck
16
Q
What is called if the babies fetal presentation is head first?
A
Cephalic Presentation
17
Q
Occiput
A
The back of the babies skull
18
Q
The Vertex
A
The foremost (posterior top) of the babies skull
19
Q
Breech
A
a fetal presentation where the lower half of the infant is presenting
20
Q
Frank Breech
A
When the infants buttocks are the presenting part
Buttocks down and legs up
21
Q
Single or Double Footling Breech
A
Fetal presentation when a foot or both feet are the presenting parts
22
Q
If the fetal presentation is the shoulder, what part is presenting
A
the scapula
23
Q
Anteflexed
A
babies chin is flexed to the chest
this is why the occiput comes through first in a head presentation
24
Q
Why does the infant commonly come out with the head anteflexed
A
Because it can allow the head through in the narrowest diameter
25
What are some concerns regarding breech presentations
Potential for prolapsed cord
Asphyxiation
C Section need
26
Why is there concern for a prolapsed umbilical cord in a breech presentaiton?
The breech position does not fill and cork off the pelvis like the head usually does, so when the water breaks there is a greater chance the umbilical cord will slip down between the baby and pelvis and prolapse
When the baby descends, this prolapsed cord can mean no O2 is going to the baby and the baby can asphyxiate
27
Other than the potential prolapsed cord, what else can cause asphyxiation in the child ?
The head does no shift or elongate quickly, so if there head is first we can see arrest of descent usually and do interventions
However, in breech if the head is too big the head can get stuck and cause asphyxiation from the cord being pinched too
28
Arrest of Descent
when the delivery and descent of the baby is hindered and slowed and stopped due to the size of the head
29
What is not too uncommon to have to do if a child is ion the breech presentation
A Cesarean Section
This is particularly true in the first child and can be avoided if former babies were large and can allow breech delivery
30
Fetal Lie
refers to the longitudinal orientation of the fetus
So this is the spine of the infant in relation to the spine of the mother
31
What are the two types of fetal lie
Longitudinal Lie
Vertical Lie
32
Longitudinal Lie
Cephalic or breech presentation
infant spine is parallel to the mother's spine
33
Transverse Lie
when the infant spine is perpendicular to the mother's spine
a shoulder presentation
34
Fetal Attitude
Refers to the flexion of the infant
35
General Flexion
When the infant is somewhat curled up with chin flexed onto its chest
The arms and legs are flexed toward it's abdomen
This is the ideal flexion
Gives the smallest diameter for delivery
sometimes called "Vertex Presentation" - complete flexion
36
What kind of flexion can cause problems in delivery?
Extended head or arms
it can cause increased diameter
37
Flexion allows the smallest ___
diameter
38
What sort of flexions can compound with breech position to make delivery harder
Military Flexion/Presentation
Brow Flexion/Presentation
Face Flexion/Presentation
39
Military Flexion/Presentation
The head is not anteflexed with arms flexed toward the head causing slight neck extension
This is only moderate flexion
The more anterior portion of the skull rather than vertex and occiput present in this
40
Brow Flexion/Presentation
less flexion of arms and legs with head more dorsiflexed
the eyebrows present and the anterior skull
it is poor flexion and has extension
41
Face Flexion/Presentation
full extension of the neck making the face present fully
full extension and no flexion
42
Fetal Position
refers to the relationship of the presenting part to the maternal pelvis (not the spine)
done in 3 letter codes
43
What do the 3 letter codes of the fetal position mean?
First Letter - Presenting Part's Right or Left Orientation (the mothers L or R)
Second Letter - The presenting part
Third Letter - represents the presenting part's location related to an anterior, posterior, or transverse orientation
44
Are there optimal and non optimal positions?
Yes
The baby does need to rotate as well in delivery
45
What would ROP mean
Right Occiput Posterior
The babies occiput is oriented to the right posterior side of the mother
46
What are the optimal fetal positions
ROA or LOA
Right or Left Occiput Anterior Position
This is because the curve and contour of the sacrum allowing the baby to descend easily
47
What would M mean in a fetal position
mento
it means the babies face is presenting
48
What would S mean in a fetal position
sacrum
it means the babies bottom is presenting
49
Passageway
the mother's bony pelvis and soft tissue
50
What is the more significant part of the passageway and why?
The bony pelvis is the more significant of the two
there are multiple contours to the inner pelvis that are important
51
___ delivery is a rare occurrence
posterior
52
What is needed to get through the pelvis in case of obstruction in vaginal delivery
rotation
53
What is included among the passageway soft tissues that can affect labor and delivery
scar tissues in the case of female circumcision
body fat of an obese woman
54
The pelvis is comprised of...
pieces of bone joined by cartilage
it is NOT one full bone
55
What are the bones of the pelvis?
Ilium
Ischium
Pubis
Sacral Bones
56
Ilium
The large wings / hip bones you can feel in the posterior sides of the pelvis
57
Ischium
the anterior lower segment of the pelvis below the pubis bones
58
Pubis
the upper part of the pelvis anteriorly above the ischium
59
Sacrum
the piece connecting the ilium
comes forward toward the coccyx (the bottom of the sacrum) in a scooping form
60
Another name for the pelvis
coxal bone
61
For OB Purposes, what are the two segments of the pelvic canal?
1. The upper pelvis
| 2. the lower pelvis
62
The Upper Pelvis
above the brim
it is the "false" pelvis and plays no part in childbearing
it is mostly the outer and upper canal that is mostly made up of the ilium
63
The lower pelvis
the true pelvis
this is the inner more canal and lower bones
divides into 3 planes
64
What are the three planes of the lower pelvis
The inlet
the mid pelvis
the outlet
65
The arc of the sacrum is important ...
in the true pelvis
66
The inlet
the upper most portion of the true pelvis that is the start of the downward descent toward the vaginal canal
it has some constriction to it
67
The mid pelvis
the middle portion of the true pelvis
has a greatest and least diameter
68
Where is the greatest diameter to the true pelvis
about 2/3 of the way down the true mid pelvis between S2 and S3
69
Where is the lead diameter to the true pelvis
near the end of the mid pelvis between S4 and S5
70
Ischial Spines
boney projections inward in the true mid pelvis
differs in how prominent it is between different people
causes the smallest diameter of the pelvis
71
What area of the true pelvis does the baby have to work hardest to get past in any pregnancy?
The ischial spine area in the mid pelvis (true pelvis plane)
72
4 Types of Female Pelvis
1. Gynecoid
2. Android
3. Anthropoid
4. Platypelliod
73
50% of woman have a ___ pelvis type
Gynecoid
74
The optimal pelvis type for labor and delivery is
Gynecoid
75
Gynecoid Pelvis
1 pelvis type
the most frequent and best for birth pelvis shape
it gives a heart shaped true pelvis canal (interior aspect)
it is GENEROUS IN THE ANTERIOR ASPECT to encourage anterior descension
76
Android Pelvis
1 Pelvis type
a more narrow and vertically stretched interior aspect (like a more elongated heart shape than gynecoid but less than anthropoid)
it is narrow and has a transverse diameter of the interior aspect giving more GENEROUS POSTERIORLY
77
It is difficult to rotate with ___ pelvises
android
78
What pelvis tends to encourage a baby in the posterior presentation
android
79
Anthropoid
1 pelvis type
resembles ape pelvis shape
a difficult shape for delivery
its very even transverse and antpost and looks like a heart stretched out more so than android
80
Platypelloid
1 pelvis type
a flat pelvis that is very difficult for delivery
not generous anteriorly or posteriorly
81
What pelvis shapes are less generous and make birth harder
Anthropoid and Platypelloid
82
What two shapes are more V shaped and narrow at the upper aspect and make it harder for the head to get through
android
anthropoid
83
How is the descent of the baby measured?
It is the position of the baby during labor and it is where the head is relative to the ischial spines (narrowest part of the pelvis) in centimeters
It is estimated
this station can be noted during labor and should be
84
Other than the pelvis, what else are important parts related to labor and delivery
soft tissue
cervix
pelvic floor muscles
vagina and introitus
85
What does the cervix do during labor and delivery
effaces and dilates to allow passage
86
What do the pelvic floor muscles do during labor and delivery
assist the infant in rotating as it descends
87
What do the vagina and introitus (opening) do during labor and delivery
dilate to accommodate passage
88
Powers of Delivery
refer to both the involuntary contracting of the uterine muscle and the voluntary efforts of the mother to expel the fetus at the time of delivery
89
What is the pacemaker of the uterus?
It is an area near the fundus that sends impulses in late developing receptors to cause contractions
The contractions will start here and then move down the top half of the uterus
90
Where is the pacemaker of the uterus located
near the fundus, not necessarily midline, more anterior or posterior
91
How do contractions of the uterus actually work?
The top half contracts and the muscle fibers shorten progressively and draw up the lower half toward the top half thus causing the cervix to efface/thin and then dilate
92
Which part of the uterus contracts and which part does not
the upper part contracts
the lower part does not contract
93
The uterus contracts and relaxes every few ___ in a __ manner
few minutes in a rhythmic manner
94
Asa labor progresses, what happens to contractions
contractions tend to grow closer, longer and more intense
95
Frequency of contractions refers to...
how often they are happening
96
What does intensity of contractions depend on
depends on the monitor
depends on where the intensity and monitor is
depends on what position the mother is in
depends on the amount of adipose tissue
97
What is the best judge of contraction intensity? What is the exception
the mother is the best judge of contraction intensity than an electric monitor
However the exception is an internal monitor watching the contractions
98
Contraction characteristics are described with what 3 terms
frequency
duration
intensity
99
When are contractions timed from?
Duration of contraction is from the onset of one to the onset of the next contraction
we do this due to variability of contraction timings (mother may count from end of one to start of another)
100
IV Pitocin
a drug to induce labor
it can cause contractions that feel much more intense
101
Why are the resting periods between contractions important
During contractions the blood vessels through muscle fibers squeeze and get diminished blood flow (but the baby has good reserve), but the resting period allows blood flow reestablishment
contractions too close when induced can impact the baby
102
What impact does position of the laboring woman have on L&D?
has an impact on both the intensity and effectiveness of the contractions and on the ability of the infant to navigate the contours of the pelvis
103
Historically physicians deliver in the ___ position
lithotomy
104
How can the upright position benefit L&D
it increases the potential for the presenting part to act as a dilating wedge
it is a more natural position for birth
105
How can knee chest and lateral lying positions benefit L&D?
it can assist in rotating posterior positions
106
Why is the lithotomy / lying on back position not actually the best birthing position?
the baby can obstruct blood flow by sitting on it and also stimulate mother nerve responses
107
Psychological Response (P 5)
the woman's emotional response to labor can have dramatic effects on her ability to accept labor and work with it to deliver her infant
108
How can anxiety and fear impact psychological response and L&D
anxiety and fear increases the release of catecholamines
109
How do catecholamines impact L&D
they release with anxiety and fear and can slow down labor by impeding contractions (frequency and intensity)
110
If a baby needs rotation and labor has been obstructed, what may this have on the psychological impact of the woman
if we need to rotate and measurements stop too long we may tell them they need a C Section which can increase anxiety and fear leading to catecholamines and further obstructing progress and causing higher likelihood of C Section
111
What are some factors that can influence emotional response during labor?
culture (may make no or more noise - Mediterranean cultures believe noise is good for the child)
anxiety and fear (maybe from a past preg.)
previous experience (childbirth, sexual abuse and molestation, etc)
childbirth preparation
support
birth environment (can be traumatic to birth in an unexpected place)
some may simply be more stoic in tolerance and presentation
112
True Labor v False Labor
false labor involves contractions more irregular and not close together while true labor has contractions at regular intervals and get closer as time goes on
113
How do contractions differ in intervals between true and false labor
true labor has contractions at regular intervals while false labor has contractions that are irregular
114
How do the interval timings of contractions change between true and false labor
true labor has contractions where the interval between then gradually shorten while there is no real change in false labor
115
How may duration and intensity change over time for contractions between true and false labor
true labor contractions increase in duration and intensity over time while false labor usually has no change
116
Where is discomfort in true labor
begins in the back and radiates around the abdomen
117
Where is discomfort in false labor
usually just in the abdomen
118
How does contraction intensity change with walking between true and false labor
true labor contraction intensity increases with walking usually
walking has no effect on or lessens contractions in false labor
119
How does cervical dilation and effacement differ between true and false labor
true labor has cervical dilation and effacement that are progressive, but there is none of this in false labor
120
What does -3 cm mean when measuring the infant
it means its 3 centimeters above the ischial spines (the presenting part)
121
What does 2 cm mean when measuring the infant
it means the presenting part is 2 cm below the ischial spines
122
False labor may or may not...
become a general labor pattern (so it can become false labor in time)
123
The uterus goes through __ ___ throughout pregnancy that intensify toward the end of pregnancy
toning exercises
124
The definitive sign of true labor over false labor si
cervical dilation and effacement
cervix changes definitely tell us it is true labor
125
SROM
Spontaneous rupture of membranes
this occurs when the "water" (amniotic sac and fluid) break on their own
126
When can SROM occur
PROM prior to onset of labor, during labor, or at delivery (baby can come out in an intact sac)
127
PROM (L&D)
Premature rupture of the membranes (before the onset of delivery
128
How can the nurse assess for SROM/ROM
Nitra zine Paper or Nitra zine Sterile Swab
129
How is Nitra Zine used
if it detects the presence of amniotic fluid from membrane rupture it will turn indigo blue
If put on a slide it will show ferning
130
Ferning
the characteristic drying pattern of amniotic fluid on a slide
131
What color will nitra zine turn in presence of amniotic fluid
indigo blue
132
AROM
artificial rupture of membranes
This occurs when an MD or midwife intentionally break the bag of water
133
When is the only time AROM should be done during delivery?
When the presenting part (head in this case) is at the 0cm mark (at the level of the ischial spines)/ narrowest part to minimize the potential for the cord to move down beyond the infant's head and cause asphyxiation/prolapse
134
Amniohook
a device that is used through the cervix to cause AROM
135
What is the 2 fold purpose for the water to rupture
1. Water escaping the uterus will make the uterus decrease in mass allowing it to get smaller and let the muscles get dense to do effective contraction
2. The rupture leads to prostaglandin release which is a contractile hormone that causes an increase in intensity and frequency of contractions
136
Cardinal movements of labor
these are the the movements/maneuvers the fetus does while navigating the contours of the pelvis
137
What are the 7 cardinal movements of labor
engagement
descent
flexion
internal rotation
extension
restitution and external rotation
expulsion
DIE REEF - Descent, Internalrotation, Engagement, Restitutionandexternalrotation, extension, expulsion, flexion
138
Engagement Movement
This movement occurs when the baby is coming down the false pelvis to the inlet
it will ante flex the head and the soft tissue contours encourage this
139
Internal Rotation Movement
as the baby goes from false to true pelvis is will rotate from a transverse anterior posterior lie to an anterior posterior orientation of the head
140
Extension Movement
Once the head is visible and seen in the vaginal opening, this movement occurs where the contours of the sacrum allow the head to come up and out at the heads narrowest diameter
141
Restitution and External Rotation movement
When the head is out, it will rotate slightly to one side or another as the shoulders rotate in the lower part of the pelvis
142
Why must restitution and external rotation occur
the head has its widest diameter anterior posteriorly, but the shoulders are widest transversely so once the head is out the shoulders must rotate to come out at the widest diameter
AKA the head will come out with the face either up or down, and then will rotate so the shoulders also are up and down rather than side to side
143
What are the 4 stages of Labor
1. Onset of Regular Uterine contractions until full dilation of the cervix
2. Full dilation until delivery of the infant
3. from delivery of infant to the delivery of placenta
4. from delivery of placenta until 2 hours later
144
When is the cervix completely/fully dilated
at 10 cm
this is the end of stage 1 of labor
145
At what stage of delivery can we no longer palpate the cervix
stage 2 of labor
146
At what stage of delivery is the potential for postpartum hemorrhage heightened
stage 4
147
How many parts does the first stage of labor have
3 (latent, active, transitional)
148
Stage 1 Latent Phase
starts with the onset of regular uterine contractions
lasts until labor progress starts to accelerate at about 3 cm dilation
149
Stage 1 Active Phase
lasts from the initial acceleration at round 3 cm dilation to about 8 cm dilation
150
Stage 1 Transitional Phase
intense period of more rapid progress which lasts until full dilation of the cervix at 10 cm
151
What is the specific time table for labor
there is no specific time table - it differs among people
there is no predicting the length of any given stage
152
What is usually the longest phase of the first stage of labor
the latent phase is usually longest but there are multiple variables that can impact any stage of labor
153
What is usually the shortest phase of the first stage of labor
the transitional stage in general is faster, but this is not a hard and fast rule
154
Average labor for first child is about ___ hours while subsequent babies is ___ hours. However...
14.5 hours; 8 hours
However sop many variables impact these times
155
What does the second stage of labor involve...
both voluntary and involuntary forces at play together to work toward delivery
again the length of this stage is highly variable and varies from one contraction to several hours - HIGHLY VARIABLE TIME
156
How can the third stage of labor be allowed to happen?
it can either be done spontaneously or encouraged to happen in a timely manner to minimize blood loss - placenta birth
157
Why must more care be taken if an active approach to placental birth (labor state 3) is performed?
If more active management approach is taken, make sure not to shear off the cord, leave placental fragments behind, or invert the uterus in the process
158
Episiotomy
intentional cut made by the provider between the vagina and rectum (off to one side so a tear does not extend to the rectum)
not too common anymore
159
Why are episiotomies rarer nowadays
it causes muscle layer extension and this extension makes muscle integrity worse than if we just allowed skin tear that only harms skin
160
How long does the third stage of labor generally take
30 minutes
161
Signs that the placenta is separating (Stage 3 Labor)
Advancing of the cord
Change in the shape of the uterus
Change in the location of the fundus
Sudden increase in vaginal flow
Patient complaints of cramping
162
What is normal placenta delivery like
it detaches centrally with a clot forming behind it and the edges after
the shiny fetal part is then what presents
163
Shiny Schultz
when a normal placental delivery occurs with the shiny fetal part presenting first
164
Dirty Duncan
delivery of the placenta that is abnormal
the placenta attempted to adhere and stay on the lining and the maternal side is the presenting side
165
Why is Dirty Duncan Concerning
placenta delivered this way may have placental fragments remaining and we need to make sure they are removed to prevent a post partum hemorrhage
166
What does the fourth stage of labor involve
it involves minimizing the bleeding and the repair of any lacerations or incisions
from the delivery of the placenta until 2 hours later
167
What are some medications used to promote uterine contraction during the fourth stage of delivery
Pitocin (Oxytocin)
Methergine
Cytotec
Hemabate
Tranexamic Acid
168
How does the uterus control bleeding post-delivery
to control bleeding from the open bleeding vessels of the placental site the muscle will contract to act as a tourniquet on those vessels
169
Pitocin
a fast acting and effective commonly used medicine given either IV or IM in order to promote uterine contractions
170
Methergine
IM only medicine that causes longer contractions but is the second choice to pitocin
it is contraindicated in HTN hx because it can cause HTN crisis
Also a BP must be taken before giving
171
Cytotec
an older originally used medicine
sometimes used to also ripen cervix for labor and induce contractions rather than just stage 4 use
Used to control hemorrhage of large amounts
Tablets inserted rectally in half
172
Hemabate
Injectable contraction inducing med - IM
give if there is apnea or lack of tone to the uterus
highly effective
contraindication of asthma
side effects of nausea, vomiting, diarrhea near the fresh incision, and oozing stool
173
Tranexamic Acid
more currently used in postpartum hemorrhaging
historically it was used for dysfunctional uterine bleeding in non pregnant women but is now a continuous IV infusion for stage 4
174
Visceral L&D Pain
refers to the internal body areas enclosed within a cavity
visceral pain comes from infiltration, compression, extension, or stretching of the viscera
occurs in the first stage of labor
175
What causes visceral pain in the first stage of labor
cervical changes
distention of the lower uterine segment
uterine ischemia
176
Origins of L&D pain can come from what 2 systems
visceral pain
somatic pain
177
Somatic L&D Pain
caused by the activation of pain receptors in either the cutaneous (body surface) or deep tissues (musculoskeletal tissues)
occurs in the second stage of labor
178
Somatic pain in the 2nd stage of labor comes from what things
stretching and distention of the perineum and pelvic floor
distention and traction on the peritoneum and utero/cervical supports during contractions
lacerations of soft tissue
179
Pain creates both __ effects and ___ & ___responses
physiological effects and sensory and emotional responses
180
Physiological Effects of Pain Include...
SNS activation
Increased catecholamine levels
BP and heart rate increases
RR changes
Pallor
Diaphoresis
181
How does Pain differ between L&D women
different women or different pregnancies can have vastly different pain sensations they perceive
182
What are some of the sensory perceptions women have in L&D
prickling
stabbing
burning
busting
aching
heavy
pulling
throbbing
sharp
stinging
shooting
cramping
183
Emotional Responses to the L&D Pain include...
increased anxiety with lessened perceptual field
writhing
crying
groaning
gesturing
excessive muscular excitability
During labor she may become less focused and want to rest between contractions rather than talk to anyone
184
What are some physiological factors that impact pain and pain management
hormones
position
fetal size and pelvic dimensions
endorphin levels
185
How do endorphins change during a pregnancy
they increase at the very end of pregnancy and try to help with the pain
however, a preterm baby mother may not get this
186
Non Pharmacological Management Methods for Pain in L&D
relaxation
touch and massage
breathing
effleurage and counter pressure (posteriorly)
music
hypnosis
water therapy
biofeedback
acupressure
imagery and visualization
aromatherapy
intradermal water block
transcutaneous electrical nerve stimulation (TENS)
187
Effleurage
a special type of abdominal massage
188
Intradermal water block
an injection into the lower back to help with posterior positioning pain
189
Pharmacological Management Methods for Pain in L&D
sedatives
analgesia
anesthesia
190
___ specifically addresses pain
analgesia
191
Fentanyl
a short acting and clean drug for pain relief with minimum side effects
does not tend to cause respiratory depression
drug of choice
opioid agonist analgesic (an opiod)
192
Co-Drugs
drugs sometimes coupled with pain medicine
ex: transquilizers, antemetics
193
What are some co drugs seen in L&D commonly
vistaril
phenergan
194
Visteral & Phenergan
IM
sedative and anti emetic effect
tranquilizers often used to potentiate opioid effects with a lower dose
195
Narcan
an opioid antagonist
given to counteract the effects of narcotics such as CNS depression in the mother or baby
196
What are some examples of Anesthesia
local nerve blocks
regional nerve blocks
pudendal block
spinal anesthesia
epidural anesthesia
general anesthesia
197
Local nerve Blocks
may be given in anticipation of an episiotomy
blocks pain in a localized area
anesthesia
198
Pudendal Block
a bilateral regional anesthetic injection of the pudendal nerves that innervate the sides of the vaginal vault to the cervix
mostly only midwives do this
199
When may spinal anesthesia be used?
when there will be a C Section because it is immediate acting and a complete block allowing for the surgery to occur
the needle is put in the subarachnoid space with the patient either sitting or lying on her side
effects are immediate and profound
effects are gradual in onset and can be complete or patchy
200
Epidural
anesthesia used for both labor and C section births
sometimes used in labor as a continuous fusion from 1 to 24 hours use in order to give release
given via catheter and pump in the epiural space while the patient is sitting or lying on her side (like spinal), but the catheter is left in place until after delivery to allow for continuous or intermittent dosing
the dose must be controlled by the anesthesiologist
201
General Anesthesia
Rarely used in L&D when we do not have time to give spinal anesthesia or when the epidural or spinal anesthesia is contraindicated like with coagulation issues
202
Why is general anesthesia a problem in OB
it only takes 3 minutes for it to cross the placenta and potentially depress the babies respirations
This means you have to be ready to cut the cord immediately when given and the surgeon is already scrubbed and ready for surgery
203
When is pudendal block done?
in transitional labor or in the second stage of labor
204
Why may a woman develop a headache after spinal anesthesia?
leakage of cerebral spinal fluid
205
What is the most common side effect from a spinal or epidural anesthetic?
Significant hypotension from vasodilation of the effected region
The mid torso down has this massive vasodilation where most circulation is now tied up
206
What can the anesthesia induced hypotension lead to?
can result in poor placental perfusion
207
What can minimize the anesthesia induced hypotension
increased IV fluids and positioning
sometimes medications like ephedrine can be used to increase BP
208
Why do fluids help treat anesthesia induced hypotension
we give a bolus of IV fluids before anesthesia to increase circulating volume to prevent the drop and perfuse the placenta upper body and organs, or we continue to give IV fluids during use with a med for vasoconstriction o keep blood flowing everywhere
209
Fetal assessment is done by ...
either electronic fetal monitoring (doppler during contraction and for 30 seconds after)
or
fetal heart rate auscultation (listening)
210
Intermittent auscultation protocol calls for auscultation every ___ minutes for low risk patients in the active phase of labor, every ___ minutes in the second stage of labor, and every __ minutes when pushing
30
15
5
