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Flashcards in Week 6 Deck (64):
1

Mild contraction feels like...

Tip of nose

2

Strong contraction feels like...

Your forehead

3

2 main changes during first stage of labor

Effacement and dilation

4

Effacement

Shortening and thinning of the cervix

First stage of labor

5

What effacement % is ready to deliver

100%

Paper thin

6

Dilation

Enlargement of cervical os/canal

Rates 0-10

First stage of labor

7

Station

Measure present spine

The measurement of the progress of descent in cm above or below the mid plane from the presenting part to the ischial spine

0
Means the baby is dropping(lightning)

8

When do you take mother’s vital signs

During the rest period between contractions

B/c HR and RR increase during contraction

9

What should mother eat during labor

Gastric mobility is slowed

Lite meal to keep energy
Ice chips
Water
Popsicles

W/ epidural only clear liquids

10

Placental circulation during labor

Maternal supply of blood to placenta stops during STRONG contraction

Give pain meds during contractions so fetus does not get the medication.

11

Normal fetal heart rate is

110-160

12

Components of birthing process .... the 4Ps

Powers: contractions, pushing
Passage: birth canal
Passenger: baby, placenta
Psyche: mom feel tired or excited, anxiety, fatigue an affect w/labor

13

Variations of passenger

LIE
ATTITUDE
PRESENTATION
POSITION

14

LIE

The way the fetus is lying in the the uterus

Longitudinal (vertical) up and down
or
transverse(horizontal) side to side

15

Attitude

Flexion: curled up (ideal)

Extension: sprawled out

16

Presentation

Cephalic
Shoulder
Breech

17

Presentation cephalic

1. Ideal: vertex presentation (crown of head)
Complete flexion (curled up)
OCCIPUT

2. Face presentation
full extension(sprawled out)
MENTUM

18

Presentation shoulder

Baby is LIE transverse

19

Presentation breech

Buttock presentation (sacrum)

Deliver by c-section

20

Position anterior

Baby looks at mommy’s spine

21

Position posterior

Baby looks thru mommy’s belly button

22

TRUE LABOR

Contractions:
Back pain
Menstrual cramps
Regular
Stronger
Last longer

Dilation and effecement

23

FALSE LABOR/ Braxton Hicks

Contractions felt in abdomen and groin
More annoying than painful
No progression
Irregular

ACTIVITY SUCH AS WALKING RELIEVES FALSE LABOR

24

Contractions

Start from the top of the uterus

25

What is needed for cervical dilation

Strong consistent contractions

26

Warning signs for labor

Lightening(dropping) 2-3 weeks before
Braxton Hicks increase
Clear discharge increases
Bloody show (mucus plug)
Nesting- cleaning, organizing
Spontaneous rupture of membrane (water breaks)

27

What should you monitor when the waters brakes

Fetal heart rate

28

What helps make the cervix dilate easier

The bloody show/ lose mucus plug

29

Assessment of amniotic fluid (ROM)

COAT

C-color
O-odor
A-amount
T-time

30

Quickening

Can feel the fetus drop

31

Stage 1-latent phase

Longest
Dilation: 1-3 cm
Contractions: every 15-30 minutes and last 15-30 seconds
Mild intensity

32

Stage 1- latent phase interventions

1.Encourage mother/partner to participate in care

2.Assist w/comfort-change position and ambulate

3.Keep mother/partner informed of progress

33

Stage 1- active phase

Dilation: 4-7

Contractions: occur every 3-5 minutes and last 30-60 seconds

Moderate intensity

34

Stage 1-active phase interventions

1.Encourage maintenance of effective breathing patterns

2.Promote comfort w/
Back rubs
Sacral pressure
Pillow support
Position changes

Can Offer epidural

35

Stage 1-transition phase

Dilation: 8-10 cm

Contractions: occur every 2-3 minutes and last for 45-90 seconds

Strong intensity

36

Stage 1- transition phase interventions

1. Encourage rest between contractions

2. Encourage voiding every 1-2 hours (unless epidural)

37

2nd stage- baby comes out (expulsion of the fetus)

Cervical dilation is complete

Change in fetal station(-3,-2,-1,0,+1,+2,+3)

Contractions: occur every 2-3 minute, lasting 60-75 seconds

Strong intensity

Increase bloody show / mother feels urge to bear down

38

2nd stage- pushing baby out interventions

Provide encouragement and praise for rest between contractions

Assist mother in positions to help pushing

MONITOR FOR PERINEAL BULGING

39

3rd stage- expulsion of the placenta

Occurs 5-30 minutes after delivery of the baby

Examine placenta

40

3rd stage- what side of placenta shows first?

Schultze mechanism -shiny (fetal side)

Duncan mechanism- dull, dirty (maternal side)

41

4th stage- physical recovery

1-4 hrs after delivery

B/P returns to prelabor level

Pulse lowers

Fundus remains contracted, midline 1 or 2 fingers below the umbilicus

42

4th stage interventions

Monitor lochia discharge-moderate and red

Provide blankets
Apply ice to perineum
Massage uterus if needed
Provide breast-feeding support as needed

43

Antepartum

During pregnancy

44

Risk factors for fetal compromise antepartum maternal hx

Previous stillbirth
Previous c-section
Poor nutrition, poor wt gain
Multiple pregnancies close together
Chronic disease
Acute infection
Drug use
Psychosocial stress, domestic violence

45

Fetal compromise antepartum- problems identified

Gestation greater than 42 weeks
Decrease in fetal movement
Multifetal gestation
Preeclampsia, eclampsia
Diabetes
Placenta issues
Maternal severe anemia
Maternal trauma

46

Intrapartum

During L/D

47

Risk factors for fetal issues -intrapartum maternal issues

High BP, low BP
Hypertonic uterine contractions
Abnormal labor
Prolonged ROM
Chorioamnionitis
Fever

48

Risk factor fetal issues intrapartum- fetal/ placenta problems

Fetal anemia
Persistent abnormal or no reassuring FHR or pattern
Meconium-stained amniotic fluid
Abnormal presentation or position
Prolapsed cord
Abruptio placentae

49

External electronic fetal monitor

Displayed on computer or printed strip

At the bedside and nurses station

FETAL DOPPLER TRANSDUCER lower abdomen

TOCOTRANDUCER placed on upper abdomen, monitors uterine activity

50

Internal electronic fetal monitor

ROM has to happen before insertion
Cervix has to be dilated

FETAL SCALP ELECTRODE-attached to the scalp, used for accurate FHR, very obese woman

INTRAUTERINE PRESSURE CATHETERS(IUPCs) monitors contraction intensity (strength of contraction)

51

PATTERN OF FHR

BRADYCARDIA: FHR below 110 for 10 minutes or longer!!

TACHYCARDIA: FHR higher than 160 for 10 minutes or longer!!!

52

Interventions for Fetal bradycardia or tachycardia

Change mothers position

Administer oxygen

Assess VS

Notify HCP ASAP

53

Reasons for Fetal bradycardia

Due to Cord Pain meds

Mom change position

54

Reasons for Fetal tachycardia

Due to infections.... see if mom has a fever then change position

If infection start antibiotics

55

Variability

Fluctuations in baseline FHR
absent or undetected FHR is nonreasuring

56

Non stress test reassuring results mean...

FHR goes up

57

Decreased variability causes

Fetal hypoxemia
Acidosis
Maternal alcohol/drug use
Certain medications

58

Temporary decrease in variability (FHR) due to....

Fetus is in sleep state

Fetus doesn’t sleep more than 30 minutes at a time

59

Accelerations- normal

Brief temporary increases in FHR of at least 15 bpm more than baseline for at least 15 seconds

Reassuring sign
Occurs during fetal movement
Contractions
Vaginal exams
Mild cord compression
Breech presentation

60

Early deceleration

decrease in FHR below baseline but still greater than 100 bpm

Head compression agains soft tissue(cervix) or pelvis!!!!

Not associated with fetal compromise

NO REQUIRED INTERVENTIONS
During contraction HR decrease due to head compression

61

Late deceleration

Placenta exchange impaired (uteroplecental insufficiency)

Nonreassuring

Decreased HR begins well after the contraction begins and returns to baseline after the contraction ends

62

Intervention for late decelerations- fetus not getting oxygen

Change mothers position
Stop oxytocin if on it
Notify HCP
Increase iv fluids
Give mom oxygen via mask 8-10 l
Might need c-section
Document

63

Variable decelerations

Cord compression!!!
Don’t have a uniform appearance(goes up and down)
Falls and rises abruptly when relief of cord compression

64

reassuring variable decelerations

Less than 60 seconds with rapid return to baseline