-
What is relation of the other fetal body parts to one another (position the fetus assumes as it conforms to the shape of the uterine cavity)
Fetal attitude
-
What is normal general flexion
- head flexed
- chin on chest
- arms crossed over chest
- legs flexed at knees
-
What fetal lie is ideal?
Longitudinal (fetal spine parallel to mom)
-
What is the relationship of the fetal long axis (head to tail or cephalocaudal) to the mothers spine (longitudinal ideal)
Fetal lie
-
What is it called when the fetal spine is at a right angle to the mother's spine
transverse lie
-
How should a baby be delivered that is in transverse lie
c section (NO VAGINAL)
-
What determines the presentation of the baby
fetal lie
-
What presentation is most common and most desired
vertex (head completely flexed on chest, smallest diameter of head presented to pelvis)
-
What presentation is most commonly felt?
cephalic
-
What is named according to the presenting part at the cervix and leads thru the birth canal during labor?
Presentation
-
What breech presentation has hips and legs extended, feet present, can be single or double?
Footling
-
When do you feel the presentation
during exam of the cervix
-
Name 3 abnormal cephalic fetal lies
-
What type of fetal lie is when the head is partly extended, largest AP diameter if presented to the pelvis
Brow cephalic fetal lie
-
What type of cephalic lie occurs when the head is hyperextended
Face
-
What presentation occurs when the presenting part is lower extremity/extremities or buttocks
Breech
-
How is the Breech position classified
According to the position of the hips and knees
-
Breech position in which the knees and hips are both flexed and the feet present to the pelvis
complete
-
Breech position in which hips are flexed, knees are extended with feet in front of face, and butt is present
frank
-
What occurs when the largest part of the presenting part reaches or passes thru pelvic inlet
engagement
-
When is the baby said to be engaged
when the head is flexed and the AP diameter is the largest part of the skull
-
When does engagement occur in primips?
2 weeks
-
What is the baby said to be if it is not engaged
floating or ballotable
-
Acronym for fetal stations with corresponding score
- F: -3 (floating high)
- I: -2 (In the right direction)
- S: -1 (Settling in)
- H: 0 (Halfway there)
- I: +1 (Inching out)
- N: +2 (nearly there)
- G: +3 (Get the crown)
-
What is the relationship of presenting part to the imaginary line between the ischial spines of the maternal pelvis
Station
-
What marks the narrowest diameter through which the fetus must pass
station
-
At what station is delivery imminent
+3
-
When would the landmark be a zero station
- If higher than spines number assigned is negative (-5 at inlet)
- If lower than the spines, number assigned is positive (+4 at outlet)
-
What is the relationship between the presenting part to sides of maternal pelvis
Fetal position (right or left)
-
Is the baby is posteriorly positioned, what may occur
- back labor (more pressure on sacral nerves)
- May feel need to push earlier
- 2nd stage may be prolonged
-
What are the 4 landmarks with the occiput (fetal position)
- Left anterior
- Right anterior
- Left posterior
- Right posterior
-
Notations when describing position of baby
- Right or left
- Presenting part
- Anterior, Posterior, or transverse
-
Name 4 presenting parts of baby during positioning
- Occipital (O)
- Mentum (M)
- Sacrum (S)
- Scapula (Sc)
-
What are the two most common positions of baby in notation
- ROA (Right, occipital, anterior)
- LOA (Left, occipital, anterior)
-
Name 4 possible causes of labor
- progesterone withdrawal
- oxytocin
- prostaglandins
- Corticotropin releasing hormone (CHG)
-
What do u tell mom to do if suspected ROM
go to hospital, doctor
-
What is a medical emergency risk that occurs when there is a rupture of membranes without engagement
cord prolapse
-
When does labor usually begin following bloody show
12-24 hrs
-
What is it called when softening and effacement cause the mucus plug to become expelled
bloody show (small blood and the plug exposed)
-
What 5 things can lightening cause
- leg cramps/pain
- increased pelvic pressure
- Increased venous stasis (LE edema)
- Increased urinary frequency
- Increased vaginal secretions
-
What occurs when fetus begins to settle into the pelvis (engagement). Uterine moves downward and fundus no longer presses on the diaphragm
Lightening
-
What facilitates engagement
round ligament pulls the fundus forward, aligning the fetus within the bony pelvis
-
When does effacement usually occur in primips
precedes dilation
-
What is the taking up and drawing up of the cervical os and cervical canal into the uterine walls (cervix changes from long, thick structure to a tissue paper thin)
effacement
-
Name primary forces of labor
- uterine contractions
- complete effacement and dilation of cervix
-
Name secondary forces of labor
abd muscles push baby out
-
What is important to allow mom to do between contraction and why
rest to allow uterine muscles to relax to restore placental circulation to fetus
-
3 phases of contraction
- Phase 1: building up (increment: longest phase)
- Phase 2: acme (peak)
- Phase 3: decrement (letting up)
-
What can measure intensity of contractions best?
Intrauterine catheter
-
What can occur if a woman bears down and the cervix is not completely dilated
cervical edema which retards dilation, possible tearing, and bruising of cervix
-
What happens to uterus during labor??
It divides into 2 sections: upper and lower
-
What portion of placenta is contractile segment and becomes progressively thicker as labor advances
Upper portion
-
What portion of placenta includes the lower uterine segment and cervix is passive, as labor continues, it expands and thins
lower portion
-
What is the time between the beginning of one contraction and the beginning of the next
frequency
-
What is measured from the beginning of the contraction to the completion
duration
-
What is the strength of the contraction
intensity
-
What is normal resting tone intensity of contractions
10-12 mm
-
What is the peak intensity of contractions
- 25-40 (early)
- 50-70 (late)
-
What is the intensity of contraction during transition
80-100 mm
-
What is the intensity of contraction during pushing
>100 mm
-
What are the 3 phases during first stage of labor
-
How long does epidural increase first stage of labor by
1 hr
-
Name signs of early labor
- Lightening
- Braxton hicks
- Cervical ripening
- Bloody show
- ROM
- sudden burst of energy
- weight loss, increased back ache
- n/v/d, indigestion
-
What is the first stage of labor also known as
latent
-
How long is the latent phase of labor usually
- 5-7 hours (6.8 primis)
- 5.3 (multips)
-
What is the cervix dilated to for first stage of labor
0-3 cm
-
How often are the contractions during the first stage of labor
3-30 min
-
What is the duration of contractions during the first stage of labor
20-40 seconds
-
What is the intensity of contractions during first stage of labor
mild-moderate
-
What emotional state is the mother in during the first stage of labor
- Happy, excited about upcoming delivery
- divert self with activities
- pelvic rocking for backache
- abd breathing for contraction pain
-
What is the cervix dilated to during active labor
4-7 cm
-
How long does active phase of labor usually last
2-5 hours
-
What is frequency of contractions during active labor
q 2-5 min
-
What is the duration of the contractions during active labor
40-60 seconds
-
What is the intensity of contractions during active phase of labor
moderate to strong
-
How is the woman reacting to active phase of labor
- Increased anxiety
- Fears of coping with pain
- Need companion
- Tries a comfortable position
- Uses focal point
- Back rub for pain
- may ask for meds/epidural
-
How long does the transition phase last during first stage of labor
3.5 hours
-
How much is cervix dilated during active labor
8-10 cm
-
How frequent are the contractions? Duration? Intensity?
-
How is the woman reacting to active phase of labor
- Uncontrollable urge to bear down
- Significant anxiety, restless, tired
- Difficulty coping with contractions
- Irritable, withdraws
- Yelling
- Foul language
- shallow chest breathing
-
What stage of labor consists of complete dilation to birth
2nd stage
-
When is the 2nd stage usually completed
within 2 hours after cervix is completely dilated
-
How frequent are contractions during 2nd stage of labor? duration? Intensity?
- q 1.5-2 min
- 60-90 sec
- Strong
-
How is the mom reacting to 2nd stage of labor
- desire to have bowel movement
- need reassurance
- Explosive grunt with exhalation
- Complete exhaustion
- Bend in C shape and take deep breath, bend knee and push while exhaling, blow out to control delivery
-
What cardinal movement occur when the head enters the inlet in the occiput transverse or oblique position because the pelvic inlet is widest from side to side. The saggital suture is an equal distance from the sym pubis and sacral promontory
descent
-
What cardinal movement includes: Head descends and meets resistance from the soft tissues of the pelvis, the muscles of the pelvic floor and cervix. As a result, the chin flexes downward onto the chest
flexion
-
What cardinal movement includes: head must rotate to fit the diameter of pelvic cavity which is widest at the AP diameter. As the occiput of the head meets resistance, it rotates from left to right and the sagittal suture aligns in the AP pelvic diameter
Internal rotation
-
What cardinal movement includes: Resistance of pelvic floor and the opening of the vulva assist with the extension of the fetal head as it passes under the sym pubis. With this position change, the occiput, brow and face emerge
Extension
-
What cardinal movement includes: Shoulders enter the pelvis obliquely and remain so when the head rotates to the AP diameter through internal rotation. B/C of this the neck becomes twisted. Once the head emerges and is free of pelvis resistance, the neck untwists, turning the head to one side (restitution) and aligns with the position of the back in the birth canal.
Restitution
-
What cardinal movement includes: as shoulder rotate to the AP position in the pelvis, the head is turned farther to one side
external rotation
-
What cardinal movement includes: after external rotation, the anterior shoulder meets the undersurface of the sym pubis and slips under it. As lateral flexion of the shoulder and head occurs, the anterior shoulder is born before the posterior shoulder. The body quickly follows.
Expulsion
-
What 4 forces cause descent
- pressures of AF
- Direct pressure of fundus on breech
- Contraction of abdominal muscles
- Extension/straightening of fetal body
-
Name 7 cardinal movements (mechanisms of labor)
- Descent
- Flexion
- Internal rotation
- Extension
- Restitution
- External rotation
- Expulsion
-
What stage of labor includes birth to placental expulsion
third stage
-
What occurs during the third stage of labor
- placental separation
- membranes separate
- placental delivery
-
What is it called if the placenta separates from the inside to the outer margins expelling with the fetal side presenting
Schultze mechanism
-
What is it called if the placenta separates from the outer margins inward and it rolls up and presents sideways with the maternal surface delivering first
Duncan mechanism
-
What causes placental separation
decrease in surface area
-
What happens if it more than 30 minutes have lapsed during placental delivery
The placenta is "retained"
-
What stage of labor includes 1-4 hours after birth
4th stage
-
What hemodynamic changes occur during the fourth stage of labor
- Blood loss (redistributed into venous beds)
- Moderate drop in BP
- Moderate tachycardia
-
How much blood is lost by the 4th stage of labor
250-500 mLs
-
What occurs with the uterus, fundus, and cervix during 4th stage of labor
- Uterus: contracted and midline
- Fundus: halfway between umbilicus and sym pubis and contracted
- Cervix: widely spread and thick
-
What are symptoms of mom during 4th stage of labor
- n/v
- thirst/hungry
- shaking/chills
- Bladder hypotonic (urinary retention)
-
5 factors that affect process of labor
- Passenger (baby)
- Passage (birth canal)
- Power (contractions, hydrostatic pressure, pushing)
- Positioning (upright verse lying down)
- Psychological state of mom
-
Describe the pathway of birth canal
True pelvis>Cervix>vagina>pelvic floor
-
What pelvic shape is the most common and most suited to vaginal delivery
Gynecoid
-
What pelvic shape is most common in men
Android
-
What pelvic shape is when the inlet is oval shaped
Anthropoid
-
What type of pelvic shape results in slow descent, maked fetal head engage in transverse/occipital position; frequently causes extreme molding, arrest of labor, need for forces, perineal lacerations, and sometimes a c-section
Android
-
What does the inlet look like for an android pelvis
heart shaped
-
What does the inlet look like for gynecoid pelvis
rounded and wider than deep front to back
-
What does the anterior fontanel look like? posterior?
AF: 2-3 cm (diamond shaped-junction of sagittal, coronal, and frontal sutures)
PF: 1-2 cm (triangle shaped area between occipital and parietal bone
-
When are copies of prenatal records sent for intrapartum assessment
36 weeks
-
What minimal assessment do you do during imminent delivery
- VS
- Labor status (contractions, dilation, effacement, station, membrane status)
- Fetal status (presentation/position, FHT, movement)
- Labs
-
When does hearing begin and become fully developed in utero
23-24 weeks, 28 weeks
-
How long is sleep cycle in utero
40 min
-
What is a disadvantage of external monitoring of contraction using a tocodynamometer
DOES NOT MEASURE INTENSITY
-
What does internal pressure catheter measure (IUPC)
- pressure in uterus
- resting tone between contractions
- intensity
-
What is a disadvantage of IUPC
- membranes have to be ruptured
- Invasive
- doctor puts in not nurse
-
What is normal FHT
110-160
-
What do u have to look at together when monitoring contractions
FHT in relation to contraction
-
Are acels good or bad
EXCELLENT
-
What is considered fetal bradycardia
<110 for 10 min
-
What should be done if a nurse detects a wandering baseline on the FHT monitor
IMMINENT DELIVERY
-
What is baseline fluctuations of two cycles per minute or greater in the FHR and classified by the visually quantified amplitude of peak-to-trough in beats per minute
variability
-
Name 4 classifications of variability
- Absent (not detectable)
- Minimal (<5)
- Moderate (6-25)
- Marked (>25)
-
What variability to we want for FHR
moderate
-
What is an acceleration
abrupt increase in baseline (fetal movement/simulation)
-
What is the lowest point on the FHR monitor
NADIR
-
What does an early deceleration look like
mirrors contraction pattern
-
Nursing actions for late decelerations (top 3 to do right away)
- Turn mom side to side
- oxygen to mom
- stop oxytocin
-
What deceleration has NADIR after the peak of the contraction
LATE
-
What causes late decelerations
placental insufficiency
-
What causes early decelerations
head compression
-
What causes variable decels
compression of cord
-
Acronym for evaluating fetal heart tone changes
- V: variables C:cord compression
- E: earlies H: head compression
- A: accels O: okay
- L: late P: placental insufficiency
-
When would u send sample of cord blood analysis to be tested
if apgar score is < 7 at 5 min
-
What does the cord blood analysis determine in relation to fetal academia
if it was from cord compression or placental insufficiency
-
How can you gurantee you are getting arterial sample from cord blood
puncture two vessels
-
When should the mom go to doctor/hospital
- ROM
- Decreased fetal movement
- Regular, frequent contractions (q 5 min primip)
- Any vaginal bleeding
-
When do Hispanic women go to hospital
late in labor
-
If upon inspecting the cord, only 1 artery is noticed what should the nurse suspect
GU abnormalities
-
What 5 things does Apgar assess
- HR
- RR
- Muscle tone
- Reflex irritability
- Skin color
-
What score is desirable for Apgar? moderately depressed? Severely depressed?
-
What is the most important part of the Apgar score
HR
-
What does the Apgar NOT do
guide resuscitation
-
If 5 min Apgar <5, what should the nurse do?
continue Apgar scoring q 5 min until above 5
-
What is code pink
child abduction in hospital
-
Acronym that describes what to do in case of a code pink
- STORK:
- Search/Secure scene
- Telephone 111/give info
- Obtain info/protect crime scene
- Report/reassign mom/family to different room
- Keep all staff and visitors on unit till police arrives
-
What does ballooning of uterus indicate
relaxation and bleeding
-
What are signs of placental separation
- Uterus rises up while placenta settles down
- Umbilical cord lengthens
- Sudden trickle/spurt of blood
- Uterus changes from discoid
-
5 dangers to report in the 4th stage
- Tachycardia
- Hypotension
- Uterine atony
- Excessive bleeding
- Fever <100
-
What is the main side effect of epidural, how is it prevented
hypotension, fluid bolus administered
-
How is hypotension TREATED following an epidural
turn mom on left side, increase IVF, give ephedrine and oxygen if indicated
-
What causes hypotension following an epidural
Anesthesia: lowers peripheral resistance, decreases venous return to heart which decreases cardiac output
-
When is spinal block indicated
C-section
-
When is Pudendal block indicated
2nd stage of labor, birth, EPISIOTOMY
-
When is general anesthesia used
ONLY FOR EMERGENCY C-section
-
What criteria is required for mom to get pharmacological pain relief
- Mother wants it, stable VS
- FHR: 120-160
- NST reactive
- Variability present
- No late decels/meconium stains
- Labor contraction established
- Cervix dilated to 4 cm gravid 1, 3 cm gravida 2
- Presenting part engaged
- Progressive descent of presenting part
-
Why is oral pain meds not used
too slow onset and decreases GI blood flow
-
When phase of labor is morphine not used and why
active, too long lasting, causes CNS depression and depressed respirations
-
What 4 things does Anesthesia include
- Analgesia
- Amnesia
- Relaxation
- Reflex activity
-
What is birth between 37-38 weeks
Early-term
-
What is birth between 38-39 weeks
full-term
-
What is birth between 39-40 6/7 weeks
Late-term
-
What is birth after 42 weeks
Post-term
-
What is considered low birth weight infant?
<2500 g
-
What is labor that occurs between 20-37 weeks
Preterm labor (PTL)
-
What is the number 1 cause of infant mortality and neuro disabilities in the US
preterm birth
-
Is pre-term birth increasing or decreasing
decreasing
-
What race is 2x more likely to have preterm or low birth weight
African American
-
What is the most common lower GU infection in women of childbearing age
Bacterial Vaginosis (BV)
-
What is the criteria for pre-term labor (1 of the following)
- Contractions q 5 min
- 8 contractions in 60 min
- Documented cervical change or cervical effacement of 80%
- Cervical dilation >1cm
-
What are signs of preterm labor
- pain
- cramps
- vag bleeding
- bloody show
- pelvic pressure
- diarrhea
-
When is progesterone indicated
Prevention or recurrent preterm delivery d/t SROM or SPTL
-
What should a woman receive if she is a candidate for tocolytics and why
betamethasone or dexamethasone to enhance fetal lung maturity
-
What serious side effect can occur with Beta-mimetics (terbutaline, ritodrine)
pulmonary edema
-
What are nursing interventions r/t PTL
- Teach signs/sx of preterm labor and when to call doctor
- Teach woman to palpate for contractions twice a day while lying on her side
-
What do you teach the woman who experiences sx of PTL with activity
- Empty bladder
- lie on side
- drink 3-4 cups of fluid
- soak in a warm bath w/ uterus submerged
- Rest for 30 min after sx subside
- Call if sx persist
-
What is rupture of BOW after 37 weeks but before onset of labor (if labor hasn't occurred within 12 hours)
PROM
-
What test is used to detect PROM and what does it measure
Nitrazine test, amniotic fluid in vaginal secretions (pH)
-
What are the interventions for PROM for discharge
- Bedrest except bathroom
- Monitor temp 4x/day
- Fetal movement record
- Labs 2x/week
-
what might be seen for cervical insufficiency
funneling
-
What is hydraminos
>2000 mL of AF
-
What is the dangers of hydraminos with ROM
prolapsed cord
-
What med may be given for hydraminos
indomethacin
-
What is oligohydraminos
<500 mL
-
What life-threatening condition can result from oligohydraminos (in baby)
pulmonary hypoplasia
-
2 meds for cervix ripening
-
When should oxytocin be given in relation to misoprostol
give oxytocin 4 hours after
-
What is abnormal labor patterns due to problems associated with the power, passenger, or passage
Dystocia
-
Most common cause of mother experiencing dystocia
uncoordinated, ineffective uterine contraction
-
What is ineffective uterine contractions of poor quality in the latent phase of labor
tachysystolic labor patterns
-
What to do if tachysystole occurs
lay mom on left side, give oxygen
-
What do you tell mom to do after mechanical cervical ripening
stay recumbent with wedge under right hip
-
Nursing interventions for amniotomy
- mom is semi-reclining
- underpads to absorb fluid
- Inspect AF for blood/meconium
- Frequent peri-care
- Sterile vag exams
- Check temp q 2 hr
- Bedrest till presenting part engaged
- dry birth
-
When should oxytocin be discontinued
- FHT unreassuring
- Contractions > q 2 min
- Duration >60 sec
- Insufficient relaxation of uterus between contractions
-
What does the cervix have to be for amniotomy
2 cm at least
-
What is the biggest risk of vaginal birth for Macrosomia
shoulder dystocia
-
What to do if prolapsed cord is detected
- Med emergency
- Use fingers to push up on presenting part
- Place woman in knee chest position
- oxygen
-
What is the leading cause of maternal death
amniotic fluid embolism
-
What is usually the first sign of uterine rupture
Nonreassuring FHT followed by bradycardia
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