Term
| The first stage of labor is divided into the __ phase and the ___ phase. Define each of these: |
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Definition
- Latent phase: onset of regular contraction until dilated 3-5 cm, may last 14-20 hours
- Active phase: from 3-5 cm until 10 cm or pushing, contractions are closer together, cervical changes are more rapid |
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Term
| So the first stage is until: |
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Definition
cervix is diated to 10 cm
latent phase first stage: dilation up to 3-5 cm
active phase first stage: dilation from 3-5 cm to 10 cm |
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Term
| Characteristics of true labor: |
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Definition
Regular intervals
Intervals gradually shorten
Intensity gradually increases
Pain is in back and abdomen
Cervix dilates
Pain not stopped by sedation |
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Term
| Characteristics of false labor: |
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Definition
Occur at irregular intervals
Intervals remain long
Intensity remains unchanged
Pain is mainly in lower abdomen
Cervix does not dilate
Pain is usually relieved by sedation |
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Term
| Braxton Hix contractions: false labor contractions, abdomen hardens and gets tense but not real |
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Definition
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Term
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Definition
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Term
| During the active phase of the first stage of labor nulliparous women dialte ___ cm/hour so the active phase lasts about __ hours. The baby usually descends __cm/hour during this stage in nulliparous women. |
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Definition
- 1.2cm/hour
- 11.7 hours
- 1cm/hour |
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Term
| In multiparas women during the active phase of labor their cervix usually dilates __cm/hour and the baby descends _cm/hour. |
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Definition
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Term
| 3 main parts of vaginal exam during delivery: |
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Definition
- Dilation: of cervix
- Effacement: thinning of cervix
- Station: where baby is at |
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Term
| Other factors of vaginal exam during labor: |
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Definition
Ruptured membranes
Bloody show
Fetal position / presenting part
Pelvimetry |
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Term
| Station is the presenting part related to __ __. It is divided into fifths or thirds above and below. Engagement is at the __ __. |
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Definition
- ischial spines
- "0" station |
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Term
| At the end of pregnancy, the pubic symphsysis and sacroiliac joints have increased in diameter. |
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Definition
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Term
| When doing vaginal exams during labor, use __ ___ __ lubricant. Avoid __ and ___ ___. |
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Definition
- sterile water soluble lubricant
- iodine and hexachlorophene antiseptics |
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Term
| If ROM intentionally or not, check __ immediately and during next contraction to detect __ __ __. |
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Definition
- FHR
- occult cord compression
Vaginal exams are typically done every 2 hours when in labor |
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Term
| If there is a question of ROM, insert a __ __ and observe for fluid in the __ __ __. |
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Definition
- sterile speculum
- posterior vaginal fornix |
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Term
| Fetal lie is the relation of the __ __ of the fetus to that of the mother. Lie can be __, __, or ___. Oblique lie is unstable and usually becomes transverse or longitudinal during course of labor. |
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Definition
- long axis of the fetus to that of the mother
- longitudinal, transverse, or oblique |
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Term
| Presenting part should be determined by __ or __. Longitudinal lie can have the head as the presenting part (__) or the legs or butt (__). |
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Definition
- physcal or ultrasound
- cephalic
- breech |
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Term
Incidence of presentations at term:
96% Cephalic
3.5% Breech (Preterm higher -14%)
0.3% Face
can deliver vaginal if mentum anterior (MA)
0.4% Shoulder |
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Definition
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Term
| Face vaginal deliveries can occur if ___ __. |
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Definition
| mentum anterior (chin is up) |
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Term
Incidence of presentations at term:
96% Cephalic
3.5% Breech (Preterm higher -14%)
0.3% Face
can deliver vaginal if mentum anterior (MA)
0.4% Shoulder |
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Definition
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Term
| V-back= vaginal birth after a C-section. Vaginal birth after C-section carries a 1-2% chance of uterine rupture. |
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Definition
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Term
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Definition
- Vertex
- Sinciput
- Brow aka Military
- Face |
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Term
| Different Breech presentations: |
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Definition
- Complete breech(Indian Style)
- Incomplete breech aka Footling
- Frank Breech: flexed at thighs, extended at knees |
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Term
| Position is the relation of an arbitrarily chosen portion of the fetal __ __ to the __ or __ side of the __ __ __ . |
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Definition
| - presenting part to the right or left side of the maternal birth canal |
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Term
| look at slides 23-26 of normal labor powerpoint to see picture examples of position |
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Definition
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Term
| occiput posterior is much harder labor |
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Definition
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Term
Leopold’s maneurver: hand maneuvers on belly to feel position of baby and about how much it weighs
With posterior positition can feel lots of lumps and bumps b/c face and elbows up. Also harder to find heart beats when baby is in posteior position. |
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Definition
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Term
| It is just as accurate to estimate fetal weight with leopolds as a sonogram is |
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Definition
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Term
| 7 cardinal movements of labor, these occur in sequential order: |
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Definition
1. Head floating before enagagement
2. Engagement, flexion and descent
3. Further descent, internal rotation
4. Complete rotation, beginning extension
5. Complete extension
6. Restitution (external rotation)
7. Delivery of anterior shoulder
8. Delivery of posterior shoulder |
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Term
| 3 methods to monitor fetal heart rate: |
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Definition
- doppler
- continuous external fetal monitoring
- scalp electrode |
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Term
Doppler measures it intermittently.
Continuous fetal monitioring: has increased C-section rate but has not improved fetal outcomes, so you have just restricted the woman to the bed
ACOG monitors doppler every 30 minutes and then lets lady walk around instead of being on bed. Then monitor it every 15 minutes during 2nd stage.
Continuous monitoring can be external or internal (in baby’s scalp) |
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Definition
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Term
| ACOG recommends during 1st stage of labor, in absence of any abnormalities, FHR may be checked: |
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Definition
- at the end and immediately after contraction at least every 30 minutes
- every 15 minutes during the second stage of labor |
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Term
| Whats the difference b/w internal and external monitoring? |
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Definition
- external just measures frequency of contraction, NOT intensity
- internal measures frequency and intensity |
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Term
| If risk factors are present, what type of fetal monitoring should be done? |
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Definition
| continuous electronic fetal monitoring |
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Term
| what maternal things should you evaluate during active labor |
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Definition
| maternal temperature and pulse |
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Term
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Definition
If presenting part is not fixed in pelvis, risk of cord prolapse
Labor is likely to occur soon if pregnancy is at or near term appx 90% at 24 hours
If delivery is significantly delayed, increasing likelihood of intrauterine infection |
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Term
Like to keep water intct until about 4 cm, b/c risk of prolapsed cord. Membranes rupture too early> cord falls down> head puts pressure on cord (so have to put hand up there and keep babies head off cord).
Don’t like water to be broken too long> increased risk of infections. |
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Definition
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Term
| Amniotomy is when you intentionally break a pregnant woman's water. The technique involves perforation of ___ membranes (AROM). |
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Definition
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Term
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Definition
- high success rate for stimulating labor
- assess amniotic fluid for blood or meconium
- access for internal monitoring |
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Term
| If baby has meconium fluid in sac have NICU in there to suck out meconium. You don’t want baby to aspirate meconium> pulmonary hypertension. |
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Definition
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Term
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Definition
Vertex should be well applied
Vaginal exam to evaluate dilitation and station
Amnihook is passed through cervical canal across examining hand between fingers and a gentle hooking motion
Membranes retracted over vertex by blunt dissection with examining finger |
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Term
| If they get an epidural> have to be in bed and continuously monitored. But still can get on heads and knees with epidural in bed. Hands and knees can help the baby get into right position. |
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Definition
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Term
| Pain relief during labor: |
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Definition
Non-pharmacological
IV sedation
Meperidine
Butorphanol
Anesthesia
Pudendal
Spinal
Epidural |
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Term
| Person at your bedside can be as effective as 50 mg pain demural. |
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Definition
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Term
| Used to wait 4 cm until epidural, but sense then studies have been done saying epidural can be given at 1 cm and its fine. Spinal doesn’t last as long epidural. |
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Definition
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Term
| Bladder distention in labor: |
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Definition
Can lead to obstructed labor
Consider bladder distention if patient not progressing, station remains high, no relief from pain meds
Always allow patient to attempt to void on her own
May have to have a folley cath to empty bladder |
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Term
| Management of second stage: |
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Definition
Complete dilation of cervix
Woman will have urge to push if no anesthesia
Contractions may last 1 ½ minutes and recur after resting phase of no more than 1 minute |
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Term
| Side to push: optimal for baby’s heart beat b/c not as much stress on baby, decreases amount of vaginal tearing also. |
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Definition
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Term
| Duration of second stage: |
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Definition
Nulliparas is 50 minutes
Multiparas is 20 minutes
Nulliparas with epidural are given 3 hours/without epidural 2 hours
Multips with epidural 2 hours/ without epidural 1 hour
May vary from patient to patient |
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Term
Bearing down is reflex and spontaneous
Squatting position has been associated with shortened second stage
In preparation for delivery, take care not to separate legs too widely or place one leg higher than other |
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Definition
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Term
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Definition
| without the epidural> bearing down to get baby out |
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Term
| Crowning is when the largest diameter of fetal head reaches the the __ __. |
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Definition
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Term
Episiotomy
Should not be used routinely but selectively for fetal indications such as:
Fetal distress to facilitate delivery
Breech
Forceps, vacuum
Shoulder dystocia
Has been reported to increase risk of anal sphincter lacerations |
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Definition
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Term
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Definition
| foward pressure to fetal chin through perineum superiorly against coccyx while other hand supports fetal head at symphysis |
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Term
| Most often shoulders appear at vulva- grasp both sides of head and apply gentle downward pressure |
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Definition
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Term
After delivery of anterior shoulder, check for cord
Nuchal cord: Occurs in about 25% of deliveries
If unable to reduce, can be clamped and cut but deliver quickly after |
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Definition
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Term
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Definition
Increased ferritin levels in neonate up to 6 months
Antibody transfer
Stem Cell Transfer
Hyperbilirubinemia
phototherapy |
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Term
Management of Third stage of labor:
Signs of placental separation: |
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Definition
- uterus rises in the abdomen
- sudden gush of blood
- umbilical cord protrudes from the vagina |
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Term
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Definition
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Term
| What is the highest risk stage of labor? |
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Definition
3rd stage
THIS IS THE STAGE THE HEMORRHAGE OCCURS.
If the mom is bleeding a lot, have to get placenta out.
DON'T FORCE THE PLACENTA OUT> CAN INVERT THE UTERUS |
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Term
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Definition
Placental expression should never be forced
Excessive traction on umbilical cord can result in uterine inversion which is an obstetrical emergency
Apply gentle pressure to abdomen while keeping cord taut
In the absence of excessive bleeding, there is no absolute time manual removal |
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Term
| After placenta is delivered have to do a uterine massage to make uterus contract down. Most common time for uterine atony is right after delivery of placenta. |
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Definition
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Term
| when does uterine atony usually occur? |
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Definition
| third stage, right after delivery of placenta |
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Term
Apply firm uterine massage FIRST!
Examine placenta for completeness and anomalies
“Fourth Stage” is the critical hour immediately following delivery. Most common time for uterine atony.
Vasoconstriction by contracted myometrium is primary mechanism of placental site hemostasis |
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Definition
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Term
| Oxytocin for third stage: |
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Definition
Given diluted in IV fluid
Half-life 3 min
Hypotension is side effect of IV bolus. May give IM if no IV access |
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