Maternity Unit 2

True Labor

cervical changes,

contractions are more frequent/stronger/regular

and do not cease with walking or comfort measures

False Labor

No cervical changes,

Irregular pace/strength

Braxton hicks get better with walking or activity

What hormone stimulates contractions?

Oxytocin

Synthetic oxytocin

Pitocin

Elements of an aging placenta

Doesn’t work as good and perfusion is decreased

Reasons why labor is induced

High risk,

Progression of labor has slowed,

Overdue pregnancy,

Decreased placental perfusion

What hormone has decreased levels during labor

Progesterone

What hormones increase during labor

Estrogen,

Oxytocin,

Prostaglandins

Braxton hicks

irregular, painless contractions,

Enhance movement of blood= placenta circulation,

Typically cease w/ walking,

May be mistaken for true labor, however there is no cervical dilation

Lightening

Baby drops to the lower uterus, typically occurs 2 weeks before labor

SROM

Spontaneous rupture of membranes

AROM

Artificial rupture of membranes

How much weight loss may occur before labor (due to shift in hormones)

1 - 3.5 lbs

Signs of Preceding labor

Lightening, return of urinary frequency, backache, Stronger Braxton hick’s contractions, Weight loss, Surge of energy (nesting), Increased vaginal discharge (lose mucus plug/bloody show), Cervical ripening, and possible ROM

Vaginal discharge preceding labor

bloody show/loss of mucus plug

1st thing to assess at the beginning of labor

Prenatal risk factors such as preeclampsia, diabetes, HTN, asthma, multiples, clotting, etc

After assessing risk factors, What other items are assessed at the beginning of labor

LOC, Vitals, hydration status, elimination

and focused assessment based on risk factors- preeclampsia: clonus/ Deep tendon reflex, diabetes: monitor q hr

1st stage of labor -consists of which two steps

Latent and Active

Latent stage

Dilated 0-5 cm

Active stage

6-10 cm

2nd stage of labor

Expulsion of the baby

3rd Stage of labor

Expulsion of placenta

4th stage of labor

Recovery

How long is the recovery stage?

1-2 hours

What is done during the recovery stage of labor?

Fundal checks, assessment, skin to skin (bonding), infant feeding

Dilation is

How open the cervix is ( cm )

When does mom have the urge to push

In the active stage of labor (10 cm)

Stimulants are used to

induce labor

Examples of stimulants

Misoprostol (cytotec)

Pitocin,

Dinoprostone (Cervidil insert; Prepidil gel),

Mechanical dilator (nonpharmacological)

Misoprostol (cytotec) and Dinoprostone (cervidil)

softens the cervix to help with dilation and effacement

Effacement is

How thin the cervix is - measured by %

Which stimulants are used as first line tx for induction

Cytotec and Cervidil

Which stimulant is used for induction to help produce contractions

Pitocin

Pitocin usually start at

1- 2 mU/hr

Why is Pitocin often used after labor and delivery

to prevent hemorrhage by contractions that still occur

What happens with the blood flow in regard to contractions

Decreased blood flow to the uterus (due to squeezing)

Contractions can _________ for the fetus

Compromise oxygenation

What other factors are a concern with fetal oxygenation during contractions

Maternal HTN, Hypotension, Diabetes, Preeclampsia, epidural, anemia, hemorrhage

What may cause altered fetal circulation

cord compression, placental insufficiency

Placental insufficiency examples

Placenta previa, Placenta abruption

Too many contractions can cause

Decreased blood flow to the uterus and not enough muscle relaxation

Too much Pitocin can cause

too many contractions and decreased blood flow

What equipment is used for internal fetal monitoring

fetal scalp electrode, and intrauterine pressure catheter (IUPC)

IUPC measures

uterine contractions

What do we want to know in regard to rupture of membranes (ROM)

When it occurred, color, amount, odor, and if it was AROM (Artificial) or SROM (spontaneous)

SROM , we want to

assess cervical area and ensure it was not the cord coming out/compromised

When are we concerned about labor not happening in regard to ROM

if it has been more than 18 hours since ROM and delivery has not occurred yet.

What are you worried about if it has been more than 18 hours since ROM and no birth

Infection - compromising both mom and baby

Interventions if it has been greater than 18 hours since ROM and no birth

Antibiotics, possible Induction, closely monitor

What may we notice with a prolapsed cord

Drop in FHR or physically seeing the cord

Interventions for prolapsed cord

Push up and hold, move into C- Section

5 Ps of Labor

Passenger, Passageway, Powers, Position, Psychologic response

The passageway is

The birth canal

The passengers are

Baby and placenta

The position is in regards to

The position of mom

Powers are

Contractions and pushing

Components of “the passenger”

Fetal head size, Fetal presentation, Fetal lie, fetal attitude, fetal position, fetal station

Fetal presentation is

the part that enters the birth canal first (often the head)

Fetal lie is

comparison of fetus position compared to moms spine

Fetal attitude

Fetus posture/shape

Fetal position/station

Where the baby is stationed in the mom’s pelvis

Fetal station Negative score

higher up in the pelvis (cm above ischial spine)

Fetal station Positive Score

lower in the pelvis (cm below ischial spine)

What is the best/most common pelvic shape for birth

Gynecoid

What are primary powers

Involuntary uterine contractions

What is responsible for progression of effacement and dilation

Contractions

What are secondary powers

Voluntary bearing down or pushing to help baby move through the birth canal.

Maternal position to help open pelvis.

What 3 things are checked with the vaginal exam

Effacement, Dilation, and station

After effacement, dilation and station is checked what else is assessed

Maternal behaviors and contraction pattern

Elements of assessing contraction pattern

frequency, duration, and intensity

Maternal physiologic changes during labor

Increased cardiac output, increased WBC, Increased in respirations, potential increase in temperature,

Decreased peristalsis, Nausea and vomiting, and drop in Blood glucose (pay close attention to diabetic patients)

Psychological items to assess during labor

expectations/plan, interventions for pain, mood/affect, support, self-esteem, acceptance

Fetal heart rate

110-160 bpm

First thing to assess when reading FHR monitor

Establish a baseline FHR

Second thing to assess when reading FHR monitor

Establish Variability

What is Variability with FHR

Any fluctuations in HR

What are the 4 descriptions of variability

Absent, Minimal, Moderate, and Marked

Absent Variability

No change, no fluctuations in FHR that last less than 15 seconds

If a change in FHR lasts between 15 seconds and 2 minutes this is considered a

Acceleration or Deceleration. NOT a variability in FHR

What is minimal variability

Little change. less than 5 bpm

What is moderate variability

6-35 bpm

What does Moderate variability mean

Describes a normal acid/ base balance and overall fetal well being

What is marked variability

Greater than 25 bpm change in 15 seconds

What is a periodic change described as

Changes in FHR that occurs with contractions

What is an episodic change described as

changes in FHR that do NOT occur with contractions

What is normal periodic changes

FHR drops during contractions

What is the 3rd step in reading FHR monitoring

Establish if there are any accelerations

What is the 4th step in reading FHR monior

Establish if there are any decelerations

What is an acceleration

Marked increase in FHR that lasts 15 seconds to 2 minutes

What is prolonged acceleration

Increased FHR that lasts between 2-10 minutes

When is a baseline change occur with FHR

When there has been either an acceleration/deceleration that lasts at least 10 minutes

What is an early deceleration

Drop in FHR that lines up with contractions

What type of deceleration is expected

Early

What is a deceleration

Drop in FHR lasing between 15sec -2 minutes

What is a late deceleration

Drop in FHR that occurs after the contraction

What does a late deceleration tell us

the fetus has a delayed reflex to decreased oxygenation

what is variable deceleration

an abrupt drop in FHR (not related to contractions). FHR drops more than 15bpm lasting 15sec-2min

what is a variable deceleration often caused by

cord compression