Maternity Mid-Term

Preterm labor; what are the risks

late or no prenatal care, previous preterm birth, maternal age, domestic violence, placenta abruptio, overdistension of the uterus, incompetent cervix, cervical and maternal inflammation, torch infections, hormonal changes, inadequate perfusion, short cervix.

Prophylactic medication given for the fetus

Corticosteroid therapy is listed as a medical intervention for preterm labor. The goal of delaying delivery in preterm labor is specifically for the fetal lungs to mature.

True labor vs. false labor

True labor -

regular intervals, increasingly more intense, increased duration over time, begins in the back and radiates to the front, cause cervical effacement and dilation, may intensify with walking, unchanged with a warm shower or rest.

False Labor -

irregular, do not increase in duration, do not cause cervical effacement and dilation, may cease with rest or a warm shower, do not intensify with walking.

medication are used for induction both cervical ripening and induction

Oxytocin and Prostaglandins.

used for post-term pregnancy and potential macrosomia.

why are VBACs concerning

may cause uterine rupture

what is the duration and frequency of contractions that are alarming

Uterine contractions lasting 2 minutes or longer or occurring within 1 minute of each other are considered alarming.

what is the relaxation phase of a contraction

known as the Decrement

Important because during the peak of a contraction, there is a decrease in circulation and perfusion to the placenta.

First stage of labor

Latent phase

mild and erratic. may occur 5-20 minutes apart and last 20-40 seconds

dilation to 3 cm

Second stage of labor

Active labor

contractions 2-3 minutes apart and last about 60 seconds

dilation 4-6 cm

Third stage of labor

transition phase

most intense phase of labor, contractions 2-3 minutes apart, last about 60-90 seconds

dilation to 10cm

this phase may last 1-3 hours

how do you know the mom has moved onto the transition phase

intensity and pattern of contractions

women physical and emotional resposnes

how should pushing be initiated (how many breaths)

pant-blow breathing - 3 to 5 quick breathes followed by a longer exhale

what happens if they push too early

it may cause cervical swelling and slow the dilation.

concerns and decreasing risk during the 4th stage of labor

Concerns- risk of Hemorrhage (leading cause of maternal mortality)

Decreasing risk - frequent maternal assessment, uterine and bladder management, monitoring blood loss, supportive care and emergency preparedness.

fundal massage

performed during the postpartum period, primarily to address and prevent the most common cause of postpartum hemorrhage; uterine atony.

descriptors of a vertex presentation

Presenting part - head is first to enter the pelvis, fetus fully flexed with the chin on the best, the back rounded, the thighs flexed on the abdomen, and he legs flexed at the knees.

Fetal lie - longitudinal lie

Fetal position - fetus presenting part with the mothers pelvis; first letter (left or right) second letter (vertex presentation [usually occiput {O}]) third letter (anterior [A], transverse [T], or posterior [P])

Best fetal position for delivery

vertex presentation, known as cephalic presentation; where the head is the presenting part.

most common and easiest presentation for delivery.

ROP presentation cause what kind of pain or what kind of labor

right occiput posterior (ROP) presentation

can contribute to Dysfunctional labor and Visceral Pain

frank breech presentation

the buttocks are the presenting part. may require a cesarean delivery.

what does the appearance of meconium stained fluid mean

may indicate a unhealthy fetus.

should be reported immediately to healthcare provider

how does a new mom know she’s in labor

True labor occurs; discomfort typically begins in the back and radiates to the front, thinning (effacement) and dilation of the cervix, contractions may intensify with walking, contractions will not stop with rest or with a warm water.

when does a new mom NEED to go to the hospital

uterine contractions lasting 2 minutes or longer and occur within 2 minute of each other

what influences pain reactions

physical and psychosocial factors

Natural substance released to help us during peak pain

endorphins

what is different about childbirth pain

Visceral pain - origination from internal organs. active and transition phases of labor

Somatic pain - activation of pain receptors on the body surface or in musculoskeletal tissues. fetal head begins to descend and the perineum stretches.

non-pharmacological methods of pain management

Dick-read method - relaxation using hyponosis

Bradley method - muscle control

Lamaze method - breathing patterns with a focal point

massage, warm baths, relaxation techniques

what would prohibit a mother from receiving epidural

labor progresses too quickly or baby is close to being delivered

risk to the fetus when taking epidural

abnormal fetal heart rate (FHR) , slower cerival dilation and longer labor

what vital signs do you take right after getting an epidural

continual fetal monitoring

hourly sedation, HR, respiratory rate, pain score (while awake)

usual side effect of an epidural that is also a concern in the 4th stage of labor

requirement for a catheter to keep the bladder from becoming too full, a full bladder can impede labor and fetal descent, can also lead to uterine atony.

gate control therapy and how is it used in labor

a mechanism, in the spinal cord, in which pain signals can be sent up to the brain.

cognitive, sensory, and cutaneous methods to close the “gate” in the spinal cord and reduce the pain messages headed to the brain during labor.

signs of hyperventilation and interventions

dizziness or lightheadedness, SOB, weakness, confusion.

breathing through pursed lips

breathing through one nostril

breathing through a paper bag

risk of Pitocin and what to do if it happens

risk factor for postpartum hemorrhage. come use is uterine atony.

intervention - identify excessive bleeding, notify rapid response team, perform fundal massage, support the lower uterine segment, VS, level of consciousness, weigh periods and linens, iv fluids, monitor oxygen levels, elevate the patient legs, provide psychosocial support.

why no narcotics late in labor

possible cause of persistent absent or minimal fetal heart rate variability. most significant sign of fetal distress.

antidote medication for narcotics

Naloxone

Breaking the BOW (amniotomy) what is your first concern

aka “water breaking”, first corner is to check the characteristics of the fluid.

should be clear with no offensive odor.

what causes a tear or laceration and edema during labor

Tear - If the baby’s head is too big for the vagina to stretch around.

Edema - accumulation of fluid

when is Rhogam given

around 28 weeks of gestation to Rh-negative pregnant individuals.

within 72 hours after birth if the baby is Rh-positive and the parent is Rh-negative.

after any event that might cause fetal-maternal hemorrhage.

why is Rhogam given

prevents isoimmunization (Rh sensitization)

protects future pregnancies

when can pregnant women be give a live vaccine

immediately after birth

signs of pulmonary embolism

sudden onset of dyspnea

chest pain

tachycardia

what does a good Apgar score indicate

newborn is adapting well to life outside the womb and likely does not need immediate medical intervention

correct sequence of mechanisms of labor

1. Engagement

2. Descent

3. Flexion

4. internal rotation

5. extension

6. external rotation (restitution)

7. expulsion

side effects of Mg Sulfate

flushing nd warmth

nausea and vomiting

drowsiness or lethargy

Serious - loss of deep tendon reflexes, respiratory depression, decreased urine output, hypotension and Bradycardia

what is the first concern after birth and the baby is stable

risk of postpartum hemorrhage.

1st hour after delivery is considered the most dangerous .