OB Exam 2 Study Guide - Labor & Delivery Flashcards

Flashcards for OB Exam 2 study guide covering stages of labor, 5 Ps, labor complications, operative delivery, fetal presentation/position, medications, cervical assessment, uterine monitoring, decelerations, and preeclampsia/magnesium toxicity.

What defines the cervical dilation range and contraction characteristics during the latent phase of labor?

Cervical dilation is $0-5\,\text{cm}$. Contractions are irregular, mild to moderate, occurring every $5-30\,\text{minutes}$, and lasting $30-45\,\text{seconds}$.

What physical maternal discharge is characteristic of the latent phase of labor?

A scant amount of brownish discharge, pale pink mucus, or a mucus plug.

What are the cervical dilation range and contraction characteristics during the active phase of labor?

Cervical dilation is $6-10\,\text{cm}$ (dilating at $1\,\text{cm}$ per hour, but can jump). Contractions are more regular, moderate to strong, occurring every $3-5\,\text{minutes}$, and lasting $40-90\,\text{seconds}$.

What maternal emotional and physical characteristics are seen in the active phase of labor?

The mother becomes more serious with an inward focus, feeling helpless, anxious, apprehensive, irritable, and in severe pain out of control. She may experience nausea, vomiting, urge to push, increased rectal pain/bowel movement sensation, and increased blood show.

What cervical dilation and contraction frequency/duration define the transition phase?

Cervix is $8-10\,\text{cm}$ dilated. Contractions are strong, occurring every $2-3\,\text{minutes}$, and lasting $45-90\,\text{seconds}$.

What nursing care is performed during the latent and active phases of labor?

Leopold's maneuvers, maternal position changes, comfort measures, and PRN analgesics.

What is the purpose of Leopold's maneuver and where should fetal heart tones be assessed?

To determine fetal position; fetal heart tones are assessed on the side where the back of the baby is located.

What defines the second stage of labor and what care is provided?

From complete dilation ($10\,\text{cm}$) to the birth of the newborn, characterized by pushing and fetal descent. Care involves monitoring contractions, pushing effort, inspecting for lacerations, and comfort.

What defines the third stage of labor?

From the birth of the baby to the delivery of the placenta, including placental separation/expulsion and assessment of quantitative blood loss (QBL).

What is the difference between Schultze and Duncan placental presentations?

Schultze presentation features the shiny fetal surface emerging first, while Duncan presentation features the dull maternal surface emerging first.

Why is Oxytocin administered during the third stage of labor?

It is administered after the baby is out to help expel the placenta and monitor/prevent hemorrhage.

What is the primary focus of the fourth stage of labor?

Maternal recovery and stabilization of vital sign homeostasis, requiring comfort measures, fundal massage, lochia assessment, and assisting the patient to urinate.

What are the 5 Ps of labor?

1. Passenger (fetus and placenta), 2. Passageway (birth canal), 3. Powers (contractions), 4. Position (maternal/provider preference and condition), 5. Physiological (feelings).

What is a prolapsed umbilical cord and what risk factors contribute to it?

Displacement of the umbilical cord preceding the presenting part or protruding through the cervix, compromising fetal circulation. Risk factors include rupture of amniotic membranes, abnormal fetal presentation, and transverse lie.

How is a prolapsed umbilical cord managed?

Repositioning the mother, manually lifting the baby off the cord, and applying a wet rag with sterile water to keep the cord moist.

What is chorioamnionitis and its standard medical management?

Infection of the chorion and amniotic sac; managed by monitoring maternal fever and administering antibiotics like ampicillin.

What clinical signs indicate fetal distress during labor and what is the immediate intervention?

Recurring decelerations or variable decelerations (indicating hypoxia); the immediate intervention is to stop oxytocin.

What defines precipitous labor and how is it managed?

Birth that occurs in less than $3\,\text{hours}$. Management includes administering Magnesium sulfate (monitoring for toxicity), monitoring bleeding, and stopping oxytocin.

What is shoulder dystocia, what classic sign indicates it, and how is it managed?

Occurs when the shoulder cannot fit under the pubic bone (indicated by the turtle sign), cutting off circulation. Managed by Mcroberts maneuver first, followed by suprapubic pressure.

What potential complications can a baby experience following shoulder dystocia or operative delivery?

Hypoxia, brachial plexus injury (Erb's palsy), broken clavicle, and cerebral palsy (CP).

What requirements must be met before applying forceps for an assisted birth?

Cervix must be $10\,\text{cm}$ dilated, vertex membranes ruptured, and no cephalopelvic disproportion (CPD).

What newborn complications are associated with forceps delivery?

Facial bruising, facial nerve palsy, cephalohematoma, and subdural hematoma.

Define Cephalic, Transverse, and Breech fetal presentations.

Cephalic: head positioned downward toward the cervix; Transverse: baby lies horizontally across the uterus; Breech: buttocks or feet positioned toward the cervix.

How are fetal positions LOA, ROA, LOP, and ROOP defined?

LOA: baby's back/head towards mother's left/front; ROA: mother's right/front; LOP: mother's left/back; ROOP: mother's right/back.

How is fetal station defined and interpreted from $-5$ to $+5$?

Measures fetal head descent relative to ischial spines in cm. Station $0$ is at the ischial spines; negative values are above; positive values ($+1$ to $+5$) are below, with $+4$ to $+5$ indicating very close to delivery.

What is the indication, route, dose, and key monitoring parameter for Terbutaline?

Tocolytic given $0.25\,\text{mg}$ SUBQ to temporarily stop contractions; monitor for maternal tachycardia.

Why is Betamethasone given during preterm labor?

To promote fetal lung maturation.

What are the maternal contraindications for Methergine and Hemabate?

Methergine is contraindicated in hypertension; Hemabate is contraindicated in asthma.

Define the four abnormal placenta types: Succenturiate, Battledore, Velamentous, and Placenta Accreta.

Succenturiate: double-lobed placenta; Battledore: attached to the side (increased risk for fetal hemorrhage); Velamentous: attached to membranes; Placenta Accreta: attaches deeply into uterine wall and does not separate normally after birth.

What parameters does an Intrauterine Pressure Catheter (IUPC) measure and what are its prerequisites?

Measures Frequency, Duration, and Intensity of contractions. Prerequisites: membranes must be ruptured and cervix sufficiently dilated.

What is an amnioinfusion, what fluids are used, and what complication must be monitored?

Instillation of Normal Saline (NS) or Lactated Ringer's (LR) into the amniotic sac via IUPC to treat cord compression, oligohydramnios, or variable decelerations. Monitor for uterine overdistension.

What are the contraindications for placing a Fetal Scalp Electrode (FSE)?

Maternal HIV, active genital herpes, or maternal blood-borne infections.

How is a cervical exam documented as $8\,\text{cm}/90\%/+1$ interpreted?

The cervix is $8\,\text{cm}$ dilated, $90\%$ effaced (thinned), and the fetal head is $1\,\text{cm}$ below the ischial spines.

What is the priority nursing action following an amniotomy (AROM)?

Check fetal heart status immediately to evaluate for a prolapsed cord.

What criteria permit and what conditions prohibit Vaginal Birth After Cesarean (VBAC)?

Permitted: no previous rupture, clinically adequate pelvis, non-recurring labor pattern. Prohibited: LGA, malpresentation, CPD, or previous vertical uterine incision.

What is uterine tachysystole and how is it managed?

More than 5 contractions in 10 minutes averaged over a 30-minute window. Managed by discontinuing oxytocin.

What causes late decelerations and what intervention does LION represent?

Caused by uteroplacental insufficiency. LION intervention: Left lateral position, Increase IV fluids, Oxygen administration, Notify provider.

What cause and intervention are associated with variable decelerations?

Caused by umbilical cord compression; managed by changing maternal position.

What causes early decelerations and what is the appropriate initial action?

Caused by fetal head compression (reassuring); perform a vaginal exam first to assess labor progress.

What is normal baseline FHR and normal moderate variability?

Normal FHR is $110-160\,\text{bpm}$; moderate variability is $6-25\,\text{bpm}$.

What are the four pelvic types and their occurrence rates/characteristics?

Gynecoid: round (most favorable, $50\%$); Platypelloid: oval (likely C-section, $5\%$); Android: wedge-shaped (slow exit, $20\%$); Anthropoid: long oval (narrow passage, $25\%$).

How should oxygen be delivered to a laboring woman during intrapartum resuscitation?

Via a non-rebreather face mask at $10-15\,\text{L/min}$ (do not use nasal cannula or venturi mask).

What major maternal signs indicate preeclampsia developing after 20 weeks gestation?

High blood pressure, severe headache, visual changes, and RUQ epigastric pain.

What signs indicate Magnesium Sulfate toxicity and what is its specific antidote?

Signs include respiratory depression and absent or decreased deep tendon reflexes (DTRs). The antidote is Calcium Gluconate.