Labor and Delivery Flashcards

Flashcards for Labor and Delivery based on Archer Review Crash Course

What are the Four P's

The Four P's related to the mom include Powers, Passageway, Passenger, and Psyche

Powers - Pushing

Voluntary pushing during contractions when fully dilated.

Powers - Contractions

Involuntary uterine muscle contractions around the fetus.

Passageway

Birth canal and width of the Pelvis. Does the baby have enough space to successfully pass through.

Passenger (The Baby)

Size: Macrosomia <4,000g and tolerating labor with HR decelerations.

Psyche

Emotions (fear, anger, joy, excitement) and support (father, doula, doctor, midwife).

Attitude

The posture of the fetus, relationship of fetal head to maternal spine (flexion - normal).

Lie

Relationship of fetal and maternal spines (longitudinal - parallel spines - normal).

Presentation

The position of the baby in the birth canal (cephalic, breech).

Vertex, Brow, Face

Cephalic Presentations

Breech Presentations

Frank, Full, Footling

Presenting Part

The part of the fetus that leads through the birth canal (head, foot, shoulder, abdomen, butt).

Position

The position of the baby in relation to the mom’s pelvis, presenting part and the relationship of that part to the mom (anterior, posterior, or transverse; right or left). Left occiput anterior is most common.

Station

How far down in the birth canal the baby is, measured in relation to mom’s ischial spine (most narrow spot; at ischial spine = 0 station).

Leopold Maneuvers

A technique used to determine the position of a fetus inside the woman's uterus

Classifications of Placenta Previa

The classification depends on where the placenta is located. Complete: covers the cervix. Partial: part of the placenta covers the cervix. Marginal: covers only the edge of the cervix.

Assessment

Painless bright red bleeding with placenta previa.

Nursing Interventions for Placenta Previa

Never perform a vaginal exam if you suspect a placenta previa, continue to monitor for blood loss, cesarean section indicated in most cases.

Patient Education for Placenta Previa

Bed rest to minimize blood loss, report any bleeding that occurs, monitor baby for decreased perfusion with excessive blood loss.

Abruptio Placentae Types

Causes massive amounts of painful bleeding; incomplete (partial separation, internal bleeding) and complete (complete detachment, massive external bleeding).

Abruptio Placentae Physiology

Once the placenta has detached, there is no perfusion from mom to baby; MEDICAL EMERGENCY; stat c-section.

Abruptio Placentae Assessment

Dark red bleeding, intense abdominal pain, board-like abdomen, rigid uterus, hypotension, maternal tachycardia, fetal bradycardia.

Abruptio Placentae Interventions

Monitor for fetal distress, monitor maternal bleeding, keep the BP up with IVF and/or blood products, prepare for delivery (most likely c-section).

Previa vs. Abruptio

Placenta previa presents with painless bleeding, and abruptio placenta presents with painful bleeding.

Dystocia

Difficult birth, typically caused by a large or awkwardly positioned fetus, by smallness of the maternal pelvis, or by failure of the uterus and cervix to contract and expand normally.

Causes of Dystocia

Macrosomia, malposition of the fetus, hypotonic contractions, hypertonic contractions, maternal pelvis.

Macrosomia

Extremely large fetus (Greater than 4,000 grams) that is unable to fit through maternal pelvis.

Malposition of Fetus

Fetus is not in proper alignment for maternal pelvis.

Hypotonic Contractions

Weak and ineffective contractions that are not able to work efficiently enough to get fetus through maternal pelvis.

Hypertonic Contractions

Contractions are too strong and too fast, not allowing the uterus time to relax and refill with proper nutrients, uncoordinated and not effective.

Dystocia Assessment

Extreme pain (especially with hypertonic contractions), uncoordinated contractions, labor is not progressing as expected; fetal distress, monitor fetal heart rate for late decelerations.

Dystocia Interventions

Monitor for fetal distress, medications (pain medications, IV fluids, tocolytics for hypertonic contractions, oxytocin for hypotonic contractions), rest between contractions, encourage walking with hypotonic contractions, positioning (left side lying).

Term

A baby born from 37-40 weeks gestation.

Preterm

A baby born between 20 and 37 weeks.

Preterm labor

Any labor occurring between 20 and 37 weeks.

Viability

The threshold at which an infant can survive outside the womb, about 20 weeks gestation.

PROM

Premature Rupture of Membranes (rupture of the membranes before labor begins).

PPROM

Preterm Premature Rupture of Membranes (PROM that occurs before the 37th week of gestation).

Assessment of True Labor

Contractions at regular intervals, increasing intensity, pelvic pain, lower back pain, rupture of membranes.

Interventions - Try to stop labor!

If at all possible, we want contractions to stop so that the pregnancy can continue and the baby can be born at a normal gestational age.

Ways to Stop Labor

Tocolytics (Terbutaline, Magnesium Sulfate), bedrest, fluids.

Obstetric Medications

Tocolytics slow contractions (Terbutaline, Magnesium-sulfate, Indomethacin, Nifedipine) and Oxytocics stimulate contractions (Oxytocin, Ergometrine, Misoprostol).

Education

Most important educational point for mothers is what the signs and symptoms of true labor are, so that they know when to call their doctor.

Teach mothers to call their OB for

Rupture of membranes, regular contractions, contractions that become stronger and more frequent with walking, back pain.

Definition of PROM

The rupture of membranes before labor begins.

Assessment of PROM

Should be clear without a foul odor, can be just a small amount of fluid up to a few hundred mLs; infection concern.

Nitrazine test

pH test that differentiates amniotic fluid from urine or other secretions, strip will turn blue if the fluid is amniotic fluid.

Interventions for PROM

Monitor for infection, fetal monitoring with heart rate and decelerations.

Postpartum Hemorrhage

The major loss of blood (hemorrhage) after a vaginal delivery, can occur immediately after the delivery, up until 2 weeks after delivery.

Risk factors for PPH

Twins or triplets, macrosomic fetus, preeclampsia, prolonged labor, precipitous labor, use of forceps or vacuum during delivery, placenta previa, abruptio placenta.

Causes of PPH

Uterine atony (inability of the uterus to contract), injury to the birth canal, retention of the placenta, bleeding disorders.

Assessment of PPH

Boggy uterus, blood loss, shock.

Interventions PPH

Fundal massage, Estimated Blood Loss, Mediations such as Oxytocin or blood products.

Prolapsed Umbilical Cord

Umbilical cord slips through the cervix and into the vagina after rupture of membranes and before the baby descends into the birth canal; cord compressed by the presenting part of the fetus cutting off oxygen to the fetus.

Assessment of Prolapsed Umbilical Cord

Cord visualized protruding through vagina; cervical exam.

Nursing Interventions for Prolapsed Umbilical Cord

Elevate the presenting part of the fetus off of the prolapsed cord, keep your hand on the baby’s head lifting it up and call for help, positioning (knees-to-chest position, Trendelenburg), administer oxygen, NEVER ATTEMPT TO PUSH THE CORD BACK IN, wrap cord in sterile moist towel, emergency Cesarean delivery.

Fetal Heart Monitoring Terminology Variability

Fluctuation in the fetal heart rate, and deceleration is a slowing down.

Variability

Absent, marked, moderate

Fetal Acceleration

Okay

Deceleration

Early , Variable, Late

Variable Decelerations

Cord Compression.

Early Decelerations

Head Compression.

Late Decelerations

Placental Insufficiency

Non-reassuring fetal heart rate

Lay the mother on her LEFT side, Increase IV fluids, Oxygen, Notify the healthcare provider.