Maternity Exam 2

true labor: contraction timing

true labor: contraction timing

regular, becoming closer together, usually 4-6 minutes apart, lasting 30-60 seconds

true labor: contraction strength

becomes stronger with time, vaginal pressure is usually felt

true labor: contraction discomfort

starts in the back and radiates around toward the front of the abdomen

how long to stay home for true labor

until contractions 5 minutes apart, lasting 45-60 seconds, and so strong conversation during is impossible

true labor: contraction alleviation

continue no matter what positional change is made

main indication of true labor

cervical changes

false labor: contraction timing

irregular, not occuring close together

false labor: contraction strength

frequently weak, not getting stronger with time or alternating

false labor: contraction discomfort

usually felt in the front of abdomen

false labor: contraction alleviation

slow down or stop with walking, position changes, and fluid consumption

false labor indication

braxton hicks contractions

indications for induction of labor

Prolonged gestation, prolonged premature rupture of membranes, gestational hypertension, cardiac/renal disease, chorioamnionitis, dystocia, IUFD, and diabetes

methods for induction of labor

cervidil, cytotec, foley bulb, herbs, sexual intercourse with breast stimulation, stripping of membranes to cause detachment

when is cervical ripening done

before the administration of pitocin

what herbs are used for induction

evening primrose oil, raspberry leaf, black haw

fetal fibronectin

predicts preterm labor with a cervical swab that turn blue if positive

what are manifestations of preterm labor

cramps, UTI symptoms, pelvic pressure/fullness, nausea, vomiting, diarrhea, or general discomfort

what is preterm labor

The occurrence of regular uterine contractions accompanied by cervical effacement and dilation before the end of the 37th week of gestation

what is dystocia

the abnormal progression of labor

what are the risks for dystocia

Epidural analgesia, excessive analgesia, multiple pregnancy, hydramnios, maternal exhaustion, ineffective maternal pushing technique, occiput posterior position, maternal age over 34 years, high caffeine intake, overweight, gestational age over 41 weeks, chorioamnionitis, ineffective urine contraction, and high fetal station at complete cervical dilation

Mcrobert's Maneuver

legs extended way back; thighs flexed/abducted to straighten pelvic curve

suprapubic pressure

Mcroberts with light pressure above the pubic bone pushing fetal anterior shoulder down

macrosomia

4000-4500g baby birthweight (8.8-9.9lbs)

cephalopelvic disproportion

head too big to pass through pelvis, requires emergency c-section

what is the true pelvis

the bony passageway through which the fetus must travel

what are the three planes of the true pelvis

the inlet, the mid-pelvis (cavity), and the outlet

the inlet

upper pelvic narrow, entrance toward birth canal, and wider transversely than it is front to back

the mid-pelvis (cavity)

As fetus passes through this small area, their chest is compressed causing lung fluid and mucus to be expelled – allows air to enter lungs with newborn’s first breath

the outlet

bound by ischal tuberosities, wider from front to back, measured to ensure the adequacy of pelvic outlet for vaginal birth

marked s/s of amniotic fluid embolism

sudden hypotension and difficulty breathing

amniotic fluid embolism

obstetric emergency; sudden onset of hypotension, hypoxia, and coagulopathy due to disruption in maternal circulation and amniotic fluid

risk factors of intrauterine fetal demise

renal disease, substance abuse, advanced maternal age, uterine rupture, and trauma

intra uterine fetal demise

after 20 weeks gestation before birth and unknown cause

s/s of uterine rupture

sudden fetal distress, abdominal pain without epidural, vaginal bleeding, hematuria, irregular abdominal wall contour, loss of station in the fetal presenting part, and hypovolemic shock

uterine rupture

catastrophic tearing of the uterus at site of previous scar, emergency c-section indicated

what is the onset of uterine rupture marked by

sudden fetal bradycardia

what are the risk factors of uterine rupture

back to back pregnancies, failed TOLAC, drugs, untreated infections

what is TOLAC

trial of labor after cesarean

early recognition of mag sulfate overdose

frequent monitoring of maternal respiratory effort and DTR

what to monitor for mag sulfate

monitor mother for N/V, HA, weakness, hypotension, and cardiopulmonary arrest

how to administer pitocin

10 units added to 1L/1000mL of isotonic solution

what are risks with pitocin

uterine hyperstimulation leading to fetal compromise and impaired oxygenation

antidiuretic effect w/ pitocin

resulting in decreased uterine flow that can lead to water intoxication

what to monitor for pitocin

headache and vomiting

variability

back and forth between SNS and PNS

absent variability

no fluctuation in HR, straight line on strip

minimal varability

less than 5 bpm change in HR

moderate variability

ideal; between 5-25 bpm change in HR

marked variability

greater than 25 bpm change in HR

decelerations

transient decline in fetal HR baseline (downward peaks on strip)

early decelerations

with contractions; show head compression

variable decelerations

cord compression

late decelerations

uteroplacental insufficiency and O2 cut off

what can late decelerations indicate

umbilical cord prolapse

accelerations

15 bpm or more above baseline for greater than 15 seconds but less than 2 minutes

what are the types of fetal monitoring

doppler, external, and internal

FHR indicates?

clinical indicator of acid-based balance and cerebral perfusion

what impacts FHR

meds, hydration, bleeding, hypoxia, maternal fever, street drugs, fetal anomalies, and fetal infections

FHR monitoring for low risk

every 15 minutes

FHR monitoring for high risk

every 5 minutes

normal FHR

110-160 bpm

FHR bradycardia

below 110, lasts 10 minutes or longer

FHR tachycardia

above 160, last 10 minutes or longer

category 1 pattern

normal baseline, moderate variability, accelerations, and early decelerations

category 2 pattern s/s

tachy or brady; absent, minimal, or marked variability; prolonged decelerations (>2 but <10 mins)

category 2 pattern predictions

not predictive of abnormal fetal abid-base status but requires evaluation and continuous monitoring

category 3 pattern prediction

predicitive of abnormal fetus acid-base balance and requires intervention

category 3 pattern s/s

fetal bradycardia, reccurent late decels, recurrent variable decels (declining or absent)

intervention for category 3 patterns

give mom O2, IV fluids, or stop pitocin to promote rest

treatment of opiod overdose

naloxone/narcan to prevent or reverse CNS depression

opiod effect on mom and newborn

respiratory depression and decrease in FHR variability and transient FHR pattern change

other systemic effects of opiods

N/V, pruritis, delayed gastric emptying, drowsiness, hypoventilation, and newborn depression

nesting

sudden increase in energy 24-48 hrs before labor when women focus on childbirth preparation by cleaning, cooking and preparing nursery

what causes nesting

increase in epinephrine release and decrease in progesterone

indications for C-section

previous c-section, breech presentation, dystocia, and fetal distress

cervical effacement

softening of the cervical tissue to allow the passage of the fetus through the canal (0-10cm)

what are the critical factors affecting labor and birth (5 Ps)

passageway, passenger, powers, position, and physical response

fetal physical response

decreased breathing movements, increased PCO2, decreased circulation/perfusion secondary to uterine contractions

maternal physical response for GI

Decreased gastric motility and food absorption, Decreased gastric emptying and gastric pH

maternal physical repsonse immune

increased WBCs and sligh temp elevation

maternal physical response O2 and heart

increased HR and CO during contractions, and increased RR and O2 consumption

other maternal physical response

Muscle aches/cramps, Decreased glucose levels due to NPO status

maternal position kneeling

remove pressure on the maternal vena cave and helps rotate the fetus from a posterior position to an anterior on to facilitate birth

maternal position squatting

enlarges the pelvic inlet and outlet diameters

position: maternal

changes can influence pelvic size and contours, and walking can facilitate decent and rotation

powers (contraction)

primary stimulus that cause complete dilation and effacement of the cervix during the first stage of labor

secondary power in labor

involve the use of intra-abdominal pressure exerted by the woman as she bears down during delivery

mild contractions

feel like cheek

moderate contractions

feel like tip of nose

high contractions

feel like forehead

fetal engagement

presenting part reaching 0 station

floating

no engagement; present part freely moveable about pelvic inlet

fetal station

refers to the relationship of the presenting part to the level of the maternal pelvic ischial spine

fetus descend past ischial spine

toward the goal of birth, station is positive from +1 to +4 (fetus presenting outside)

fetus not descending past ischial spine

station is negative from -1 to -4 (farthest from delivery)

shoulder dystocia

scalpular presentation, when the fetal shoulders present first with the head tucked inside

what is the most favorable position

left occiput anterior

breech

when fetal buttocks or feet enter the maternal pelvis first and the fetal skull enters last

fetal head

size and presence of molding

fetal attitude

degree of body flexion