Studied by 3 people
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
Note 
Flashcard (93)