1
Q
how many stages of labor are there?
A
4
2
Q
stage 1 of labor is subdivided into:
A
- latent: up to 5 cm dilated
- active: 6-7 cm dilated
- transition: 8-10 cm dilated
3
Q
what happens during stage 1 of labor?
A
- ROM
- cervix dilates and causes pain
- assess vitals
- assess pain
- FHR & contractions
- cervical changes
- fetal decent & position
4
Q
which stage of labor is the longest?
A
stage 1
5
Q
nursing actions: stage 1
A
- limit PO fluids
- assist with comfort measures
- encourage frequent position changes
- help with bowel movements
- educate
- peri care
6
Q
ROM means
A
rupture of membranes
7
Q
SROM means
A
spontaneous rupture of membranes
8
Q
how to assess ROM
A
- ferning: sample fluid from upper vaginal area is placed on a glass slide and assessed for a ferning pattern-ROM occurred
- nitrazine paper: turns blue when in contact with amniotic fluid-ROM occurred
9
Q
nursing actions: ROM
A
- check for umbilical cord prolapse
- assess color of fluid: should be clear/cloudy without odor; report other colors
- educate regarding when to seek medical attention
10
Q
ROM: non-risk patient education *when to go to hospital
A
- go to hospital when contractions are consistent for 1 hour, and are 5 minutes apart, lasting 60 seconds
11
Q
ROM: immediate risk patient education
A
- SROM
- intense pain
- bloody show increases
(needs to go to hospital asap)
12
Q
stage 2 of labor is
A
10 cm dilated to birth
13
Q
how does the nurse assist with pushing?
A
- push for 6-8 seconds
- slight exhale
- repeat 3-4 times
14
Q
what happens during stage 2 of labor?
A
- baby actively moves down the birth canal
- lasts about 50 minutes
- contractions intensify
- perineal stretching can help decrease tears
- mom feels urge to push
- perineum flattens
- rectum and vagina bulge
15
Q
episiotomy
A
- surgical incision made to perineum to aid in delivery
- done by HCP
- can be midline (straight down)
- can be mediolateral (diagonal)
16
Q
nursing actions: episiotomy
A
- inspection approximated
- free of foul smell drainage
17
Q
laceration
A
- tear of perineum
- not done by HCP, happens naturally
- graded: 1st, 2nd, 3rd, 4th
18
Q
nursing actions: laceration
A
- assess for slow, steady trickle of blood
19
Q
stage 3 of labor
A
begins after birth and ends with the expulsion of the placenta
20
Q
nursing interventions: stage 3 of labor
A
- watch for signs of placental separation:
-increase in cord length
-upward rising of uterus into a ball shape
-sudden gush of blood from the vagina - assist w/ delivery of placenta:
-encourage breathing and abdominal relaxation during delivery of the placenta - assess fundus continuously; palpate fundus
- possible need for admin of Pitocin if excess bleeding is noted * have med & IV fluids in room if hemorrhage occurs
- placenta out: assess for hemorrhage
- provide newborn care
- skin to skin
- monitor delivery of placenta
- admin oxytocin IM or IV if placenta takes > 30 min to deliver
- inspect placenta to make sure it is 100% (don’t want to leave any behind)
- obtain order for pain meds or uterotonics PRN
- assess vitals q15 min
- encourage bonding
- admin pain meds
- document
21
Q
nursing interventions: stage 4 of labor
A
- palpate fundus q15 min x 1 hour: assessing for uterine involution and/or uterine atony
- assess vaginal bleeding
- encourage bonding & breastfeeding
- have Pitocin IV available, if needed, for hemorrhage
- assess perineum & provide perineal care: tears and lacerations
- heated blanket
- provide food
- encourage rest
21
Q
stage 4 of labor
A
delivery of placenta to maternal recovery
22
Q
pain management in labor: nonpharmacologic
A
- childbirth classes
- relaxation and breathing
- cutaneous stimulation- effleurage
- thermal stimulation
- mental stimulation
23
Q
pain management in labor: pharmacologic
A
- local
- pudendal block
- epidural block
- spinal
- general
24
labor triggers: maternal factors
- stretching of uterine muscles
- estrogen/progesterone changes
- oxytocin release
- release of prostaglandins
25
labor triggers: fetal factors
- fetal cortisol changes
- placenta ages
- prostaglandins increase causing contractions
26
5 P's: factors affecting labor
- Powers: contractions
- Passage: pelvis and birth canal
- Passenger: the fetus
- Psyche: the response of woman
- Position: maternal posture and the physical positions to facilitate birth
27
powers
uterine contractions
- rhythmic
- synchronized
- intermittent (not constant, come and go)
upper 2/3 contracts and pushes down
lower segment less active - becomes thin and pulls up
28
DIF of contractions
Duration: how long
Intensity: how strong
Frequent: how often
29
passage
includes pelvis and birth canal
30
pelvis types
- gynecoid: fat heart
- android: skinny heart
- anthropoid: narrow but tall (oval)
- platypelloid: wide but short (narrow)
31
parts of the pelvis
- ileum
- ischium
- pubis
- sacrum and coccyx
32
what plays the biggest role in determining a successful vaginal delivery?
the maternal pelvis
33
effacement
- shortening and thinning of the cervix
- expressed in percentages 0-100%
- starts out 2-3 cm long and 1 cm thick
34
female pelvis: ischial spines- station
- stations are measured as cm up or down the ischial spine
- -3 to 0 = above the ischial spine
- 0 = narrowest point & is at the ischial spine
- +1 to +3 = below the ischial spine
35
passenger vs passageway relationship
* relationship of fetus to passageway is a major factor in the birthing process
relationship includes:
- size of fetal head/skull
- fetal lie
- fetal attitude
- fetal presentation
- fetal position
- fetal size
36
fetal skull
- head is biggest part of fetus
- head molds to allow the skull to fit through the birth canal
- sutures (listed anterior - posterior) : frontal |, coronal - , sagittal |, lambdoid -
- fontanels (squishy, soft patches): anterior, posterior
37
fetal attitude
relationship of the fetal parts to one another
- vertex presentation
- brow presentation
- face presentation
38
fetal attitude: general flexion
back of the fetus is rounded, chin to chest, thighs are flexed on abdomen, legs flexed at the knees
*deviations from normal/gen flex can cause difficulties with labor and birth (i.e. extended head)
39
vertex presentation
head is completely flexed onto the chest
occiput is the presenting part
40
brow presentation
forehead down
41
face presentation
face down
- bruising on baby's face
42
fetal lie
- refers to the relation of the long axis of the fetus to the mom's long axis
- longitudinal: vertical
- transverse: horizontal
43
frank breech
butt down, legs extended up by head
44
complete breech
butt down, legs crossed, head tucked chin to chest
45
footling breech
1 foot down, 1 foot out, head up
46
fetal position
- relationship of the reference point of the fetus to the mom's pelvis
- examiner during internal vaginal exam feels for the presenting part and figure out what it is
- cephalic: occipital bone
- breech: sacrum
47
positions: right occiput
- ROA: occiput is on the right side of the maternal pelvis: anterior meaning closer to the front of the pelvis
- ROT: occiput is on the right side of the maternal pelvis: transverse meaning across the maternal pelvis
- ROP: occiput is on the right side of the maternal pelvis: posterior meaning to the back part of the pelvis
48
positions: left occiput
- LOA: occiput is on the left side of the maternal pelvis: anterior meaning closer to the front of the pelvis
- LOT: occiput is on the left side of the maternal pelvis: transverse meaning across the maternal pelvis
- LOP: occiput is on the left side of the maternal pelvis: posterior meaning to the back part of the pelvis
49
positions: breech
- LSA: sacrum is on the left side of the maternal pelvis with the sacrum sitting anterior (in the front) of the maternal pelvis
- LSL: sacrum is on the left side of the maternal pelvis with the sacrum sitting lateral of the maternal pelvis
- LSP: sacrum is on the left side of the maternal pelvis with the sacrum sitting posterior (behind) of the maternal pelvis
- RSP: sacrum is on the right side of the maternal pelvis with the sacrum sitting posterior (behind) of the maternal pelvis
- RSL: sacrum is on the right side of the maternal pelvis with the sacrum sitting lateral of the maternal pelvis
- RSA: sacrum is on the right side of the maternal pelvis with the sacrum sitting anterior (in the front) of the maternal pelvis
50
maternal psyche
refers to mother's disposition during each stage of labor
51
psyche: coping mechanisms
- culture
- expectations
- support systems
- type of support during labor
52
maternal positions
- upright
- all fours
- lateral
53
maternal position: upright
- walking
- standing
- kneeling
- squatting
- sitting: improve abdominal muscles working in greater synchrony with contractions and bearing down effort
54
maternal position: all fours- purpose
relieves backache if fetus is occiput/posterior
55
the lateral maternal position is used to ____
help rotate fetus that is in a posterior position
56
intrapartum
onset of labor through the delivery of the placenta
57
lightening
fetus decsends into the pelvis
58
braxton hicks
practice contractions
does not change the cervix
prepares the body for labor
59
how does labor influence the cervix/what changes happen to the cervix?
soften and thin
60
nesting
moms organize, clean and prepare for baby
61
involuntary uterine contractions
effacement: thin out the cervix
62
voluntary expulsion of the infant
pushing
63
what are the two types of powers?
- involuntary uterine contractions
- voluntary expulsion of the infant
64
what is the most common pelvis shape?
gynecoid
- 50% of women have this shape
65
what is the optimal pelvis shape?
gynecoid
66
which pelvis type would have molding of the head?
android pelvis
67
which pelvis type is the least common?
platypelloid
68
which pelvis type typically has the longest labor?
anthropoid
69
dilation
the widening of the cervical opening from less than 1 cm to 10 cm (full dilation)
- fully dilated = 10 cm
70
do effacement and dilation both need to happen for delivery?
for vaginal- yes
71
do effacement and dilation happen at the same time or one before the other?
a nulligravida mom will have effacement before dilation; a multigravida mom may have effacement and dilation occur simultaneously
72
most common presentation
cephalic (head)
- vertex
- occiput is presenting part
- 95% of all deliveries
73
what are the ideal positions for a vaginal delivery?
ROA or LOA
74
what is the presenting part of a frank breech infant?
buttocks
75
shoulder presentation
- usually represents a transverse lie
- c section
76
false labor
- contractions but no change in cervix
- activity doesn't change pattern
- hydration or sedation slows/stops ctxs
77
true labor
- regular contractions increase in frequency and intensity
- change in cervix
- causing effacement and dilation
78
active labor is defined as ___
6 cm
79
why is prolonged pushing (2 hr) good for baby?
- pushes all the mucous and fluids out of fetal chest/lungs
- baby comes out dry, ready to eat
80
1st degree laceration
involves the perineal skin and vaginal mucous membrane
81
2nd degree laceration
involves skin, mucous membrane, and fascia of the perineal body
82
3rd degree laceration
involves skin, mucous membrane, and muscle of the perineal body
83
4th degree laceration
extends into the rectal mucosa and exposes the lumen of the rectum
84
oxytocin (pitocin)
hormone -IV or IM
- stimulates uterine muscle that produces intermittent contractions
- has vasopressor and antidiuretic properties
85
methergine
oxytocic or ergot alkaloids
- increases the tone, rate and amplitude of contractions on the smooth muscles of the uterus, producing sustained contractions and reducing blood loss
86
hemabate/carboprost
prostaglandin F2a analog
increases contractions of the uterine smooth muscles
87
misoprostol (cytotec)
synthetic analog of prostaglandin E
- acts as a prostaglandin analogue causing uterine contractions
88
tranexamic acid/TXA
antifibronolytic
- inhibits fibrinolysis (stops the breakdown of clots)
89
1 g blood loss = __ mL blood loss
1 mL
90
retained placenta causes what ?
PPH (post partum hemorrhage)
91
oxytocin/pitocin: side effects
- hypotension
- tachycardia
- water retention
92
oxytocin/pitocin: indications
- control of postpartum bleeding after placental expulsion
93
methergine: indications
- prevent or treat PPH, uterine atony, or subinvoliution
- used as a second-line medication
94
what do we monitor with methergine use?
- BP
- CNS status
- vaginal bleeding
- may cause nausea
(patient may require antiemetic)
95
methergine is contraindicated in patients with __
- hypertension
- preeclampsia
- may cause severe vasoconstriction
96
hemabate/carboprost: indications
- uterine atony
- second-line medication
- carboprost is a treatment alternative to methylergonovine for patients with HTN disorders
- may be used in hemorrhage situations retractory to methylergonovine and oxytocin
97
hemabate/carboprost: side effects
- nasuea
- vomitting
- diarrhea
98
hemabate/carboprost is used with caution with patients with ___
asthma
- carboprost can stimulate vasospasm
99
misoprostol: side effects
- abdominal pain
- diarrhea
- fever
- chills
100
misoprostol: indications of use
- used to control PPH
- 1st line medication in low-resource areas where oxytocin is not available
101
tranexamic acid/TXA: side effects
- abdominal pain
- headache
- nausea
- vomiting
- diarrhea
102
tranexamic acid/TXA: route/dosage
1g IV over 10-20 minutes
103
what are the most common uterotonic medications?
- oxytocin/pitocin
- methergine
- hemabate/carboprost
- misoprostol (cytotec)
- tranexamic acid/TXA
NU 330
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