Labor and Delivery

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review of chapter 26 in Foundations book.

Lightening

descent of the uterus into the pelvic cavity that occurs late in pregnancy. baby has "dropped"

Nitrizine Test

Test used to differentiate urine and ROM. (Uses pH of discharge)

pH of urine and most vaginal fluids

5.0-6.0

pH of amniotic fluid

6.5-7.5

Maximum length of time after ROM for delivery to occur

18-24 hrs

Blood-tinged mucus that occludes the cervical opening, is released before true labor begins.

Bloody Show

Irregular tightening of the pregnant uterus; remains irregular; does not dilate the cervix

Braxton Hicks contractions

Effacement

shortening of the uterine cervix and thinning of its walls as it is dilated during labor

When assisting a delivery, what PPE should be donned?

Cover gown and mask or protective eyewear.

5 P' of Labor

Passageway, Passengers, Powers, Position of mother, Psyche

Most common type of pelvis in women

Gynecoid

Molding

Overlapping of cranial bones or shaping of the fetal head to accomodate and conform to the bony and soft parts of the mother's birth canal during labor.

Sutures

areas where cranial bones join together

Fontanelles

The membrane-covered gaps between the bones of an infant's skull. They allow the bones of the skull to push through the birth canal, and subsequently accommodate the rapid increase in brain size during childhood.

Fetal Attitude

Relationship of the fetal parts to one another.

Flexion

back is bowed outward, chin touching sternum, arms crossed at chest, thighs flexed on abd.

Fetal Position

the relationship of the occiput, sacrum, chin, or scapula of the fetus to the front, back, or sides of the mother's pelvis

oligohydramnios

too little amniotic fluid

Fetal Lie

Relationship of the long axis (head-to-foot or cephalocaudal axis) of the fetus to the long axis of the mother. Relationship of the fetal spine to the spine of the mother. Longitudinal or Transverse

Fetal Presentation

the part of the fetus (head, face, breech, or shoulders) that first enters the pelvis and lies over the inlet.

Most common fetal presentation

Cephalic, 96%

Four types of cephalic presentation

vertex (between fontanelles), brow, face, and mentum (chin)

Complete Breech

Buttocks present and thighs are well flexed on abd.

Frank breech

buttocks present and thighs are extended across abd and chest

Footling Breech

No flexion, one or both feet present

Most common postion for delivery

left occiput anterior (LOA)

Appropriate positioning for prolapsed cord

modified sims' or trendelenburg

Signs of deatched placenta

firmly contracting uterus, cord lengthening, sudden gush of dark red blood

Primary Powers

involuntary uterine contractions, which signal the beginning of labor

Secondary Powers

Voluntary brearign down by woman in labor

Resposnible for effacement and dilation of cervix, and descent of fetus

Primary Powers

Dilation

enlargement of the cervical opening and canal

Marks the end of stage 1 in labor

Full dilation (10cm)

Ferguson's Reflex

maternal urge to bear down

Valsalva's maneuver

spontaneous bearing down efforts

Mechanisms of labor

turns and adjustments fetus makes as it moves through the pelvis

Engagement

bilateral diameter of the fetal head crosses into the pelvic inlet

Decsent

downward progress of the presenting part

Internal rotation

allows fetal head to progress through the maternal pelvis

Extension

the occiput passes under the symphysis pubis

Restitution

Fetus's head moves to realign with the undelivered body

Expulsion

the body of the infant leaves the pelvis

First stage of labor

starts with onset of regular contractions, ends with complete dilation of the cervix

second stage of labor

begins with 10cm dilation and ends with birth of the baby

Third stage of labor

begins wiuth birth of the baby, ends with delivery of placenta

Episiotomy

surgical incision of the perineum to enlarge the vagina and so facilitate delivery during childbirth

When is episiotomy performed?

At the end of stage 2 of labor.

Most common type of episiotomy

Midline, or median

Normal amt of blood lost in vaginal delivery

200mL-300mL

Excessive amt of blood loss in vag delivery

>500mL

How often DURING 1ST HR post delivery are VS done?

Q15 mins

How often AFTER 1st hr are VS done?

Q30 mins

Normal FHR

1210-160bpm

FHR measured how often in 1st stage of labor?

Q15-Q30 mins

FHR measured how often in 2nd stage of labor?

Q5 mins

What are early decelerations caused by?

pressure on fetal skull

What are late decelerations caused by?

decreased oxygen and blood flow to fetus through placenta

what are variable decelerations caused by?

Compression on the umbilical cord

Tocotransducer

measures frequency and duration of contractions

What does an intrauterine catheter measure?

frequency, duration, intensity, and resting tone of uterine contractions

When can internal monitoring be used?

During intrapartal stage, 2-3cm dilated, membranes ruptured

Tachycardia in fetus

>160bpm

Bradycardia in fetus

< 100bpm

meconium

thick dark green mucoid material that is the first feces of a newborn child

When is Apgar scoring used?

1 and 5 mins after birth

What is Apgar criteria

HR, Respiratory effort, muscle tone, reflex irritability, color

What is considered an optimal score for Apgar?

8-10

Surfactant

substance produced by the infant that decreases suface tension within alveoli and permits inflation

Loss of heat due to ___ can lead to hypothermia

evaporation

Which side is the infant turned on to facilitate drainage from mouth and promote emptying of the stomach?

Right Side

How of often should a laboring woman void?

Q2hr

When should ambulation be encouraged in a laboring woman?

before ROM or presenting part is fully engaged

Side in which the woman should be placed due to late decelerations or hypotension

Left Side

Precipitious Labor

labor that last less than 3 hours from onset of contractions to time of birth

Leopold's maneuver

determines fetal lie, presentation, and position

When does the anterior fontanelle close?

18 months

When does the posterior fontanelle close?

2 months

Triangle shaped fontanelle

posterior

Diamond shaped fontanelle

anterior

Fx of upper part of uterus in labor

provides force during labor

Fx of lower part of uterus in labor

acts as a passive tube

Phases during first stage of labor

Early latent, active, and transitional

Which stage does the mother feel the urge to push?

second stage

SROM

Spontaneous rupture of membranes

Common medical complication in labor

hemorrhage

Strip chart

upper line is FHR, bottom line is uterine contractions.

Hormones secreted by placenta

estrogen, progesterone, human placental lactogen, HCG

Hegars sign

enlargement of uterus, changes in isthmus in uterus

Chadwicks Sign

violet our purple coloring of vulva, vagina, and or cervix

Goodells Sign

softening/increased pliability of cervix

BUBBLES

breasts, uterus, bowl, bladder, lochia, episiotomy, surgical site

Linea Terminals

imaginary line dividing pelvis into two sections

Android pelvis shape

heart

gynecoid pelvis shape

round

anthropoid pelvis shape

oval

platypelloid pelvis shape

flat

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