OB Test 3 Cobb extra
Cobb test 3: intrapartum
Terms in this set (75)
Decreased circulating blood volume to placenta (eg when she is laying on her back); Supine position (vena cava compression); Hypertension (decreased perfusion)
Pathologic Change: Fetal O2
Nuchal cord-cord ard baby's neck; Cord compression; Knot in cord; Reduced amniotic fluid to cushion cord; Reduced blood flow = FHR increases at first (later FHR drops)
Pathologic Change: Fetal O2
Frequency of Assessment for Low-risk
Intermittent assessment adequate; FHR q30 min 1st stage, q15 min. 2nd stage; Check contractions q hr- latent phase, q30 min- active phase, q15 min -transition
Frequency of Assessment for High-risk
FHR q15min 1st stage; FHR q5min 2nd stage
VBAC: Continuous assessment, monitor
Can be external or internal: Records uterine contraction & FHR; FHR: upper strip (30-240 bpm), Ctx: lower strip (0-100 mm Hg); Dark vertical lines = 1 min, light lines = 10 sec.; Can time contractions; Internal uses US
Bedside monitor unit
External machine that measures uterine activity; Bell-shaped line; All movement registers; Not reliable for: Contraction intensity or Resting tone (between contractions); Internal better for that
Internal Monitor; Accurate for intensity & resting tone; Solid tip = pressure transducer, lumen for amnioinfusion (may record higher); Fluid-filled tip = needs to be level w/ transducer on the outside for accuracy
Intrauterine Pressure Catheter (IUPC)
when electronic monitoring, staff should focus on _____________ not the monitor
<110 bpm for 10 min
>160 bpm for 10 min.
these will all cause_____________
Narcotics / sedatives for mom, Fetal sleep, Tachycardia, Prematurity, Fetal hypoxia, CNS / heart abnormality
Decreased baseline variability
Fetal head compression (pass through birth canal); No intervention needed; "Mirror image"; Happening with early contractions. Generally doesn't drop lower that 100 BPM
Assoc. with hypoxia in baby; Non-reassuring fetal heart pattern; Lack of O2 in intervillous spaces; acute or chronic; FHR lowest point is after peak of the contraction; FHR may remain in normal range; Immediate intervention needed
Late decel's (not good)
Intervention: Late deceleration
Reposition to left side; Administer oxygen by face mask at 8-10L; Discontinue IV oxytocin if in place; Increase nonadditive IV fluids; Notify physician or midwife immediately; Interventions specific to cause/severity
Caused by Cord compression; May or may not be due to contraction; Not uniform; **Less than 100 bpm expect variable decel instead of early; May be unrelated to contraction
Variable decelerations Interventions
Reposition mom to side; Elevate hip to shift fetal presenting part (knee-chest); Oxygen and nonadditive IV fluids; Rule out cord prolapse; Reduce cord compression; Amnioinfusion =cushions umbilical cord; Report to attending MD or midwif
these would be considered abnormal or ________________________
Hypoxia or acidosis? (tachycardia, bradycardia); Decreased / absent variability; Late decelerations; Variable decelerations; Prolonged decelerations; Hypertonic uterine activity (uterine contractions are continuous or prolonged)
Fetal oxygen saturation monitor normal sats are
Braxton Hicks Contractions=
How would you treat Supine Hyoptensive Syndrome
Place the mother on the left side to encourage blood flow to the heart
What are the five P's?
Passage, passenger, powers, psyche, position
What is a gynecoid pelvis?
Most common type of female pelvis, inlet is rounded
What is an android pelvis?
normal male pelvis that is occasionally seen in females, inlet is heart shaped.
the pelvis is flattened, not favored for vaginal birth
occurs when the presenting part of the fetal head passes the pelvic inlet at the level of the ischial spines
the progress of the presenting part through the pelvis
when the feal head meets resistance of the cervix, pelvic wall or pelvic floor
the fetal occiput ideally rotates to a lateral anterior position as it progresses from the ischial spines to the lower pelvis in a corkscrew motion to pass through pelvis
the fetal occiput passess under the symphysis pubis and then the head is deflected anteriorly and is born by extension of the chin away from the fetal chest
after the head is born it rotates to the position occupied as it entered the pelvic inlet in alignment with the fetal body and completes a quarter turn to face transverse as the anterior shoulder passes under the symphysis
restitution and external rotation
after birth of the head and shoulders the trunk of the neonate is born by flexing it toward the symphysis pubis
what stage of labor?
Begins with onset labor, ends with complete dilation. Cervical dilation for 1 cm/hr for clients who are primigravida and 1.5 cm for clients who are multigravida
first stage of labor
Begins with cervix at 0 and ends with cervix at 3. There is some dilation and effacement, talkative and eager, irregular milde to moderate contractions
What phase?Begins with cervix at 4 cm and ends with cervix at 7 cm. Rapid dilation and effacement, anxiety and restlessness increase as contractions become stronger.
what phase ? cervix is 8 cm then goes to 10 cm. urge to push, increased pressure, feeling of can't go on
full dilation to birth; pushing results in the birth of the fetus
begins with the delivery of the neonate and ends with the delivery of the placenta (placenta separates)
placenta delivers and maternal stabilization of vitals.
What are characteristics of false labor?
contractions are painless and irregular, decrease in frequency, felt in lower back, often stop with sleep, cervix is not changed
What are characteristics of true contractions?
start irregular and then become regular, stronger, felt in lower back to abdomen, walking increases it, bloody show
breech with fully flexed legs
breech with extended legs (Most common)
one or both thighs are extended
peak of contraction
building up of contraction
letting up of contraction
When is the apgar scoring performed?
at 1 and 5 minutes
What is fern testing?
examines a sample of cervicle mucus for fern like patterns which indicate the presence of amniotic fluid. Fern like pattern is positive
When is a fern test used?
When the mother report an excessive amount of vaginal secretions
What is nitrazine testing?
Placing a piece of nitrazine tape on the vaginal opening. The tape tests the vaginal secretions again a guide, checking for the presence of amniotic fluid. positive: test will turn dark green or blue
what manouver? using pressure on the dorsal aspect of the posterior shoulder to help adduct the shoulders
two assistants hyperflex the mother's thighs against her abdomen
ROM and SROM stand for
rupture of membranes/spontaneous rupture of membranes
________________refers to the relation of the fetal body parts to one another. describes the
posture the fetus assumes as it conforms to the shape of the uterine cavity. The normal attitude of the
fetus is termed general flexion, where the head is flexed so that the chin is on the chest with the arms
____________refers to the relationship of the long, or cephalocaudal, axis (spinal column) of the fetus to the
long, or cephalocaudal, axis of the mother. The fetus may assume either a longitudinal (vertical) or a
transverse (horizontal) lie.
A ___________lie occurs when the cephalocaudal axis of the fetus is parallel
to the woman's spine.
A ___________________lie occurs when the cephalocaudal axis of the fetal spine is at a right
angle to the woman's spine
A ___________ lie is associated with a
shoulder presentation and can lead to complications in the later stages of labor.
fetal ____________is determined by fetal lie and refers to the body part of the fetus that enters the
maternal pelvis first and leads through the birth canal during labor. The presenting part or the portion
of the fetus that is felt through the cervix on vaginal examination determines it
The most common presentation is ____________. When this presentation occurs, labor and birth are more
likely to proceed normally.
__________ presentations are associated with difficulties during labor and do not proceed as normal; therefore, they are called malpresentations.
Breech and shoulder
The ____________ presentation can be further classified into vertex, sinciput, brow, or face
presentation according to the degree of flexion or extension of the fetal head (attitude).
When the presenting part is the occiput, the presentation is noted as __________.
Vertex is the most common type of presentation.
• The fetal head is completely flexed onto the chest.
_______is the most common type of presentation (The fetal head is completely flexed onto the chest.)
The fetal head is partially flexed.
•• The top of the head is the presenting part
The fetal head is partially extended.
The fetal head is hyperextended (complete extension
A _________presentation indicates that the presenting part is the lower
extremities or buttocks. __________presentations occur in approximately 3% of all term births
(Cunningham et al., 2010). These presentations are classified according to the attitude of the fetus's
hips and knees. In all variations of the breech presentation (complete, frank, or footling breech), the
sacrum (the bone on the buttocks that is felt when palpating) is the landmark.
_________presentations occur in approximately 3% of all term births
The fetal knees and hips are both flexed, the thighs are on the abdomen, and the
calves are on the posterior aspect of the thighs.
• The buttocks and feet of the fetus present to the maternal pelvis.
what breech?The fetal hips are flexed, and the knees are extended.
• The buttocks of the fetus present to the maternal pelvis
The fetal hips and legs are extended.
• The feet of the fetus present to the maternal pelvis.
• In a single footling one foot presents; in a double footling both feet present
When the fetal shoulder is the presenting part, the fetus is in a
___________ lie and the acromion process of the scapula is the landmark. This type of presentation occurs
less than 1% of the time
on a fetal exam, if the acromian process is the presenting part, the lie is ________
-__________of the presenting part occurs when the largest diameter of the presenting part reaches or
passes through the pelvic inlet
Engagement can be determined by vaginal examination. In ___________, engagement usually occurs 2
weeks before term. Multiparas, however, may experience engagement several weeks before the onset
of labor or during the process of labor
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