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OB-Intrapartum
| Question | Answer |
|---|---|
| signs of true labor | dilatation (opening 0-10cm) of cervix; effacement (thinning 0-100%) of cervix; regular and consistent with increasing intensity over time |
| **longest stage of labor; begins with the first true contraction and ends with full dilation (opening) of the cervix; because this stage lasts so long, it is divided into three phases, each corresponding to the progressive dilation of the cervix | **first stage of labor |
| **first phase of first labor stage: cervix dilates to from 0-3 cm, 25% or so effaced, 6-8 hrs, 5-30 min apart, last 30 sec each with mild to moderate contractions | **early/latent phase |
| **second phase of first labor stage: cervix dilates from 4-7 cm, up to 75% or so effaced, 4-6 hrs, 3-5 min apart, last 45-60 sec each with moderate to strong contractions | **active phase |
| **third phase of first labor state: cervix dilates from 8-10 cm, 100% effaced, up to 2hrs, 1 ½-2 min apart, last 60-90 sec each with intense, strong contractions | **transition phase |
| **stage of labor? begins with complete cervical dilation (10 cm) and effacement and ends with the birth of the newborn | **second stage of labor |
| **stage of labor? begins with the birth of the newborn and ends with the separation and birth of the placenta | **third stage of labor |
| the relationship of the presenting part of fetus to the level of the maternal pelvic ischial spines; measured in cms and is referred to as a minus or plus, depending on its location above or below the ischial spines | fetal/pelvic station |
| fetal/pelvic station? baby is high in pelvic cavity within the iliac crest | negative numbers |
| fetal/pelvic station? head of baby equal, or "engaged", with ischial spines | zero station |
| fetal/pelvic station? baby’s head is engaging through the pelvis past the ischial spines | positive numbers |
| fetal/pelvic station? +4 pelvic station | crowning of head |
| clear and odorless fluid; nitrazine test PH-alkaline; nurse’s action: first check fetal HR for distress or prolapsed cord | rupture of membranes |
| a few weeks or hours prior to labor the fetus will drop into the pelvis; maternal breathing easier but more pressure on bladder (increased urinary frequency) | lightening |
| a bag of clear, odorless fluid that maintains temperature and protects the fetus | amniotic sac |
| a thinning out of the cervical tissue (0-100%) | effacement |
| an opening of the cervix from 0-10 cm | dilation |
| a stringy discharge that can be clear, pink, brown, or red in color | mucus plug |
| a posterior fetal position causing back discomfort in labor | back labor |
| placenta abnormally adheres to the myometrium | placenta accreta |
| the body part of the fetus that enters the pelvic inlet first (the “presenting part”); this is the fetal part that lies over the inlet of the pelvis or the cervical os | fetal presentation |
| occurs when the fetal buttocks or feet enter the maternal pelvis first and the fetal skull enters last; this abnormal presentation poses several challenges at birth | breech presentation |
| the presenting part is usually the occipital portion of the fetal head | cephalic presentation |
| the fetal shoulders present first, with head tucked inside; clinically, signs of this appear while woman is pushing as neonate's head slowly extends and emerges over perineum, but then retracts back into vagina (commonly referred to as the “turtle sign") | shoulder presentation (or shoulder dystocia) |
| relationship of the long axis (spine) of the fetus to the long axis (spine) of the mother | fetal lie |
| occurs when the long axis of the fetus is parallel to that of the mother (fetal spine to maternal spine side-by-side) | longitudinal lie |
| occurs when the long axis of the fetus is perpendicular to the long axis of the mother (fetal spine lies across the maternal abdomen and crosses her spine); cannot be delivered vaginally | transverse lie |
| fetal long axis is at an angle to the bony inlet, and no palpable fetal part is presenting; is usually transitory and occurs during fetal conversion between other lies; cannot be delivered vaginally | oblique lie |
| artificial rupture of the fetal membranes; may be performed to augment or induce labor when the membranes have not ruptured spontaneously | amniotomy |
| fetal head is too large to fit through the pelvic inlet for birth | cephalopelvic disproportion |
| umbilical cord presents through the vagina for delivery prior to fetal head | umbilical cord prolapse |
| **stage of labor? the first hour after delivery; recovery stage | **fourth stage of labor |
| **fetal heart monitoring: normal pattern and no treatment needed; causes: uterine contractions/ fundal pressure/ vaginal exams (head compression); normal during stage 2 (pushing); Tx: facilitate delivery | **early decelerations |
| **causes (umbilical cord compression): maternal position, cord around baby’s body parts, short/knotted or prolapsed cord, prolonged tachycardia, uterine tachysystole | **variable decelerations |
| **Tx: change position (lateral), D/C oxytocin, O2 (8-10 LPM), notify MD, assess for cord prolapse, assist with birth | **variable decelerations |
| **causes (uteroplacental insufficiency): anesthesia, placenta previa/abruptio, hypertensive disorders, DM, intra-amniotic infection, post maturity | **late decelerations |
| **Tx: change position (lateral), correct maternal hypotension, IV fluids, D/C oxytocin, administer oxygen (8-10 LPM), internal monitoring, contact provider, may need C-section delivery | **late decelerations |
Created by:
nurse savage
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