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OLOL OB T 1 B
| Question | Answer |
|---|---|
| Passage | the journey the baby takes being delivered |
| Powers | primary- UC, secondary- mom pushing |
| Position | baby’s and moms |
| Psyche | feelings and emotions during the process |
| Passenger | baby |
| What are the 5 "P's" | Passage, Powers, Passenger, Position, Psyche |
| Vertex | most common.Head is fully flexed. Occiput is presenting part of head.This is the most favorable presentation for normal progress of labor because a small diameter is presenting. |
| Military | head in neutral position (neither flexed nor extended).Sinciput (top of head) is presenting part. |
| Brow | head is partly extended.___ area is presenting part.This is an unstable presentation and may change to vertex if flexes or face if extends.The longest diameter is presenting here. |
| Face | head is extended & fetal occiput is near fetal spine.Baby will have lots of bruising on face.Mentum (or chin) is usually the presenting part. |
| What is the most desirable fetal position? | occiput anterior (OA) |
| What is Malpresentation? | Any position other than OA |
| First Stage | lasts from onset of regular UC to full dilation of cervix (0-10cm) |
| Second Stage | lasts from full dilation of cervix to birth of fetus |
| Third Stage | lasts from birth of fetus until delivery of placenta |
| Fourth Stage | the period of immediate recovery post-birth(approximately 2 hrs and up to 4 hrs) |
| Chara. of the First Stage of Labor | The longest of all of the stages of labor; Divided into three phases: Latent – 0-3cm, Active – 4-7cm, Transition – 8-10cm |
| Characteristics of Latent Phase | 0 – 3 cm dilation; UC:mild to moderate intensity, 5-30 min apart, 30-45 sec long; Maternal behavior: excited,alert,open to directions,talkative-good time to talk mother through the process she should expect if she didn’t take any classes |
| Characteristics of Active Phase | 4 – 7 cm dilation; UC:moderate to strong,3-5 min apart,40-70 sec long; Maternal behavior:more serious,apprehensive,doubtful of abilities, > difficulty following directions,becoming fatigued; Usually when mother receives epidural |
| Characteristics of Transition Phase | 8-10 cm; Shortest of 3 phases; UC:strong to VERY strong,2-3 min apart,45-90 sec long(don’t want them any closer than 2min-over stimulation);Mom behav:pain very intense,fearful,irritable, N/V,shaking,c/o rectal press, focus & directions difficult to follo |
| Chara. of Second Stage of Labor | Begins w/ full cervical dil.& ends w/ delivery baby;“Laboring Down”- fully dilated and effaced,just having contractions not pushing; Ferguson’s reflex(strong urge to bear down)is stimulated-usually only felt in those going natural; Fetal head “crowning” |
| “Laboring Down” | fully dilated and effaced,just having contractions not pushing |
| Ferguson’s Reflex | (strong urge to bear down)is stimulated-usually only felt in those going natural |
| Cardinal Movements of the Mechanism of Birth | Descent,Engagement,Flexion,InternalRotation,Extension,External Rotation,Expulsion |
| Descent | the fetal presenting part thru the true pelvis. Accompanies all other mechanisms.Without this one, none of the others will occur |
| Engagement | largest diameter of presenting part reaches level of mother’s ischial spines |
| Flexion | head is flexed as it meets resistance from soft tissues of pelvis.It must do this so that the smallest head diameters will pass thru pelvis. |
| Internal Rotation | to allow largest fetal head diameters to match with largest maternal pelvic diameters. |
| Extension | as head passes beneath mother’s symphysis pubis. Action of pubis causes fetal head to swing anteriorly (extend) with each push. |
| External Rotation | allows shoulders to rotate internally to best fit mother’s pelvis. |
| Expulsion | of fetal shoulders & body |
| Premonitory Signs of Labor | Lightening,Braxton-Hicks-false labor walking dec;if intensifies ~true labor,Bloody Show, Backache,Urinary Frequency,Diarrhea,Indigestion,N/V,Rupture of Membranes,1-3 lb.Wt Loss,Sudden Burst of Energy, Cervical Changes |
| Chara of False Labor | Irregular UC, Often Stop w/ Walking, Felt Only in the Back/Upper Abdomen, No Cervical Changes |
| Chara of True Labor | Regular UC~getting stronger & closer, Felt in Lower Back & Radiating to Abdomen, Intensity Increases w/ Walking (gravity), Cervix Dilates & Effaces |
| Chara of Third Stage of Labor | Delivery of the placenta,Signs include:Firmly contracted uterine fundus,Change in uterine shape from discoid to globular (ovoid),Sudden gush of dark blood from vagina,Apparent lengthening of umbilical cord |
| Perineal Lacerations & Episiotomies 1st Degree | extends thru skin and structures superficial to muscles |
| Perineal Lacerations & Episiotomies 2nd Degree | extends thru muscles of perineal body |
| Perineal Lacerations & Episiotomies 3rd Degree | continues thru the anal sphincter muscle |
| Perineal Lacerations & Episiotomies 4th Degree | also involves the anterior rectal wall- may have incontinence |
| If a pt's platelet count is ______ then she is not a candidate for an epidural | < 90,000-100,000 |
| When do you give IVP meds during labor? | at the beginning of 2-3 UCs |
| Fetal Reserve | the concept that the fetus is provided with resources (i.e., oxygen & nutrition) in excess of its baseline needs;it refers to the degree of hypoxemia the fetus can tolerate before tissue hypoxia and acidosis will occur. |
| How long is the Fetal Reserve of O2? | about 90 sec (1-2 Min) |
| How often do you auscultate FHR in low risk pt in the 1st stage of labor~Latent Phase? | q 60 min (0-3cm) |
| How often do you auscultate FHR in low risk pt in the 1st stage of labor~Active Phase? | q 30 min (4-7cm) |
| How often do you auscultate FHR in low risk pt in the 2nd stage of labor? | q 15 min (10cm) |
| How often do you auscultate FHR in high risk pt in the 1st stage of labor~Latent Phase? | q 30 min |
| How often do you auscultate FHR in high risk pt in the 1st stage of labor~Active Phase? | q 15 min |
| How often do you auscultate FHR in high risk pt in the 2nd stage of labor? | q 5 min |
| What are the causes of FHR Bradycardia? | postmaturity, congenital heart block, fetal compromise and fetal sleep |
| What are the causes of FHR Tachycardia? | maternal fever, maternal drugs, fetal hypoxia & premature fetus |
| FHR Variability | Irregular fluctuations in the baseline FHR of two cycles per minute or greater. |
| Short Term Variability (STV) | Short-term is beat to beat |
| Long Term Variability (LTV) | is considered 3-6 cycles/min |
| In a NST what results do we want to see and what is the criteria? | Reactive test/criteria: 2 or more accels(15 x 15 rule) over a 20 min period;Normal BL rate;Positive variability of FHR. |
| In a NST what results do we NOT want to see and what is the criteria? | Non-reactive test/criteria: Test takes longer than 40 minutes(b/c baby does not move),OR No accelerations with FM,OR Decelerations are noted. |
| Biparietal Diameter | the largest transverse diameter of the fetal head. |
| In cephalic presentation where is the best place to hear fetal heart tones? | the lower quadrant of the mother's abdomen |
| In breech presentation where is the best place to hear fetal heart tones? | in the upper quadrant of the mother's abdomen |
| Fetal Engagement | occurs when the largest diameter of the presenting part reaches or passes through the pelvic inlet |
| What is the first NSG. intervention with AROM or SROM? | Listen to FHR |
| During the 1st Stage of Labor what do you do in the Physical Assessment? | VS(q 1hr),Temp(q 4hr until ROM,then 2hrs unless fever than q 1hr),UC & FHR q 30min,sterile vag exam PRN(q 2hr unless her condition warrents it more frequently) |
| During the 2nd Stage of Labor what do you do in the Management of Care? | VS(q 30min),UC & FHR(q 5-15min),Provide comfort,Assist w/ breathing~Open & Closed Glottis Pushing,Encourage & Support,Verify all equipment is working |
| During the 3rd Stage of Labor what do you do in the Management of Care? | Instruct to push to assist placental delivery,add oxytocin to IVF after placental delivery,chart time & type of placental delivery,prepare mom for perineal repair if necessary |
| What do we avoid giving to a mom who is dependent on Opoids? | Stadol |
| What are the chara. of Indetermine FHR Patterns(Category 2)? | Bradycardia not accompanied by absent baseline variability,Tachycardia,Minimal or absent baseline variability not accompanied by recurrent decels,marked baseline variability,no accelerations in response to fetal stimuli,periodic or episodic decels |
| What are the chara of Normal(Reassuring)FHR Patterns? | Baseline FHR 110-160BPM,Moderate baseline variability,Absent late or variable decels, Early decels may or may not be present |
| What are the chara of Abnormal(Nonreassuring)FHR Patterns? | Nonreassuring FHR pattern assoc w/ fetal hypoxemia, Hypoxemia can deteriorate to severe fetal hypoxia,Absent baseline variability,Recurrent or late decels,Bradycardia,Sinusoidal pattern |
| Chara of Accelerations | Can be periodic/episodic,A visually apparent abrupt inc. in FHR above BL,Must be at least 15 bpm or greater and last 15 sec or longer (“15 x 15 rule”),If accels lasts longer than 10 min,is considered to be BL change,Consider normal,Cont. routine monitor |
| Chara of Decelerations | May be benign/nonreassuring, Described by visual relations to the onset & end of a UC and by their shape,3 types: Early, Late, and Variable |
| What causes Early Decelerations? | Fetal Head Compression |
| Chara of Early Decelerations | Visually apparent gradual dec in FHR & return to BL;Usually begins before peak of UC & returns to BL as UC ends;May also occur w/ vag exams,fundal pressu,during FSE placement,& w/ mom pushing;benign. -no interve.;Not assoc. w/ fetal compromise,no interv. |
| What Causes Late Decelerations? | Uteroplacental Insufficiency |
| Chara of Late Decelerations | visually apparent dec. in & return to BL that begins after the UC starts,w/nadir occurring after the peak of UC.;“Lates” typically do not return to BL until after the UC is over;Indicates fetal hypoxemia d/t insufficient placental perfusion |
| What can cause Uteroplacental Insufficiency? | uterine hyperstimulation w/oxytocin;post term pregnancy-b/c placenta is old; chorioamnionitis-infection of the chorion;maternal diabetes;placenta previa/abruptio placenta;pregnancy-induced hypertension (PIH) |
| What Causes Variable Decelerations? | Umbilical Cord Compression |
| Chara of Variable Decelerations | abrupt dec FHR below BL.; Dec @ least 15 bpm,lasting 15 sec or longer,but no more than 2 min;Can occur w/ UC or w/o UC;have chara U or V shape,w/a rapid descent & ascent;IMP.when FHR repeatedly ↓s to <70bpm & persists for @ least 60 sec before return BL |
| What Causes Prolonged Decelerations? | Benign causes:pelvic exam,FSE application,rapid fetal descent, sustained Valsalva maneuver;Less benign(possibly ominous):Severe variable decels,maternal hypotension,tetanic UC(contstant contraction where uterus doesn’t relax),maternal hypoxia |
| Chara of Prolonged Decelerations | A visually apparent decrease in FHR 15 bpm or more below the BL, lasting longer than 2 minutes, but less than 10 minutes;Longer than 10 minutes is a BL change, indicating bradycardia;Typically benign,but may be ominous. |
Created by:
cristenlp
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