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Intrapartum
BC3 - Maternity
| Question | Answer |
|---|---|
| The 5 P's of successful labor | Passageway, Passenger, Powers, Psyche, Position |
| Passageway refers to | the maternal pelvis |
| The pelvic inlet | the pelvis brim is bordered by the linea terminalis |
| transverse diameter | the largest diameter of the pelvic inlet, its adequacy is determined by the diagonal conjugate |
| diagonal conjugate | distance between the sacral promontory and the lower margin of symphysis pubis |
| Pelvic Outlet | measurement that really counts |
| Pelvic types | Gynecoid, Android, Arthropoid, Platypelloid |
| Gynecoid | Round, female pelvic type; Classic - what you want to have - only 50% have it; outlet wide |
| Android | male - not adequate for childbirth |
| Anthropoid | narrow side to side, long front to back; usually ok for childbirth w/ assist (vacuum or forceps) |
| Platypelloid | Flattened, not adequate; precipatace deliver (fast <3 hrs); Risk for hemorrhage for mom; O2 deprivation for baby |
| Fetal Attitude | *Important role in delivery process; relationship of fetal parts to one another; the problems come with deviation from the normal fetal attitude of flexion |
| Normal fetal attitude | Flexion - back of fetus flexed; chin flexed on chest; thighs flexed up; arms & legs crossed |
| Fetal Lie | The relationship of the long axis of the fetus to that of the mother (want baby to be longitudinal) |
| Fetal Presentation | The portion of the baby's body that lies nearest the external os of the cervix (the presenting part what the examiner is feeling - hopefully its the head 96%) |
| If fetal presentation is the bottom | Breech birth |
| If shoulder or breech presentation | C-Section |
| effacement | thinning of the cervix; described in %; 10% not much; 80-90% is good |
| 4 / 80 / -1 | 4=dilation; 80=effacement; -1 above ischial spine |
| Hardest part to deliver | the fetal skull |
| Sinciput | brow |
| Vertix | **should present - the area between the anterior and posterior fontanelle |
| Occiput | area of fetal skull occupied by the occipital bone, beneath the posterior fontanelle |
| Mentum | fetal chin |
| Presentation can be (3) | cephalic, breech, shoulder |
| Cephalic Presentation | head first (further classified by fetal attitude) |
| Vertex (cephalic presentation) | *most common - head completely flexed on chest, the smallest diameter of head presents |
| Military (cephalic presentation) | top of the head presents |
| Brow (cephalic presentation) | head partly extended - sinciput is presenting part |
| Face (cephalic presentation) | may have risk for CP d/t nerve damage |
| Breech presentation | Bottom first |
| Complete (breech presentation) | thighs & knees completely flexed |
| Frank (breech presentation) | thighs are flexed on hips (feet in air by head) |
| Footling (single & double) | foot is dangling |
| Engagement | occurs when the largest diameter of presenting part (hopefully the head) reaches or passes through the pelvic inlet (confirms adequacy of inlet - not outlet) |
| Station | refers to the relationship of the presenting part to the imaginary line between the ischial spines (narrowest part the fetus must pass through) |
| 0 Station = | ischial spines |
| Negative station | above the ischial spines (0 to -5) |
| Positive station | below the ischial spines (0 to +5) |
| Fetal position | the exact relationship of the presenting part to the maternal pelvis |
| Primary Powers | The uterine contractions |
| Secondary Powers | Maternal abdominal muscles used during the pushing stage |
| Acme | The peak of the contraction |
| Decrement | The letting up of the contraction |
| Duration | The time from the beginning to the end of a contraction |
| Frequency | From the beginning to the beginning of another |
| Increment | The building up of the contraction |
| Intensity | The strength of the contraction |
| Mechanisms of Labor & Birth (Cardinal Movements) | Engagement, Descent, Flexion, Internal Rotation, Extension, External Rotation, Expulsion |
| Why monitor I & O | if mom has an epidural - offer bedpan - may have to straight cath |
| Monitor VS | after epidural - BP for 5-10 minutes; after delivery every 15 minutes |
| Observe ROM for | color, odor, amount and consistency of amniotic fluid |
| After ROM check FHR often for evidence of | prolapsed cord |
| Observe for hypotensive syndrome | If BP falls, position mom on left side, increase IV fluids, Oxygen at a few Liters |
| Supine hypotension | late decelerations |
| Fetal assessment during L & D include | Inspection (fetal lie); Palpation (Leopolds Maneuvers); Auscultation of FHR (monitor) |
| Leopolds Maneuvers | 4 external abdominal palpations |
| Position for Leopolds Maneuvers | Lay on back with shoulders slightly raised on a pillow and knees drawn up a little |
| Sources of pain during labor | dilation/stretching of cervix; emotional tension; hypoxia of uterine muscle cells during contraction; stretching of lower uterine segment; pressure of presenting part on organs/structures; distension of vagina & perineum |
| Factors affecting pain perception | Cultural background, self concept, fatigue, attention and distractions |
| Non-Pharmacologic Measures | Effleurage; Distraction; Controlled breathing; Relaxation techniques |
| Effleurage | Light abdominal stroking in a circular motion - downward |
| Distractions include | reading, TV, cards |
| Analgesia | absence of sensibility to pain, relife of pain, without loss of consciousness |
| Demerol | Alleviates pain during 1st stage of labor; acts in 5-10 min of IV admin; lasts up to 3 hours |
| Maternal S/E of Demerol | respiratory depression, N/V, hypotension, drowsiness |
| Fetal S/E of Demerol | respiratory if given within 2 hours of delivery |
| Stadol and Fentanyl | "takes the edge off"- fairly decent - doesn't eliminate pain - can be given anytime during |
| Anesthesia | Loss of feeling or sensation |
| Lumbar epidural | injection of medication into epidural space in the lumbar regions at levels L2 - L5 |
| When is lumbar epidural done | usually after a cervical dilation of 4-5 cm to prevent slowing down of labor |
| Lumbar epidural provides analgesia for what stages of labor without direct adver effects on fetus | 1st and 2nd stages |
| If lumbar epidural is done too late | won't feel the need to push |
| Disadvantages of lumbar epidural | maternal hypotension (monitor BP q 15 min until stable); decreased urge to push; risk of increased need for forceps; risk of dural puncture |
| Spinal | injection of medication into the CSF in the spinal cord - needle penetrates meninges - more chance of s/e |
| S/E of spinal anesthesia | postspinal headache; urinary retention, increased maternal hypotension |
| When can a spinal affect the newborn | if too much time elapses between anesthetic agent and birth |
| Pudendal Block | injection into the pundendal nerves (femoral area) - relief to perineum for episiotomy |
| Local Infiltration | anesthesia is injected into the nerves of teh perineum - main use is for pain caused by the stretching perineum |
| How long could it take to establish a baseline FHR | 5-10 minutes |
| Baseline FHR | the average rate when the woman is not in labor or is between contractions |
| Baseline FHR (#bpm) | between 110-160 bpm (120-160 is normal) |
| Tachycardia (FHR) | above 150 bpm |
| Possible causes of FHR tachycardia | infection, anxiety from mom, medications |
| Bradycardia (FHR) | below 110 bpm |
| Possible causes of FHR bradycardia | heart/cardiac block - not enough O2 |
| Variability | the normal irregularity of the cardiac rhythm - internal fetal monitoring measures this best |
| Accelerations | occur in breech presentations |
| Accelerations | are the basis for the nonstress test and occur with fetal movements, indication fetal well being (want to see irregularities) |
| Accelerations | should be seen with every contraction (GOOD) |
| Decelerations | may be benign or ominous - down but comes back up |
| Early deceleration | occur in response to compression of the fetal head (head compression) - OK to have during labor |
| Late deceleration | caused by uteroplacental insufficiency. Deceleration begins after the contraction is well established and persists after contraction ends |
| Late deceleration | Not getting enough O2 - possibly b/c of mom's position, so reposition on Left side, Inc fluids, elevate HOB - if continues > C-section |
| Late deceleration could be a sign of | fetal distress |
| Variables | are caused by compression of the umbilical cord - Do not mirror uterine contraction - No pattern > reposition |
| Reassuring FHR patterns | Baseline FHR in normal range of 110-160 with average variability; accelerations; early decelerations; mild variables |
| Non-Reassuring FHR patterns | Progressive inc or dec in baseline FHR; Tachycardia above 160; progressive dec in baseline variability; severe variable decels; repetitive late decels; total absence of variability; prolonged decels of any kind; severe bradycardia |
Created by:
okrecota
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