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Interpartum
Childbearing
| Term | Definition |
|---|---|
| Tocotransducer (Toco) | External monitor for contractions, least invasive method; monitors frequency |
| IUPC; Intrauterine Pressure Catheter; | Most accurate for intensity of contractions |
| Contraction Analysis | Four characteristics: frequency, duration, intensity, and resting tone |
| Duration | How long contraction lasts (beginning to end of contraction) |
| Frequency | Range measured in minutes (ex:2-4) |
| Intensity | Strength of contraction; use IUPC |
| Resting tone | Return back to baseline before contraction; need for oxygen return to fetus |
| Contraction | Decreased blood flow; has to last at least 30s |
| Tachysystole | Could result if contracts too often, lack of resting tone; >5contractions/10minutes |
| If contractions too often | Slow down Pitocin, give some oxygen, give fluid bolus, breathing |
| Baseline Fetal Heart Rate | Average range between contractions; normal 110-160bpm |
| Tachycardia | FHR 160< for at least 10min (moderate 160-179 & severe 180<) |
| Tachycardia Causes | Elevated maternal temperature, dehydration, anxiety, breathing, fetal infection, hypoxic environment, prematurity |
| Bradycardia | <110 |
| Bradycardia Causes | Maternal position (supine), epidural, hypotension |
| Baseline Variability | Absent (undectectable) Minimal (0-5 bpm) Moderate 6-25 bpm Marked (25<); look at between contractions |
| Periodic changes | Occur with contractions (accelerations or decelerations) |
| Nonperiodic changes | Occur between contractions |
| Early Deceleration | Should begin and end with contraction (signifies head compressing into pelvis) but resolves by end of contraction - good |
| Variable Deceleration | Most common type; common during pushing, commonly U V or W shaped (cord compression) rapid drop rapid rise |
| Variable Deceleration | First intervention is change her position |
| Late Deceleration | Characteristic of uteroplacental insufficiency (drop begins after contraction peaks) |
| Late Decels Caused by | Low/high maternal BP, Hyperstimulation (too frequent contractions, decreased maternal oxygenation, placental abnormalities (Ex: post-term) |
| Intrauterine Resuscitation | Reposition/re-examine, readjust/remove oxytoxin/pitocin, rehydrate, re-oxygenate, report, record |
| Labor Triggers | Decreased progesterone, increased estrogen, prostaglandins, and oxytocin, fetus' thyroid hormones |
| Impending Signs of Labor | E surge, Braxton hicks, lightening (baby drops), cervical ripening, mucous discharge, bloody show, rupture of membranes, weight loss, GI changes (n&v, diarrhea) |
| Braxton Hick | Primarily in back, goes away with activity, dilation or effacement (thinning) |
| Membrane Assessment | Spontaneous Rupture of Membranes (SROM): Nitrizine test, ferning |
| AROM | Artificial Rupture of Membranes |
| Nitrizine test | Don't check cervix before test, blood or ky jelly can cause false+, amniotic fluid more alkaline so paper will turn blue if membrane ruptured |
| Ferning | Swab fluid from cervix, if amniotic fluid will look like a fern |
| True Labor | Back &Hip pain, increased intensity and duration, dilation, regular intervals (stronger, longer, and closer together over time) |
| When to go to the hospital | Regular contractions, bright red vaginal bleeding, SROM, Decreased fetal movement |
| 5 P's of Labor | Powers, Passage, Passenger |
| Powers Primary | Effacement & dilation, begins at fundus and follows contour of uterus, increased frequency, intensity, duration |
| Secondary Powers | Voluntary - mom pushing |
| Passage | Types of pelvis Gynecoid (most common, best,round) Platypeloid (least conducive, shaped like Playtypus bill), Android (heart shaped), Arthropoid (oval) |
| Passenger | Fetus, membranes, and placenta (fetal sutures and fontanels allow molding of head) fetal attitude (head down/relation of fetal parts to one another) fetal line (look at maternal/fetal spines - longitudinal(horizontal), transverse (vertical), oblique) |
| Best positions for delivery | Occipit anterior (head down) ROA Right Occipit interior LOP left occipit interior |
| Fetal Station | Relationship of fetal head to mother's pelvis (more + number = closer into birth canal baby is) 0= ischial spine +3 best -3 above ischial spine |
| Order of Cardinal Movements | Engagement, descent, flexion, internal rotation, extension, restitution/external rotation, expulsion |
| Engagement | Stays in pelvis (doesn't ascend with ballotment) |
| Descent | Descend into pelvis |
| Flexion | Tucks chin to chest |
| Internal rotation | Turn to align with mom's axis |
| Extension | Extends head out |
| Restitution | External rotation, turns to allow shoulders (position before internal rotation) |
| Expulsion | Removal |
| Stages of Labor | Stage 1 (0-10cm) Stage 2 10 cm - delivery Stage 3: delivery of baby to delivery of placenta Stage 4: first postpartum hour |
| Stage 1 | Phase 1: Latent (0-3) Phase 2: Active (4-7) Phase 3: Transition (8-10) |
| Latent Phase Length | Multigravida ~6h and primigravida ~9h |
| Latent Phase | Alert, excited, anxious; effacement and dilation beginning, regular contractions are beginning, increasing intensity and frequency, cervix dilates 0-3cm |
| Active Phase | Prim ~5h Multi ~2-3h; fear loss of control, increased anxiety, fetal descent into pelvis, dilates 4-7, intensity, frequency, duration, get epidural or IV narcotics, increase in bloody show |
| Transition Phase | 100% effaced, primi~2h multi~1-2h, increased anxiety,fear, irritability, increased bloody show, contratcitons about q2 and last 40-60s, increased rectal pressure, n&v, involuntary shaking, 8-10cm |
| Prep for birth | Cleanse perineum, position for birth, nurse washes hands, opens prep tray, sterile gloves, pushing with patient |
| Second Stage | Feels powerless&sense of purpose, completely dilated, feel like BM needed, perineum begins to bulge, flatten, and move anteriorly |
| Ferguson's Reflex | Urge to push |
| Third Stage | Lengthening of cord and small gush of blood means placenta is ready to separate, will start bolus of oxytocin |
| Fourth Stage | Euphoria and Bonding; increased P decreased BP, urine retention, massage fundus(should be firm), nonpalpable bladder, smooth&pink perineum w/o bruising or edema |
| Fourth Stage Comfort Measures | Tremors common (heated blanket, warm drink) provide food and encourage rest |
| APGAR Score | 1 minute (tells us about intrauterine life) 5minutes (tells us how baby is adapting to external uterine life) Monitor T, HR, R, skin color, tone Absent = 0 |
| A | Activity (muscle tone) 1- flexed arms and legs 2-active |
| P | Pulse 1- <100 2- 100 |
| G | Grimace (ex: irritability) 1- Minimal response to stimuli 2- prompt response to stimuli |
| A | Appearance (Skin color) 1- pink body blue extremities 2- pink |
| R | Respiration 1-slow&irregular 2- vigorous cry |
| Non Pharm Pain Relief | Comfort, gate control theory, imagery, breathing, position changes, hydrotherapy |
| Gate Control Theory | Effleurage, counter pressure on sacrum, thermal stimulation (warm/cool compress) decreases pain stimuli |
| Systemic Analgesia | Goal is to provide maximum pain relief with minimal risk |
| IV Opioids | Nalbuphine (Nubain), Meperidine (Demerol), Butorphanol tartrate (Stadol) |
| Advantages of IV opioids | RN administration, rapid onset, short duration |
| Disadvantages of IV opioids | Decrease ctx frequency and intensity, crosses placenta, possible poor pain control |
| IV Opioid Antagonist | Narcan |
| Lumbar Epidural Block | Local anesthetic into epidural space; post-procedure head of bed 25 degrees, lateral uterine tilt, monitor q5-15min, continue fluid bolus |
| Spinal Block | Immediate onset, risk for spinal headache (give lots of caffeine or blood patch) |
| General Anesthesia | Impaired unconsciousness, common indications (perceived lack of time, contraindications to regional, failure to successfully insert regional, patient refusal) |
| Induction | Post-term, medical necessity (ex: HELLP), PROM(Premature rupture of membranes), chorioamnionitis(Temp,WBCs, foul discharge), fetal jeopardy |
| Contraindications for Induction | Previa (low lying placenta), Abnormal presentation (breech or transverse), CPD (cephalopelvic disproportion - bad pelvis type), Scarred upper uterus (previous abortions or surgery), gestational age less than 39 weeks, unless medically indicated |
| Cytotec | Given orally or vaginally for induction by softening cervix in preparation for Pitocin introduction; synthetic prostaglandin, more effective than oxytocin, adverse outcomes in doses greater than 25mcg, prn q4h, don't give if contractions q3-4min |
| Cervidil | Looks like tampon, helps ripen cervix by slowly releasing medicine over 12h period, removed 30mins before pitocin |
| Balloon Catheters | Foley Cath (25-80ml balloon) ripens cervix by applying pressure |
| Bishop Scale | Used for induction; less than 5 unfavorable for induction |
| Stripping Membranes | Gloved hand, rotate 360 degrees twice; labor typically begins w/n 24-48h |
| Amniotomy | Artificial rupture of membranes (AROM) Disadvantages: infection risk/prolapsed cord |
| Oxytocin Infusion | Initiate uterine contractions (10-20u oxytocin & D5W) Risks (tachysystole of uterus/uterine rupture) |
| Pitocin given which stages | 1 and 2 and post-partum |
| 1st degree episitomy | perineal skin and mucous membranes |
| 2nd degree episiotomy | also muscles of perineal body |
| 3rd degree episiotomy | Also involves anal sphincter |
| 4th degree episiotomy | Into rectum |
| Emergent indicaitons | Abruption, umbilical cord prolapse, amniotic fluid embolus, non-reassuring fhr, uterine rupture |
| HnH, CBC, Platelet Count (100,000) | Pre-op C section |
| Prophylatic/Cathetier | Given Pre-op |
| TIME OUT | Patient, procedure, time of antibiotics, fire risk, sedation scale, everyone present, allergies, everyone confirms they agree |
| Morphine Side Effects post c-section | Pruritus (Bendaryl and Narcan), n&v, urinary retention,, respiratory depression |
| External cephalic version ECV) | Fetus changed from breech, transverse, oblique; 36-37w |
| ECV Contraindications | Intrauterine growth restriction, FHR abnormal, rupture of membranes, C-section indicated, amniotic fluid abnormalities |
| ECV | Trendlenberg, physician turns baby, nurse uses ultrasound, routine toco |
| Vaginal Birth after Cesarean (VBAC) | Low transverse incision, adqueate pelvis, no other uterine scards, in house staff |
| Operative Deliveries | Forcep delivery (outlet - perineum, low 2+ or below) vacuum (at outlet) |
| Contraindications for operative deliveries | Gestation <34, cephalopelvic disproportion, macrosomic, |
| Precipitous Labor | Labor that lasts less than 3h from onset of labor to birth (hypertonic UC, rapid dilation) |
| Inadequate Expulsive Forces | 2nd stage of labor when woman is not able to push or bear down (due to exhaustion, epidural) |
| Hypertonic Uterine Dysfunction | Frequent contractions with decreased intensity and increased uterine tone (won't dilate or efface) prolongs labor |
| Hyotonic Uterine Dysfunction | Infrequent contractions with decreased intensity (no dilation or effacement - prolonged labor) might give AROM and pitocin |
| Fetal Dystocia | May be caused by excessive fetal size, malpresentation, multifetal pregnancy, fetal anomialies |
| Fetal Dystocia Complications | Asphyxia, maternal lacerations, fetal injury, CPD |
| Fetal Dystocia Risk factors | abnormal presentation, hydrocephalus, macrosomic over 4500g |
| Shoulder dystocia | Difficulty encountered during delivery of shoulders after birth of head that may occur with macrosomia, prolonged 2nd stage |
| Prolapse of Umbilical Cord | When cord lies below the presenting part of the fetus |
| Rupture of uterus | when there is partial or complete tear in the uterine muscle (scar, tachysystole, eversion are causes) tearing sensation, late decels, loss of FHR |
| Disseminated Intravascular coagulation (DIC) | Syndrome that occurs when the body is breaking down blood clots faster that it can forma a clot; quickly leads to hemorrhage (petechia,blood oozing, blood in urine) causes: fetal demis, uterine rupture, embolism, abruption |
| Anaphylactic Syndrome (Amniotic fluid embolism) | Embolism forms when the amniotic fluid that contains fetal cells, lanugo, and vernix enters the maternal vascular system and results in cardio-respiratory collapse |
Created by:
TedMed
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