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Labor
OB Nursing
| Question | Answer |
|---|---|
| What is parturition? | Labor |
| What is labor? | The process by which the fetus and products of conception are expelled as the result of regular, progressive, frequent, and strong uterine contractions. |
| What drug is associated with oxytocin stimulation? | Pitocin |
| Where are prostaglandins produced? | In the myometrium, cervix, fetal membranes, and placenta |
| True or False: NSAIDs work against prostaglandins. | True |
| How is cervical efface measured? | 0-100% |
| How is cervical dilation measured? | 0-10 cm |
| What does stimulation of the breast cause? | Release of oxytocin |
| How does increased cortisol levels near term affect the uterus? | It decreases the production of progesterone, thus relaxing the myometrium |
| What are the mechanisms of labor? | Passageway (birth canal), passenger (fetus and placenta), powers (uterine contractions), position of mother, psychological response of the mother |
| What is the purpose of relaxin and estrogen in pregnancy? | To soften cartilage and increase the strength and elasticity of the pelvic organs |
| What is the false pelvis? | The shallow upper section of the pelvis |
| What is the true pelvis? | The lower curved bony canal including the inlet, cavity, and outlet |
| What is station? | The relationship between the ischial spines in the passage and the presenting part of the fetus |
| What station are the ischial spines? | Station 0 |
| What are the 4 types of pelvises? | Gynecoid, platypelloid, android, and anthropoid |
| What is the most common pelvis type? | Gynecoid |
| What types of pelvis allow normal vaginal delivery? | Those with wide suprapubic arches (gynecoid and platypelloid) |
| What types of pelvis increase the risk for forceps and C-sections? | Those with narrow suprapubic arches (android and anthropoid) |
| When does the anterior fontanel close? | Around 12 months of age |
| When does the posterior fontanel close? | By 8 weeks of age |
| What can sunken fontanels indicate? | Dehydration |
| What can bulging fontanels indicate? | Increased cerebrospinal fluid or intracranial pressure |
| What is the overlapping of the fetal skull that helps the head adapt to the size and shape of the maternal pelvis? | Molding |
| How long can it take the effects of molding to resolve with the newborn? | Up to 3 days |
| What does fetal presentation refer to? | The anatomic part of the fetus that is either in or closest to the birth canal |
| How is fetal presentation determined? | Vaginal exam |
| What is the most common fetal presentation? | Cephalic |
| What is often associated with a shoulder presentation? | Macrosomia |
| How is fetal position described? | Side of pelvis (left, right, transverse); presenting part (occiput, sacrum, scapula, mentum); part of maternal pelvis (anterior, posterior) |
| What is the fetal lie? | The relationship of the fetal long axis (head to foot) |
| What is a fetal lie in a breech or cephalic presentation? | Longitudinal |
| What is the fetal lie in a shoulder presentation? | Transverse |
| Is the oblique lie usually temporary? | Yes |
| What is the fetal attitude? | The relationship of the fetal body parts to one another |
| What is the largest transverse diameter of the fetal head? | The biparietal diameter (at term it's about 9.25 cm) |
| What is the purpose of the first Leopold's maneuver? | To determine which fetal pole is present in the fundal area |
| What is the purpose of the second Leopold's maneuver? | To locate the fetus's back |
| What is the purpose of the third Leopold's maneuver? | To determine fetal presentation |
| What is the purpose of the fourth Leopold's maneuver? | To assess fetal attitude |
| Describe uterine contractions. | They're involuntary and generally independent of extrauterine control |
| What is the physiological reaction ring? | The process by which the uterus divides itself into 2 portions during labor |
| Which uterine segment becomes thicker as labor progresses? | Upper |
| What is responsible for the effacement and dilation of the cervix? | Uterine contractions |
| How are uterine contractions measured? | By their frequency, from the beginning of one to the beginning of the next contraction |
| What is effacement? | The shortening and thinning of the cervix |
| Describe the cervix before labor. | 2-3 cm long and 1 inch thick |
| True or False: When the cervix is fully dilated and retracted into the lower uterine segment, it is still palpable. | False; it is not palpable |
| What is the best position for labor? | A lateral recumbent position |
| What is the first task in maternal role attainment? | The mother seeks a safe passage for herself and her child during pregnancy |
| Which women see motherhood as their purpose in life? | Canadian Jewish and American Mormon women |
| What is lightening? | The descent of the fetus and uterus into the pelvic cavity 2-3 weeks before the onset of labor |
| What is a bloody show? | Expulsion of the mucous plug |
| True or False: Braxton-Hicks contractions produce cervical changes. | False |
| True or False: In primigravida, the effacement of the cervix usually begins before dilation. | True |
| How does effacement and dilation progress in multigravida? | Generally together |
| How long before the onset of labor begins is the bloody show expelled? | 24-48 hours |
| What is nesting? | The boost of energy occurring 24-48 hours before the onset of labor |
| Which stage of labor is the longest? | First stage |
| What are the 3 phases of the first stage of labor? | Latent, active, and transition |
| When does the first stage of labor end? | When the cervix is completely dilated |
| Describe contractions during the latent phase. | 15-20 minutes apart, lasting 20-30 seconds |
| When does the latent phase of labor end? | When the cervix is dilated 3-4 cm |
| When does the active phase of labor end? | When the cervix is 8 cm dilated |
| During which phase of labor is pain relief often requested? | Active phase (during the first stage) |
| Describe contractions in the active phase. | Occur every 2-3 minutes and last up to 60 seconds |
| What is the shortest phase in stage 1 of labor? | Transition |
| Describe contractions during the transition phase. | Occur every 1.5-2 minutes and last 60-90 seconds |
| When does the second stage of labor end? | When the fetus is expelled |
| What is the most common method of anesthesia during labor? | Epidural |
| What is crowning? | The point at which the fetal head is visible at the vulvar opening |
| What is the most common maternal position during crowning? | Lithotomy (Supine with legs separated, flexed, and in raised stirrups) |
| What are the 7 cardinal movements of labor? | Descent, flexion, internal rotation, extension, restitution, external rotation, and expulsion "Don't forget I enjoy expensive equipment." |
| How is descent measured? | By stations |
| What is flexion? | The fetal head is flexed with the chin against its chest due to the head meeting resistance from the pelvic floor |
| What is internal rotation? | Rotation of the fetal head from occiput transverse to occiput anterior |
| What is extension? | Passing of the fetal head under the symphysis pubis |
| What is restitution? | After the birth of the head, it turns to realign with the shoulders |
| What is external rotation? | Rotation of the shoulders so they're in an anteroposterior position |
| What is expulsion? | Birth of the entire body |
| What is the mechanism of placental separation? | A combination of uterine contractions and involution |
| What is involution? | The uterine fundus coming down into the pelvis |
| How often does the uterus contract after delivery of the fetus? | Every 3-4 minutes |
| How long does it take to deliver the placenta after the fetus is expelled? | 10-15 minutes |
| What are signs of placental separation? | Lengthening of the umbilical cord, sudden gush of blood, increase in level of uterine fundus, and change in shape of the uterus |
| What is the fourth stage of labor? | The first hour after delivery |
| What are signs of postpartum hemorrhage? | Placental retention and bladder distension |
| True or False: A woman who has a C-section will not have a Foley catheter. | False |
| What is the most common reason for labor induction? | Post-term gestation (42+ weeks) |
| What is Bishop's score? | A prediction of cervical readiness for induction; highest score is 13 |
| What Bishop's score indicates a successful induction? | 6 or more |
| What is the usual dose of misopostol (Cytotec)? | 25-50 mg |
| What is the safest anesthesia for labor? | Local infiltration |
| What is the use of sodium citrate (Bicitra) during labor? | It's given prior to C-section to reduce the risk of aspiration |
| What should Pitocin be diluted with if given IV? | An isotonic solution (e.g., Lactated ringers) |
| Should Pitocin be the primary or secondary IV? | Always the secondary |
| What is a risk of Pitocin? | Uterine rupture and water intoxication |
| How long after stripping of the membranes does labor begin? | Usually 1-2 days |
| What is an amniotomy? | Artificial rupture of membranes done for urgent induction |
| Does the cervix have to be dilated to perform an amniotomy? | Yes |
| What is the first nursing action after spontaneous rupture of membranes (SROM)? | Check FHR |
| What is the first indication of SROM? | A variable FHR deceleration |
| What is uterine atony? | When the uterus isn't contracting |
| When should traction be applied to forceps? | Only during contractions |
| When should rotations be performed with forceps? | Only between contractions |
| Why are vacuum extractors preferred over forceps? | There is less trauma |
| How does advanced pregnancy affect the PMI? | It's slightly more to the left |
| What acid-base imbalance occurs during the first stage of labor? | Respiratory alkalosis |
| What acid-base imbalance occurs during the second stage of labor? | Respiratory acidosis |
| How much blood does the mother lose during a vaginal birth? | 500 mL |
| How much blood does the mother lose during a C-section? | 1,000 mL |
| When is blood pressure measured during labor? | Every hour between contractions |
| What should you expect if the membranes are ruptured more than 12 hours? | Chorioamnioitis |
| What are the cardinal signs of pregnancy-induced hypertension? | Edema, hypertension, and albuminuria |
| What you expect if DTRs are 3+ or greater? | Possibility of clonus, which is associated with preeclampsia |
| Should you perform a pelvic exam in the presence of frank bleeding? | No |
| Does a woman need a Foley catheter if she's had an epidural? | Yes |
| What drug is associated with preterm labor? | Yutopar |
| What are visible signs of descent? | Crowning and bulging of the perineum |
| How many times should a woman be encouraged to push per contraction? | At least 4 times |
| What is dystocia? | Difficult labor |
| What can cause hypertonic uterine dysfunction? | The Pitocin drip being too high |
| True or False: Psychological stress in the woman can contribute to dystocia. | True |
| What drugs are used for preterm labor? | Tocolytic drugs |
| What are some examples of tocolytic drugs? | Magnesium sulfate and nifedipine (Procardia) |
| What drug classification is nifedipine (Procardia)? | Calcium channel blocker |
| What drugs are given in conjunction with tocolytic drugs for a woman in preterm labor? | Steroids for fetal lung maturity and prophylactic antibiotics |
| What are fetal risks of post-term labor? | Shoulder dystocia, brachial plexus injuries, low Apgar score, and cephalopelvic disproportion |
| How often should a woman post-term have a non stress test? | 2 times weekly |
| How is intrauterine fetal demise confirmed? | Ultrasound |
| What is umbilical cord prolapse? | Partial or total occlusion of the cord with rapid fetal deterioration |
| What maternal position is necessary for umbilical cord prolapse? | Knee-chest position |
| What marks the onset of uterine rupture? | Sudden fetal bradycardia |
| What are the S/S of amniotic fluid embolism? | Sudden onset of hypotension, hypoxia, and coagulopathy; respiratory distress |
| What is augmentation? | Enhancing ineffective contractions after labor has begun (e.g., Pitocin) |
| What is labor induction? | Stimulating contractions via medical or surgical means |
| When is amnioinfusion indicated? | Severe variable decelerations due to cord compression; oligohydraminos; post maturity; preterm labor with PROM: thick meconium fluid |
| True or False: To have an amnioinfusion, an intrauterine catheter must be in place. | True |
| What is necessary for VBAC? | A low transverse C-section incision |
| What can happen if analgesia is given too early in labor? | It can prolong labor and depress the fetus |
| What can happen if analgesia is given too late in labor? | It can cause neonatal respiratory depression with no maternal benefit |
| What is local infiltration anesthesia during labor? | An anesthetic agent is injected into the perineal tissue during the 2nd stage of labor |
| When should general anesthesia be administered, if indicated? | Just before the birth to limit fetal exposure |
| What is a major maternal risk of general anesthesia? | Aspiration |
| What dose of Bicitra should be administered before a C-section? | 30 mL |
| When is an epidural administered? | Between contractions in lumbar region L2-L5 |
| What is the "gold standard" for labor pain management? | An epidural |
| What is butorphanol's (Stadol) use in labor? | 100 mL/h is given if mother itches due to epidural |
| What is a major side effect of Stadol? | Late decelerations |
| Where is a pudenal block administered? | Through the vagina in the area of the pudenal nerve |
| When is a pudenal block indicated? | Spontaneous vaginal delivery and vacuum extraction |
| What is a fetal risk for a paracervical block? | Bradycardia |
| What is precipitate labor? | Rapid labor less than 3 hours resulting in unattended birth |
| Which type of FHR monitor includes an ultrasound transducer placed over the fetal back? | External monitoring |
| What is necessary for internal monitoring? | The cervix dilated to at least 2 cm with rupture of membranes |
| What is the normal FHR range? | 120-160 bpm |
| What is short term variability? | A change in rate between one fetal heart beat and the next |
| How does a short term variability appear on a monitor? | As a zig-zag |
| How is short term variability classified? | As either present or absent |
| What is long term variability ? | The rhythmic fluctuations (called cycles) |
| What are causes of decrease variability? | Hypoxia, acidosis, drugs such as valium, gestation less than 32 weeks |
| What are causes of increase variability? | Early mild hypoxia, fetal stimulation, and acoustic stimulation |
| What is an ominous sign? | A decreasing variability that does not appear |
| What are accelerations? | Transient increases in FHR normally caused by fetal movements |
| True or False: Accelerations are a sign of fetal well-being. | True |
| What are decelerations? | Periodic decreases in FHR from the normal baseline |
| What are early decelerations? | Decrease in FHR beginning at the onset of a contraction and return to baseline by the end of it |
| What should you do if early decelerations occur? | Perform a vaginal exam to determine if the fetus is descending; call HCP if not |
| What are late decelerations? | A decrease in FHR beginning after the onset of a contraction; not an assuring pattern |
| What is the cause of late decelerations? | Uteroplacental insufficiency |
| What does nursing care focus on with late decelerations? | Position woman in left-lateral, administer oxygen by mask at 7-10 L/min, discontinue Pitocin |
| What causes variable decelerations? | Umbilical cord prolapse |
| What is a sinusoidal pattern associated with? | Rh isoimmunization, fetal anemia, and chronic fetal bleed |
| When is a scalp stimulation indicated? | When FHR variability is decreased or to assess acid-base balance |
| Is acoustic stimulation used with internal monitoring? | No |
| What is acoustic stimulation used with? | A nonstress test |
Created by:
shrewsburysd
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