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Labor

OB Nursing

QuestionAnswer
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