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M/B Exam 2
Mom/Baby Exam 2
| Question | Answer |
|---|---|
| What is labor? | the work of delivering the fetus and placenta |
| What are the 4 potential causes of labor? | -uterine distention -increased estrogen and decreased progesterone -increased oxytocin receptors -release of prostaglandins |
| What is lightening? | when the baby drops down towards the birth canal |
| What causes bloody show? | capillaries of the cervix rupture as it stretches |
| cervical ripening | softening of the service so it can stretch out |
| effacement | thinning, shortening, and drawing up of the cervix |
| What is effacement measured in? | percentage |
| Location of true labor pains | start in the back and wrap around to the front |
| When should a mom go to the hospital? | when contractions are five minutes apart |
| What are the five Ps of labor? | passageway, passenger, powers, position, psyche |
| What is the most conducive pelvic shape? | gynecoid |
| What plane of the baby should be straight across? | suboccipitobregmatic plane |
| fetal lie | relationship of fetal to maternal spine |
| fetal attitude | relationship of fetal parts to each other (flexion or extension) |
| fetal presentation | what part of the fetus enters the pelvic inlet first |
| fetal position | fetal position in relation to maternal position |
| Most ideal fetal position | LOA |
| fetal station | relationship of presenting part to the ischial spine |
| how is fetal station measured | in cm (positive is below ischial spine and negative is above) |
| primary power of labor | contractions |
| secondary power of labor | mom pushing |
| gate-control theory | brain can only accept one thing at a time |
| When can sedation and analgesia be used in labor? | only in early labor |
| Should analgesia be given with or between contractions? | With contractions (helps not as much med get to the fetus) |
| What does analgesia do to the fetal hear rate? | decreases variability |
| Risk of analgesia and sedation in labor? | Can cause respiratory depression in the baby after birth |
| pudendal block | -given transvaginally during late 2nd stage -stops nerve impulses in the pelvic area |
| spinal block | -given to subarachnoid space -used in non-emergent cesarean section |
| epidural | -given in epidural space during labor |
| How does anesthesia impact the mother? | can cause hypotension |
| What occurs during stage 1 of labor? | start of contractions to full dilation and effacement |
| What is latent stage 1? | 0-5 cm, occurs slowly |
| What is active stage 1? | 6-10cm, usually dilates 1cm/hr |
| What occurs during stage 2 of labor? | dilation to birth, mom is pushing |
| What occurs during stage 3 of labor? | baby born to delivery of the placenta |
| What occurs during stage 4 of labor? | delivery of the placenta until maternal stabilization, usually 1-2 hours |
| What to expect from mom during latent stage | -talkative and excited with pain controlled -irregular, shorter contractions -slow, deep breathing |
| What to expect from mom during active stage | -serious, inward focused, cannot follow directions -longer, more frequent contractions -bleeding, N/V, shaking -pant, pant, blow breathing -DO NOT PUSH |
| What to expect from mom during stage 2 | -grunting, involuntary pushing, focused -frequent contractions (push with them) -distention of the perineum and crowning |
| What to expect from mom during stage 3 | -elation, relief, exhaustion -fundus becomes firm -gush of dark red blood |
| What to expect from mom during stage 4 | -excited, exhausted -eat a snack and walk |
| Where should the fetal monitor be placed? | between fetal shoulder blades |
| Leopold maneuver | feel for baby head and body to determine position |
| intermittent auscultation | -monitor baby intermittently -allows mom to move around |
| continuous electronic fetal monitor | -checks FHR and contractions -mom has to stay close to bed |
| What is required for an internal monitor to be used? | water broken, mom dilated |
| fetal scalp electrode | screws into baby's scalp to monitor FHR |
| intrauterine pressure catheter | monitors contractions in uterus |
| normal fetal heart rate | 110-160 |
| How long does bradycardia or tachycardia have to occur to count? | 10 minutes |
| causes of bradycardia | uteroplacental insufficiency, anesthetic, maternal hypotension, fetal heart failure |
| causes of tachycardia | maternal fever, maternal infection, chorioamnioitis, maternal dehydration, cocaine |
| minimal variability | less than 5 bpm |
| moderate variability | 6-25 bpm |
| marked variability | 26+ bpm |
| What kind of variability is desired? | moderate |
| How to measure contraction frequency? | start of one contraction to the start of the next one |
| What is required for strength of contractions to be measured? | intrauterine monitor |
| normal uterine activity | 5 or less contractions in 10 minutes |
| resting tone | how soft uterus is in between contractions |
| How to measure contractions | -in Montevideo unites -add up over 10 minutes (want over 200) |
| uterine hyperstimulation (tachysystole) | -more than 5 contractions in 10 minutes OR -contractions lasting more than 2 minutes OR -contractions less than 1 minute apart |
| accelerations | increase in fetal heart rate by 15bpm for 15 seconds |
| early decelerations | shallow FHR decrease with contractions |
| What do early decelerations indicate? | fetal head compression |
| late decelerations | FHR decreases with nadir after contractions |
| What do late decelerations indicate? | placental insufficiency |
| variable decelerations | abrupt FHR decrease |
| What do variable decelerations indicate? | cord compression |
| prolonged deceleration | FHR decrease between 2 and 10 minutes |
| sinusoidal pattern | wave-like pattern of the FHR |
| What does a sinusoidal pattern indicate? | severe asphyxia or hypoxia |
| Category I strip | -FHR baseline 110-160 -moderate variability -can have accelerations or early decelerations -no variable or late decelerations |
| Category III strip | -sinusoidal pattern OR -absent variability AND late decels, variable decels, or bradycardia |
| What occurs to temperature during labor? | increases, want to keep under 100.4 |
| What occurs to pulse during labor? | increases 10-20 bpm |
| What occurs to respirations during labor? | increases up to 24 |
| What occurs to blood pressure during labor? | increases 35 mmgHg during contractions |
| What do we determine with vaginal exams? | dilation, effacement, station, presenting part |
| When doe we do vaginal exams? | upon admission, before pain medications, maternal behavior change, urge to bear down, FHR change |
| When to not do vaginal exams? | active vaginal bleeding (risk of placenta previa) |
| What do edema, deep tendon reflexes, and clonus help screen for? | preeclampsia |
| nitrazine test | turns blue if amniotic fluid is present |
| ferning test | amniotic fluid looks like fern leaves under the microscope |
| pooling test | use speculum to look for pooling of fluid in the vagina |
| characteristics of normal amniotic fluid | clear with no odor |
| chorioamnionitis | infection inside the amniotic sac |
| S/S of chorioamnionitis | maternal fever, fetal tachycardia, discharge, tender uterus |
| When can a mom choose to induce labor? | after 39 weeks |
| Bishop Score | helps to determine if induction will be successful |
| What bishop score is needed for cervix to be ready for labor? | 8+ |
| What is used in cervical ripening? | prostaglandins |
| How is PGE1 (Cytotec) given? | vaginal pill |
| How is PGE2 (Cervidil) given? | tampon-like into the vagina |
| How long to wait between uterine ripening and starting Pitocin? | 4 hours |
| amniotomy | provider manually ruptures membranes |
| How is Pitocin titrated? | until contractions are 2-3 minutes apart |
| external cephalic version | turn baby externally to be in a cephalic position |
| What are the criteria for a VBAC? | -no previous uterine scars or ruptures -one or two previous c-sections -adequate pelvis -provider available for emergency c-section |
| hypotonic uterine dysfunction | contractions not strong enough |
| hypertonic uterine dysfunction | frequent but ineffective contractions |
| precipitous labor | labor lasts under 3 hours |
| cord prolaps | cord comes out of the vagina |
| What is the risk with meconium-stained amniotic fluid? | fetal aspiration |
| shoulder dystocia | baby gets stuck with shoulder on pelvis |
| turtle sign | fetal head extends and then retracts |
| McRobert's Maneuver | mom flexes legs, nurse applies suprapubic pressure |
Created by:
mbaldwin13