Intrapartum Word Scramble
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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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