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What are these abbreviations:
- G = Gravida or # of pregnancy; P = Parity or # of deliveries
- IUP = intrauterine pregnancy
- BOW = bag of waters
- FM = fetal movement
What are the 4 P's for dysfunctional labor?
This P of dysfunctional labor refers to ineffective contractions or ineffective maternal pushing
(this multiple choice question has been scrambled)
Is Hypertonic dysfunction a latent phase of dysfunctional labor or an active phase?
Is this hypertonic or hypotonic dysfunction:
- UC's uncoordinated and erratic, painful but ineffective
- Loss of downward pressure
- Increased uterine resting tone
T or F: Hypertonic dysfunction is when UC's are coordinated but too weak for labor
List nursing management of Hypertonic contractions
- Promote rest
- ID contributing factors: CPD, fetal malpresentation
- Tocolytics to decrease uterine irritability
List nursing management of HYPOtonic contractions
- Change positions, ambulate
- Pain management
- Amniotomy (amniotic sac is deliberately ruptured)
- Augment labor (Pitocin)
- Consider C-sec
This is characterized by labor that can last as little as 3 hours and is typically less than 5 hours. How do you manage it?
- Precipitous Labor:
- Monitor closely for fetal distress
- DC pitocin
- Optimize uteroplacental profusion by positioning on left side
- Guard perineum and prevent rapid decent
This term refers to when a baby's head or body is too large to fit through a mother's pelvis
Cephalopelvic Disproportion (CPD)
How can these hormones complicate delivery: Catecholamines, cortisol, Epinephrine, Beta-endorphrine?
Release of these stress hormones interfere with uterine contractility and lower placental perfusion.
For normal labor, dilation should be __a__ cm/hr for nullip and __b__ cm/hr in multip
For normal labor, normal descent is _a__ cm/hr for nullip and __b__ cm/hr in multip
This med can inserted directly into the vagina or cervix to induce Labor, where the action is to produce cervical changes
What are implications of induced labor from prostaglandin?
- Might cause abnormal or execssive contractions which diminish baby's O2 and HR
- Increased risk that uterine muscles won't properly contract after birth, causing serious bleeding
What is Terbutaline used for during complicated deliveries?
For induced labor complications that ause achysystole of the uterus resulting in fetal bradycardia and possible hypoxia
Is this augmentation or induction:
This intervention is intended to increase the intensity of labor, usually when labor is not progressing or progressing too slowly
What are indications of Augmentation? What is its intended goal?
If contractions have become weak, not coordinated (or irregular), far apart, not lasting long enough or have ceased.
It is aimed at strengthening, coordinating and/or increasing frequency of contractions until cervix is fully dilated and baby is born
Is this augmentation or induction:
When labor does not naturally start on its and and delivery needs to happen soon.
What are some indications for induced labor?
- Pregnancy has gone 1-2 weeks past due date
- A condition that may threaten your or your baby's health if pregnancy continues
- Amniotic sac has broken but no active labor contractions starte
- Baby has a condition that needs treatment
State if augmentation or induction
1. Stimulates uterine contractions before the onset of spontaneous labor
2. Enhances ineffective contractions after labor has begun
- 1. Induction
- 2. Augmentation
What is a sufficient Bishop score for fetal readiness?
7 or higher
Amniotomy (AROM) is indicated if dilation is only __a__ and there is a bulging BOW.
What are the risks of AROM?
- Prolapse of the ubilical cord
- Prolonged rupture leading to risk of infection
- Need for augmentation
What are some near-term tests for fetal well being?
- Sonograms (placenta, cervix, fetus and fluid)
- Fetal movement (10 kick counts over 3hr period)
- FHR patterns (NST, CST, BST (breast stimulation test))
- AFI (amniotic fluid index)
What is the normal range of the AFI (amniotic fluid index)?
Normal = >5cm and <20cm of fluid
What are the components of the Biophysical profile (5)
- 1. fetal breathing movements
- 2. fetal muscle tone
- 3. gross body movement
- 4. amniotic fluid volume
- 5. reactive FHR NST
What could these findings mean:
FHR = persistent fetal tachycardia
Maternal temp >100.4
Maternal pulse high
foul smelling amniotic fluid
What are some causes of PROM?
- infection of vagina or cervix
- Chorioamnionitis - intraamniotic infection
- Hydramnios - excess of amniotic fluid
- Poor nutrition
- Overdistention of uterus
Define these infection complication risks for PROM:
- 1. Also known as intra-amniotic infection, it is an inflammation of the fetal memranes due to a bacterial infection.
- 2. an inflammatory condition of the lining of the uterus, usually d/t an infection.
T or F: If someone with PROM shows signs of sepsis, you would use induction
T or F: If an fFN test is positive, it means that she is about to go into labor.
False: It can indicate that she will go into preterm labor soon, but may or may not go into labor for weeks.
List three medications that an help stop preterm labor
- 1. Mag Sulfate
- 2. Terbutaline
- 3. Nifedipine
This corticosteroid therapy drug can accelerate Preterm Fetal Lung Maturity. When should it be used?
Betamethasone: If gestational age is >24 weeks and <34 weeks to reduce risk of RDS and IVH
T or F: You would delay delivery of a preterm labor if giving Betamethasone
What is the dose of Betamethasone? What is it for?
Given in two doses of 12mg, 24 hours apart.
Given for preterm labor: accelerates fetal lung maturity and prevent respiratory distress syndrome
List interventions for Preterm Labor
- 1. avoid pelvic exams
- 2. Monitor temp and labs if PROM
- 3. Bedrest
- 4. Hydration
Why do you want to avoid pelvic exams during preterm labor?
It stimulates UC
T or F: You do not want to restrict liquids if a mom is on MagSulfate
What are complications of a prolonged pregnancy?
- Insufficient placental function
- Decreased amniotic fluid
- Large fetus
- Harder labor or birth injury
What is Velamentous Insertion?
When the umbilical cord inserts into the fetal membranes, then travels within the membranes to the placenta.
This means that the blood vessels of the umbiliccal cord are unprotected by the Wharton's jelly and may rupture during anytime of the pregnancy.
Fill in: When cord prolapse is diagnosed, goal is __a__ off of cord and __b__ in __c__ position
Fill in: When cord prolapse is diagnosed, goal is elevation of presenting
off of cord and emergent delivery
in knee chest
- a. Elevation of presenting
- b. emergent delivery
- c. knee chest position
What is amniotomy?
Artificial rupture of membanes
T or F: an Amniotomy is performed during a prolapsed cord delivery
How much pressure do you use with a vacuum extractor?
How long do you use it for? When should u d/c it?
- 50-60 mmHg of pressure
- No more than 10 minutes
- after , should be d/c3 pop-offs
T or F: If placenta isn't delivered after 10 minutes the baby is born, it should be manually removed.
False: if it is longer than 30 minutes
What are the 4 P's of the birth process?
- Powers: The two powers of labor are uterine contraction and maternal pushing efforts
- Passage: passage for birth of the fevus
- Passenger: the fetus and placenta
- Psyche: anxiety and fear, which increase catecholamines (inhibit uterine contracility and placental blood flow)
Which of these presentations is the most favorable:
(this multiple choice question has been scrambled)
State if this is a characteristic of False or True labor:
1. Inconsistent frequency, duration and intensity in contractions
2. Walking tends to increase the frequency and strength of contractions
3. Discomfort is felt in the lower back and gradually sweeps around to the lower abdomen like a girdle
4. Discomfort is felt in the abdomen and groin
5. Effacement and/or dilation of cervix occurs
Put these mechanisms of labor in correct order:
- 1. Descent: fetal presentation through pelvis
- 2. Engagement: fetal presenting part as its widest diameter reaches the level of the ischial spine
- 3. Flexion: of the fetal head so that the smallest head diameter passes through the pelvis
- 4. Internal rotation: to allow the largest head diameter to match the largest maternal pelvis diameter
- 5. Extension: of the fetal head as it passes beneath the mother's symphysis pubis
- 6. External roatation: of the fetal head to allow the shoulder to rotate internally to fit the mother's pelvis
- 7. Expulsion: of the fetal shoulders and fetal body
Describe the first stage of labor.
Cervical effacement and dilation occur in the first stage of labor, or stage of dilation.
It begins with true labor contractions and ends with complete dilation and effacement of the cervix.
It also contains three phases: Latent (early), active, and transition.
Which stage of labor contains the three phases and what are the phases?
- First stage:
- Latent Phase (early): this phase lasts from beginning of labor until 3-5cm dilation. The woman is usually sociable and excited during this early phase of labor
Active Phase: Dilation is more rapid and begins around 4-6cm. Discomfort usually increases as the pace of labor picks up.
Transition: Starting at 7-8cm, bloody show often increases with completion of cervical dilation. Here is where the urge to push starts to occur, they become anxious and irritable, or helpless.
Describe the Second stage of labor
Begins with complete dilation (10cm and 100% effacement) and ends with the delivery. The mother will be pushing, and the fetus descends low in the pelvis, and the vulva distends with crowning of the fetal head.
Describe the Third and Fourth Stage of Labor
- Third: Begins with the birth of the baby and ends with expulsion of the placenta.
- Fourth: Recovery stage for the mother and infant. Lasts from delivery of placenta through the first 1-4 hours after birth. Vaginal discharge will be lochia rubra (mostly blood), with small clots possibly present.
Describe Category I FHR patterns
- Baseline rate 110-160 BPM
- Variability Moderate
- No late decels
- Early decels okay
- No interventions needed
Describe Category II FHR patterns
- Possible to revert to category I and/or Category III
- Still reassuring but no activity or accelerations present
- Require close observations
- Contains Variables (cord compressions)
What is given to sedate a Hypertonic contractions mom?
Moms with precipitous labor migh be placed in this position for best uteroplacental profusion
This is when the shoulders become stuck during delivery
Precipitous labor is considered to be delivery within ___ hours of onset labor.
This drug is a prostaglandin, which main goal is to do what?
What is the risk?
Misoprostyl: cervical change facilitating vaginal delivery.
- risk: tachysystole (hyperstimulation) of the uterus with resulting fetal bradycardia and possible hypoxia?
- - Treat with sq terbutaline
Foley bulb does what?
Mechanically releases prosglandins into the uterus
Stimulates contractions before the onset of spontaneous labor
Enhances ineffective contractions after labor has begun
Is amniotomy best as induction or augmentation?
What do you have to consider post partum with a mom you had to augment?
Post partum hemorrhage: uterus unable to contract enough postpartum
What is version?
What do you need to know before performing?
What do you give before?
Actively trying to change fetal position
Know: placenta location, cord, amount of AF (low?), <37 weeks?
What causes a negative CST
No reaction to a contraction
Interuterine infection first s/s
Elevated HR on baby: take mom's temp more often
- Other signs: foul smelling amniotic fluid
- Maternal tachycardia and tachypnea
What are complications of maternal and neonatal after PROM?
- respiratory distress syndrome
- fetal sepsis
What used to be given to stop preterm labor at 34-37 weeks and why is it not given anymore
Terbutaline: showed to cause heart valve damage in the mom
Increase in LPIs (34-37 weeks)
Most common drug to stop preterm labor?
List other drugs
- Most common: Mag Sulfate
- Others: Terbutaline, Nifedipine
Mag Sulfate should be given with True preterm labor
List complications of Post term (>41 weeks)
- Placental insufficiency
- Large fetus
- Dysfunctional labor
- Birth injury
Vasa praevia, also spelled vasa previa, is a condition in which babies' blood vessels cross or run near the internal opening of the uterus. These vessels are at risk of rupture when the supporting membranes rupture, as they are unsupported by the umbilical cord or placental tissue.
What position should mom be in with a prolapsed cord if a c-section isn't immediately available?
Oh hands and knees, any position to put pressure of cord
T or F: a fetal weight of >4500 grams -> c-sec
What is the initial intervention when meconium is present during labor?
Constant FHR monitoring
retained placenta is when third stage is longer than ___ minutes.
30 minutes: requires manual removal d/t prolonged bleeding if everything isn't removed from uterus.
Chorioamnionitis is an infection of the fetal membranes, which is associated with what?
Vacuum extractors are often applied for prolonged _a_ (1st, 2nd, 3rd) stage. Use only _b_ mmHg of pressure.
No more than _c_ minutes of 3 pop-offs should be d/c.
- a. 2nd
- b. 50-60mmHg
- c. 10 minutes