Wk 8 Intrapartum Assessment L&D Flashcards Preview

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Flashcards in Wk 8 Intrapartum Assessment L&D Deck (29)
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1
Q

Premonitory signs of labor

A

Braxton Hicks: practice contractions, comes from fundus

Lightening: dropping of fetus, 2-3 wk before labor

Increase in clear vaginal secretions: pressure from fetus

Bloody show: ripening, dilating, pink/brown in color

An energy spurt: nesting

Small weight loss: 1-3 lbs due to changes of estrogen and progesterone levels

2
Q

Signs of false labor

A

Inconsistent in frequency, duration and intensity
Change in activity such as walking does not alter contractions or activity may decrease them
Felt in the abdomen and groin
May be more annoying than truly painful
No significant change in effacement or dilation of the cervix after an observation of 1-2 hours

3
Q

Signs of true labor

A

Consistent pattern of increasing frequency, duration and intensity
Walking tends to increase frequency and strength of contractions
Begins in lower back and gradually sweeps around to the lower abdominal girdle
Back pain may persist in some women, early labor often feels like menstrual cramps
Effacement/dilation of cervix occurs, progressive effacement/dilation of cervix are most important characteristics

4
Q

What are the five “P’s”

A
Powers
Passage
Passenger
Position
Psyche
5
Q

Five “P’s”

Powers

A

Powers
Contractions:
involuntary- can not stop or start

frequency- beginning of one contraction to the beginning from the next, measured in minutes and fractions of a minute

duration- beginning of the contraction to the end of the contraction, measured in seconds

intensity- palpation: mild (tip of nose), moderate (chin), strong (forehead)

interval- rest period, uterine relaxation

6
Q

Five “P’s”

Passage

A

Maternal pelvis
1 inlet
2 midpelvis (pelvic cavity)
3 outlet (pelvic opening)

Cervix

Soft tissue- vaginal canal and parineium

7
Q

Five “P’s”

Passage: Pelvis Stations

A

Ballottable: fetus head seems to float up and down during cervical exam. No engaged into the pelvis

Negative: head is high up in the pelvis

Zero: fetus head is at the level of the Ishial spine/pelvic bone

Positive (up to +5): fetus is descending down the vaginal canal, when fetal head is “crowning” it is at +5 station

8
Q

Five “P’s”

Passage: Cervix

A

Softening: before effacement and dilation

Effacement: thinning and shortening of cervix

Dilation: opening of the cervix

9
Q

Shape of anterior and posterior fontanels

A

Anterior: diamond shape
Posterior: triangle shape

10
Q

Five “P’s”

Passenger: Attitude and Presentation

A

Attitude:
Flexion
Extension

Presentation (fetal part entering the pelvis, presenting part):
Vertex- complete flexion, occiput is the leading part
Military- moderate flexion
Brow- poor flexion (extension), (emergent c-sec)
Face- full extension (emergent c-sec)

11
Q

Five “P’s”

Passenger: Presentation Breech types (3)

A

Frank breech: most common, baby’s legs are folded flat up against his head and his bottom is closest to the birth canal
Full breech: both of the baby’s knees are bent and his feet and bottom are closest to the birth canal
Footling breech: single or double foot presentation

12
Q
Five "P's"
Labor: position
What does
Occiput
Mentum
Sacrum
A

Occiput- vertex presentation
Mentum- face presentation
Sacrum- breech presentation

13
Q

What is Leopold’s maneuver?

A

Used to determine fetal presentation and position

14
Q

Five “P’s”

Psyche

A

Maternal catecholamines are secreted in response to anxiety or fear and can inhibit uterine contractility and placental blood flow.

Marked anxiety, fear, or fatigue decreases a woman’s ability to cope with pain in labor

Relaxation strengthens the natural process of labor

Advocate for the laboring patient to decrease her anxiety and fear

15
Q

Assessment for the first stage (1 out of 4)

A

ENDS with complete dilation and effacement.
Latent phase- early labor
Active phase- more rapids dilation of the cervix
Transition phase- intense contractions, fetal descent, and final cervical dilation 7/8cm to complete

16
Q

Assessment of Latent/early labor

First stage

A

Dilation 0cm - 3-5cm
Contractions: Initially mild, progress to moderate, every 5 min with reg pattern, duration increases to 30-40 sec
Nulliparous: 7.5-8.5 hours
Multiparous: 4-5.5 hours

17
Q

Assessment of Active labor

First stage

A
Dilation 4-10cm
Bloody show
Contractions: increase duration, frequency, intensity, q2-3 min lasting 40-60 sec, moderate to strong intesity
Nulliparous: 8-10 hours
Mulitparous: 6-7 hours
18
Q

Assessment of Transition phase

First stage

A
Dilation/cervix 7-10cm
Contractions: very intense, q2-3 min
Station: fetal presentation, urge to push
Nulliparous: 3.5 hours
Multiparous: 0-30 minutes
19
Q

Assessment of Second stage

A

BEGINS with complete cervical dilation and full effacement
Fetus descends low into pelvis
Needing to push, Ferguson reflex (fetal ejection reflex)
ENDS with delivery of infant

20
Q

Assessment of Third stage

A

BEGINS with birth of baby
Decrease size of uterus, placental site causing placenta to separate from uterine wall
Contractions: uterus is firmly contracted
Nulliparous and Multiparous: 5-10 min and up to 30 min
ENDS with expulsion of placenta

21
Q

Assessment of the Fourth stage

A
STARTS with delivery of the placenta
First 1-4 hours after birth
Fundus should be firmly contracted
Assess lochia color and amount (Lochia rubra, red, some clots)
"Golden hour"
22
Q

Significant problems

A

Pre-eclampsia: High blood pressure
Eclampsia: same S/S but with seizures
Shoulder systocia: complication during delivery when an infant’s shoulders become lodged in the mother’s pelvic
Non-reassuring fetal heart tones

23
Q

Normal fetal heart rate?

A

110-160 bpm

pre-term 26-28 weeks upper end of normal 160

24
Q

Assessing fetal HR

Accelerations

A

Temporary increase, peaks at least 15 bpm above the baseline and last for a least 15 seconds
Often with fetal movement
Nonperiodic= no relation to contractions
Periodic= in relation with contractions

25
Q

Assessing fetal HR

Decelerations

A

Decrease in baseline and return to baseline gradually
Onset of decel to the nadir (lowest point) is at least 30 seconds
Occur with contractions
Rarely decrease more than 30-40 bpm below baseline

26
Q

Early decels

A
Mirror of the contraction
Returns to baseline by end of contraction
Unaffected by maternal position
Fetal head compression
No fetal compromise
27
Q

Late decels

A

Begin after the start of contraction
May be subtle deceleration
Caused by impaired placental blood flow and fetal oxygenation
Not ominous if only occasional

28
Q

Variable decels

A

Abrupt deceleration down from baseline.
Decrease of at least 15 bpm and last for a least 15 seconds (opposite of acceleration)
Cord compression
Often described as carrot, V or W shaped

29
Q

Assessing fetal HR on grid sheet

A

Each square is 10 seconds

Baseline should be for 2 minutes