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OLOL OB T 1 B

QuestionAnswer
Passage the journey the baby takes being delivered
Powers primary- UC, secondary- mom pushing
Position baby’s and moms
Psyche feelings and emotions during the process
Passenger baby
What are the 5 "P's" Passage, Powers, Passenger, Position, Psyche
Vertex most common.Head is fully flexed. Occiput is presenting part of head.This is the most favorable presentation for normal progress of labor because a small diameter is presenting.
Military head in neutral position (neither flexed nor extended).Sinciput (top of head) is presenting part.
Brow head is partly extended.___ area is presenting part.This is an unstable presentation and may change to vertex if flexes or face if extends.The longest diameter is presenting here. 
Face head is extended & fetal occiput is near fetal spine.Baby will have lots of bruising on face.Mentum (or chin) is usually the presenting part.
What is the most desirable fetal position? occiput anterior (OA)
What is Malpresentation? Any position other than OA
First Stage lasts from onset of regular UC to full dilation of cervix (0-10cm)
Second Stage lasts from full dilation of cervix to birth of fetus
Third Stage lasts from birth of fetus until delivery of placenta
Fourth Stage the period of immediate recovery post-birth(approximately 2 hrs and up to 4 hrs)
Chara. of the First Stage of Labor The longest of all of the stages of labor; Divided into three phases: Latent – 0-3cm, Active – 4-7cm, Transition – 8-10cm
Characteristics of Latent Phase 0 – 3 cm dilation; UC:mild to moderate intensity, 5-30 min apart, 30-45 sec long; Maternal behavior: excited,alert,open to directions,talkative-good time to talk mother through the process she should expect if she didn’t take any classes
Characteristics of Active Phase 4 – 7 cm dilation; UC:moderate to strong,3-5 min apart,40-70 sec long; Maternal behavior:more serious,apprehensive,doubtful of abilities, > difficulty following directions,becoming fatigued; Usually when mother receives epidural
Characteristics of Transition Phase 8-10 cm; Shortest of 3 phases; UC:strong to VERY strong,2-3 min apart,45-90 sec long(don’t want them any closer than 2min-over stimulation);Mom behav:pain very intense,fearful,irritable, N/V,shaking,c/o rectal press, focus & directions difficult to follo
Chara. of Second Stage of Labor Begins w/ full cervical dil.& ends w/ delivery baby;“Laboring Down”- fully dilated and effaced,just having contractions not pushing; Ferguson’s reflex(strong urge to bear down)is stimulated-usually only felt in those going natural; Fetal head “crowning”
“Laboring Down” fully dilated and effaced,just having contractions not pushing
Ferguson’s Reflex (strong urge to bear down)is stimulated-usually only felt in those going natural
Cardinal Movements of the Mechanism of Birth Descent,Engagement,Flexion,InternalRotation,Extension,External Rotation,Expulsion
Descent the fetal presenting part thru the true pelvis. Accompanies all other mechanisms.Without this one, none of the others will occur
Engagement largest diameter of presenting part reaches level of mother’s ischial spines
Flexion head is flexed as it meets resistance from soft tissues of pelvis.It must do this so that the smallest head diameters will pass thru pelvis.
Internal Rotation to allow largest fetal head diameters to match with largest maternal pelvic diameters.
Extension as head passes beneath mother’s symphysis pubis. Action of pubis causes fetal head to swing anteriorly (extend) with each push.
External Rotation allows shoulders to rotate internally to best fit mother’s pelvis.
Expulsion of fetal shoulders & body
Premonitory Signs of Labor Lightening,Braxton-Hicks-false labor walking dec;if intensifies ~true labor,Bloody Show, Backache,Urinary Frequency,Diarrhea,Indigestion,N/V,Rupture of Membranes,1-3 lb.Wt Loss,Sudden Burst of Energy, Cervical Changes
Chara of False Labor Irregular UC, Often Stop w/ Walking, Felt Only in the Back/Upper Abdomen, No Cervical Changes
Chara of True Labor Regular UC~getting stronger & closer, Felt in Lower Back & Radiating to Abdomen, Intensity Increases w/ Walking (gravity), Cervix Dilates & Effaces
Chara of Third Stage of Labor Delivery of the placenta,Signs include:Firmly contracted uterine fundus,Change in uterine shape from discoid to globular (ovoid),Sudden gush of dark blood from vagina,Apparent lengthening of umbilical cord
Perineal Lacerations & Episiotomies 1st Degree extends thru skin and structures superficial to muscles
Perineal Lacerations & Episiotomies 2nd Degree extends thru muscles of perineal body
Perineal Lacerations & Episiotomies 3rd Degree continues thru the anal sphincter muscle
Perineal Lacerations & Episiotomies 4th Degree also involves the anterior rectal wall- may have incontinence
If a pt's platelet count is ______ then she is not a candidate for an epidural < 90,000-100,000
When do you give IVP meds during labor? at the beginning of 2-3 UCs
Fetal Reserve the concept that the fetus is provided with resources (i.e., oxygen & nutrition) in excess of its baseline needs;it refers to the degree of hypoxemia the fetus can tolerate before tissue hypoxia and acidosis will occur.
How long is the Fetal Reserve of O2? about 90 sec (1-2 Min)
How often do you auscultate FHR in low risk pt in the 1st stage of labor~Latent Phase? q 60 min (0-3cm)
How often do you auscultate FHR in low risk pt in the 1st stage of labor~Active Phase? q 30 min (4-7cm)
How often do you auscultate FHR in low risk pt in the 2nd stage of labor? q 15 min (10cm)
How often do you auscultate FHR in high risk pt in the 1st stage of labor~Latent Phase? q 30 min
How often do you auscultate FHR in high risk pt in the 1st stage of labor~Active Phase? q 15 min
How often do you auscultate FHR in high risk pt in the 2nd stage of labor? q 5 min
What are the causes of FHR Bradycardia? postmaturity, congenital heart block, fetal compromise and fetal sleep
What are the causes of FHR Tachycardia? maternal fever, maternal drugs, fetal hypoxia & premature fetus
FHR Variability Irregular fluctuations in the baseline FHR of two cycles per minute or greater.
Short Term Variability (STV) Short-term is beat to beat
Long Term Variability (LTV) is considered 3-6 cycles/min
In a NST what results do we want to see and what is the criteria? Reactive test/criteria: 2 or more accels(15 x 15 rule) over a 20 min period;Normal BL rate;Positive variability of FHR.
In a NST what results do we NOT want to see and what is the criteria? Non-reactive test/criteria: Test takes longer than 40 minutes(b/c baby does not move),OR No accelerations with FM,OR Decelerations are noted.
Biparietal Diameter the largest transverse diameter of the fetal head.
In cephalic presentation where is the best place to hear fetal heart tones? the lower quadrant of the mother's abdomen
In breech presentation where is the best place to hear fetal heart tones? in the upper quadrant of the mother's abdomen
Fetal Engagement occurs when the largest diameter of the presenting part reaches or passes through the pelvic inlet
What is the first NSG. intervention with AROM or SROM? Listen to FHR
During the 1st Stage of Labor what do you do in the Physical Assessment? VS(q 1hr),Temp(q 4hr until ROM,then 2hrs unless fever than q 1hr),UC & FHR q 30min,sterile vag exam PRN(q 2hr unless her condition warrents it more frequently)
During the 2nd Stage of Labor what do you do in the Management of Care? VS(q 30min),UC & FHR(q 5-15min),Provide comfort,Assist w/ breathing~Open & Closed Glottis Pushing,Encourage & Support,Verify all equipment is working
During the 3rd Stage of Labor what do you do in the Management of Care? Instruct to push to assist placental delivery,add oxytocin to IVF after placental delivery,chart time & type of placental delivery,prepare mom for perineal repair if necessary
What do we avoid giving to a mom who is dependent on Opoids? Stadol
What are the chara. of Indetermine FHR Patterns(Category 2)? Bradycardia not accompanied by absent baseline variability,Tachycardia,Minimal or absent baseline variability not accompanied by recurrent decels,marked baseline variability,no accelerations in response to fetal stimuli,periodic or episodic decels
What are the chara of Normal(Reassuring)FHR Patterns? Baseline FHR 110-160BPM,Moderate baseline variability,Absent late or variable decels, Early decels may or may not be present
What are the chara of Abnormal(Nonreassuring)FHR Patterns? Nonreassuring FHR pattern assoc w/ fetal hypoxemia, Hypoxemia can deteriorate to severe fetal hypoxia,Absent baseline variability,Recurrent or late decels,Bradycardia,Sinusoidal pattern
Chara of Accelerations Can be periodic/episodic,A visually apparent abrupt inc. in FHR above BL,Must be at least 15 bpm or greater and last 15 sec or longer (“15 x 15 rule”),If accels lasts longer than 10 min,is considered to be BL change,Consider normal,Cont. routine monitor
Chara of Decelerations May be benign/nonreassuring, Described by visual relations to the onset & end of a UC and by their shape,3 types: Early, Late, and Variable
What causes Early Decelerations? Fetal Head Compression
Chara of Early Decelerations Visually apparent gradual dec in FHR & return to BL;Usually begins before peak of UC & returns to BL as UC ends;May also occur w/ vag exams,fundal pressu,during FSE placement,& w/ mom pushing;benign. -no interve.;Not assoc. w/ fetal compromise,no interv.
What Causes Late Decelerations? Uteroplacental Insufficiency
Chara of Late Decelerations visually apparent dec. in & return to BL that begins after the UC starts,w/nadir occurring after the peak of UC.;“Lates” typically do not return to BL until after the UC is over;Indicates fetal hypoxemia d/t insufficient placental perfusion
What can cause Uteroplacental Insufficiency? uterine hyperstimulation w/oxytocin;post term pregnancy-b/c placenta is old; chorioamnionitis-infection of the chorion;maternal diabetes;placenta previa/abruptio placenta;pregnancy-induced hypertension (PIH)
What Causes Variable Decelerations? Umbilical Cord Compression
Chara of Variable Decelerations abrupt dec FHR below BL.; Dec @ least 15 bpm,lasting 15 sec or longer,but no more than 2 min;Can occur w/ UC or w/o UC;have chara U or V shape,w/a rapid descent & ascent;IMP.when FHR repeatedly ↓s to <70bpm & persists for @ least 60 sec before return BL
What Causes Prolonged Decelerations? Benign causes:pelvic exam,FSE application,rapid fetal descent, sustained Valsalva maneuver;Less benign(possibly ominous):Severe variable decels,maternal hypotension,tetanic UC(contstant contraction where uterus doesn’t relax),maternal hypoxia
Chara of Prolonged Decelerations A visually apparent decrease in FHR 15 bpm or more below the BL, lasting longer than 2 minutes, but less than 10 minutes;Longer than 10 minutes is a BL change, indicating bradycardia;Typically benign,but may be ominous.
Created by: cristenlp
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