Term
| Hypertonic Labor Patterns |
|
Definition
Contractions more frequent but ineffective
Intensity may decrease
Innefective in dilating or effacing cervix
Seen in early latent phase
May prolonged latent phase |
|
|
Term
|
Definition
Usually develops in the active phase
Fewer than 2-3 contraction in a ten minute period
May be due to overstretched uterus, medications, malpositions |
|
|
Term
|
Definition
Increase discomfort due to uterine muscle cell anoxia
Stress
Exhaustation, fatigue
Dehydration
Infection risk |
|
|
Term
|
Definition
Prolonged pressure
Excessive molding
Caput succedaneum
Cephalhematoma |
|
|
Term
|
Definition
Bed rest
Sedation-Nembutal, seconal, morphine
Pitocin administration
Ammiotomy |
|
|
Term
|
Definition
Oxytocin infusion
Nipple stimulation, breast pump
Ammiotomy
IV fluid
AMOL
Surgical birth if needed |
|
|
Term
|
Definition
active management of labor
Preventing protracted labor and arrest of progress |
|
|
Term
|
Definition
Increased risk of infection
Excessive intervention
Increased instrument-assisted birth |
|
|
Term
| Indications for Labor induction |
|
Definition
DM
Pre-eclampsia, PROM
With fetal maturity, chorioaninitis, post gestation-esp w/oligohydrammnios, IUFD(intrauterine fetal death), IUGR (intrauterine growth restriction)
Allowimmunization, non reassuring fetal testing |
|
|
Term
| Contraindication for labor induction |
|
Definition
Client refusal
Placenta previa
Floating presenting part
Prior uterine scar/incision
Active genital herpes
Umbilical cord prolapse
Acute fetal distress
Absolute CPD
Relative:
Cx carcinoma
Malpresentation
Funic presentation |
|
|
Term
Prelabor status evaluation scoring system
0 |
|
Definition
Cervical dilation closed
cervical effacement 0%-30%
Fetal station -3
Cervical consistency Firm
Cervical position Posterior |
|
|
Term
Prelabor status evaluation scoring
1 |
|
Definition
1-2
40%-50%
-2
Moderate
Midposition |
|
|
Term
Prelabor status evaluation scoring
2 |
|
Definition
|
|
Term
Prelabor status evaluation scoring
3 |
|
Definition
5-more
80% or more
1+, or lower
+1 or lower |
|
|
Term
|
Definition
Consist of effacement and softening of the cervix
Cytotex and prostaglandin agents |
|
|
Term
| PGE2 Prostaglandin gel, cervidil, prepidil |
|
Definition
intravaginally
causes softening and effacement or cervical ripening
S/E abdominal cramping, n/v, diarreah |
|
|
Term
|
Definition
Synthetic prostaglandin oral, vaginal to induce contractions
Continuos monitoring of FHR, uterine act. VS
S/E sudden onset of hypertonic contractions fetal distress |
|
|
Term
| Stripping of the membranes |
|
Definition
Gloved finger inserted into internal os and rotated 360 degrees twice. separating amniotic membranes lying against lower uterine segment
no need monitoring
may cause bleeding |
|
|
Term
|
Definition
delivered piggyback
active phase maintain dose, contraction 40-90, 2-3 min 1 cm |
|
|
Term
|
Definition
Tumultuous labor
Premature separation of the placenta
Rupture of the uterus
Laceration of the cervix
infection
Water intoxication
DIC
fetal:
Asphyxia
Neonatal hypoxia |
|
|
Term
|
Definition
| as a result of VBAC (vaginal birth after cesarean), trauma, excess pitosin adm, fetal lie, difficult forceps/assisted birth |
|
|
Term
| Symptoms of uterine rupture |
|
Definition
pain
contraction
decrease in FHR
bleeding
sharp pain followed by no contraction
C/S |
|
|
Term
|
Definition
| Labor that is completed in less than three hours |
|
|
Term
| Precipitous Labor contributing factors |
|
Definition
multiparity
large pelvis
previous precipitous labor
small fetus in a favorable position |
|
|
Term
| Postterm pregnancy increased possibility of |
|
Definition
induction
forceps or vacuum/assisted or Cesarean birth
decreased amount of amniotic fluid and possible cord compression
meconium aspiration
macrosomia or a loss of fat and muscle mass SGA newborn |
|
|
Term
|
Definition
Persistent occiput posterior (OP) sunny side up
causes:
Poor quality contractions
Abnormal flexion of head
Incomplete rotation
Inadequate maternal pushing efforts
Large fetus |
|
|
Term
| Implications of malpositione fetus |
|
Definition
Prolonged labor or arrested descent
Increased risk of episiotomy and laceration
Vaginal trauma
Increased fetal morbidity and mortality
Facial bruising
Exxagerated fetal molding |
|
|
Term
| Malposition nursing assessment |
|
Definition
S/S intense back pain
Dysfunctional labor patterns
Arrest of dilation or fetal descent
FHR heard laterally on abdomen
OP
POSITION KNEE CHEST
Changing positions |
|
|
Term
|
Definition
Breech
Face
Brow
Transverse/shoulder
OP |
|
|
Term
| Treatment for malpresentation |
|
Definition
Manual rotation
External cephalic version-prior to labor btw 36-38 weeks EGA
C/S |
|
|
Term
|
Definition
| Presenting part-forehead is slightly flexed, occitomental |
|
|
Term
| Causes of Brow presentation |
|
Definition
high parity
placenta previa
anomalies
Low birth weight (LBW)
Large infants |
|
|
Term
| Outcomes from Brow presentation |
|
Definition
| converts to vertex, C/S, epiosiotomy if vaginal del |
|
|
Term
| Implications of Brow Presentation-fetal |
|
Definition
trauma to trachea or larynx
Facil bruising and edema
Exaggerated fetal head molding
Increased fetal mortality from cerebral and nucheal compression |
|
|
Term
|
Definition
No evidence of CPD
Mentrum anterior
Effective labor pattern
Reassuring FHR
Cesarean if mentum posterior |
|
|
Term
|
Definition
Fetal head is not present part. 3-4%
Preterm birth
placenta previa
hydramnios
multiple gestatio
Fetal anacephaly, hydrocephaly |
|
|
Term
| types oh breech presentation |
|
Definition
Frank-flexion thighs, extension knees, buttocks present
Complete- flexion at thigs and knees, feet and sacrum buttocks present
Footling- single or double, ext. thighs and knees, foot or feet pres.
Kneeling-extension thighs, flexion at knees, knees present (most common) |
|
|
Term
|
Definition
preterm fetus
Excessive abnormal fliud
Placenta previa
Contracted pelvis
Risk of Prolapsed cord
Cesarean delivery |
|
|
Term
| Treatment for Malpresentation |
|
Definition
ECV external cephalic version prior to labor after 36 weeks
Cesarean if not succesfull
Tocolytics |
|
|
Term
|
Definition
Newborn weighing more than 4000 g
Shoulder dystocia
Maternal tissue damage
Post partuum hemorrhage |
|
|
Term
|
Definition
McRoberts maneuver
C/S
Baby: check for chaphalhematoma
Erb´s Palsy
Fractured clavicles or brachial plexus |
|
|
Term
|
Definition
onset of labor btw 20-37 completed weeks of pregnancy
Tocolytics |
|
|
Term
|
Definition
Beta adrenergics agonist . terbutaline, magnesium sulfate
Prostaglandin synthetase inhibitors, indomethacin
Calcium channel blockers. Procardia |
|
|
Term
| Intrauterine resuscitation |
|
Definition
| corrective measures used to optimize oxygen exchange within maternal fetal circulation |
|
|
Term
| Intrauterine Resuscitation |
|
Definition
turn woman to left lateral position to treat hypotension
Begin or increase IV
Perform vaginal exam to check for cord prolapse
Knee chest position is cord prolapse suspected |
|
|
Term
| Intrauterine Resuscitation |
|
Definition
Discontinue pitosin
O2
Physician
info about fetus |
|
|
Term
|
Definition
Umbilical cord precedes fetal presenting part placing pressure on cord and diminishing blood flow to fetus
Bed rest
Assess for non reassuring fetal status |
|
|
Term
| Cord Prolapse nursing care |
|
Definition
Avoid cord compression
Knee chest/trendeleburg
Bed rest w/o engagement
Assess for nonreasuring
Expedite CS/death |
|
|
Term
| Cephalopelvic Disproportion (CPD) |
|
Definition
Occurs when fetus is larger than pelvis diameter
Shortest AP diameter <10cm
Diagonal conjugate <11.5 cm
Greatest transverse diameter <12 cm |
|
|
Term
|
Definition
Vaginal birth depending
AVOID lithotomy
Cesarean |
|
|
Term
|
Definition
Care of woman with more than one fetus
Assist in ECV
Rest prior birth |
|
|
Term
| Internal Version Podalic version |
|
Definition
used to turn second twin during vaginal birth
Tocolytics
Only if second fetus does not descend
Physician grabs feet and pulls |
|
|
Term
|
Definition
Sudden onset respiratory distress
Acute hemorrhage
Circulatory collapse
Cor pulmonale
Hemorrhagic shock
Coma
fetal death |
|
|
Term
| S/S Amniotic Fluid Embolism |
|
Definition
Dyspnea
Frothy sputum
Chest pain
Tachycardia
Hypotension
Mental confusion
Massive hemorrhage |
|
|
Term
|
Definition
| One or more accessory lobes of fetal villi will develop of the placenta |
|
|
Term
|
Definition
| a double fold of chorion and ammion form a ring around the umbilical cord, on the fetal side of the placent |
|
|
Term
|
Definition
| The umbilical cord is inserted at or near the placental margin |
|
|
Term
|
Definition
| The vessels of the umbilical cord divide some distance from the placenta in the in the placental membranes |
|
|
Term
|
Definition
Retention of the placenta beyond 30 minutes after birth 2-3%
if not must be removed, conscious sedation may be required |
|
|
Term
|
Definition
Excess amniotic fluid
SOB
Edema
Cesarean
Abruptio placentae
PP hemorrhage |
|
|
Term
|
Definition
Small amount of amniotic fluid
Postmaturity
Renal agenesis
Dysplatic kidneys
Mostly renal
Skin and skeletal abnormalities
head compression |
|
|
Term
|
Definition
maternal heart disease
Infection
Exhaustion
Fetal stress |
|
|
Term
|
Definition
| an instrument with two curved blades is used to assist in the birth of the fetal head |
|
|
Term
|
Definition
fully dilated
Presenting part must be engaged and vertex presentation.
membrane rupture
Low forceps +2
mid forceps engaged |
|
|
Term
|
Definition
Outlet forceps-fetal skull in perineum
Low forceps +2
Midforceps engaged |
|
|
Term
|
Definition
Bruising, edema, facial lacerations, cephalhematoma, cerebral hemorrhage
Vaginal laceration
infection
Bleeding
Bruising
Perineal edema |
|
|
Term
|
Definition
utlizes a vaccum cup to the fetal head, use negative pressure to assist in birth of the fetal head
fully dilated
cup cause caput form
Increase risk for jaundice, alceration hematoma |
|
|
Term
|
Definition
Vertical
Transverse (Pfannenstiel) |
|
|
Term
| Types of uterine incisions |
|
Definition
Transverse (Kerr incision)
Vertical low segment
Vertical upper segment |
|
|
Term
|
Definition
midline
mediolateral
local anesthesia |
|
|
Term
| DIC (disseminated intravascular coagulation) |
|
Definition
| overstimulation of the coagulation process triggered by underlying disease and vascular injury |
|
|
Term
|
Definition
begins with complete dilatation and ends with delivery of placenta
4 stages |
|
|
Term
|
Definition
| Ability of pelvis and cervix to accommodate passage of fetus and for the introitus (external vaginal) opening to distend |
|
|
Term
|
Definition
Forms bony canal through which fetus must pass
Divided into three sections: inlet pelvic cavity outlet |
|
|
Term
|
Definition
Favorable for vaginal birth
Outlet adequate |
|
|
Term
|
Definition
Not favorable
midpelvis reduced |
|
|
Term
|
Definition
favorable for vaginal birth
inlet in oval shape |
|
|
Term
|
Definition
not favorable for vaginal birth
inlet in oval shape |
|
|
Term
|
Definition
has three major parts
Face
Base of skull
Vault of Cranium |
|
|
Term
|
Definition
| Cranial bones overlap under pressure of the powers of labor and demands of unyielding pelvis |
|
|
Term
| Landmarks of the fetal skull |
|
Definition
Mentum: chin
Sinciput: area of the brow
Bregma: anterior fontanel-large diamond shape
Vertex: are btw the anterior and posterior fontanell
Posterior fontanelle-btw posterior cranial sutures
Occiput: area of the occipital bone/posterior fontanelle |
|
|
Term
| Sutures of the fetal skull |
|
Definition
Sagittal
Lamboidal
Coronal
Frontal |
|
|
Term
|
Definition
two parietal bones
Two temporal bones
Frontal bone
Occipital bone |
|
|
Term
| Diameters of the fetal head |
|
Definition
Occipitofrontal -12 cm
Occipitmental -13.5 cm
Suboccipitobregmatic- 9.5 cm
Biparietal - 9.25 cm |
|
|
Term
|
Definition
| refers to relation of fetal of body parts to each other flexion, extension. it is the posture of the fetus in utero |
|
|
Term
|
Definition
| flexion of the head, back rounded, thighs flexed on the abdomen, arms crossed over thorax |
|
|
Term
|
Definition
| is the relation of the long axis (spine) of the fetus, to the long axis of the mother. May be longitudinal or transverse |
|
|
Term
|
Definition
| determined by fetal lie and by body part of fetus that enter pelvic passage first. this portion of fetus called presenting part |
|
|
Term
|
Definition
| Vertical. Long axis of the fetus is parallel with long axis of the mother |
|
|
Term
|
Definition
| Horizontal. long ais of the fetus is at right angle to that of the mother- vaginal birth no possible |
|
|
Term
| Cephalic presentation divided |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
cephalic -occiput
Breech- sacrum
Shoulder-Scapula |
|
|
Term
|
Definition
| Of presenting part ccurs when largest diameter of presenting part reaches or passes through pelvic inlet |
|
|
Term
|
Definition
| refers to relationship of presenting part to imaginary line drwn btw ischial spines of maternal pelvis |
|
|
Term
|
Definition
Progesterone: decrease
Estrogen: stimualtion of uterine muscle contractions
Prostaglandins: effect not known but effects successful in inducing labor Protaglandin E
Corticotrophin: releasing Hormone sharp increase prior to labor |
|
|
Term
|
Definition
Primary force: uterine muscular contractions, responsible for effacement and dilation of the cervix
Secondary force: Is use of abdominal muscle to push during second stage of labor. Down effots with abdominal muscles and perineal muscles |
|
|
Term
| Physiologic Forces of Labor |
|
Definition
Frequency: time of one contraction
Duration: leght of contraction
Intensity: strenght of the contraction |
|
|
Term
|
Definition
Pressure of fetal head causes cervical dilation
Rectum and vagina are drwan upward and forward with each contraction
During secodn stage, anus evert |
|
|
Term
| Premonitory SIgns of Labor |
|
Definition
Lightening
Braxton Hicks contractions
Cervical changes
Bloody show
loss cervical mucuos plug
Loss 1-3 pounds
Diarreah, indigestion,N/V
Rupture of membranes
Sudden burst of energy |
|
|
Term
|
Definition
contractions occur at regular intervals
interval btw contractions gradually shorten. increase in duration and intensity
Discomfort begins in back and radiates around to abdomen
intensity increase with walking
cervical dilation and effacement are progressive |
|
|
Term
|
Definition
1st stage from onset of true labor to complete dilaion of cervix
2nd stage begins with complete cervical dilation and ends with birth of infant
3rd Stage begins after the delivery of the baby and ends with delivery if the placenta
4th Stage process when woman experience chills , hunger, euphoria, thirsty |
|
|
Term
|
Definition
Latent phase: 0-3 cont. every 10-30 min, 30-40 min duration
Active phase: 4-7, 1-2 min, 40-60 sec, moderate to strong
Transition phase: 8-10, 1-2 min, 60,0 sec strongs |
|
|
Term
|
Definition
Complete dilation
every 1-2 min 60-90 sec strongs
Out of control, helpless panicky |
|
|
Term
|
Definition
Engagement
Descent
Flexion
Internal rotation
Extension
Restitution
External rotation
Expulsion |
|
|
Term
|
Definition
|
|
Term
|
Definition
Refers to the progress of the presenting part though the pelvis
F |
|
|
Term
|
Definition
| occurs as the descending head meets resistance from the cervix, pelvic wall, or pelvic floor |
|
|
Term
|
Definition
| Fetal head must rotate to fit the diameter of the pelvic cavity, which is the widest in the anteroposterior diameter |
|
|
Term
|
Definition
| when the fetal head reaches the pereneum for birth, it is defleted anteriorly by the perineum |
|
|
Term
|
Definition
| A brief rotation of the head to the position it held when it was engaged in the pelvic inlet. sort of untristing of the neck |
|
|
Term
|
Definition
| as the shoulders engage and descend the head further rotates |
|
|
Term
|
Definition
| after the birth of the head and shoulders the rest of the body is expelled |
|
|
Term
|
Definition
FHR normal range 120-160 bpm
PV exam
Rupture of membranes
Infections
Contractions
Fundal pressure
Fetal cord compression
fetal respiration affected |
|
|
Term
|
Definition
factor 0: closed, 0-30%, -3, Firm, posterior
Factor 1: 1-2, 40-50%, -2, moderate, midposition
Factor 2: 3-4, 60-70%, -1, soft, anterior
Factor 3: 5 or more, 80% or more, +1 or lower |
|
|
Term
| Vaginal examination us used to assess |
|
Definition
Cervical dilatation
Cervical effacement
Station
true labor
ROM-characteristic of amniotic fluid
Fetal position |
|
|
Term
|
Definition
| by spontaneous rupture of membrane in 25 % of pregnancies |
|
|
Term
| Assessing for Amniotic fluid |
|
Definition
Nitrazine test paper to determine ph. acid=urine, pus, blue=ammiotic fluid
or
In the lab Fern Test presence of ferning=amniotic fluid |
|
|
Term
|
Definition
Normal=pale, straw colred, watery, no strong odor, 500-1200 ml
Greenish brown= hypoxia
Yellow stained=fetal hypoxia
Port wine-bleeding
Thick cloudy, foul smelling=infection
Fluid lmore 1200ml-hydramnios-congenital anomalies
Fluid less 500 ml oligohydramnios=incomplete or absent kidney |
|
|
Term
|
Definition
empty bladder
Lie on her back with feet on bed
knes bent
Universla precautions
Palpate
One hand held steady as other explore abdomen |
|
|
Term
|
Definition
most clearly at fetal back
Leopolds maneuvers first to locate FHR
Vertex= FGT heard below the umbilicus
Breech= FHR heard above the umbilicus |
|
|
Term
|
Definition
| is encouraged if membranes are intact, engaged presenting part after ROM, no medication for pain |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| woman admitted with vaginal bleeding |
|
Definition
NO VE
FHR
amount blood loss
evaluate labor pattern
physician |
|
|
Term
| Presence of greenish or brownish ammiotic fluid |
|
Definition
FHR
dilatation, chech for cord prolapse
presentation
bed rest
physician |
|
|
Term
|
Definition
physician
stay with couple |
|
|
Term
| Prolapse of umbilical cord |
|
Definition
Relieve pressure on cord manually
FHR
physician
knee chest position
oxygen |
|
|
Term
|
Definition
EDB
Hx
OTC illicit drugs?
problems?
FHR, VS
Blood type and Rh
physician
stay
gloves |
|
|
Term
| Fetal Heart Rate Variability |
|
Definition
Variability irregular fluctuation in FHR baseline
Minimal-undetected but not by more than 5 beat
Moderate 6-25 beats difference
Marked 25 beats per minute
Absence or undetected variability is non-reassuring
Moderate variability is reassuring |
|
|
Term
|
Definition
Aceleration are transient increases in fetal heart rate normally cuased by fetal movement, usually with contractions
Decelarations are periodic decreases in FHR from baseline. Can be early, late, and variable |
|
|
Term
|
Definition
Early: occur before onset of uterine contaction, fetal head compresion
Late: Onset occurs after onset of a uterine contraction caused by uteroplacental insufficiency
Variable: Due to compression of the umbilical cord which results in a decrease in blood flow btw placenal and fetus. Varies on timing |
|
|
Term
|
Definition
Opioid
Stadol, Nubain, Demerol, fentanyl
Analgesic potentiarors: vistaril, phenergen |
|
|
Term
|
Definition
Injection of anesthesic agento into epidural space. Produces little or no feeling to area from uterus downward
Need floey due to loss of bladder sensation |
|
|
Term
|
Definition
Local anesthesic agent injected directly into spinal canal. higher use of rcesarean birth or lower vaginal birth
Severe headache |
|
|
Term
|
Definition
injected into preineum prior to episiotomy
Pain relief
No effects in VS |
|
|
Term
|
Definition
induced unconsciousness
Complication: fetal respiratory depression
Cricoid pressure per request |
|
|
Term
|
Definition
Local anesthesia directly to into pudendal nerve which produces anesthesia to lower vagina, vulva, perineum
Has no effect on fetus or progress of labor
Cont: brad ligament hematoma, perforation of rectum, sciatic nerve trauma |
|
|
