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OB Test 2/1


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copy deck
round pelvis, most common
long ap measurement, short transverse measurement
long transverse measurement, short AP measurement
Heart shaped
Types of Lie
Longitudinal Lie
parallel to mothers
Transverse Lie
perpendiclar to mothers
between mothers perpendicular and parallel
relation of fetal parts to one another
complete flexion of the fetal head onto the chest (Occiput)
Fetal head is neither flexed or extended (Top of head)
fetal head is partially extended (Sinciput)
Fetal head is fully extended (Mentum)
Mother, Other, Mother
Positiong of the fetus in relation to presenting part and position within the mother.
the part of the fetus closest to the internal os, the part that enters the maternal pelvis first.
Cepahlic presentation
head first, vertex, military, brow, face
butt first
Complete Breech
knees and hips flexed
Frank Breech
Hips flexed, knees ext
knees, hips extended, can be a double or single footling
Shoulder first
usu the acromion process presents first
MOM postion
M-direction, L or R
O-fetal presenting part,
o-occipital (vertex), m-mentum (face), s-sacrum, (breech), a-scapula (shoulder).
M-Anterior or posterior
LOA most common
Three parameters for measuring contractions
Frequency, Intensity, Duration
time from the start of one contraction to the start of the next one.
Strength of the contraction
how long a contraction lasts
Increment-building up
Acme-peak of the contraction
Decrement-letting up of cont
Interval-rest phase
Cervical changes
dilation and effacement
expansion of the external os form an opening of a few millimeters in size to an opening large enough to allow passage of the infant (10CM)
used for ripening of the uterus
thinnig and shortening of the cervix, occours late in pregnancy, or early in labor
Primipara vs multipara
p-effacement then dialtion
m-effacement and dialtion at the same time
Uterine contraction
Top of uterus does contract, lower seg is passive
Cardinal movements
Engagement, descent, flexion, internal rotation, Extension, external rotation, expulsion.
True contractions
Inc FID, regular, radiate, aggrivated with activity, cervix changes (softens).
False contractions
No inc in FID, Irregular, discomfort in abdomen only, relieved by walking, no cervical change.
Stages of labor
4 stages
Stage one
cervix dilates form 0-10cm
Phase 1-latent
Phase 2-active
Phase 3-transition
Stage two
10cm to birth, pushing stage.
3 good pushes (10 sec's each)
Lasts 2-3 pushes to 2-3 hours. Crowning, or fetal head encircled by the external opening of the vagina
Stage 3
birth of the infant to placental expulsion. 3-5 min to 30 min, shiny shultz or a dirty duncan. Meds-Pitocin or Methergine. Infant care-apgar score.
Stage 4
placental expulsion to homeostasis. Lasts 1-4 hours, nussing assessments, vitals q 15min.
Stage one, Phase one, latent
0-3cm, contractions 5-20min apart, last 30-60sec, mild
Stage one, Phase two, active
4-7cm, 2-4 min apart, last 45-60 sec, moderate
Stage one, Phase three, transition
8-10cm, 30-90 sec apart, 60sec, strong
Fastest stage, lasts 30-90min, multiple peaks to contractions, inc bloody show, inc rectal pressure, urge to push with contractions, N/V, stomach shuts down, shaking, irritable.
work, emptying of all products of conception
How many times a person has been pregnant
how many tmes a person has give birth after 20 weeks
gravida, term, preme, abortion, living
4 p's
passage, passenger, powers, physchological
Symphysis pubis
cartilaginous, streches up to 5cm
diagonal conjugate
sym pubis to sacral promontory, 12.5cm
Sacral promontory
bulge, ridge below the spine
Ischial spines (Bi-ischial diameter)
transverse diameter, 8.5cm
true pelvis
below linea terminalis-inlet cavity and outlet
false pelvis
above the linea terminalis, supports the weight of the lrg preg uterus
AP diameter (inlet)
true/diag conj-12.5cm
Trans diam (outlet)
bi-ischial diam, >8.5cm
anterior fontanel
bregma, diamond shaped, bulging=edema, inc ICP
posterior fontanel
triangular shaped
vertex (between ant/post font)
bones of fetal skull overlap to allow for easier passage
spaces between bones
large body
Bishop score
indicates whether or not ready to deliver (0-13, 8or higer is a good score)
Dilation, effacement, station
what the doctors want to know and part of documentation
What are some psychological concerns?
previous child birth, support, prepared (are they)feel like a big BM, perceptions and myths, motivation, soicioeconmic readiness, age, labor alterations such as focus and coping, cultural influences, c/b education, pain.
Causes of pain
hypoxia of uterus, streching and pressure, traction (on ovaries, uterine ligs, lower pressure on bladder, urethra.
takes the edge off, but you can still feel
takes away all sensation, systemic, local, reigonal, general.
systemic anesthesia
IV push, throughout the whole body, crosses placenta, slows respirations of the infant
Types of systemic anesthesia
demerol, stadol, numorphan, fentanyl. (stadol is like narcan, so don't give if mom is a drug addict=w/d.)
local anest
right around perineum, does't cross placenta, pudendal block or paracervical block; local(lidocaine)
Reigonal anest
bathes nerves, doesnt cross placenta, safe for baby.
Types of reigonal anest
Epidural, spinal
outside dura mater, cath with cont meds, 20 min onset, spinal headache id CSF leakage.
through the dura, into CSF, use with a C section, smaller needle
se's of reigonal anest
hypotension (dec blood to placenta, baby doesnt get o2 and nourishment), get a 500 to 1000 cc bolus infusion sp BP wont dec as much
go to sleep, for emergencys, will cross placenta w/in 4 min.
Local and regional
only two that don't cross placenta
What effects do pain meds have on labor
slow it down
when should you give meds (epidural)
when cervix is dialated to a 3-4cm, not before establishment of good labor
What is pain affected by?
Previous exp, attidue, culture, education, fear and anxiety, excitement, fatigue, attention and distraction.
Gate control theroy
can only handel so many senses, rubbing, felling, touching helps reduce pain
Types of pain mgmnt
backrubs (pressure on sacrum), sacral pressure, effleurage (rubbing belly), suggestion, distraction, conditioning, focusing, medication.
What to know before giving meds in Labor
OB history, allergies, baseline vitals for before and after comparison, special requests from the mother, effects of meds on mother and baby, delivery time(dont wait to long).
How to give a systemic medication
at the begining of a contraction, slowly over two to three contractions, because during contraction placenta is not perfusing, can not cross as readily
What causes the labor process
oxytocin stim theroy, estrogen stimulation, progesterone w/d, inc prostaglandins, fetal cortisol, myometrium stretch, placental aging, biochemical.
Oxytocin stim theroy
durng pregnancy, the number of oxy receptors inc on the uterus, the pituitary gland produces pitocin and nipple stimualtion inc it as well.
Estrogen stimulation
increase late in pregnancy makes uterus irritable
Progesterone w/d
with dec progesterone, contents of the uterus empty
prostaglandin inc
help simulate smooth muscle contractions, uterus contracts. Cervidil and semen
Fetal cortisol
fetus produces cortisol, slows prod of progesterone
uterine stretch, it can only get so big and then empties
Placental aging
has a 9 month life span, then decreased perfusion
combo of all the causes
feeling mom has when the baby has settled into the pelvic cavity, baby drops and allows for an ease in breathing, eating, presuure(inc urine and vaginal secretions, inc in leg pressure and urgency)
braxton hicks contractions
painless tightening and relaxation of uterine muscle, intermittent and irregual, 4 to 5 month of pregnancy
mucous plug
defends against invading orgs
bloody show
losing mucous plug, or from baby pushing on uterus
rupture of membranes, labor will begin 12-24 hours, inc risk of infection, monitor baby right away, caution ofr prolapsed cord
energy burst
quick burst of energy towards the end of pregnancy
backaches and weight loss, NVD, indigestion
more signs of labor coming
rupture of membranes, Artificial, spont, premature
How much fluid is lost with ROM, and what is it called?
approx 1000cc, called amniotic fluid
What are the characterisitics of amniotic fluid and what is it for?
should be clear, with a characterisitic odor, pH neutral to slightly alkaline. It provides a safe protective environemt, and the baby is able to drink it and urinate in it.
What does the amniotic flud tells us, what test can be done so we know it is a/fluid?
It tells us the sex, status, and the pH, the test is the ferning test, and nitrazine is used to find out the pH.
What is the nursing mgmnt after the ROM?
FETAL HEART TONES!! number one priority!!! Doc time of rupture, dont want labor >12 hours form time of ROM, infection chance.
More nursing mgmnt after ROM
Bed rest, dont wnat a prolapsed cord, temp q 2 hrs, comfort care-change the pad, will cont to leak fluid. Keep mom dry and clean.
Nursing resp
FHT, vaginal exam, rule out a prolapsed cord, which will dec FHT
What are some of the colors that the amniotic fluid may be?
CLear, normal. Yellow, old meconium staining. Green, greenish black-recent mec staining. Red, blood, could be placenta starting to detach.
Leopolds mauevers
locate the head, breech, fetal back.
Maternal systemic response to labor/Cardio
Dec blood perfusing in the placenta during cont. Inc blood pressure in maternal system during contraction.
Maternal systemic response to labor/BP
inc during contraction (norm between cont). Dec with supine hypotension (turn mother to left side.
Maternal systemic response to labor/Fluids/electrolytes
increased diaphoresis, inc breathing causes loss of fluids, replaced by IV therapy
Maternal systemic response to labor/GI
Gastric motility is stopped-no food absorbed, even for a few days after
Maternal systemic response to labor/Resp
Stage 1-oxy consum inc 40 %
Stage 2-oxy consum inc 100%
Resp acidosis, excessive breathing causes resp acidosis
Maternal systemic response to labor/Hemato
inc wbc's, 25%, change in coagulation, factors dec allowing to bleed out
Maternal systemic response to labor/Renal
Possible edema of bladder, protienuria, muscle breakdown; <2+, could be caused by dec blood and lymph drainage(protienuria)
Fetal response to labor/Heart rate change
inc ICP(vagus nerve pressure) can lead to brady and decelerations
Fetal response to labor/Acid base balance
stage 1-slow dec in fetal pH.
stage 2-rapid dec in fetal pH.
normal pH for newborn, 7.25-7.35, below 7.2 is critical, need to get baby out immediately.
Fetal response to labor/Fetal movements
fetus moves during labor, watch for breathing movements
Fetal response to labor/behavior
wake and sleep states, 20-40 min with dec variability.
Fetal response to labor/Hemodynamics
exchange of nutrients from mom to baby through placenta, babies bp needs to maintain itself during contr.
Fetal monitoring/types
External-Toco, round ultrasound.
Internal-Scalp electrode(SE), IUPC (intrauterine pressure catheter).
External monitoring
two belts, non invasive.
Round ultrsound
picks up baby's heart rate, goes over lower abdomen
place near fundus, times mothers contractions
Advantages/disadvantages of external monitoring
A-non invasive, easy to trace
D-uncomfortable, not as accurate, lose heart rate (have to readjust) This is just a sceening tool!!
Internal monitoring
scalp electrode-screws into baby's head (for HB)
IUPC-measures contractions in mmHG
Advantages/disadvantages of internal monitoring
A-much more accurate, more comfortable.
D-patient has to have ROM, at risk for infection, takes skill to place, must be dilated 2-3cm.
inc in fetal heart rate, comp for stress of labor. No NI, goes along with stress test
Decelerations, 3 types
Early, Late, variable
Early decleration
not sign of distress, mirro image of contraction, caused by HEAD COMPRESSION (vagus nerve), CPD (Head to big). NI-observe and watch, usually happens around 5-7cm.
Late decelertation
FETAL DISTRESS!!! dec fetal HR at top of contraction (Peak). UROPLACENTAL INSUF, hypoxia. Not getting enough nutrients and O2. DOCUMENT!!
IMMEDIATE Tx, patient on left side, turn off pitocin, inc BP with IV fluids, give O2, call doctor, vag exam (push or c-section)
Variable decleration
caused by CORD PRESSURE. nothing to do withvcontraction. V or W shaped. A reassuring sign. Tx-vag exam to rule out prolapsed cord, reposition and give O2.
What are some things you would write on the tracings?
DES, position, ROM (type and fluid assess/spontaneous or artificial), VS, position changes, IUPC/SE, Meds/oxy/IV/epidural, Behavioral(emesis), Voiding(amount/cath or get up?), Birth time, doctors visits.
Inutero fetal assess
Fetal scalp sampling, stimulation, and acoustic stim.
Fetal scalp sampling
insert a cone, use a lancet to get a drop of blood, blood should be within norm pH of 7.25-.735, if lower, acidotic
Fetal scalp stim
when chcking for dilation, rub head. Should see a inc FHR that indicates pH is WNL.
Acoustic stimulation
loud noise on mothers abdomen. Inc FHR indicates pH is WNL. Good for reassurance.
Maternal assessment/Health history
name, age, doc, weight, allergies, blood type, previos med conditions, prenatal probs, gravida/para, EDD/EDC, prenatal education, method of feeding (breast or bottle)
Maternal assessment/Risk factors
bleeding, diseases or probs during preg, PROM (color, time, odor)
Maternal assessment/Physical assessment
BP/pulse/temp/resp, Fundal height, comfort needs, staus of labor, contractions, membranes, bleeding, DES/Vag exams.
Maternal assessment/Psychosocial assess
anxiety, childbirth education, support systems, response to labor.
Maternal assessment/labor progression
Sterile vag exam for DES
Nursing management, Interventions
safety, comfort/support, coping and adaptation, fear and anxiety, caring, problems, education.
Nursing responsibilities
Doc of-Routine procedures (cath, fetal monitoring), Dr visits, Temp q4 or q2 if ROM, Vitals q15-30, VAg exam for DES, contractions/FIDResting, FHT with ADV, Q voids, epidural, what meds/how often, postion changes, friedmans graph to compare dilation to station.
Nurses do what?
We montior the WHOLE experience!!!!

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