OB Test 2/1
Terms
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- Gynecoid
- round pelvis, most common
- Anthropoid
- long ap measurement, short transverse measurement
- Platypelloid
- long transverse measurement, short AP measurement
- Android
- Heart shaped
- Types of Lie
- Longitudinal/Transverse/Oblique
- Longitudinal Lie
- parallel to mothers
- Transverse Lie
- perpendiclar to mothers
- Oblique
- between mothers perpendicular and parallel
- Attitude
- relation of fetal parts to one another
- Vertex
- complete flexion of the fetal head onto the chest (Occiput)
- Military
- Fetal head is neither flexed or extended (Top of head)
- Brow
- fetal head is partially extended (Sinciput)
- Face
- Fetal head is fully extended (Mentum)
- MOM
-
Mother, Other, Mother
Positiong of the fetus in relation to presenting part and position within the mother. - Presentation
- 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
- Breech
- butt first
- Complete Breech
- knees and hips flexed
- Frank Breech
- Hips flexed, knees ext
- Footling
- 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
- Frequency
- time from the start of one contraction to the start of the next one.
- Intensity
-
Strength of the contraction
mild-cheek
moderate-nose
strong-forehead - Duration
-
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
- dilation
- 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)
- Cervadil
- used for ripening of the uterus
- effacement
- 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. - Labor
- work, emptying of all products of conception
- Gravida
- How many times a person has been pregnant
- Para
- how many tmes a person has give birth after 20 weeks
- GTPAL
- 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
- mentum
- chin
- sinciput
- brow
- occiput
- vertex (between ant/post font)
- Molding
- bones of fetal skull overlap to allow for easier passage
- sutures
- spaces between bones
- macrosomia
- 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.
- Analgesia
- takes the edge off, but you can still feel
- Anesthesia
- 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
- Epidural
- outside dura mater, cath with cont meds, 20 min onset, spinal headache id CSF leakage.
- Spinal
- 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
- General
- 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
- myometrium
- uterine stretch, it can only get so big and then empties
- Placental aging
- has a 9 month life span, then decreased perfusion
- biochemical
- combo of all the causes
- lightening
- 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
- BOW
- 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
- ROM, AROM, SROM, PROM
- 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
- Toco
- 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. - Accelerations
- 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!!!!