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Flashcards in Labor and Delivery Deck (16)
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1
Q

What hormonal changes occur during labor

A

increase in prostaglandins, estrogen, and oxytocin

2
Q

What are Leopold’s Maneuver

A
Four palpitations of the fetus through the abdominal wall to deremine where the feturs lies, it's presentation, and position
Fundal grip
Umbilical grip
Pawlick's grip
Pelvic grip
3
Q

Definitions of Lie, Presentation, and Position

A

Lie-relation of the long axis of the fetus with the maternal long axis
Presentation-determined by the presenting part (breech or cephalic)
Position-relation of the fetal presenting part to the right or the left

4
Q

What are the 3 identifiable parts on a fetus’s skull to help determine what way the baby is facing

A

Sagittal suture

Anterior and posterior fontanel

5
Q

7 cardinal movements of labor

A
Engagement
Descent
Flexion-chin meets chest
Internal rotation-head rotates to look at coccyx
Extension
External rotation-after head is born
Expulsion
6
Q

First stage of labor (latent and active phases)

A

Latent-cervical effacement and early dilation; may take 12-18 hours; no complications and occurs at home

Active- rapid cervical dilation about 1cm/hr
Need to manage maternal vital signs, IV access, frequent voiding, pain management (analgesics and anesthetics), pelvic exams, contractions, fetal HR, rupture of membranes

7
Q

Nonpharm pain options for labor

A
Cont labor support
warm water baths
intradermal water injections
maternal movement and positioning
touch and massage
acupuncture
8
Q

Pharm pain options for labor

A

Parenteral opiods
Epidural analgesia
paracervical block
nitrous oxide

9
Q

Second stage of labor

A

voluntary maternal effort (pushing)
“laboring down”-delayed pushing, decrease hard labor and increase duration of second stage; start when pt feels the urge to push

Options to help with delivery: episiotomy (not common), spontaneous vaginal delivery, vacuum extractors

10
Q

Third stage of labor

A

Signs of placental seperation (uterus rises in abdomen, gush of blood, lengthening of umbilical cord)

Active management of 3rd stage: early cord clamping, controlled cord traction, uterine massage, Pitocin, or manual removal

Evaluate placenta: two umbilical arteries, one umbilical vein, cotyledons, intact membraneN

11
Q

Indications for c section delivery

A

failure to dilate or failure to descend are MC

12
Q

Breastfeeding

A

do within 1 hour of delivery
recommended nutrition for first 4-6 months
Advantages: mom: decreased breast cancer, wt loss, attachment, quicker to amenorrhea
Baby: better immunity, decreased DM, GI illness, HTN

13
Q

Cervical ripening/induction

A

dilators or French foley balloon

Misoprostol

14
Q

Electronic fetal monitoring

A

Baseline FHR 110-160bpm

Variability: most reliable indicator of fetal status; suggests adequate fetal CNS oxygenation (absent, minimal, moderate, marked)

Accelerations: increase in FHR above baseline >15bpm x 15 sec; reassuring for fetal well being

Decelerations: Early (mirror image of contraction, not concerning)
variable (varies when slowing of FHR begins, abrupt fall and rapid return; most common deceleration seen)
late (slowing that begins after contraction starts, more ominous)

15
Q

Category 1 EFM

A

normal, moderate variability, may have accelerations, but no decerlations

16
Q

Catergory 3 EFM

A
minimum to absent variability +
sinusoidal
recurrent late decels
recurrent variable decls
bradycardia