Intrapartum- Labor and Delivery
fern test
Appearance of a fernlike pattern found on microscopic examination of certain fluids such as amniotic fluid
AROM
Artificial Rupture Of Membranes
BOW
Bag Of Water
prostaglandins
Biologically active lipids which produce many effects in the body, including smooth muscle contractions, inflammation, and pain.
obstetrics
Branch of medicine dealing with pregnancy and childbirth
GBS
Causes of Meningitis in newborns (0-6 mos)
gestational age
The estimated age of the fetus is calculated from the first of the last (normal) menstrual cycle and is expressed in weeks. Ex. 22w 4d?
Station
The location of the presenting part of the fetus in the birth canal (engagement)
When is it time to go to the hospital?
Typically when ctx. are 5 mins apart and membranes rupture
Premonitory Signs of Labor "Prelabor Signs"
- Braxton Hicks warm-up ctx - Lightening/ engagement- fetus dropping into pelvis- increases urinary frequency -loss of mucous plug -increased vaginal secretions -bloody show/bloody spotting -weight loss 1-3 lbs -backache -diarrhea -bust of energy ''nesting instinct'' -cervical changes- softening, thinning, dilation -spontaneous rupture of membranes- leak or gush -quiet baby- baby slows down but does not stop moving
characteristics of the second stage of labor
- the pushing stage - cervix- fully dilated at 10 cms -ctx, 60-90 secs, every 3-5 mins -duration of phase- 20mins to 2 hrs (dependent on if mother has had previous births) -pushing with contractions
Fetal Assessment During Labor
-Amniotic Fluid Analysis -FHR monitoring -FHR patterns *Baseline, Baseline Variability, Periodic changes
Physical Assessment
-Body systems *vitals, heart and lung sounds, height and weight -Fundal Height -Uterine activity -Status of membranes -COAT -Dilation and effacement (Vaginal Exam) -Fetal assess: FHR, position, station -Pain level -Psychological status -Birth plan
Amniotic Fluid Analysis
-COAT
characteristics of true labor contactions
-Ctx. continue even when change in position -starts in the back and radiates around the front of the abdomen -regular, become closer together, usually 4-6 mins apart lasting 30-60 secs -become stronger with time, vaginal pressure is usually felt
stage 1 phone assessment
-EDB -fetal movement, frequency in past few days -other premonitory signs of labor -gravida/para status and previous childbirth experiences -time frame in previous labors - characteristics of contractions - bloody show and membrane status -presence of supportive adult in household or if she is alone (kids?)
Admission assessment- hospital
-Maternal health history *EDD *medical and obstetrical history (including GTPAL) -Lab studies *Urinalysis *CBC *Bloodtype/Rh factor, cross match (transfusion) *Prenatal lab tests: HbsAg (Hep. B surface antigen), GBS, HIV, STI's, and possible drug screening if not included in prenatal history
Nursing management of the laboring woman
-assessment -comfort measures -emotional support -information and instruction -patient advocacy -support for the partner
WARNING SIGNS in pregnancy
-bright red bleeding- more than bloody show -temperature >100 F or 37.7 C -pain with urination -sudden puffiness around eyes/face -severe dramatic swelling of face, hands, legs, ankles, feet -weight gain >5lbs (possible preeclampsia) -major changes in baby movement - sudden severe pain
the first stage of labor includes...
-cervix thins and opens - 0-100% effacement - 0-10cm dilated
active phase
-dilation 4-7 cms -ctx. 40-60 secs, every 3-5 mins -duration of phase- 3-5 hrs -ctx. more uncomfortable, stronger, longer, more frequent, unable to walk or talk during ctx. accepts support from staff/support person, more seious -ctx. 50-7- iupc
early/latent phase
-effacement -dilation 0-3 cms -ctx. 30-45 secs long, every 5-30 mins - duration of stage- 6-12 hrs -shorter if woman has had previous pregnancies -ctx.- irregular, mild, menstrual like cramps, able to walk and talk during ctx., excited, talkative, anxious -ctx.- 3-30 mmHg (IUPC)
Signs of separation of the placenta
-lengthening of umbilical cord outside the vagina -gush of blood -uterus changes from oval (discoid) shape to globular -mother describes "full" feeling in vagina -continued firm uterine contractions -placental expulsion -massaging of uterus- should feel firm not boggy -OXYTOCIN- may be used to aid contraction of uterus, iv or im
Immediately after birth...
-nurse will dry nb, assess, and assign apgar score -place nb on mom's chest- skin to skin contact -breast feeding may be initiated
what are the factors that influence the onset of labor?
-uterine stretch -hormones: progesterone/ estrogen -aging placenta -increased oxytocin sensitivity -increased release of prostaglandins
1 gm of weight = __ ml of blood?
1 gm = 1 ml of blood
how many para is a multifetal pregnancy?
1 para with explanation
fourth stage of labor
1 to 4 hours following delivery
nursing assessment throughout the stages of labor
1- 1st stage of labor phone assessment 2- admission assessment-hospital 3- physical assessment 4- fetal assessment during labor 5- 2nd stage assessment 6- 3rd stage assessment 7- 4th stage assessment
pregnancy lasts approximately how many lunar months?
10 lunar months
Normal Newborn Heart Rate
110 - 160 bpm
Normal FHR
110-160 bpm
what is the duration of the "second trimester"?
14 weeks through 26 weeks
what is the duration of the "third trimester"?
27 weeks through 40 weeks
pregnancy lasts approximately how many days?
280 days
how many phases are in the first stage of labor?
3 phases 1- early latent phase 2- active phase 3- transition phase
pregnancy lasts approximately how many weeks?
40 wks
pregnancy lasts approximately how many calendar months?
9 calendar months
Apgar score
A SCORING SYSTEM FOR ASSESSING THE STATUS OF A NEWBORN THAT ASSIGNS A NUMBER VALUE TO EACH OF THE 5 AREAS OF ASSESSMENT (1) APPEARANCE (2) PULSE (3) GRIMACE (4) ACTIVITY (5) RESPIRATIONS
preeclampsia
A serious condition of pregnancy in which the blood pressure rises to 140/90 mm Hg or higher accompanied by proteinuria, the presence of protein in the urine
primip
A woman who has given birth to her first child (past the point of viability), whether or not that child is living or was alive at birth.
Premature Rupture of Membranes (PROM)
Condition occurring when the amniotic sac breaks open before contractions begin, woman beyond 37 wks but before labor has begun
Engagement
Descent of the widest diameter of the fetal presenting part to at least a zero station(the level of the ischial spines in the maternal pelvis)
EBL stands for
Estimated Blood Loss
EDC
Estimated Date of Confinement
T/F: there are known true causes of labor
False: we do not know the true causes of labor, only factors that can influence the onset of labor
ROM
Rupture of Membranes
SROM
Spontaneous Rupture of Membranes
T/F: a full bladder can prevent the uterus from involuting
TRUE
T/F: contractions occur during placental separation
TRUE: ctx. occur but they are not as strong
iupc
This is a small uterine catheter, inserted thru the cervix into uterus, past the presenting part, used to measure the strength of contractions. example of internal fetal monitoring
T/F: a woman's body naturally knows how to give birth
True- a woman's body releases hormones necessary to open the passageway to bring a baby into the world
VE
Vaginal Exam
should laboring woman eat/drink during the early/latent phase of pregnancy?
YES, eat light snacks before 5 cm dilated, drink fluids but frequently empty the bladder
at how many cm's dilated do you begin to push to birth the baby?
a full 10 cm dilated
what is GTPAL?
a method commonly used for recording a woman's pregnancy history. it indicates the number or pregnancies as well as the outcome of the pregnancies.
palm sized bleeding
abnormal
what does the A in GTPAL stand for?
abortions- either elective (ETP) or spontaneous loss (miscarriage)
characteristics of amniotic fluid
clear or straw colored and odorless
as the onset of labor occurs, what pattern do contractions start to form?
contractions become stronger, longer and closer together
Braxton hicks contractions
contractions not strong enough or frequent enough to open cervix significantly as true labor contractions do -sporadic -< 30 seconds -Ctx. may go away with change in activity -irregular -usually felt in the front abdomen -dehydration and full bladder increase incidence
intensity of uterine contractions
degree of pressure, baseline is 8-12mmHg, peak ranges 35-75mmHg
third stage of labor
delivering the placenta -birth of infant to placental separation 5-20 mins after birth
the third stage of labor includes...
delivery of the placenta
transition phase
effacement- 100% dilation- 8-10 cms ctx.- 60-90 secs, every 1-3 mins duration of phase- 30 mins to 2 hrs ctx.- strong, pt irritable, agitated, self absorbed, dependent, ''I cant do it'', most challenging and intense but shortest phase ctx. 70-90 mmHg (IUPC)
regularity of uterine contractions
established pattern that increases in frequency and duration
EDB stands for..
estimated date of birth
EDD stands for..
estimated date of delivery
what is Nagele's Rule?
first day of last normal menstrual period subtract 3 months and add 7 days= due date in most cases add 1 year
meconium
first stool of the newborn, greenish color, tarry stool that is extremely difficult to clean - could be a sign of fetal distress
Timing uterine contractions: Frequency
from the beginning of one ctx. to the beginning of the next ctx.
Timing uterine contractions: Duration
from the beginning of one ctx. to the end of that same ctx.
what is the duration of the "first trimester"?
from the first day of the last menstrual period through 13 weeks
why is it important to ask pt gestational age?
gestational age will determine your treatment
what does the G in GTPAL stand for?
gravida- the number of times pregnant including the present pregnancy
HbsAg
hepatitis B surface antigen
major signs of shock
hypotension, tachycardia, cool, clammy, pale skin
how is length of pregnancy computed?
length of pregnancy is computed from the first day of the last normal menstrual period (lnmp)
quarter sized bleeding
normal, ok!
define para
number of deliveries at 20 weeks or greater whether the newborn is born or alive
what does the L in GTPAL stand for?
number of living children- if child had died further explanation is needed for clarification
define gravida
number of times pregnant including the present pregnancy regardless of the outcome
Preterm Premature Rupture of Membranes
occurs in woman less than 37 wks
how long does labor typically last?
on average about 6-24 hrs
How long does it take for a woman in the fourth stage of labor to hemorrhage to death?
only 8-12 mins, this is why nursing care in the fourth stage of labor is so critical
nitrazine paper
paper-dye impregnated test paper for determining pH; differentiates amniotic fluid which is slightly alkaline from urine & other fluids amniotic fluid will turn paper blue
Braxton hicks contractions are also referred to as..
pre labor contractions, warm up contractions, or false labor contractions
what does the P in GTPAL stand for?
preterm deliveries- number of preterm deliveries, 20 wks to less than 37 weeks
the second stage of labor includes...
pushing to birth the baby
C.O.A.T. (ROM)
report ROM to MD or Midwife: C- color O- odor A- amount T- time
rupture of membranes (ROM) refers to
rupture of amniotic fluid, also called "water broke"
what does the T in GTPAL stand for?
term pregnancies- number of full term deliveries (37-40 wks)
the fourth stage of labor includes...
the 1-4 hours after birth
which stage of labor is the longest?
the first stage
in which stage of labor is nursing care most critical?
the fourth stage of labor, post partem hemorrhage is most likely to occur and mom needs to be monitored very closely
involuting
the process of reduction of the uterus to its normal non-pregnant size and state following childbirth
effacement
the shortening, softening, and thinning of the cervix. thinning (from thick to thin)
why does the uterus need to contract down in the fourth stage of labor?
to prevent hemorrhage
how would you instruct a woman who is having Braxton Hicks contractions?
woman should empty bladder, lie down, drink plenty of fluids
you may be in preterm labor and should call the HCP immediately if..
you are <37 weeks pregnant and are experiencing 4 or more contractions in 1 hr
