- Shuffle
Toggle OnToggle Off
- Alphabetize
Toggle OnToggle Off
- Front First
Toggle OnToggle Off
- Both Sides
Toggle OnToggle Off
Front
How to study your flashcards.
Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key
Up/Down arrow keys: Flip the card between the front and back.down keyup key
H key: Show hint (3rd side).h key
PLAY BUTTON
PLAY BUTTON
63 Cards in this Set
- Front
- Back
|
In normal labor, how long does the early phase last in nullip/multip?
|
Nullip:8.6hours
Multip: 5.3hours |
|
According to Friedman, how long does the active phase last for nullip/multip?
|
Nullip: 4.9
Multip: 2.2 |
|
What is the mean amount of time the expulsion phase lasts in nullip/multip?
|
Nullip:54 min
Multip: 19min |
|
When is the expulsion phase considered prolonged?
|
Unmedicated: over 2 hours (nullip) and over 1 hour (multip)
With Epidural: up to 2 hours for multips & 3 hours for nullips |
|
What is considered a precipitous labor for N and M?
|
Nullip: >5cm/hr dilation
Multip:>10cm/hr |
|
what are some complications of precipitous labor?
|
trauma to birth canal, fetal distress, and PPH
|
|
What is labor dystocia?
|
abnormal labor that results from problems with the power, passenger, and/or passage
|
|
When can FTP or FTD be determined?
|
After an adequate trial of labor has been achieved
|
|
What are protraction disorders?
|
slower than normal labor
|
|
What are arrest disorders?
|
cessation of progress
|
|
Who is at risk for first stage dystocias?
|
AMA
Nullips Maternal anxiety Multiple gestation Intrauterine infections |
|
Who is at risk for second stage dystocias?
|
Prolonged 1st stage
Large fetus High station with complete dilation Nullips |
|
What characteristics of Nullips make them at risk for second stage dystocias?
|
short stature
>35 y/o GA >41 wks > 6hrs between epidural and full cervical dilation fetal station above +2 at 10cms. |
|
What 2 criteria should be met for dx of arrest?
|
Latent phase is complete
UC pattern exceeds 200MVU for 2 hours w/o cervical change |
|
when does labor dysfunction happen?
|
when the power of the uterus is insufficient to effect the mechanisms of labor
|
|
How is the uterus weakened
|
Sepsis, prolonged labor
|
|
when is more uterine power needed?
|
When fetus is asynclitic, deflexed or posterior presentation
|
|
What is augmentation?
|
stimulation of uterine contractions when spontaneous ctx have failed to result in progressive cervical dilation or decent of the fetus
|
|
When should you consider augmentation?
|
When UC's <3 in 10min. intensity is <25mmhg or both
|
|
When determining labor adequacy, what is the only direct measure of UC?
|
IUPC
|
|
how are adequacy of ctx measured?
|
by having sufficient strength (MVU) in a defined period of time (10Min)
|
|
when is a dx of labor arrest appropriate?
|
when cervical dilation is not progressing with > or = to 150-200 mvu in 10min that has been consistent for 2-4 hours
|
|
What are the 3 distinct phases of the first stage?
|
Latent
Active Deceleration |
|
When is the latent phase?
|
from 0-3 or 4cm
|
|
When is the active phase?
|
from 3 or 4cm to 10cm
|
|
When is the deceleration phase?
|
9-10cm
|
|
What are some characteristics of the latent phase?
|
it is the most unpredictable and differs for nullips and multips
|
|
How long does the latent phase last for nullips?
|
Mean is 8.6 hours with a range of 1-44 hours
|
|
How long does the latent phase last for multips?
|
Mean phase is 5.3 hours with a .4-36 hour range
|
|
What does the management of the latent phase include?
|
accurately diagnosing labor & letting it happen (or intervening & hoping trouble doesn't happen!)
|
|
Once an accurate dx of labor is made, what is prolonged latent phase?
|
progressive cervical change that occurs at an inordinately slow pace
|
|
what is the period of time for prolonged latent phase?
|
Nullips: >20hours
Multips > 14 hours |
|
What are some cx of prolonged latent phase?
|
unripe cervix, false labor, sedation, uterine inertia
|
|
What problems are encountered by the prolonged latent phase?
|
maternal fatigue/exhaustion d/t lack of sleep
maternal dehydration that can lead to contractures and contraction patterns that are problematic |
|
What does management of the latent phase include?
|
support/encouragement
hydration rest augmentation with oxytocin |
|
What is the mean time for active phase?
|
nullips: 4.9hours (range .8-34)
Multips: 2.2 (range of .3-15) |
|
Once in active phase, how fast will the cervix change
|
Nullip: 1.2cm/hr
Multip: 1.5cm/hr |
|
how long can the deceleration phase take?
|
up to 2 hours
|
|
What are some abnormalities that occur with dilation?
|
secondary arrest of cervical dilitation
Protracted active phase |
|
When does secondary arrest happen?
|
whe the labor has entered the active phase and progress stops (no change for 2 hours)
|
|
When does a protracted active phase occur?
|
when the labor has entered the active phase and progress is made, but less than expected
|
|
What is the general guideline for progress?
|
That the cervix should dilate by 1cm Q2 hours regardless of parity
|
|
What are causes of dilatation abnormalities?
|
*Ineffective contractions
*Fetal malposition *Interventions/stress |
|
What are ineffective contractions?
|
ctx that space out or have less strength
|
|
what cx ineffective ctx?
|
*maternal fatigue,
*pain (catacholamine response), * overmedication in either dose or timing |
|
What is the second stage of labor?
|
the stage of fetal expulsion
|
|
Whta is the mean time of the second stage?
|
Nullip: 57 min (range .5-5hr)
Multip:24 min (range 0-3hr) |
|
How fast is decent in second stage?
|
no less than 1cm station/hour
|
|
What are abnormalities in fetal decent?
|
*Arrest of decent
*Protracted decent |
|
What is arrest of decent?
|
the fetus stops decending following being complete
|
|
What is protracted decent?
|
there is slow decent outside of the nml range (<1cm/hr in nullips, <2cm hr in multips)
|
|
what is the general guideline during the second stage?
|
the fetus should be born 2hours following complete dilation in the non-aesthetized mother (3 with epidural)
|
|
What are cx of decent abnormalities?
|
*fetal position/malpresentation/size
*ineffective ctx *ineffective materal effort *Medications |
|
What are the hallmarks of active mgmt of labor?
|
*accurate dx of labor
*1:1 midwifery mgmt *Aggressive assessment and mgmt if labor slows |
|
According to O'Driscoll, what makes a dx of labor?
|
*regular painful ctx
*complete effacement with or without dilation *bloody show *SROM |
|
What is a minimally interventive strategy?
|
Hydration
|
|
What does Hydration do during labor?
|
increased fluids improve skeletal muscle performance during prolonged exercise
|
|
How many cc/hr is recommended for hydratiom?
|
250cc/hr is better than 125cc/hr
|
|
What are some non-interventive mgmt strategies?
|
Ambulation
Warm water immersion Castor oil stripping membranes |
|
What are the claims with ambulation?
|
That it shortens labor, decreases pain, decreases use of meds, improves apgar scores
|
|
What does ambulation do for the mother?
|
changes the perception of herself and her labor
|
|
What does ambulation do?
|
prevents stagnation and may assist in effective fetal rotation
|
|
Once admitted, when should fht be done when ambulating?
|
Q1 hr during latent phase,
Q15-30min during active phase |
