OB Exam 2 Already Graded A+

OB Exam 2 Already Graded A+ Stages of Labor 1st Stage: Dilation and Effacement of the Cervix - Latent Phase (0-4 cm dilation): - Longest phase of labor. - Contractions are mild to palpation and feel like menstrual cramps. - Active Phase (5-7 cm dilation): - Women may become more focused and experience increased anxiety or restlessness. - Contractions become more regular and painful. - Transition Phase (8-10 cm dilation): - Strong contractions that are closer together. - Women may feel out of control, irritable, or dependent. - This is the shortest phase of labor. --- 2nd Stage: Pushing - Definition: Begins with complete dilation of the cervix and ends with the birth of the baby. - Duration: May last from 20 minutes to 2 hours. - Fetal Descent Stages: 1. Engagement: Fetal head at the level of ischial spines. 2. Descent: Fetal head moves past the ischial spines. 3. Flexion: Fetal chin touches chest in response to pressure from maternal tissue. 4. Extension: Fetal chin comes off the chest; neck arches as the head is born. 5. External rotation: Fetal head rotates as shoulders move into position for delivery. 6. Expulsion: Birth of the fetal body. --- 3rd Stage: Delivery of the Placenta - Definition: Begins with the birth of the baby and ends with the delivery of the placenta. - Duration: Typically complete within 5-30 minutes. - Concern: Failure to contract may lead to uterine atony, a primary cause of postpartum hemorrhage. --- 4th Stage: Recovery - Definition: Begins with the delivery of the placenta and lasts for about 4 hours or until the mother is clinically stable. - Nursing Assessment: - Assess uterine position, vaginal bleeding (lochia), and vital signs. - Administer pain medication as needed. - Assist the patient with skin-to-skin contact and initiating breastfeeding. --- Fetal Heart Rate (FHR) Monitoring - Purpose: To assess FHR patterns indicative of fetal compromise. - Abnormal patterns can indicate hypoxemia and lead to hypoxia. - Monitoring Techniques: - Intermittent Monitoring: FHR assessed every 15-30 minutes during the active phase; every 5-15 minutes during the second stage. - Continuous Monitoring: Evaluated every 30 minutes for low-risk women in the first stage; every 15 minutes for the second stage. Higher frequency for high-risk women. - Characteristics: - Baseline heart rate normally between 110-160 bpm. - Variability: Reflects the normal fluctuations in FHR. - Moderate Variability: 6-25 bpm (desirable). - Absent Variability: 0-2 bpm. - Minimal Variability: 2-6 bpm. - Marked Variability: >25 bpm. - Accelerations: Increase of at least 15 bpm lasting at least 15 seconds. - Decelerations: Decreases from baseline; categorized as: - Late Decelerations: Due to poor placental perfusion. - Variable Decelerations: Due to cord compression. - Early Decelerations: Benign, due to head compression. - Prolonged Decelerations: Lasting 2-5 minutes. Interventions for Decelerations - Change maternal position. - Discontinue oxytocin infusion if in use. - Administer oxygen (8-10 L via non-rebreather mask). - Correct any present hypotension. - Notify the provider of significant changes. --- FHR Categories - Category 1: Good (HR 110-160, moderate variability, no late or variable decelerations). - Category 2: Caution (may include variable or late decelerations, tachycardia, minimal variability). - Category 3: Emergency (includes prolonged decelerations, absent variability; may require immediate surgical intervention). --- Cord Prolapse - Definition: Occurs when the umbilical cord slips between the fetal presenting part and the maternal pelvis. - Causes: Polyhydramnios, premature rupture of membranes. - Types: - Overt Cord Prolapse: Cord comes out ahead of the presenting part; requires emergency C-section. - Occult Cord Prolapse: Cord is alongside the presenting part; vaginal delivery may still be possible. - Risks: Compression of the cord can compromise fetal oxygenation. - Notice variable decelerations or bradycardia in the fetal heart rate. - Cord prolapse is confirmed during vaginal examination. Emergency Protocol for Cord Prolapse 1. Establish fetal heart rate monitoring. 2. Place sterile gloves and lift the fetal head off the presenting part to relieve pressure on the cord. What is preterm labor? ️-labor that is prior to 37 weeks and may be spontaneous or induced -Common reasons for premature induction of labor: Placental problems History of uterine scarring Fetal growth restriction Chronic hypertension Preeclampsia Poorly controlled gestational diabetes Pregestational diabetes, poorly controlled or with vascular complications Preterm premature rupture of membranes What are some symptoms of preterm labor? ️-Irregular contractions, often mild -Report of menstrual like cramping -Low back pain -Feelings of vagina or pelvic pressure -Light bleeding or spotting -Bloody show What are some diagnosis of preterm labor? ️-Cervical dilation of 3cm or more -Cervical shortening on ultrasounds -Positive fetal fibronectin test ; evaluation of a protein concentrated between the placental and the decidua of the uterus What is the treatment of preterm labor? ️-Suppression of labor, physical activity restriction, progesterone supplements, and management of medications -Physical activity restriction is commonly recommended but lacks supportive evidence -Progesterone supplementation may be given to extend the pregnancy. Dosing may be 100 mg vaginally daily or 250 mg IM weekly -Corticosteroids promote fetal lung maturity and reduce the risk of ventricular bleeding and necrotizing enterocolitis Antibiotics administered because preterm labor may be caused by infection What drugs could be administered for preterm labor? ️Tocolytics ( Most effective )