Labor and
Delivery
Delivery
What are the stages of labor?
First stage- 2 phases (latent 0-5cm, active 6-10cm)
Second stage- pushing to delivery of newborn
Third stage- placenta expulsion
Fourth stage- recovery up to 4 hours
What does the acronym BUBBLE-EE stand for?
Breasts, Uterus, Bowel, Bladder, Lochia, Episiotomy, Extremities, Emotional status
What are normal vital signs for a newborn?
HR- 110/120-160 bpm
RR- 30-60 breaths per minute
Temp- 36.5 – 37.5 C (97.7 – 99.5 F)
What does Apgar stand for and when do we use it?
A- appearance, P- pulse, G- grimace (reflex irritability), A- activity (muscle tone), R- respiratory effort
Done at 1 and 5 minutes of life.
0, 1, 2 points. less than 7 at 5 minutes- call peds to evaluate.
A mom reports a severe headache and blurred vision postpartum. What could this indicate?
Postpartum preeclampsia
Next steps- assess BPs 160/110 antihypertensives and magnesium sulfate for seizure prophylaxis.
The cervix- dilates, thins (effaces) and the presenting part (fetal head) descends into the pelvis.
Dilation 0-10
Effacement- 0-100%
Station- -3 -+3
Why is oxytocin given?
After fetal is delivered and before or during placenta expulsion- oxytocin is given to increase uterine contractility to prevent excess uterine bleeding.
Name and describe 3 newborn reflexes.
Rooting
Moro
Babinski
Palmar
Plantar
Scarf (fencing)
Stepping
What injection is recommended postpartum for Rh-negative moms with Rh-positive babies?
RhoGAM
A postpartum mom is saturating a pad every 15 minutes. Priority action?
Fundal massage, call for help—suspect hemorrhage, when did patient last void?
Explain why pregnancy is called a hypercoagulable state?
Blood loss is inevitable during delivery. The body must prepare for this so there is an increase in fibrin and fibrinogen level in the blood to prepare for clotting that needs to occur during delivery of placenta.
A mom is day 3 postpartum and crying frequently. What's your assessment?
Postpartum blues- s/s= anxiety, low self-esteem, sleep disturbances, crying, hormonal.
monitor, support, educate
More than 2 weeks of same feelings and cannot care for baby postpartum depression
Name two signs of respiratory distress in a newborn.
Nasal flaring, grunting, retractions.
What would your next steps be?
How is Preeclampsia different from HELLP syndrome?
Preeclampsia is elevated BPs, HA and possibly BV, RUQ pain.
HELLP- hemolysis (destruction of RBCs- low Hgb), Elevated liver enzymes (LFTs, ALT, AST etc.), low platelets (<150,000) lab driven- may or may not have severely high BPs.
Magnesium Sulfate Tx for both HELLP more severe form bc can progress to DIC with the low platelets.
A postpartum c-section patient complains of unilateral leg pain and swelling. Upon assessment you notice the affected leg is red and has warmth. What do you suspect?
Deep Vein Thrombosis (DVT)
Bedrest and notify provider immediately
Your patient asks you the difference between true vs false labor. Explain the difference to the patient.
True labor- regular contractions in timing, get stronger and more painful. Starts in the back radiates to the front. Contractions don't stop.
False labor- irregular in timing, weaker- no change in intensity, usually felt in front, drinking fluid and walking can make them stop.
A 39-week gestation patient has delivered a 9lb 4oz newborn. She experiences a postpartum hemorrhage. Name two medications you anticipate the provider asking for.
Oxytocin/Pitocin
Methylergonovine, /Methergine- IM, contraindicated in high BP
Carboprost/Hemabate- IM, contraindicated in asthma
Misoprostol/Cytotec- buccally, rectally
A nurse is assessing a newborn and notices the baby is lethargic, has a weak cry, and is experiencing increased respiratory rate. The newborn’s skin feels cool to the touch. What should the nurse do next?
Assess temperature- less than 97.7F or 36.6C Immediately initiate warming measures:
Place the newborn under a radiant warmer or use skin-to-skin. Use warm blankets and keep the environment warm.
Monitor vital signs closely, especially temperature and respiratory rate.
Check blood glucose levels to assess for hypoglycemia. Why? - babies do not shiver so the non-shivering thermogenesis mechanism to getting warm is to increase energy expenditure through increase RR and increased metabolic rate which in turn drops blood glucose.
A 3-day-old newborn appears yellowish, especially on the face and chest. The nurse notes the skin blanching yellow with pressure. What should the nurse do next?
Jaundice- assess for risk factors (prematurity, RH incompatibilities- blood type), did mom get RhoGAM this pregnancy and in prior pregnancies?
Physiologic occurs within 24 hours usually- and is associated with blood incompatibilities and immature liver excretion
Pathologic occurs after 24 hours and is associated with immature liver excretion. Bilirubin builds up due to slow excretion of RBCs and causes sclera and mucous membranes and skin for yellowing, increased Bilirubin levels in blood.
Monitor bilirubin levels via blood tests.
Evaluate feeding patterns and hydration status- excreted through stools.
Check for signs of worsening jaundice (lethargy, poor feeding, high-pitched cry).
If jaundice diagnosis light therapy initiated until levels decrease.
A post op patient has just had an emergency c-section for a placenta abruption at 28 weeks' gestation. In the postop area during your assessment, you notice oozing of blood from her IV site, and petechiae on her abdomen near the dressing. What condition do you expect?
DIC- disseminated intravascular coagulation
The body’s normal clotting factors become overactive and are eventually depleted. This results in a cycle of multiple tiny fibrin clots entering the microcirculation, which are ineffective. Risk factors in pregnancy include abruptio placentae, AFE, severe hemorrhage, HELLP
CBC
↓ Fibrinogen
↓ Platelets
↑ PT and aPTT
Positive D-Dimer test (presence of fibrin split or degradation products)
Type and crossmatch must be done STAT
*Management: Assess, notify HCP, increase IV fluids, oxygen, blood product replacement