[14] MIDTERMS | INTRAPARTUM PART 2 (SIGNS, RESPONSES, & DANGER SIGNS)

Question 1

SIGNS OF LABOR

PRELIMINARY/PREMONITORY SIGNS OF LABOR
1. ____
2. ____
3. ____
4. ____
5. ____
6. ____
7. ____

Answer 1

PRELIMINARY/PREMONITORY SIGNS OF LABOR
1. Lightening
2. Braxton Hicks Contractions
3. Cervical Ripening
4. Bloody Show
5. Rupture of Membranes
6. Sudden Burst of Energy
7. Other Signs

Question 2

SIGNS OF LABOR

• descent of the fetal presenting part into the pelvis
• uterus becomes lower and more anterior
• occurs early in primiparas
• occurs on the day of labor or even after labor has begun in multiparas

Answer 2

LIGHTENING

Question 3

SIGNS OF LABOR

LIGHTENING
the mother may experience the following:
* ____
* increased ____
* increased ____
* increased ____
* increased ____

Answer 3

LIGHTENING
the mother may experience the following:
* shooting leg pains
* increased vaginal secretions
* increased urinary frequency
* increased pelvic pressure
* increased venous stasis

Question 3

SIGNS OF LABOR

• irregular, intermittent contractions
• felt in the abdomen or inguinal region and patients may mistake them for true labor

Answer 3

BRAXTON HICK’S CONTRACTION

Question 3

SIGNS OF LABOR

• internal sign which can be determined only on pelvic examination
• throughout pregnancy, the cervix feels softer than normal (Goodell’s sign). At term, the cervix becomes still softer (described as “butter soft”), and it tips forward.

Answer 3

CERVICAL RIPENING

Question 3

SIGNS OF LABOR

• involve uterine and cervical changes
• surest sign that labor has begun is progressive uterine contractions

Answer 3

TRUE LABOR

Question 4

SIGNS OF LABOR

RUPTURE OF MEMBRANES
Yellow-green tinged amniotic fluid may indicate the following:
* signals the need for further assessment and ____
* if engagement has not occurred leads to ____
* open pathway into the uterus increases ____

Answer 4

RUPTURE OF MEMBRANES
Yellow-green tinged amniotic fluid may indicate the following:
* signals the need for further assessment and fetal heart rate monitoring
* if engagement has not occurred leads to danger of prolapsed cord
* open pathway into the uterus increases risk of infection

Question 4

SIGNS OF LABOR

OTHER SIGNS
* weight loss of ____
* ____
* ____
* ____

Answer 4

OTHER SIGNS
* weight loss of 1 to 3 lbs.
* diarrhea
* nausea
* vomiting

Question 4

SIGNS OF LABOR

• approximately 24 – 48 hours before labor
• increase in activity = increase in epinephrine release
• prepares a woman’s body for the work of labor ahead

Answer 4

SUDDEN BURST OF ENERGY

Question 4

SIGNS OF LABOR

• the amniotic membranes rupture once labor is well established, either spontaneously or amniotomy

Answer 4

RUPTURE OF MEMBRANES

Question 4

COMPARISON OF TRUE AND FALSE LABOR

TRUE LABOR
* Contractions increase in ____

FALSE LABOR
* ____

Answer 4

TRUE LABOR
* Contractions increase in frequency, duration and intensity

FALSE LABOR
* Usually no change

Question 5

COMPARISON OF TRUE AND FALSE LABOR

TRUE LABOR
* Contractions are at ____

FALSE LABOR
* Contractions are ____

Answer 5

TRUE LABOR
* Contractions are at regular intervals

FALSE LABOR
* Contractions are irregular

Question 5

COMPARISON OF TRUE AND FALSE LABOR

TRUE LABOR
* Intensity usually increases with ____ ( ____ usually increases labor pains)

FALSE LABOR
* Change of activity has ____ on contractions ( ____ may lessen the pain)

Answer 5

TRUE LABOR
* Intensity usually increases with change in activity (walking usually increases labor pains)

FALSE LABOR
* Change of activity has no effect on contractions (walking may lessen the pain)

Question 5

SIGNS OF LABOR

• pink-tinged secretions signaling that labor will begin within 24 - 48 hrs
• with softening and effacement of the cervix, the mucous plug is often expelled, resulting in a small
  amount of blood loss from the exposed cervical capillaries

Answer 5

BLOODY SHOW

Question 5

SIGNS OF LABOR

RUPTURE OF MEMBRANES
If the membranes rupture at home, note the following:
* ____, ____, and ____ of the amniotic fluid
* contains ____ and ____
* fluid should be ____ and ____
* ____ tinged amniotic fluid = infection or fetal passage of meconium

Answer 5

RUPTURE OF MEMBRANES
If the membranes rupture at home, note the following:
* color, amount, and odor of the amniotic fluid
* contains white specks (vernix caseosa) and lanugo
* fluid should be clear and odorless
* yellow-green tinged amniotic fluid = infection or fetal passage of meconium

Question 6

MATERNAL RESPONSES

FLUID BALANCE
* increase in rate and depth of respirations and diaphoresis leads to increase in ____

Answer 6

FLUID BALANCE
* increase in rate and depth of respirations and diaphoresis leads to increase in insensible water loss

Question 6

COMPARISON OF TRUE AND FALSE LABOR

TRUE LABOR
* Intervals between contractions gradually ____

FALSE LABOR
* ____

Answer 6

TRUE LABOR
* Intervals between contractions gradually shorten

FALSE LABOR
* Usually no change

Question 6

COMPARISON OF TRUE AND FALSE LABOR

TRUE LABOR
* ____ and ____ are progressive

FALSE LABOR
* ____

Answer 6

TRUE LABOR
* Cervical dilatation and effacement are progressive

FALSE LABOR
* No change in the cervix

Question 6

COMPARISON OF TRUE AND FALSE LABOR

TRUE LABOR
* Pains usually begin in ____

FLASE LABOR
* Pains usually occur in the ____

Answer 6

TRUE LABOR
* Pains usually begin in lower back, radiating to the abdomen

FLASE LABOR
* Pains usually occur in the abdomen

Question 6

MATERNAL RESPONSES

NEUROLOGIC AND SESNORY RESPONSES
During the second stage of labor, pain is caused by:
1. ____ of the contracting uterine muscle cells

2. distension of the ____ and ____
3. pressure on ____ structures

Answer 6

NEUROLOGIC AND SESNORY RESPONSES
During the second stage of labor, pain is caused by:
1. hypoxia of the contracting uterine muscle cells

2. distension of the vagina and perineum
3. pressure on adjacent structures

Question 6

MATERNAL RESPONSES

CARDIO VASCULAR OUTPUT
* ____ increase in circulating blood volume

• With each contraction ____ ml of blood volume is forced back into the ____
• ____ position, CO lowers;
• ____ position, CO increases
• Contraction blood flow to the uterus

Answer 6

CARDIO VASCULAR OUTPUT
* 50% increase in circulating blood volume

• With each contraction 300 to 500 ml of blood volume is forced back into the maternal circulation
• Supine position, CO lowers;
• Lateral position, CO increases
• Contraction blood flow to the uterus

Question 6

MATERNAL RESPONSES

GASTROINTESTINAL SYSTEM
* Reduced ____ and ____ of solid food

• Gastric ____ is prolonged and gastric ____ remains increased

Answer 6

GASTROINTESTINAL SYSTEM
* Reduced gastric motility and absorption of solid food

• Gastric emptying time is prolonged and gastric volume remains increased

Question 6

COMPARISON OF TRUE AND FALSE LABOR

TRUE LABOR
* Contractions do not decrease with ____ or ____

FALSE LABOR
* ____ and ____ lessen contractions

Answer 6

TRUE LABOR
* Contractions do not decrease with rest or warm tub bath

FALSE LABOR
* Rest and warm tub bath lessen contractions

Question 6

MATERNAL RESPONSES

RESPIRATORY SYSTEM
* increase in cardiovascular parameters increase ____

• ____ increase oxygen consumption
• Using appropriate ____ during labor can help avoid severe hyperventilation.

Answer 6

RESPIRATORY SYSTEM
* increase in cardiovascular parameters increase RR hyperventilation

• 100% increase oxygen consumption
• Using appropriate breathing patterns during labor can help avoid severe hyperventilation.

Question 6

# MATERNAL RESPONSES **INTEGUMENTARY SYSTEM** * vagina and perineum have a great ability to ____

Answer 6

**INTEGUMENTARY SYSTEM** * vagina and perineum have a great ability to **stretch**

Question 6

# MATERNAL RESPONSES **MUSCULOSKELETAL SYSTEM** * Release of ____ * ____ and the ____ become more relaxed and movable * increase the size of the pelvic ring by ____ cm

Answer 6

**MUSCULOSKELETAL SYSTEM** * Release of **Relaxin** * **symphysis pubis and the sacral/coccyx joints** become more relaxed and movable * increase the size of the pelvic ring by **2 cm**

Question 7

# MATERNAL RESPONSES **BLOOD PRESSURE** * increase in systolic and diastolic BP (____ with each uterine contraction) * 2nd stage of labor: ____ VS. ____ position

Answer 7

**BLOOD PRESSURE** * increase in systolic and diastolic BP (**15 mmHg** with each uterine contraction) * 2nd stage of labor: **Supine vs. upright or side lying position**

Question 7

# MATERNAL RESPONSE **TEMPERATURE REGULATION** * increased muscular activity leads to ____ * ____ with accompanying evaporation to cool and limit excessive warming

Answer 7

**TEMPERATURE REGULATION** * increased muscular activity leads to **slight elevation (1F)** * **Diaphoresis** with accompanying evaporation to cool and limit excessive warming

Question 7

# MATERNAL RESPONSES **NEUROLOGIC AND SENSORY RESPONSES** * Pain during the third stage results from ____ and ____ as the placenta is expelled

Answer 7

**NEUROLOGIC AND SENSORY RESPONSES** * Pain during the third stage results from **uterine contractions and cervical dilation** as the placenta is expelled

Question 7

# FETAL RESPONSES **ACID-BASE STATUS** * Blood flow is decreased to the fetus at the peak of each contraction = ____ * During the second stage of labor = pH ____ more rapidly

Answer 7

**ACID-BASE STATUS** * Blood flow is decreased to the fetus at the peak of each contraction = **low in pH status** * During the second stage of labor = pH **decreases** more rapidly

Question 7

# FETAL RESPONSES **NEUROLOGIC SYSTEM** * increased ____ pressure * The fetal heart rate (FHR) decreases by as much as ____ during a contraction, as soon as contraction strength reaches ____

Answer 7

**NEUROLOGIC SYSTEM** * increased **intracranial** pressure * The fetal heart rate (FHR) decreases by as much as **5 bpm** during a contraction, as soon as contraction strength reaches **40 mmHg**

Question 7

# MATERNAL RESPONSES **URINARY SYSTEM** * increase in maternal ____, ____ activity, and ____ * decrease in ____ during labor & increased insensible water loss leads to ____ * Inc. ____ * reduces ____ or the ability of the bladder to sense filling * ____

Answer 7

**URINARY SYSTEM** * increase in **maternal renin**, **plasma renin activity**, and **angiotensinogen** * decrease in **fluid intake** during labor & increased insensible water loss leads to **concentrated urine** * Inc. **specific gravity** * reduces **bladder tone** or the ability of the bladder to sense filling * **edema**

Question 7

# MATERNAL RESPONSES **IMMUNE SYSTEM AND OTHER BLOOD VALUES** * WBC count increases to ____ during labor and early postpartum period * increased ____ * ____ levels decrease leads to decrease in insulin requirements

Answer 7

**IMMUNE SYSTEM AND OTHER BLOOD VALUES** * WBC count increases to **25,000 to 30,000/mm3** during labor and early postpartum period * increased **neutrophils** * **Maternal blood glucose** levels decrease decrease in insulin requirements

Question 7

# MATERNAL RESPONSES **NEUROLOGIC AND SENSORY RESPONSES** Pain during the first stage of labor arises from: 1. ____, which is the primary source of pain 2. stretching of the ____ segment 3. pressure on ____ structures 4. ____ of the uterine muscle cells during contractions.

Answer 7

**NEUROLOGIC AND SENSORY RESPONSES** Pain during the first stage of labor arises from: 1. **dilatation of the cervix**, which is the primary source of pain 2. stretching of the **lower uterine** segment 3. pressure on **adjacent** structures 4. **hypoxia** of the uterine muscle cells during contractions.

Question 7

# MATERNAL RESPONSES **NEUROLOGICAL AND SENSORY RESPONSES** Factors on perception and response to pain: * ____ classes * ____ and ____ * ____ with pain * ____ * ____ and ____

Answer 7

**NEUROLOGICAL AND SENSORY RESPONSES** Factors on perception and response to pain: * **Childbirth preparation** classes * **fatigue and sleep deprivation** * **previous experience** with pain * **Anxiety** * **attention and distraction**

Question 7

# MATERNAL RESPONSES **PSYCHOLOGICAL RESPONSES** * ____ * ____

Answer 7

**PSYCHOLOGICAL RESPONSES** * Fatigue * Fear

Question 7

# FETAL RESPONSES **CARDIOVASCULAR SYSTEM** * During a contraction, the arteries of the uterus are ____ * The amount of ____, including ____, exchanged during this time is reduced = slight but inconsequential ____ * Increased ____ pressure caused by uterine pressure on the fetal head serves to keep circulation from falling below normal during the duration of a contraction. * ____ can occur with intracranial pressures of ____, as the head pushes against the cervix

Answer 7

**CARDIOVASCULAR SYSTEM** * During a contraction, the arteries of the uterus are **sharply constricted** * The amount of **nutrients**, including **oxygen**, exchanged during this time is reduced = slight but inconsequential **fetal hypoxia** * Increased **intracranial** pressure caused by uterine pressure on the fetal head serves to keep circulation from falling below normal during the duration of a contraction. * **Early fetal deceleration** can occur with intracranial pressures of **40 to 55 mmHg**, as the head pushes against the cervix

Question 8

# FETAL RESPONSES **INTEGUMENTARY SYSTEM** * ____ or ____ areas on a fetus (particularly the presenting part) * edema of the presenting part (____)

Answer 8

**INTEGUMENTARY SYSTEM** * **petechiae or ecchymotic** areas on a fetus (particularly the presenting part) * edema of the presenting part (**caput succedaneum**)

Question 9

# FETAL RESPONSES **MUSCULOSKELETAL SYSTEM** * The force of uterine contractions tends to push a fetus into a position of ____, the most advantageous position for birth

Answer 9

**MUSCULOSKELETAL SYSTEM** * The force of uterine contractions tends to push a fetus into a position of **full flexion**, the most advantageous position for birth

Question 10

# FETAL RESPONSES **RESPIRATORY SYSTEM** * maturation of ____ production by alveoli * The pressure applied to the chest from contractions and passage through the birth canal helps to clear it of ____

Answer 10

**RESPIRATORY SYSTEM** * maturation of **surfactant** production by alveoli * The pressure applied to the chest from contractions and passage through the birth canal helps to clear it of **lung fluid**

Question 11

# FETAL RESPONSES **FETAL SENSATION** * ____ gestation - sensations of light, sound, and touch * full term - able to hear ____ and the ____ * The term baby is aware of ____ sensations

Answer 11

**FETAL SENSATION** * **37 or 38 wks** gestation - sensations of light, sound, and touch * full term - able to hear **music and the maternal voice** * The term baby is aware of **pressure sensations**

Question 12

# FETAL DANGER SIGNS * High or Low ____ * ____ Staining * ____ * ____

Answer 12

* High or Low **Fetal Heart Rate** * **Meconium** Staining * **Hyperactivity** * **Fetal Acidosis**

Question 13

# MATERNAL DANGER SIGNS * Rising or Falling ____ * Abnormal ____ * Inadequate or Prolonged ____ * Abnormal ____ * Increasing ____

Answer 13

* Rising or Falling **Blood Pressure** * Abnormal **Pulse** * Inadequate or Prolonged **Contractions** * Abnormal **lower Abdominal Contour** * Increasing **Apprehension**

Question 14

# MATERNAL DANGER SIGNS Occurs under abnormal labor of the uterus

Answer 14

PATHOLOGIC RETRACTION RING (BANDL'S RING)