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NURS ADN004 Maternity > Week 4 Intrapartal Period > Flashcards

Week 4 Intrapartal Period Flashcards

1
Q

This stage lasts from beginning of dilation to when the cervix is fully dilated

A

1st stage of labor

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2
Q

Lasts from full dilation to birth of infant

A

2nd Stage

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3
Q

Lasts from the infants birth to the expulsion of the placenta - typically 30 min max

A

3rd stage of labor

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4
Q

1st 2 hours after birth

A

4th stage of labor

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5
Q

Name the phases of the 1st stage of labor

A

Phase I- Latent or early phase -0-3/4 cm
Phase 2- Active phase-4-7 cm
Phase 3- Transitional Phase- 7to 10 cm

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6
Q

Second stage is ________ cm to _________

A

10 cm to delivery

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7
Q

delivery of baby to delivery of placenta is the ____ stage

A

3rd stage of labor

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8
Q

4th stage of labor is

A

Recovery period

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9
Q

What are the 5p’s of labor?

A

Powers
Passageway
Passenger
Position of the woman
Psychological Responses

Forces that affect the progress of labor and help to bring about childbirth

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10
Q

Name factors affecting Labor

A

Primary Powers UCS
- Effacement
- Dilation
- Ferguson reflex- application of pressure to the Ferguson plexus or cervical and vaginal structures

Secondary Powers: Abdominal MS
Valsalva

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11
Q

How strong and affective are contractions?

A

Lot of factors involved

Frequency and duration

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12
Q

Beginning on one contraction to end of the same contraction

A

Duration

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13
Q

Beginning of one contraction to the beginning of another

A

Frequency

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14
Q

Resting time between contractions allows for placental perfusion

A

Interval

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15
Q

How are contractions measured?

A

External TOCO

Measured peak to peak

Start from top left of uterus and makes it way down and around

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16
Q

What are the uterine muscle layers?

A

Outer

Middle

Inner

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16
Q

Power=

A

Contractions + Maternal Pushing

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17
Q

Uterine contractions are initiated by

A

Pacemakers - uterotubal junction

Contractions meet at the fundus
Contraction waves progress downward

Shortening of muscle fibers
Retractions
Intra uterine pressure

Additional forces- maternal pushing and intraabdominal pressure= pushing out of fetus

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18
Q

Contractions of the uterus after the cervix has been stimulated

During labor this causes urge to push

Urge to push is caused by baby pressing onto this plexus of nerves

A

Ferguson Reflex

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19
Q

During process of labor the myometrium contracts by positive feedback effect

A

Ferguson reflex

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20
Q

Strong contraction of myometrium are influenced by what hormone?

A

Oxytocin

Secreted by posterior pituitary gland and hormone prostaglandins from the placenta

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21
Q

These contractions expel the fetus from the uterus into the vagina and also constrict blood supply from the

A

Placenta

After delivery, myometrium contracts to expel the placenta and reduce blood loss where Criss cross fibers compress the blood vessels

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22
Q

During childbirth baby’s head pushes against sensors near opening of uterus …

A

Oxytocin is released- stimulates uterine contractions

More contractions- more oxytocin

Only stops when pushing stops

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23
Q

Estrogen from ovaries induces

A

oxytocin receptors on uterus

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24
Q

Oxytocin from fetus and pituitary stimulates

A

Uterus to contract

Stimulates placenta to make prostaglandins
Stimulate more contractions of uterus

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25
Q

Contractions of uterus wall force baby head to cervix
Stretching of cervix
Receptors stretch sensitive nerve cells in cervix send nerve impulses
- Control center brain interprets input and releases oxytocin
Hit effector muscles in wall of uterus contract more forcefully

Baby body stretches cervix more

A

Ferguson Reflex

Positive feedback

Stretching of cervix= more oxytocin

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26
Q

Effects of the cervix in the primigravida

A

Beginning of labor- no cervical effacement or dilation. Fetal head is cushioned by amniotic fluid.

Then as cervix effaces, more amniotic fluid collects below the fetal head.

Cervix begins to be about one half effaced and slightly dilated. Increasing amount of amniotic fluid creates hydrostatic pressure.

Complete effacement and dilation.

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27
Q

How to gauge cervical dilatation?

A

Nurse places the index and middle fingers against the cervix and determines the size of the opening.

Can NOT insert before labor begins. During labor begins cervix begins to dilate. Goes from 1-10cm.

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28
Q

Name the primary and secondary powers affecting labor

A

Primary
- Effacement
- Dilation
- Ferguson reflex

Secondary
- Abdominal MS
- Valsalva

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29
Q

Valsalva Maneuver

A

Same maneuver as you would have a bowel movement

Closed glottitis - air pressure increases in lungs increases and exerts force against anterior surface of vertebral column-

Erector muscle contraction- Fluid pressure in abdomen increases and exerts force against anterior surface of the vertebral column

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30
Q

The passageway or birth canal is composed of?

A

Bony Pelvis
Soft tissues of cervix
Pelvic floor
Vagina
Introitus - External opening to the vagina

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31
Q

Type of continuous and slightly movable joint

A

Amphiarthrosis

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32
Q

Connected by broad flattened disks of fibrocartilage, of a more or less complex structure, which adhere to the ends of each bone, as in articulations between the bodies of the vertebrae or the inferior articulation of the two hip bones- aka the pubic symphysis.

A

Symphysis

33
Q

Passenger of labor includes

A

Size of the fetal head
Fetal Presentation
Fetal lie
Fetal attitude
Fetal Position

34
Q

What is the major factor in determining the course of the birth?

A

Fetal Head

When there is a mismatch we call that Cephalopelvic Disproportion

35
Q

Name the landmarks significant in birth

A

Sinciput
Vertex
Occiput
Mastoid fontanelle
Mentum
Sphenoid fontanelle
Posterior fontanelle

36
Q

Typical anteroposterior diameters of the fetal skull

A

Vertex of the fetus presents and the fetal head is flexed with the chin of the chest

Smallest anteroposterior enters birth canal- subocciptobregmatic

37
Q

Transverse diameters of fetal skull

A

Biparietal

Bitemporal

38
Q

_________ creates the smallest anteroposterior diameter enters the birth canal

A

Flexion

  • subocciptobregmatic
39
Q

How many cm is vertex presentation?

A

9.5 cm

40
Q

How many cm is sinciput presentation?

A

12 cm

41
Q

What is cm for brow presentation?

A

13.5 cm

42
Q

What is fetal attitude?

A

Relationship of fetal body parts to self

Flexion is normal

43
Q

Normal fetal attitude is

A

Head flexed forward
Chin resting on the chest

Arms and legs flexed

44
Q

Fetal skull is made up number of bones divided by sutures

A

True

Moulding

These bones only fuse after birth

45
Q

Allows bones to?

A

Overlap during delivery to decrease the diameter this is called moulding.

Moulding allows the pelvis to accommodate the fetal head

46
Q

Referred to the fetal presenting part. Part of the fetus that enters the pelvis first.

A

Fetal Presentation

Cephalic
Breech
Shoulder

47
Q

Presentation of any part of the fetus head during labor

A

Cephalic

Vertex

48
Q

Relationship of fetal parts to one another all joints in flexion

A

Fetal Attitude

49
Q

Relationship of cephalocaudal axis( spinal column) of fetus to the cephalocaudal axis of mother- transverse, parallel

A

Fetal Lie

50
Q

Most common fetal presentation

Happens 97% of the time

A

Cephalic

Vertex- area between the anterior and posterior fontanelles - most common

51
Q

Head is in neutral position and top of head is presenting part

A

Military

52
Q

Head partially extended and brow is presenting part

A

Brow

  • Tough on baby’s neck, could have neck or shoulder injuries during delivery
53
Q

Head is hyperextended and face is presenting part

A

Face Presentation

54
Q

Complete flexion of the head allows the subocciptobregmatic diameter to present to the pelvis

A

Vertex Presentation

Presentation refers fetal enter pelvis part of 9.5 cm

55
Q

Median vertex presentation with no flexion or extension

A

Military

Occipitofrontal diameter presents to the pelvis

56
Q

Fetal head is in the halfway extension

A

Brow presentation

Occipitomental diameter which is largest diameter of the fetal head presents to the pelvis

57
Q

Fetal head is complete extension, and the submentobregmatic diamter presents to the pelvis

A

Cephalic

Full extension of the head at 13.5 cm occipitomental diameter

58
Q

Dorsoanterior is or dorsoposterior

A

Shoulder presentation

59
Q

Name 3 types of breech positions

A

Frank breech
Full Breech
Single footing breech

60
Q

Refers to the position of the long axis of fetus in relation to the long axis of mother

A

Fetal lie

3 lies
- Oblique lie
- Transverse lie
- Longitudinal lie

61
Q

Refers to the position of an arbitrarily chosen portion of the fetal presenting part to the right or left side of the maternal birth canal

A

Fetal Position

Determining points in vertex, face, and breech presentations are fetal occiput, chin, and sacrum

62
Q

Fetal position part in either what positions?

A

Anterior
Transversely
Posteriorly

Six varieties of each 3 positions

63
Q

Name Fetal vertex presentations

A

ROP LOP

ROT LOT

ROA LOA

64
Q

Categories of fetal presentation

A

ROA ROT ROP

LOA LOT LOP

RMA RMP

LMA LSA LSP

65
Q

Anterior Asynclitism

A

Anterior parietal

66
Q

Normal synclitism

A

Pelvic inlet plane

Occipital frontal plane

67
Q

Posterior Asynclitism

A

Posterior parietal

68
Q

Fetal head is directed toward the pelvis but can still easily move away from the inlet

A

Floating

69
Q

Fetal head dips into the inlet but can be moved away by exerting pressure on the fetus.

A

Dipping

70
Q

Biparietal diameter of the fetal head is in the inlet of the pelvis.

A

Engaged

Presenting part is the occiput at level of ischial spine- zero

71
Q

______________ affects the woman’s anatomic and physiologic adaptations to labor

A

Position

Frequent changes in position
- Relieve fatigue
- Increase comfort
- Improve circulation

Laboring woman should be encouraged to find positions most comfortable to her

72
Q

Role of emotions in labor

Tension and fatigue

Experience, preparation, and culture

A

Psyche

73
Q

Process of moving fetus, placenta, and membranes out of the uterus and through the birth canal

A

Labor

74
Q

________________ ____________ take place in woman’s reproductive system days and weeks before labor begins

A

Various changes

Labor can be discussed in terms of mechanisms involved in process and stages woman moves through

75
Q

Seven cardinal movements of mechanism of labor that occur in vertex presentation

A

Engagement
Descent
Flexion
Internal rotation
Extension
External rotation - Restitution
Expulsion- Birth

76
Q

Woman progresses through stages of labor, various body system adaptations cause her to exhibit both objective and subjective symptoms

A

Maternal Adaptation

77
Q

Physiologic Adaptation to Labor

A

Maternal adaptation

  • CV changes
  • Resp. changes
  • Renal changes
  • integumentary changes
  • Musculoskeletal changes
  • Neurologic changes
  • GI changes
  • Endocrine changes
78
Q

Signs of preceding labor

A

Lightening
Blood show
Energy spurt
Braxton hicks contractions
Loose stools

79
Q

Onset of true labor can not be ascribed to single cause

Many factors involved including changes in maternal uterus, cervix, and pituitary gland

A

Onset of Labor

NURS ADN004 Maternity (11 decks)

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