Antepartum exam 2

Question 1

Five factors that affect labor

Answer 1

Powers (contractions)
Passageway (birth canal)
Passenger (fetus & placenta)
Position of mother
Psychological response

Question 2

Explain the movement of Uterine contractions

Answer 2

Coordinated:

Fundus and move toward the cervix

Question 3

List and describe the parts of the contraction cycle

Answer 3

Increment-begins
peak
decrement-declines

Question 4

Contractions cause the cervix to:

Answer 4

Effacement: thinning 0-100%

Dilation-streching 0-10cm

Question 5

Ferguson reflex

Answer 5

neuroendocrine reflex of uterine contractions initiated by:

pressure on cervix/vaginal walls

Question 6

How are contractions measured

Answer 6

Frequency- minutes=beginnning of one to the beginning of the next one
Duration-seconds
Intensity- mild (nose)
moderate (chin)
strong (forehead)

Question 7

During which stage of labor does the women bear down, or the woman adds her voluntary efforts to propel the fetus through the pelvis?

Answer 7

2nd stage

Question 8

What can be determined by the social spines of the pelvis?

Answer 8

The position of the baby

Question 9

What is the most important pelvis in childbirth and list its subdivisions

Answer 9

True pelvis:
Inlet-upper pelvic opening
Midpelvis-pelvic cavity
Outlet-lower pelvic opening

Question 10

At what number station is the fetal head engaged?

Answer 10

0

Question 11

fetal station during childbirth is measured in plus and minus where minus is?

Answer 11

bad plus is good

Question 12

What factors of the Passenger or fetus effect labor?

Answer 12

Size of head
Presentation-part that enters inlet
Lie-
Attitude
Position-of head in inlet=vertex, sinciput, brow

Question 13

List the fetus presentations and describe

Answer 13

Cephalic: head, vertex, brow, or chin
Breech: Frank, full, single footling
Shoulder

Question 14

fetal head at term measures

Answer 14

9.5 cm

Question 15

Define fetal lie and Attitude

Answer 15

Lie: Longitude of fetus to longitude of mom
Attitude: relation of fetus body parts to another-flexion is normal

Question 16

What type of lie can vaginal birth not occur?

Answer 16

transverse

Question 17

Frequently changing positions of mother relieves

Answer 17

fatigue

increases comfort & circulation

Question 18

Maternal catecholmines secreted in response to anxiety or fear can?

Answer 18

inhibit uterine contractility and placental blood flow

Question 19

A woman with a small pelvis (passage) and a large fetus (passenger) can have a normal labor and birth if?

Answer 19

Fetus is ideally positioned

Uterine contractions & bearing down efforts (powers) are vigorous

Question 20

Signs before labor

Answer 20

Braxton Hicks 
Lightening 
Bloody show
Increased vaginal secretions due to fetal pressure causing vaginal mucosa congestion
Energy spurt
Small weight loss

Question 21

Difference between true labor and false labor

Answer 21

Change in:
Behavior
Contractions

Question 22

List and describe the stages of labor

Answer 22

Early: 3 cm excited pt
Active: 4-7 cm; Effacement= 100% more serious

Transition: 8-10 cm; short but intense, signs are-urge to push, leg tremors, N & V

Question 23

7 cardinal signs of labor that occur in vertex presentation

Answer 23

Engagement – Presenting part at ischial spine.
Descent – present part through the true pelvis
Flexion – of head
Internal rotation – allows largest fetal head diameter to match largest maternal pelvic diameter.
Extension – of fetal head as it passes beneath the mother’s symphysis.
Restitution and external rotation – of the fetal head to allow the shoulders to rotate internally to fit the mother’s pelvis
Expulsion (birth) – of shoulders, body and head.

Question 24

List and describe the stages of labor

Answer 24

1: dilation begins to full dilation
2: full dilation to birth
3: placental separation and expulsion
4: first 2 hours after birth

Question 25

Traits of the 3rd stage of labor

Answer 25

``` Firmly contracting fundus Uterus shape change Sudden gush of dark blood Lengthening of umbilical cord Vaginal fullness Shiny Schultz or Dirty Duncan (placenta) ```

Question 26

The smallest anterior diameter to help the head fit through the true pelvis is the

Answer 26

Suboccipitobreymatic: complete flexion of head and chest

Question 27

Define secondary powers

Answer 27

bearing down efforts

Question 28

List the different degrees of vaginal tears

Answer 28

2: Perineal muscle torn and can see anal sphincter 3: both perineal and sphincter torn 4: Perineal, anal sphincter, and rectum torn

Question 29

List the assessments for the 4th stage of labor

Answer 29

hemorrhage S&S VS q15min for first hour Fundal Checks Bladder – a full bladder interferes with the contractions of the uterus. Lochia – saturation of perineal pads (1 per 15 minutes) is a clue that she is bleeding to much.

Question 30

Most common reason for excessive postpartum bleeding is that the

Answer 30

uterus does not firmly contract and compress the open vessels at the placental site.

Question 31

What causes supine hypotension in labor

Answer 31

relationship of ascending vena cava to uterus

Question 32

Common Augmentation methods

Answer 32

Oxytocin | Amniotomy

Question 33

List the indications for augmentation of labor

Answer 33

``` 39 wks or greater HTN ROM w/o UC worsening condition fetal death IGRI Post term ```

Question 34

What are the chemical agents for cervical ripening

Answer 34

Prostaglandin 2 vaginal insert

Question 35

What are the mechanical methods for cervical ripening?

Answer 35

Foley cath Hydroscopic dilators-absorb surrounding fluid Laminaria tents-seaweed

Question 36

What should a nurse monitor for when giving oxytocin

Answer 36

``` Placental abruption Uterine rupture C/S Postpartum hemorrhage Infection Fetal hypoxemia & acidemia ```

Question 37

What stages of labor is visceral pain felt?

Answer 37

1st & 3rd

Question 38

somatic pain is localized and felt at which stage in labor

Answer 38

2nd

Question 39

List nonpharmalogical methods of relieving pain in childbirth

Answer 39

dick-read says to clock fear Lamaze-relax bradkey says deep breathing w/ partner