Chapter 15 - Family During Labor and Birth Flashcards
(70 cards)
1
Q
Define attitude
A
the degree of head flexion a fetus assumes during labor, or the relation of the fetal parts to each other
2
Q
Define breech presentation
A
fetal presentation in which either the buttocks or feet are the first body parts to contact the cervix
3
Q
Define cephalic presentation
A
fetal presentation in which the head is the first body part to contact the cervix
4
Q
Define dilation
A
widening of the opening of the cervix in labor
5
Q
Define effacement
A
- the thinning of the cervix during labor
- In pramiparous pts effacement occurs before dilation
- Inform the pt of both dilation and effacement to avoid discouragement with perceived lack of progress
6
Q
Define engagement
A
The settling of the fetal head into the pelvis to the level of the ischial spines, during labor
7
Q
Define fetal descent
A
sinking of the fetus in the birth canal just prior to birth
8
Q
Define fetal position
A
the relationship of the presenting part to a specific quadrant and side of a woman’s pelvis
- Vertex presentation - Occiput (O) position is chosen
- Face presentation - Mentum (M) position is chosen
- Breech presentation - Sacrum (S) position is chosen
- Shoulder presentation - Scapula or accromion process (A) position is chosen
9
Q
Define lie
A
- the relationship between the long axis of the fetus with the long axis of the mother
- 99% of fetuses present at the longitudinal lie (the axis of the fetus matches the axis of the mother)
10
Q
Define molding
A
the change in shape of the fetal skull due to uterine contractions pressing the vertex against the not-yet-dilated cervix
11
Q
Defne ripening
A
softening of the cervix with the approach of labor
12
Q
Define station
A
the relationship of the presenting part of the fetus to the level of the ischial spines
- 0 station indicates presenting part has descended to the ischial spines
- -1 to -4 cm indicates presenting part is that distance above the ischial spines
- +1 to +4 cm indicates presenting part is that distance below the ischial spines
- +3 or +4 indicates the head is at the perineum and can be seen if the vulva is separated (crowning)
13
Q
Define transition
A
the end of the first stage of labor, just before the woman experiences pushing sensations
14
Q
Define the p’s
A
The four integrated concepts for successful labor are:
- passage
- passenger
- powers
- psychological outlook
15
Q
Define passage
A
- the mother’s pelvis
- It must be of appropriate size and contour for birth to be successful
- Uterus - cervix - bony pelvic ring - vagina - external perineum
16
Q
Define passenger
A
The fetus
It must be of appropirate size should be in good position and presentation for a successful birth
17
Q
Define powers
A
- Uterine factors or contractions
- they must be adequate for optimum birth
- Assessed according to frequency, duration and strength
18
Q
Define psychological outlook
A
the mother’s outlook or experience of birth
It should be a positive experience
19
Q
Define the sinciput
A
the area over the (fetal) frontal bone
20
Q
Define the occiput
A
the area over the (fetal) occipital bone
21
Q
Define the (fetal) vertex
A
the space between the two fontanelles
22
Q
Define the mentum
A
the chin
23
Q
The common reason for disproportion between fetus and pelvis occurs
A
- due to pelvic structure
- fetal disproportion is most often due to presentation rather than head circumference
24
Q
What is the reason for palpating the fontanelles during labor?
A
- to determine position of the fetal head and if optimal positioning has been acheived for birth
25
The attitude when a fetus presents sinciput first is typically
fetus is presenting at the forehead
attitude/flexion is moderate; chin not touching the sternum
26
The attitude when a fetus presents with the brow is
* moderate/military attitude
* partial extension
27
The attitude when the fetus presents with the face is
poor attitude
poor flexion, complete extension
28
The attitude when the fetus presents in vertex is
* sub**_occipito_**bregmatic presentation
* full flexion (good attitude!)
* chin touching sternum
29
The attitude when the fetus presents at Mentum is
* very poor attitude
* hyperextension
* presenting the cranium at the the widest part (occipitomental)
* vaginal birth may not be possible
30
Define cephalic presentation
* presenting part is the fetal head
* occurs 95% of births
31
Define *caput succedaneum*
* edema on the presenting part of the fetus due to pressure applied during labor and birth
32
Define breech presentation
* presentation by the feet or buttocks
* occur 3% of births
* good attitude with breech births is knees tucked against abdomen
* poor attitude is extension of knees and feet
33
Define footling breech
presentation of one or both feet
34
Define frank breech
presentation of the buttocks with the hips flexed and the knees extended (pike position)
35
Define complete breech
presenting with the buttocks and feet with the thighs tightly flexed against the abdomen
36
Define shoulder presentation
* The shoulder, iliac crest, hand or elbow is presenting
* Occurs 1% of births
* Fetus is transverse lie
* Position may be modified, C-section will be necessary in most cases
37
Causes of shoulder presentation include
* pelvic contractions
* presence of placenta previa
* relaxed abdominal walls
* grand multiparity
38
Fetal position is denoted by a three-part abbreviation. In order, letters denote
* Second letter denotes - the fetal landmark presenting
* First letter denotes - the direction, relative to the mothers body, the fetal landmark is pointing (Left or Right)
* The third letter denotes - the direction, relative to the mothers body, the fetal landmark is pointing (Anterior or Posterior)
39
The cardinal movements of labor are
1. descent
2. fexion
3. internal rotation
4. extension
5. external rotation
6. expulsion
40
Characteristics of Braxton Hicks are
* Irregularity
* Confined to abdomen and groin
* Often disappear with ambulation or sleep
* Do not increase in frequency, duration or intensity
* No cervical dilation
41
Characteristics of True contractions are
* Regularity
* First felt in lower back and sweep in a wave to the abdomen
* Continue regardless of activity
* Increase in duration, frequency and intensity
* Cervix dilates
42
The phases of contractions are
* Increment - increasing
* Acme - maximum strength
* Decrement - decreasing
43
Describe the changes in contour of the uterus as labor progresses
* the uterus elongates and becomes defined in two zones
* The upper zone thickens
* The lower zone thins
44
Define the latent phase of labor
* the first phase of stage 1 labor
* 0 - 3 cm
* average time 6hr nullipara, 4.5 multipara
* encourage activity for the mother
* Time the duration of the latent phase - prolongment indicates complications
45
Define active phase of labor
* 2nd phase of 1st stage labor
* cervical dilation 4-7 cm
* dilation progresses ~1cm/hr nullipara; ~2cm/hr multipara
* Contraction stronger, duration 40-60 sec q 3-5 min
* average length 3hr nullipara; 2hr mulitpara
* Show and spontaneous rupture increase
* Encourage activity and comfortable positioning (except flat on back)
46
Define the transitional phase of labor
* 3rd phase of 1st stage of labor
* cervical dilation 8-10cm
* Contractions peak, duration 60-70 sec q 3-5 min
* N/V may occur
* Mother may be anxious, paniced, irritable and experience loss of control
* irresistable urge to push
47
Define the second stage of labor
* Full dilation and effacement to birth
* ~1hr w/o complications
48
Define the third stage of labor
* the placetal stage
* birth of infant to delivery of placenta
* uterus should be firm and round when palpated after birth
* 5-30 after birth
* 300-500mL blood loss
49
Define Schultze presentation
* presentation of the fetal side of the placenta
* "shiny" Schultze
50
Define Duncun presentation
* presentation of the maternal side of the placenta
* "dirty" duncun
51
Physiological effects on cardiac output by labor are
* Output increases 40-50% during pushing
* Birth causes momentary drop of pressure in the vena cava; the body compensates to increase output to ~80% above prelabor levels
* Output gradually decreases from this value
52
Physiological effects on blood pressure with labor
* systolic pressure rises ~15mmHg with contractions
* \*supine positioning in 2nd stage puts pressure on the vena cava and causes hypotension
* Hypotension can also result from an epidural w/o sufficient hydration
53
Physiological effects on the hematopoetic system
* leukocytes increase from 5,000-10,000 cells to 25,000-30,000 cells/mm3
54
Physiological effects on the respiratory system
* increasing cardiovascular parameters causes increasing respiratory rates
* O2 consumption increases by 100% during stage 2 labor
* risk for hyperventilation
* breathing techniques
* breath into paper bag
55
Physiological changes in temperature regulation
Slight (1oF) increase; diaphoresis to cool
56
Physiological changes to fluid balance
* Insensible water loss increases (diaphoresis, panting)
* Sip fluids, ice chips or candy during labor
57
Physiological changes to the urinary system
* Pressure of the fetal head reduces bladder tone or the ability to sense filling.
* mother should attempt to void q 2hr
* urine concentration occurs; proteinuria not unusual
58
Physiological changes to the musculoskeletal system
* *relaxin*, a hormone released by the ovary causes softening of cartilage
* joints become more flexible
* pelvic ring will stretch up to 2 cm
* related pain to back and pubis
59
Physiological changes to GI system
activity decreases/ceases
60
Physiological changes to the neurological and sensory responses
* pain
* increased pulse
* increased respiratory rate
*
61
Signs of maternal danger related to blood pressure
* systolic BP \>140mmHg or Diastolic BP \>90mmHg
* Increase of systolic BP \>30mmHg or diastolic \>15mmHg
* indicates gestational hypertension
* drop in BP may indicate hemorrhage
62
Signs of maternal danger related to pulse
* Normal rate is 70-80 bpm
* Rate \>100bpm may indicate hemorrhage
63
Signs of Maternal danger related too inadequate or prolonged contractions
* Decreased frequency, intensity or duration
* uterine exhaustion
* Contraction durations \>70 sec
* reduced nutrients and hypoxia in the fetus
64
Signs of maternal danger related to abdominal contour
* a bulge on the lower abdomen indicates a full bladder
* bladder injury possible
* counterpressure by the bladder may prevent descent
65
Signs of maternal danger related to apprehension
* increasing apprehension
* psychological - needs may not be met
* physiological - oxygen deprevation or internal hemorrhage
66
Signs of fetal danger related to heart rate
* HR \>160 bpm or \<110 bpm indicates fetal distress
67
Fetal danger signs related to meconium staining
* a green color in the amniotic fluid caused by loss of rectal sphincter control
* may indicate fetal hypoxia
* not always stress but _always_ report
68
Fetal signs of danger related to hyperactivity
may indicate hypoxia
69
fetal signs of danger related to low oxygen saturation
* Normal saturation is 40-70%
* \<40% can cause acidosis
70
