- prod by fetal adrenal glands - incr + acts on placenta to decr progesterone + incr prostaglandin

time from start of 1 contraction to the start of another - in minutes ex) occurring Q 3-4 mins

time from start 1 contraction to end of contraction - in seconds ex) lasts 40-50 seconds

Chapter 8 - Labor triggers + 5 P Flashcards by jessica quintos

uterine muscles are stretched to the threshold point, leading to the release of…

prostaglandin + oxytocin

>stim contraction

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increased pressure on the cervix stim the ____ causing the release of ___ by the ___

nerve plexus> oxytocin> pituitary gland

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progesterone effects

-quieting effect on uterus

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oxytocin + prostaglandin MOA

inhibit calcium binding in muscle cells
>incr intracellular calcium levels
>activate contraction

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Maternal labor triggers

1 incr estrogen
2 incr oxytocin
3 incr prostoglandins
4 decr progesterone

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as placenta ages, it begins to ____, triggering ____

deteriorate> invitation of contraction

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Fetal labor triggers

1 placenta ages/deteriorates
2 synthesis of prostaglandins
3 incr in fetal cortisol> decr progesterone + incr prostaglandin

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fetal cortisol

prod by fetal adrenal glands

- incr + acts on placenta to decr progesterone + incr prostaglandin

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Factors affecting labor

[5 P’s]

Powers
Passage
Passenger
Psyche
Position

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Power

involuntary UC + voluntary pushing/bearing down

-propels + delivers bb + placenta fr uterus

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pacemakers in the uterus

signals to posterior pituitary to secrete oxytocin + stim contraction

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how does contraction affect upper + lower uterine?

upper: contracts pushing bb down
lower: less active, becomes thinner

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___ is responsible for dilation + effacement of cervix in _____ stage of labor

UC> first stage

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each contractions has a

allows woman + myometrium to pause for a rest

that was temporarily reduced during contraction phase

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during the contraction phase, the BF…

to the uterus + placenta is temporarily reduced

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during the resting phase or uterine relaxation phase

allows blood flow to return to uterus + placenta
much of fetal xchange of O2 + nutrients + wastes occurs
rest for mom + myometrium

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w every contraction, ___ of blood leaves the _____ + moves back into ____

500 mL> utero-placental unit> maternal circulation

–gets rid of waste + replenishes O2

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UC is described by…

frequency
duration
intensity

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UC Frequency

time from start of 1 contraction to the start of another

in minutes
ex) occurring Q 3-4 mins

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UC duration

time from start 1 contraction to end of contraction

in seconds
ex) lasts 40-50 seconds

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UC Intensity

mild (tip of nose, easily intended)
mod (chin, resistant to indentation)
strong (forehead, cannot be intended)

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the cervix is considered fully/completely dilated when it is

10 cm

-can no longer be palpated on vaginal examination

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effacement

the shortening + thinning of the cervix

-measured by percentage

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Ferguson reflex

the urge to push/bear down

-activated when the presenting part stretches the pelvic floor

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effects of estrogen + relaxin during labor

softens cartilage + incr elasticity of the ligaments

station

refers to the relationship of the ischial spines to the presenting part of the fetus -for assessing fetal descent during labor

station 0

the narrowest diameter the fetus must pass thru

major factors in the birthing process

the relationship of the passenger + the passage

passenger

the fetus - affected by fetal skull, attitude, lie, presentation, position, + size * *the position of the fetus r/t the birth canal is the most critical - size of fetus is less significant

any position other than cephalic

indicated c section

molding

ability of fetal head to change shape + accommodate the pelvis

fetal skull is composed of...

2 parietal bones + 2 temporal bones + frontal _ occipital

biparietal diameter [BPD]

- 9.25 cm - largest transverse skull measurement - most important indicator of head size

fetal attitude or posture

relationship of fetal parts to one another | -noted by flexion + extension of fetal joints

goal fetal attitude/posture during term

- convex fetal back - flexed head w chin against chest - arms crossed over thorax - thighs flexed on abdomen

fetal lie

refers to long axis (spine) of bb in relation to long axis of women

types of fetal lie

longitudinal or transverse

bb cannot be delivered if fetal lie is...

transverse

fetal presentation

determined by part or pole of the bb that first enters the pelvic inlet

times of fetal presentation

cephalic (head first) breech (pelvis first) shoulder (shoulder first)

presenting part

specific fetal structure lying nearest to the cervix

how to further classify cephalic presentation

by degree of flexion or extension of head + neck: - vertex - frontum/brow - face

VERTEX cephalic presentation

head is sharply flexed, chin tucked | -denominator is occiput

FRONTUM/BROW cephalic presentation

partial extension of neck + brow - presenting is brow - denominator is frontum

FACE cephalic presentation

neck is sharply extended, arching to the back like bb is facing up -denominator is chin

Breech presentation

presenting part is butt or feet

how to further classify breech presentation

- complete - frank - footling

COMPLETE breech presentation

- flexion of thigh + legs extended over anterior surface | - criss cross apple sauce

FRANK breech presentation

complete flexion of thighs + legs | -like folding, head to toe

FOOTLING breech presentation

extension of one or both legs so that one or both feet are presenting

Transverse presentation

shoulder is presenting part

compound presentation

fetus assumed unique posture

factors that negatively affect PSYCHE

- unrealistic expectation> cause anxiety - bad past experience - hx of complications - recent immigrants w different birth experiences in their countries - difficulty conceiving + unplanned pregnancies

1st theory of labor support

during labor, women feel uniquely vulnerable bc unfamiliar environment, unfamiliar personnel, lack of privacy >>leads to anxiety >>decr in confidence + competence

2nd theory of labor support

- enhanced passage by encouraging mobility + using gravity | - decr stressed response

anxiiety during labor is assoc w...

``` -high levels of epinephrine> >abnormal FHR >decr UC >low apgar score >longer labor ```

Position

maternal positions during labor + birth

freedom of mvmt

enhance ability to cope w pain

upright position

- great for first stage of labor - gives advantage of gravity in second stage - walking, sitting, kneeling, squatting

benefits of upright position

- decr the compression of descending aorta + ascending vena cava - aids in descent - shorter labors - less severe lacerations - less need for episiotomies - less fatigue - improved circulation

gravity neutral positions

side-lying + hands-knees