Exam 2 - Study Material (Intrapartum) Flashcards
What are some maternal factors that trigger labor?
Maternal factors
- ◦Stretched uterine muscles & release of prostaglandins
- ◦pressure on cervix stimulates nerve plexus → oxytocin
- ◦> estrogen → stimulates uterus to contract
- ◦Withdrawal of progesterone = < quieting
- ◦> release of oxytocin + prostaglandins = inhibit CA binding → contractions activated
- ◦Surge of oxytocin → contractions
What are some fetal factors that trigger labor?
- Placental aging → triggers contractions
- Fetal membranes synthesize prostaglandins → contractions
- ↑Fetal cortisol (adrenal glands) → < progesterone → > prostaglandins → contractions
What are the premonitory signs of labor?
- Lightening
- Braxton-Hicks (will go away when walking) vs. true labor contractions (they will not go away when walking)
- GI changes (diarrhea, nausea, indigestion)
- Backache
- Bloody show (brownish or blood tinged)
- Spontaneous rupture of membranes
What are 5 factors affecting labor?
- Powers (the contractions)
- Passage (the pelvis)
- Passenger (the fetus)
- Psyche (the response of woman)
- Position (maternal postures and physical positions to facilitate labor)
What is effacement?
- It is the thinning and shortening of the cervix that occurs during labor
- At 100% effacement, the cervix is paper-thin
What is dilatation/dilation?
It is the widening of the cervical external os from less than 1 cm, to full dilatation (approx. 10 cm) to allow birth of a full term fetus
What is a placenta previa?
- Low-lying placenta may cause the baby to assume a transverse lie
- Placenta previa can be associated with breech presentation, this increases the chances of being in a breach
- May also impede descent of a vertex baby
During the intrapartum period what would you observe for in the cervix and vagina?
}Cervix:
◦Cervical Scarring
LEEP, conization, biopsy
◦Causes firm or “purse-string” consistency
- ◦Prolonged effacement period followed by rapid dilatation once tissue softens
}Vagina:
- ◦Obstructions
- ◦“Tissue Dystocia”
What is a fetal “lie” and what are the different types?
Definition: the relationship of the fetal long axis to the long axis of the mother
Types:
- Vertical/Longitudinal (normal)
- head first
- Vertical/Longitudinal (variation)
- breech
- Perpendicular (abnormal)
- Transverse (spines make a T )
- oblique
What is fetal presentation and what are the different types?
Definition: the leading or most dependent portion of the fetus.
Types:
- Cephalic
* Vertex, Brow, Face - Shoulder
- Breech
* Frank (feet up), Complete (both feet + sacrum), Footling (just a foot/feet)
What are some options of a breech at term?
External Cephalic Version
Turning the fetus
Requirements:
- Normal fetus with reassuring FHR tracing
- Adequate amniotic fluid
- Not in labor
- Presenting part not engaged
Default option: cesarean delivery
}Manipulating the fetus in order to turn it to head first
}Procedure: IV, ultrasound, terbutaline (to relax uterus), Rhogam (if Rh-negative), provide for emergency C-S.
}Risk: separation of the placenta, uterine rupture, fetal-maternal hemorrhage, failure.
}Very painful for the mother
What is fetal position and what are the different types?
Definition: the relationship of the presenting part to the specific area of the woman’s pelvis
Types:
- Right (R) or Left (L) of maternal pelvis
- Occiput (O), Mentum (M), or Sacrum (S) of fetus
- Anterior (A), Posterior (P), or Transverse (T) of maternal pelvis
What are some position and presentation issues with labor?
Position: Occiput Posterior “sunny side up”
- Longer labors
- Spontaneous or assisted rotation to OA
- Some feel that sedentary behavior in Mom ↑ this
Compound Presentation: more than just a head….
- 1:700 deliveries
- Associated with umbilical cord prolapse 15% to 20% of cases
- More than just a head comes out of the mother, increased risk of an umbilical cord prolapse –> Emergency (lift presenting part off of cord)
What are sutures?
- They are the meetings of the bones of the fetal skull
- Covered by a membrane
What are fontanelles?
- Fontanelles are the space where two sutures meet
- Covered by a membrane
- You never want to put a scalp electrode on his scalp
Cabit = fluid
What is fetal attitude?
Definition: posturing of the joints and the relationship of the fetal body parts (chest, chin, arms) to each other.
}Flexion - normal fetal attitude when labor begins
}Extension increases diameters
}
What are primary “powers” (involuntary)?
Primary (involuntary) Contractions:
- Frequency (Beginning of one to the beginning of another)
- Duration (beginning from one to end of it)
- Intensity (How strong it is)
- resting tone (Important because of oxygenation to baby)
What are secondary (voluntary) contractions?
maternal bearing-down efforts
Describe the frequency of contractions
Timed from the START of one contraction to the START of the next
Describe the duration of contractions
Timed from the START of the contraction to the END of that contraction
What are some losses experienced in labor?
- Privacy
- Control of Situation
- Control over Bodily Functions
- Loss of Current Family Constellation
- Couples become parents, parents of one become parents of two, etc
What is “engagement”
Occurs when the biparietal diameter is at or below the inlet of the true pelvis
What are the physiological changes of labor?
a.> BP, Increased cardiac output, Fluid and electrolyte loss, Diaphoresis, Hyperventilation & Elevated temperature
What are the mechanisms of labor?
- Engagement
- Descent
- Flexion
- Internal rotation
- Extension
- External rotation
- Expulsion
What is the decent of labor?
What is the flexion of labor?
Chin to chest to < diameter
What is the internal rotation of labor?
c. Process of alignment of fetal long axis to
maternal long axis
What is the extension of labor?
a. presenting part pivots beneath symphysis pubis with the birth of the head
What is the expulsion of labor?
What is labor and how many stages are there?
Labor is the process in which the fetus, placenta, and membranes are expelled spontaneously
4 Stages of labor
When does stage 1 of labor occur?
- Begins with onset of labor and ends with complete cervical dilation
- Has 3 phases, latent, active, and transition phase
Describe the active phase of the 1st stage of labor
- Average dilation 1.2 cm/hr depending on gravida
- Dilation progresses 4–7 cm, 40–80% effacement
- Fetal descent
- Intense contraction q 2–5 min, lasting 40–60 sec
- Increase in pain
- Medical interventions
- Nursing actions
Describe the latent phase of the 1st stage of labor
- ◦Cervix 0–3 cm dilation, 0–40% effacement
- ◦Contraction every 5–10 min, mild intensity, lasting 30–45 sec
- ◦Discomfort described as feelings of strong menstrual cramps
- ◦Medical interventions
- ◦Nursing actions
Describe the transition phase of the 1st stage of labor
- Dilation from 8 to 10 cm, 100% effacement
- Contractions intense, q 1–2 min lasting 60–90 sec
- Exhaustion, difficulty concentrating
- Bloody show
- N/V, backache, diaphoresis, and trembling
- Strong urge to bear down
- Medical interventions
- Nursing actions
What are some medical interventions for the 3 phases during the 1st stage of labor?
- Latent phase: orders for lab tests, IV or saline lock, intermittent fetal monitoring
- Active: ROM, FHR monitoring, apply fetal scalp electrode or Uterine transducer PRN, Pain management, Evaluate labor progression
- Transition: AROM, assess fetal position & cervix; prepare for delivery
When does the 2nd stage of labor occur?
Begins with complete cervical dilation and ends with delivery of baby
What are some behaviors during the 2nd stage of labor?
- Urge to bear down is strong
- Pushing feels more productive to many mothers; they are eager to push
- Exhausted mothers may find the exertion overwhelming
- Burning as head crowns often causes fear of “splitting open”
- Pushing causes very intense sensations that can frighten unprepared mothers
What are some characteristics of the 2nd stage of labor?
- Complete dilatation
- Sudden burst of energy, improved focus
- Shorter duration with multips than primips
- Intense contraction every 2 min, lasting 60–90 sec
- Increase in bloody show
- Perineum flattens, with bulging rectum and vagina
- Medical interventions
- Nursing actions
-
What are some nursing interventions during the 2nd stage of labor?
- Prepare radiant warmer for newborn - baby blankets, labels.
- Adjust lighting and obtain/set up table
- Call anesthesia/ NICU if necessary
- Inform pt of progress and events
- When physician at bedside, position pt
- Prep perineum as requested
- Document delivery time & watch for NB void
What is the 3rd stage of labor?
- Period involving separation and expulsion of placenta/membranes
- Lasts 5–20 min
- Medical interventions
- Nursing actions
