Factors Affecting L&D

Question 1

Passageway

Answer 1

Ability of pelvis & cervix to accommodate passage of fetus

Question 2

Four pelvis types and most ideal

Answer 2

1. Gynecoid
2. Anthropoid
3. Android
4. Platypelloid

Question 3

Passenger refers to

Answer 3

Ability of fetus to complete birth process

Question 4

Define molding

Answer 4

cranial bones overlap under pressure of the powers of labor and demands of unyielding pelvis

Question 5

What is the largest transverse diameter of the fetal skull?

Answer 5

Biparietal

Question 6

What is the smallest transverse diameter of the fetal skull?

Answer 6

Suboccipitobregmatic

Question 7

Fetal attitude

Answer 7

Relationship of fetal parts to one another, particularly to head

Question 8

Optimal fetal attitude

Answer 8

Flexed

Question 9

Fetal lie

Answer 9

refers to relationship fetal spine (cephalocaudal axis) to maternal spine (cephalocaudal axis)

Question 9

Ideal fetal lie

Answer 9

longitudinal; parallel relation

Question 10

True or false: if a fetal lie is longitudinal it is not breeched

Answer 10

False; breech refers to presentation

Question 11

Fetal presentation

Answer 11

Determined by body part of fetus that enters pelvic passage first + fetal lie

Question 12

What are the 4 general types of fetal presentation?

Answer 12

1. cephalic: head
2. breech: buttocks
3. shoulder
4. compound: another part presents first

Question 13

Which fetal presentation can not be delivered vaginally and why?

Answer 13

Shoulder; it is associated with a transverse or oblique lie

Question 14

Fetal position

Answer 14

Position of fetus in relation to pelvis; where is occiput aiming in pelvis

Question 15

What is the ideal fetal position

Answer 15

right or left occiput anterior

Question 16

Fetal station

Answer 16

relationship of presenting part (head, buttocks) to imaginary line drawn between ischial spines of maternal pelvis

Question 17

Fetal engagement

Answer 17

presenting part at 0 station/level of the ischial spines is engaged
and/or
largest diameter of presenting part reaches or passes through pelvic inlet

Question 18

Why must contractions be assessed?

Answer 18

They are expected to decrease uteroplacental blood flow; could adversely affect oxygen delivery to fetus

Question 19

Contraction timing of false labour

Answer 19

irregular, not occurring close together

Question 20

Contraction strength of false labour

Answer 20

weak, not getting stronger with time or alternating

Question 21

Contraction discomfort of false labour

Answer 21

Front of abdomen

Question 22

Change in activity associated with contractions of false labour

Answer 22

Contractions may stop or slow down with walking or making a position change

Question 23

What to tell patients when suspected they are experiencing false labor?

Answer 23

Drink fluids and walk around to see if the intensity of the contractions change; if the contractions diminish in intensity after either or both stay home

Question 24

7 Premonitory Signs of Labour

Answer 24

1. Lightening 2. Cervical changes - Prostaglandins change cervix from long to short and thin and flexible (ripening) 3. Bloody show 4. rupture of membranes 5. sudden burst of energy 6. loss of 0.5-1kg 7. diarrhea, indigestion, nausea, vomiting

Question 25

What occurs in the 1st stage of labor?

Answer 25

Cervical Changes 0-10cm

Question 26

What physiologic changes occur in the early 1st stage of labour?

Answer 26

- regular mild contractions every 5-10 min - effacement and dilation begin 0-3cm

Question 27

What physiologic changes occur in the active 1st stage of labour?

Answer 27

Contractions increase to every 2-5min Dilation 4-7cm Fetus begins to descend

Question 28

What physiologic changes occur in the transition 1st stage of labour?

Answer 28

Contractions increase Cervix effaces and dilates to 8-10cm Rapid descend of fetus N/V, diaphoresis, increased bloody show

Question 29

What cardiovascular changes occur in labour?

Answer 29

Increased blood pressure with each contraction

Question 30

What respiratory changes occur in labour?

Answer 30

increase O2 demand and consumption mild respiratory acidosis

Question 31

What GI/GU changes occur in labour?

Answer 31

Bladder edema due to pressure from fetal head Delayed motility/emptying

Question 32

What hematological and immune changes occur in labour?

Answer 32

WBC increase, glucose decrease

Question 33

Define the second stage of labour?

Answer 33

10cm to delivery of baby; equated with pushing

Question 34

What intervention occurs with the delivery of the anterior shoulder?

Answer 34

occurs with the delivery of the anterior shoulder? 3 units IV or 10 units IM oxytocin is given between 2nd and 3rd stage to contract the uterus to prevent hemorrhage and to fully expel placenta.

Question 35

Define the 3rd stage of labour

Answer 35

Delivery of baby to delivery of placenta

Question 36

What physiologic changes occur in the 4th stage of labour

Answer 36

- increased pulse and decreased BP r/t * redistribution of blood from uterus and blood loss - uterus contracted between umbilicus and symphysis pubis - shaking chill - urinary retention