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TEST 2 > Intrapartum > Flashcards

Intrapartum Flashcards

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1
Q

Labor is a physiological event, involving sequential changes within the

A

myometrium, decidua, & cervix

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2
Q

Name the 6 signs of PREMONITORY SIGNS OF LABOR

( s/s labor is near)

A
  • Cervical Changes
  • Lightening- Fetus descend into true pelvis
  • INCR. Energy Level
  • Bloody Show
  • Braxton Hicks Contr.
  • SROM
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3
Q

Cervical changes (dilation) occur

A

1 month - 1 hr BEFORE labor begins.

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4
Q

Cervical changes include

A
  • Shortened, thinned segment
  • Effacement - softer, more stretchable
  • Dilation
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5
Q

Lightening may occur

A

2 weeks or more bEFORE labor begins

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6
Q

S/S of lightening occuring

A
  • Improvement in breathing
  • May experience:
    -increase Pelvic pressure
    -Leg cramping
    -Dependent edema Lower extremities
  • Low back discomfort
    -increase Vaginal discharge
  • Urinary frequency
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7
Q

INCREASE in energy levels

A
  • occurs 24 - 48 hrs BEFORE onset of labor
  • Mom begins to prep for childbirth
  • Increase of epinephrine, decr of progesterone
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8
Q

Increased energy levels is called

A

NESTING

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9
Q

BLOODY SHOW sign of labor

A
  • pressure ruptures cervical capillaries
  • Expulsion of Mucous plug
  • Mucus and blood mix= Pink-tinged secretions
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10
Q

What do Braxton Hicks Contractions do?

A
  • become STRONGER AND MORE FREQUENT
  • FUNDUS feels Tightening or pulling sensation
  • felt in abdomen & groin then spread downward
  • Cervix moves from post. to ant. position.
  • Assist w/ cervical ripening & softening
  • Irregular
  • Last 30 secs to 2 min.
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11
Q

Spontaneous Rupture of Membranes (SROM) is

A
  • rupture of membranes with loss of amniotic fluid prior to the onset of labor.
  • begin labor w/i 24 hrs
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12
Q

WHat to expect during SROM sign of labor

A
  • labor begins within 24 hrs
  • Sudden gush or a steady leakage of amniotic fluid
  • Risk for infection & Danger of cord prolapse
  • Advise women to notify HCP & get evaluated
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13
Q

True vs false labor

A
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14
Q

Factors Affecting the Labor Process

A
  • Passanger (Fetus and placenta)
  • PASSAGEWAY (maternal pelvis and soft tissues)
  • POWERS (contraction)
  • Position (moms position)
  • psyche
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15
Q

different types of pelvic shape becomes determining factor for

A

vaginal birth.

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16
Q

Pelvis shape is determined by 4 MAIN SHAPES

A
  1. GYNECOID
  2. ANTHROPOID
  3. ANDROID
  4. PLATYPELLOID
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17
Q

TYPE OF PELVIS:

  • True female pelvis
  • Less common in men
  • Most favorable for VB
  • Allows early & complete fetal internal rotation during labor
A

GYNECOID PELVIS

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18
Q

TYPE OF PELVIS:

  • Common in men & non-white women.
  • ‘Deep pelvis’- oval inlet & long sacrum
  • Wider AP diameter than transverse)
A

ANTHROPOID PELVIS

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19
Q

TYPE OF PELVIS:

  • Male-shaped pelvis
  • Funnel shape
  • Slow fetal head decent
  • Failure of fetus to rotate
  • Poor prognosis for VB, lead to CS
A

ANDROID PELVIS

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20
Q

TYPE OF PELVIS:

  • Least common type
  • Difficult for fetus to descend
  • Labor prognosis is poor
  • Frequent arrest at inlet
  • Not favorable for VB
A

PLATYPELLOID (FLAT) PELVIS

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21
Q

Important PASSANGER factors are -

A
  • Fetal head (size & presence of molding)
  • Fetal attitude (POSTURING: degree of body flexion)
  • Fetal lie (SPINE of fetus vs SPINE of mother)
  • Fetal presentation (first body part in inlet- Presentation part)
  • Fetal position (relationship to maternal pelvis)
  • Fetal station
  • Fetal engagement (head in pelvic inlet)
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22
Q

Fetal Head factors

A
  • Cranial bones
    -Not fused, soft & pliable
    -2 frontal, 2 parietal, & 1occipital bone
  • Sutures present (gaps b/t cranial bones)
  • Molding: elongated shape of fetal sjull at birth
  • Caput Succedaneum- Fluid collection in the scalp
  • Cephalohematoma- Blood collection beneath scalp
    -reabsorbed over 6-8 weeks
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23
Q

Fetal head diameter include

A
  1. Occipitofrontal
  2. Occipitomental
  3. Suboccipitobregmatic (9.5 cm)
  4. Biparietal (9.25 cm at term)
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24
Q

Fetal Head Diameters:

  • Largest transverse diameter of fetal skull
  • Distance between two parietal bones
A

Biparietal diameter
9.25 cm at birth

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25
What is CEPHALIC PRESENTATION
* HEAD-FIRST presentation- in pelvis * occurs in 95% of all term births. * "Vertex"
26
Most common Fetal attitude
Flexion: *** All joints flexed** -Back rounded -Chin on chest -Thighs flexed on abdomen * Legs flexed at knees * Most favorable for vaginal birth * **Smallest fetal parts presents to pelvis first** **anything outside these norms is considered ABNORMAL**
27
There are 3 possible Fetal Lies
1. longitudinal 2. transverse 3. oblique
28
Which Fetal Lie is the MOST COMMON
longitudinal
29
THe main 3 FETAL PRESENTATIONS
1. CEPHALIC/VERTEX (head fist) 2. BREECH (pelvis/butt first) 3. SHOULDER (scapula /shoulder first)
30
Cephalic (also known as the VERTEX) presentation has 3 different variations. Name them
1. Military 2. brow 3. Face **basically 3 ways the baby's head can come out during the CEPHALIC presentation**
31
Most common fetal presentation is?
Cephalic presentation.
32
Breech fetal presentation is when
Fetal buttocks or feet come FIRST
33
Challenges at birth with a breeched baby
1. Largest part (skull) becomes stuck in pelvis 2. umbilical cord compressed (stops O2 to baby) 3. buttocks are not cervical dilators (pelvis does not open more)
34
Breeched babys are associated with
* prematurity * placenta previa * uterine abnormalities (fibroids) * congenital anomalities * possible trauma to head.
35
Shulder fetal presentation
* Presents shoulders * Turtle sign- head slowly emerges into perineum but then retrachs back into vagina * **TRANSVERSE LINE POSITION** * Rare: 1 in 300
36
The relationship of a given POINT ON THE PRESENTING PART of the fetus to a designated POINT ON THE MATERNAL PELVIS
fetal position.
37
*Fetal position:* The landmark fetal PRESENTING PARTS include: 4 total
* Occipital bone (O) - Vertex * Chin (Mentum [M]) - Face * Buttocks (Sacrum [S])- Breech * Scapula (Acromion [A]) - Shoulder
38
Documenting: **Vertex** Fetal presentation
Occipital bone (O)
39
Documenting: **Chin** Fetal presentation
Mentum [M]- FACE
40
Documenting: **Buttocks** fetal presentation
Sacrum [S] "Breech"
41
Documenting: **Shoulder** fetal presentation
Acromion [A]- Scapula
42
*Fetal position:* Maternal pelvis is divided in 4 quadrants
* Right anterior (RA) * Left anterior (LA) * Right posterior (RP) * Left posterior (LP)
43
Fetal position FIRST LETTER is
First letter: * Left (L) * Right (R)
44
Fetal position SECOND LETTER is
SECOND LETTER: * O - Occiput * S - Sacrum * M - Mentum * A - Acromion Process * D -Dorsal (fetal back)
45
Fetal position THIRD LETTER is
Third letter * Anterior (A) * Posterior (P) * Transverse (T)
46
Relationship of fetal *presenting part* to level of *maternal pelvic ischial spines*
FETAL STATION
47
Fetal station is measured in
cm
48
**above** ischial spine the numbers are
negative -1 to -4
49
below ischial spine the numbers are
positive +1 to +4
50
The entrance of largest fetal presenting part into smallest diameter of maternal pelvis.
Fetal head engagement
51
Fetal head **engagement**
* Engaged AT **zero** station. * Determined by pelvic exam * largest diameter of fetal head = biparietal diameter * Transverse diameter of maternal pelvis
52
Fetal HEAD Engagement occurs
typically occurs in: * **PRIMIGRAVIDAS** 2 weeeks before term or * **multiparas**- several weeks BEFORE onset of labor or not until labor starts.
53
When fetal engagement has not occurred bc the presenting part is still freeliny moving above pelvic inlet
FLOATING
54
Fetal positional changes as it travels through the passageway
CARDINAL MOVEMENTS
55
Name the 6 cardinal movements
1. Descent 2. flecion 3. internal rotation 4. extension 5. external rotation (restitituion) 6. expulsion
56
Cardinal movement: downward movmnt of fetal heat.
Descent
57
What causes DESCENT movement
* contractions * Pressure of amniotic fluid * Pressure of fundus on fetus’s buttocks or head * Contractions of abdominal muscles (2nd stage) * Extension & straightening of fetus
58
Cardinal movement: * vertex meets resistance from cervix, walls of pelvis or pelvic floor. * Chin TO fetal thorax
Flexion
59
Cardinal movement: * fetal heat (occiput part) meets resistance from one side of pelvic floor. * Head then rotates 45 degrees anteriorly to the midline under symphasis | q
Internal rotation
60
Cardinal movement: * Head emerges under symphysis pubis along with shoulders
extension
61
cardinal movements: * Allows internal rotation of shoulders to fit maternal pelvis
external rotation
62
cardinal movements: * Reducing risk of perineal injury * Manual control of fetus expulsion * Perineal support by HCP
EXPULSION
63
The **primary** powers in labor are
uterine contractions (involuntary)
64
the secondary powers in labor are
use of intra-abdominal pressure
65
What can interfer with intra-abdominal pressure?
* sedated or extremely anxious * compromise effectiveness of powers.
66
what is EFFACEMENT
the **cervix** stretches and gets thinner
67
Effacement: * 2 cm cervix lenght= * 1 cm cervix length = * 0 cm cervix length =
* 0% effaced * 50% effaced * 100% effaced
68
What is Dialation
the diameter of the Cervical os increases from 1 cm to 10 cm.
69
Uterine contractions: Early Labor – (Mild) contractions:
* Last 30 secs * Occur every 5 to 7 min.
70
Uterine contractions: As labor progresses – (Moderate to High) contractions:
Last 60 secs, Occur Q 2 to 3 min.
71
Information to ask when monitoring and assessing uterine contractions
* Frequency - How often * Duration - How long it lasts * Intensity - How Strong
72
best labor maternal POSITION
LITHOTOMY
73
2 ways to manipulate and speed up the process of labor through medical means.
1. AROM (amniotomy) 2. Synthetic Oxytocin (Pitocin)
74
Induction of labor: Used when Fetal head is -2 station or lower with cervix dialated at 3 cm
AROM artificial rupture of membranes (amniotomy)
75
Induction of labor: * Stimulates uterin contractions. * administered piggyback into primary IV lines w/ an infussion pump titrated to uterine activity
Synthetic Oxytocin (pitocin)
76
Pain management
* Pain universal * No negative effect on Fetus
77
Maternal Physioilogic responses include INCREASE of what VS
* HR - 10 to 20 bpm. * CO - 12% to 31% , 50% 2nd stage * BP - 35 mm Hg with contractions * WBC - 25,000 to 30,000 cells/mm3 * RR * Temp. * BMR
78
Maternal Physioilogic responses include DECREASE of what VS
* Blood glucose * Gastric motility & food absorption * Gastric emptying & gastric pH * Muscular aches and cramps
79
Respiratory changes during labor prepare fetus for
extrauterine respiration immediately after birth.
80
labor is divided into _____ stages
4 stages. * 1st stage * 2nd stage * 3rd stage * 4th stage
81
FIRST stage has two phases
latent phase Active phase.
82
what happens in first stage- latent phase?
* From start of reg. cont. to cervical dilation * Cervix dilates 6 cm (sedation prolongs) * Contractions: -Q 5 to 10 min. -Last 30 to 45 secs -Mild pain * Effacement of cervix - 0% to 40%. * May stay home * Contacting their hcp
83
What happens in first stage- active phase?
* **Complete (10 cm) Cervical dilation** * **Effacement complete** * Rate of 1.2 to 1.5 cm/hr * **Fetus descends in pelvis.** * Contractions: -Q 2 to 5 mins -Last 45 to 60 secs -Moderate to strong * Use relaxation & paced breathing
84
2nd stage is called the
pushing stage
85
What happens in the 2nd stage
* From complete dilation to birth of infant * Lasts up to 3 hours * Contractions: -Q 2-3 min or less, -Lasts 60-90 sec. -Strong Intensity -Urge to Push
86
Two ways of conducting the second stage of labor. 2 ways of pushing
1. Directive pushing 2. spontaneous pushing
87
Pushing directed by caregiver epidural associated May be harmful
directed pushing
88
Pushing that: * Follow mother’s natural urge * Natural way of managing second stage * Delay pushing until woman feels an urge to push
spontaneous pushing
89
Stage that begins with the birth of newborn and ends with separation and birth of placenta.
Third stage
90
Third stage consists of two PHASES
1. placental separation 2. placental expulsion
91
What to know about placental separation
* Within 5-30 min post-delivery * Contractions cause the placenta to pull AWAY from uterine wall. * Signs of separation that placenta is ready to deliver: -Uterus rises upward -Umbilical cord lengthens -Sudden gush or trickle of blood -Change in uterine shape | f
92
Placental expulsion:
* Expelled within 2 to 30 minutes * Massage uterus till FIRM * Normal blood loss - **Over 1,000 ml - SEVERE** * If placenta DOES NOT deliver, HCP will assist with removal called **MANUAL EXTRACTION**
93
SPONTANEOUS DELIVER OF PLACENTA OCCURS IN TWO WAYS
1. fetal side or 2. maternal side
94
Placenta delivery: * shiny gray side presenting first * Called the SHINY SCHULTZ
fetal side placental delivery
95
Placenta delivery: * red raw side * ridges * Called duncan mechanism (dirty duncan)
maternal side
96
Begins with completion of the expulsion of the placenta and membranes and ends with the physiologic adjustment and stabilization of the mother.
FOURTH STAGE.
97
FOURTH STAGE
* 1-4 Hrs POST birth * initiates POST PARTUM period * **Uterus**: Should be firm & well contracted
98
Focus of Care during FOURTH STAGE
* Monitor uterus & bleeding * Watch for bladder distention & Venous thrombosis * Attachment promotion

TEST 2 (6 decks)

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