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OB > Labor/Birth Process (ch16,19 - Exam 2) > Flashcards

Labor/Birth Process (ch16,19 - Exam 2) Flashcards

1
Q

Passenger assessments during labor

A
  • Fetal head
  • Fetal lie
  • Fetal presentation
  • Fetal attitude
  • Fetal position
  • Station
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2
Q

fetal head

A

the head of the baby (hopefully the presenting part)

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3
Q

relationship of the fetal spine to the maternal spine

A

fetal lie

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4
Q

part of the fetus that enters the pelvic inlet first and leads through the birth canal

A

fetal presentation

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5
Q

relationship of the fetal body parts to one another (chin flexed to chest, thighs on abdomen, legs flexed at knees = fetal position in utero)

A

fetal attitude

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6
Q

relationship of presenting part to the mother’s pelvis

A

fetal position

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7
Q

presenting part (O,S,M,Sc,A, P, T, R, L)

start with what the presenting part is (middle letter) relationship to mother’s pelvis (R,L = 1st letter), last letter is relationship of presenting part to mother’s spine

A 
O = occiput
S = sacrum
M = mentum (chin)
Sc = scapula
A = anterior
P = posterior
T = transverse
R = right
L = left
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8
Q

relationship of the presenting part to the maternal ischial spines

(where is the baby [head, butt, feet, spine] in relation to the ischial spine)

A

station

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9
Q

how do you want the baby to come out

A

head-first, face-down

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10
Q

5 P’s

A 
Passenger
Passageway
Powers
Position of the mother
Physiological responses
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11
Q

Passenger

A

fetus and placenta

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12
Q

Passageway

A

birth canal

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13
Q

Powers

A

voluntary/involuntary UC

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14
Q

Position of the mother

A

lithotomy

(bring legs back, lean forward, and push like having a BM)

flat on back will lay on vena cava and decrease perfusion to baby

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15
Q

Bones of Fetal Head

A
  • not fused: united by membranous sutures
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16
Q

at suture intersection

A

fontanels

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17
Q

juncture of frontal and parietal bones

A

anterior fontanel

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18
Q

juncture of occipital and parietal bones

A

posterior fontanels

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19
Q

largest part of the baby that needs to be delivered

largest transverse diameter of fetal head

A

biparietal (BPD)

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20
Q

major fetal presentations

A

Cephalic or Vertex (head)
Breech (buttocks or feet)
Shoulder

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21
Q 
Vertex Presentations 
Lie:
Presentation:
Reference Point:
Attitude:
A

Lie: longitudinal or vertical
Presentation: vertex
Reference Point: occiput
Attitude: complete flexion

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22
Q

releases relaxin when preparing to deliver

A

mons pubis

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23
Q

relaxin

A

makes mons pubis soft when preparing for delivery then will go back to being hard (makes things pliable for delivery)

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24
Q

best position to deliver

A

LOA

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25
Q 
Frank breech presentation
Lie:
Presentation:
Reference Point:
Attitude:
A

Lie: longitudinal
Presentation: breech (incomplete)
Reference Point: sacrum
Attitude: flexion (except for legs at knees)

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26
Q

cervical complication of frank breech presentation

A

once the head catches on the cervix, the doctor has to put his fingers into the vaginal canal to separate them so that the cervix doesn’t rip

(cervix = vascular = tear can cause mom to bleed out)

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27
Q 
complete breech
Lie:
Presentation:
Reference Point:
Attitude:
A

Lie: longitudinal or vertical
Presentation: breech (sacrum and feet presenting)
Reference Point: sacrum (with feet)
Attitude: general fllexion

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28
Q

disadvantages of breech presentation

A
  • Not effective at dilating cervix
  • Head is the last part to be born
  • Umbilical cord can become compressed

shoulder presentation requires c-section

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29
Q

fetal lie: spines are parallel as in cephalic or breech

A

longitudinal or vertical

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30
Q

fetal lie: baby spine at right angle to mom (as in shoulder presentation)

A

transverse

vaginal birth cannot occur

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31
Q 
transverse lie
Lie:
Presentation:
Reference Point:
Attitude:
A

Lie: transverse or horizontal
Presentation: shoulder
Reference Point: scapula
Attitude: flexion

baby will NOT come out vaginal canal

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32
Q

fetal attitude: head flexed with arms folded onto chest, legs onto abdomen, back curved in C shape

examiner palpates ______

A

general flexion
(smallest part of fetal skull diameter)

posterior fontanel

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33
Q

fetal attitude: presents wider part of skull to inlet

examiner’s finger would palpate the ____

A

extended

mentum or brow

if chin first, contractions/pushing could break neck

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34
Q

to determine fetal position:

A
  • identify the presenting part

- identify the maternal quadrant the presenting part is facing

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35
Q

position abbreviations
1st letter
2nd letter
3rd letter

A

1st letter = R or L of maternal pelvis

2nd letter = specific presenting part of fetus (Occiput, Mentum, Sacrum, Acromion process/scapula)

3rd letter = location of the presenting part in relation to maternal pelvis (Anterior [symphysis pubis], Posterior [sacrum], Transverse [to mom’s side])

always start with the letter in the middle

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36
Q

LOA

A

occiput is presenting part

located in left anterior quadrant of maternal pelvis - toward pubis bone

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37
Q

Leopold’s Maneuver

A
  1. Determine fetal lie by palpating funds with fingertips
    - Soft round object = buttocks
    - Hard round object = head (cephalic)
  2. Locate fetal back by running fingers along both sides of maternal pelvis
    - Smooth = back
    - knobby = knees, elbows
  3. Presentation = head
  4. Determine attitude of head by facing client’s feet and using both hands to outline fetal head with palms and fingertips - flexion or extension
38
Q

presenting part at ischial spines

A

engagement

39
Q

-1, -2, -3, -4 station

A

means above spines

40
Q

+1, +2, +3, +4 station

A

engaged and below spines

41
Q

most favorable pelvis shape for birth

A

gynecoid shape

with fetal head in flexed position for entry at smallest part

42
Q

upper birder of true pelvis

A

inlet

43
Q

plane of least dimension in the pelvic canal

A

ischial spines because they protrude into the pelvic canal

44
Q

Primary Powers

A

Involuntary UC’s signal the beginning of labor

- cause effacement and dilation of uterine cervix

45
Q

secondary powers

A

voluntary bearing down

46
Q

primary powers:

lower uterus gradually distends to thin walled

A

passive segment

47
Q

primary powers:

exerts force of the contractions

A

upper uterine segment is thick, muscular wall

48
Q

effacement should be ____% and a ___ station before pushing

A

100%

plus station

49
Q

thinning and shortening of cervix

measured in percentage

A

effacement (100% = completely effaced)

usually precedes dilation in the nulliparous woman

50
Q

widening of cervical canal to accommodate the head of the baby

A

dilation (1-10cm)

when the cervix is fully dilated and completely retracted, it can no longer be palpated by the examiner’s finger

51
Q

end of first stage of labor

A

10 cm (completely dilated)

52
Q

shortening and thinning of cervix during the first stage of labor

A

taken up by the shortening of the uterine muscle bundles of the lower uterine segment

53
Q

stage: cervix dilated 0-5cm

A

early phase of 1st stage of labor

54
Q

stage: cervix dilates 6-10cm

A

active phase of 1st stage of labor

55
Q

marks the end of the 1st stage of labor

A

full cervical dilation (10cm/100% effaced)

56
Q

beginning of one contraction to the beginning of the next contraction, documented as minutes

A

frequency

57
Q

beginning of the UC to the end of the same UC documented in seconds

A

duration

58
Q

strength of the contraction (mild, moderate, strong)

A

intensity

59
Q

resting tone is (sec)

A

45-60sec

60
Q

maternal urge to bear down (push)

secondary powers

A

Ferguson reflex

  • mechanical stretching of the cervix when the presenting part of the fetus reaches the perineal floor
61
Q

Ferguson reflex occurs

A
  • when the cervix is 7-10 cm
  • stretch receptors cause release of oxytocin that trigger the urge to push

(educate client that pushing before 10cm could cause a tear in the cervix which will mean emergency surgery)

62
Q

premonitory signs of labor

A
  • Braxton Hicks - strong
  • Lightening
  • Energy increased
  • Ripening of cervix (starting to efface)
  • Mucus plug expelled
  • Bloody show
63
Q

blood-tinged mucus occurs as

A

effacement rupture cervical capillaries

64
Q

baby moves down

A

lightening

65
Q

Contractions:

  • Begin and remain irregular
  • Felt first abdominally and remain confined to the abdomen and groin
  • Often disappear with ambulation and sleep
  • Do not increase in duration, frequency, or intensity
  • Do not achieve cervical dilation
A

false contractions

66
Q

Contractions:

  • Begin irregularly but become regular and predictable
  • Felt first in lower back and sweep around to the abdomen in a wave
  • Continue no matter what the woman’s level of activity
  • Increase in duration, frequency, and intensity
  • Achieve cervical dilation
A

true contractions

67
Q

latent (early) phase and active phase (0-10cm)

A

first stage of labor

68
Q
  • cervical changes primarily effacement
    (UC gradually increase - 0-5cm)
  • more progress in effacement and little increase in descent
A

latent (early) phase

1st stage

69
Q
  • rapid dilation and UC gradually increase (6-10cm)

- rapid dilation and increase rate of descent

A

active phase

1st stage

70
Q

from complete cervical dilation and effacement to birth of infant (2 phases)

A

2nd stage of labor

71
Q

passive fetal descent (“laboring down”)

A

latent phase

2nd stage of labor

72
Q

“pushing phase” (Ferguson reflex)

A

active phase

2nd stage of labor

73
Q

delivery of baby to delivery of placenta

A

3rd stage of labor

report how long in between birth and placenta (if >30min, they may need to manually remove it so that mom’s body doesn’t still think there’s a baby and cause hemorrhaging)

74
Q

Signs of placenta separation

A
  1. firmly contracted uterus
  2. uterus changes shape to globular
  3. gush of blood from vagina
  4. the umbilical cord lengthens
75
Q

stage 3 ends with

A

the delivery of the placenta

76
Q

shiny shultz

A

fetal side (closest to the baby)

tree of life - blood vessels, umbilical cord

77
Q

dirty duncan

A

maternal side (closest to mom)

make sure there are no pieces missing (still in mom)

make sure all clots are out (anything bigger than a quarter is not acceptable)

78
Q

4th stage of labor

A

recovery

2hr minimum

q15min/1st hr, q30min/2nd hr - check there is no bleeding or clots

79
Q

cardinal movements

A

mechanisms of labor ( to present smallest diameter of head)

80
Q

7 movements in vertex presentation

A
  1. Engagement
  2. Descent
  3. Flexion
  4. Internal Rotation
  5. Extension
  6. External Rotation
  7. Expulsion
81
Q

engagement

A

BPD at pelvic inlet

82
Q

descent

A

measure by station (+ = lower than ischial spines)

83
Q

flexion

A

head flexes toward chest

84
Q

internal rotation

A

head rotates to occiput anterior

85
Q

extension

A

occiput passes under symphysis pubis and head (first the occiput)

86
Q

external rotation (restitution)

A

realignment of infant head to back/shoulders (back to original position)

87
Q

expulsion (birth)

A

anterior shoulder under symphysis pubis -> posterior shoulder and body completely emerges

88
Q

maternal physiologic adaptation to labor: CV system

A

CO increase (can ^ up to 51% above pregnancy baseline) - watch for supine hypotension

Intrathoracic pressure increases during pushing in 2nd stage of labor

an average 300-500mL blood is shunted from the uterus into the maternal vascular system

89
Q

maternal physiologic adaptation to labor: Respiratory system

A

hyperventilation r/t increased O2 needs (breathe into brown bag or cupped hands)

  • can cause respiratory alkalosis, hypoxia, and hypocapnia (decrease in CO2)
  • 2nd stage causes O2 consumption to double

(open glottis pushing)
Mom will hyperventilate if they don’t take breaths in between pushing

90
Q

maternal physiologic adaptation to labor: GI system

A

gastric motility decreased as well as absorption of solid foods (blood shunted to major organs)
-> NPO except ice chips

  • gastric emptying prolonged
91
Q

maternal physiologic adaptation to labor: Hematopoietic system

A

leukocytosis (WBCs increase r/t stress)

-> fibrinogen increase (keep mom from hemorrhaging)

OB (35 decks)

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