Labor/Birth Process (ch16,19 - Exam 2) Flashcards
(91 cards)
1
Q
Passenger assessments during labor
A
- Fetal head
- Fetal lie
- Fetal presentation
- Fetal attitude
- Fetal position
- Station
2
Q
fetal head
A
the head of the baby (hopefully the presenting part)
3
Q
relationship of the fetal spine to the maternal spine
A
fetal lie
4
Q
part of the fetus that enters the pelvic inlet first and leads through the birth canal
A
fetal presentation
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
6
Q
relationship of presenting part to the mother’s pelvis
A
fetal position
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
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
9
Q
how do you want the baby to come out
A
head-first, face-down
10
Q
5 P’s
A
Passenger Passageway Powers Position of the mother Physiological responses
11
Q
Passenger
A
fetus and placenta
12
Q
Passageway
A
birth canal
13
Q
Powers
A
voluntary/involuntary UC
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
15
Q
Bones of Fetal Head
A
- not fused: united by membranous sutures
16
Q
at suture intersection
A
fontanels
17
Q
juncture of frontal and parietal bones
A
anterior fontanel
18
Q
juncture of occipital and parietal bones
A
posterior fontanels
19
Q
largest part of the baby that needs to be delivered
largest transverse diameter of fetal head
A
biparietal (BPD)
20
Q
major fetal presentations
A
Cephalic or Vertex (head)
Breech (buttocks or feet)
Shoulder
21
Q
Vertex Presentations Lie: Presentation: Reference Point: Attitude:
A
Lie: longitudinal or vertical
Presentation: vertex
Reference Point: occiput
Attitude: complete flexion
22
Q
releases relaxin when preparing to deliver
A
mons pubis
23
Q
relaxin
A
makes mons pubis soft when preparing for delivery then will go back to being hard (makes things pliable for delivery)
24
Q
best position to deliver
A
LOA
25
```
Frank breech presentation
Lie:
Presentation:
Reference Point:
Attitude:
```
Lie: longitudinal
Presentation: breech (incomplete)
Reference Point: sacrum
Attitude: flexion (except for legs at knees)
26
cervical complication of frank breech presentation
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)
27
```
complete breech
Lie:
Presentation:
Reference Point:
Attitude:
```
Lie: longitudinal or vertical
Presentation: breech (sacrum and feet presenting)
Reference Point: sacrum (with feet)
Attitude: general fllexion
28
disadvantages of breech presentation
- Not effective at dilating cervix
- Head is the last part to be born
- Umbilical cord can become compressed
shoulder presentation requires c-section
29
fetal lie: spines are parallel as in cephalic or breech
longitudinal or vertical
30
fetal lie: baby spine at right angle to mom (as in shoulder presentation)
transverse
vaginal birth cannot occur
31
```
transverse lie
Lie:
Presentation:
Reference Point:
Attitude:
```
Lie: transverse or horizontal
Presentation: shoulder
Reference Point: scapula
Attitude: flexion
baby will NOT come out vaginal canal
32
fetal attitude: head flexed with arms folded onto chest, legs onto abdomen, back curved in C shape
examiner palpates ______
general flexion
(smallest part of fetal skull diameter)
posterior fontanel
33
fetal attitude: presents wider part of skull to inlet
examiner's finger would palpate the ____
extended
mentum or brow
if chin first, contractions/pushing could break neck
34
to determine fetal position:
- identify the presenting part
| - identify the maternal quadrant the presenting part is facing
35
position abbreviations
1st letter
2nd letter
3rd letter
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
36
LOA
occiput is presenting part
located in left anterior quadrant of maternal pelvis - toward pubis bone
37
Leopold's Maneuver
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
presenting part at ischial spines
engagement
39
-1, -2, -3, -4 station
means above spines
40
+1, +2, +3, +4 station
engaged and below spines
41
most favorable pelvis shape for birth
gynecoid shape
| with fetal head in flexed position for entry at smallest part
42
upper birder of true pelvis
inlet
43
plane of least dimension in the pelvic canal
ischial spines because they protrude into the pelvic canal
44
Primary Powers
Involuntary UC's signal the beginning of labor
| - cause effacement and dilation of uterine cervix
45
secondary powers
voluntary bearing down
46
primary powers:
| lower uterus gradually distends to thin walled
passive segment
47
primary powers:
| exerts force of the contractions
upper uterine segment is thick, muscular wall
48
effacement should be ____% and a ___ station before pushing
100%
| plus station
49
thinning and shortening of cervix
| measured in percentage
effacement (100% = completely effaced)
usually precedes dilation in the nulliparous woman
50
widening of cervical canal to accommodate the head of the baby
dilation (1-10cm)
when the cervix is fully dilated and completely retracted, it can no longer be palpated by the examiner's finger
51
end of first stage of labor
10 cm (completely dilated)
52
shortening and thinning of cervix during the first stage of labor
taken up by the shortening of the uterine muscle bundles of the lower uterine segment
53
stage: cervix dilated 0-5cm
early phase of 1st stage of labor
54
stage: cervix dilates 6-10cm
active phase of 1st stage of labor
55
marks the end of the 1st stage of labor
full cervical dilation (10cm/100% effaced)
56
beginning of one contraction to the beginning of the next contraction, documented as minutes
frequency
57
beginning of the UC to the end of the same UC documented in seconds
duration
58
strength of the contraction (mild, moderate, strong)
intensity
59
resting tone is (sec)
45-60sec
60
maternal urge to bear down (push)
| secondary powers
Ferguson reflex
- mechanical stretching of the cervix when the presenting part of the fetus reaches the perineal floor
61
Ferguson reflex occurs
- 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
premonitory signs of labor
- Braxton Hicks - strong
- Lightening
- Energy increased
- Ripening of cervix (starting to efface)
- Mucus plug expelled
- Bloody show
63
blood-tinged mucus occurs as
effacement rupture cervical capillaries
64
baby moves down
lightening
65
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
false contractions
66
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
true contractions
67
latent (early) phase and active phase (0-10cm)
first stage of labor
68
- cervical changes primarily effacement
(UC gradually increase - 0-5cm)
- more progress in effacement and little increase in descent
latent (early) phase
| 1st stage
69
- rapid dilation and UC gradually increase (6-10cm)
| - rapid dilation and increase rate of descent
active phase
| 1st stage
70
from complete cervical dilation and effacement to birth of infant (2 phases)
2nd stage of labor
71
passive fetal descent ("laboring down")
latent phase
| 2nd stage of labor
72
"pushing phase" (Ferguson reflex)
active phase
| 2nd stage of labor
73
delivery of baby to delivery of placenta
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
Signs of placenta separation
1. firmly contracted uterus
2. uterus changes shape to globular
3. gush of blood from vagina
4. the umbilical cord lengthens
75
stage 3 ends with
the delivery of the placenta
76
shiny shultz
fetal side (closest to the baby)
tree of life - blood vessels, umbilical cord
77
dirty duncan
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
4th stage of labor
recovery
2hr minimum
q15min/1st hr, q30min/2nd hr - check there is no bleeding or clots
79
cardinal movements
mechanisms of labor ( to present smallest diameter of head)
80
7 movements in vertex presentation
1. Engagement
2. Descent
3. Flexion
4. Internal Rotation
5. Extension
6. External Rotation
7. Expulsion
81
engagement
BPD at pelvic inlet
82
descent
measure by station (+ = lower than ischial spines)
83
flexion
head flexes toward chest
84
internal rotation
head rotates to occiput anterior
85
extension
occiput passes under symphysis pubis and head (first the occiput)
86
external rotation (restitution)
realignment of infant head to back/shoulders (back to original position)
87
expulsion (birth)
anterior shoulder under symphysis pubis -> posterior shoulder and body completely emerges
88
maternal physiologic adaptation to labor: CV system
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
maternal physiologic adaptation to labor: Respiratory system
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
maternal physiologic adaptation to labor: GI system
gastric motility decreased as well as absorption of solid foods (blood shunted to major organs)
-> NPO except ice chips
- gastric emptying prolonged
91
maternal physiologic adaptation to labor: Hematopoietic system
leukocytosis (WBCs increase r/t stress)
| -> fibrinogen increase (keep mom from hemorrhaging)
