Maternity week 3-2 Flashcards by Amanda S.

optimal time for pregnancy - age

20-35 years

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spontaneous abortion - causes (acres of spontaneity)

20% with increased age (check this), gest. diabetes, c-section, placenta acreta (placenta grows through uterine wall into abdomen and connects to bladder, intestines, etc)

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5 Ps

passenger, passage, powers, position, psychological adapations

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passageway

Pelvis structure
Birth Canal (Soft Tissues) Laboring Positionf

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true pelvis measures from..

symphaiss pubis to top of coccyx

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false pelvis

look this up

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pelvis structure

biggest reason women can not have a vaginal birth

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2nd most common reason woman can’t have vaginal birth - birth canal (2nd most common cervix)

if cervix is still there, can’t have baby.

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diagnonal conjucate

this is the symphaiss pubis to top of coccyx. should be 11.5 cm

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different shapes of pevlic bone (platepus is short)

gynecoid (this is the good one), android (20% of women) (more like a male pelvis - poor labor progress), anthropoid (25%) (oval), platypelloid (3%) (short and wide, difficult descent)

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soft tissues - cervix

can create huge barrier if not dilated all the way

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soft tissue - pelvic floor muscles

create some resistience and help rotate the baby

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soft tissue - vagina

might have some lacerations due to size

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power

contractions

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labor is defined

cervical change from regular contr. that increase in strength, cervical change - either effacement and dilation (usually occurs at the same time, but not necessarily. the more babies a women has had, it will go down, maybe 50.***ON TEST

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SIGNS PRECEDING LABOR

LIGHTENING (uterus and fetus)
BLOODY SHOW (blood in the mucus)
RUPTURED MEMBRANES (PROM - ruptures before labor)
BRAXTON - HICKS CONTRACTIONS BURST OF ENERGY (nesting syndrome)
FALSE LABOR (not changing cervix w/ contractions makes them false)
INCREASED VAGINAL DISCHARGE PROM

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True Labor - where is the pain located? (it’s truly in my back to my abdomen)

UC’s- regular, stronger longer, closer, more intense if walking
Cervix- effaces and dilates (we won’t get into this) , anterior position
Fetus becomes engaged
Felt in low back radiate to abdomen (can be a sign of true labor, baby hasn’t rotated yet and she feels head hitting lower back)

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False Labor - where is it felt?

UC’s- irregular or regular temporarily, may stop with position change
Cervix- no change in efface & dilatation
Fetus- not usually engaged
felt in back or abdomen above naval cervix

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category 2

slower baseline, good variability. absent

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copy page 9

here

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category 3

absent baseline variability. recurrent late decelerations. this is critical - call provider and prepare for a c-section immediately.

category 1

baseline - 110 - 160

late decelerations - the number (30 min late)

gradual onset - > 30 seconds from onset to nadir

nadir

lowest point of contraction

late and early are

ok, decelerations

primary powers

uterine contractions, involunarty, signal beginning of labor

secondary powers (abdomen is second)

abdominal muscles, voluntary bearing down

contractions

can you feel when they are notices on a graph (goes up)

presentation

is the part of the body that enteres teh pevlic first. cephalic (vertex) breech shoulder (baby is laying transversely)

presenting part is

the part of the fetal body felt first on the exam

fetal lie is the

relation of the spine of the fetus to the spine of the mother. longitudinal/vertical, transvers, bolique

we don't want

extension - too hard to get baby out.

attitude is the

realtionship of fetal parts to itself. general flexion and extension

position is the

relationshiop fot he presenting part to the 4 quadrants of the motehr pelvis

position - 3 letters

side of pelvis (R or L) presenting part (O, M, Sa, A) relation to anterior or posterior (A or P or T) we want it to be anterior.

MECHANISMS OF LABOR: 7 CARDINAL MOVEMENTS THAT OCCUR IN A VERTEX PRESENTATION -

just know there are 7.

SIGNS PRECEDING LABOR

LIGHTENING BLOODY SHOW RUPTURED MEMBRANES BRAXTON - HICKS CONTRACTIONS BURST OF ENERGY FALSE LABOR INCREASED VAGINAL DISCHARGE PROM

4 stages of labor

1-4 (these will be on exam)

stage 1 - from what to what?

onset of regular contractions to the full dilateion of cervix

stage 2

full cervical dilateion to the birth of the baby

stage 3

birth fo baby to birth of placenta

stage 4

brith of placenta to reestablish homeostasis

PHYSIOLOGIC ADAPTATION TO LABOR

Heart rate 110-160 HR provides information about oxygenation of the fetus and uteroplacental blood flow Responds to changes in PCO2, PO2 and other factors

PHYSIOLOGIC ADAPTATION TO LABOR - MATERNAL

Heartrate increases WBC increases Respiratory Rate increases Renal – paresthesia, difficulty voiding Neuro- endorphins GI- hypomotility Endocrine-hormone changes Cardiac output increases (30-50% 2nd stage) BP increases

PHYSIOLOGIC ADAPTATION TO LABOR

WBC up to 25,000 – normal Renal-difficulty voiding, loss of sensation, Neuro- euphoria, amnesia, elation. Raises the pain threshold. GI- Nausea, vomiting, belching Endocrine-decreased progesterone, increased estrogen, prostaglandins, oxytocin, increased metabolism, decreased blood glucose Supine hypotension

PHYSIOLOGIC ADAPTATION TO LABOR

POSITION OF LABORING WOMAN - what about squatting?

CHANGE POSITIONS FREQUENTLY *RELIEVES TENSION AND FATIGUE *INCREASE COMFORT *IMPROVE CIRCULATION UPRIGHT POSITION: * GRAVITYASSISTSWITHFETUSDESCENT * STRONGERCONTRACTIONS * IMPROVES MATERNAL CARDIAC OUTPUT squatting - increased risk of lacerations

draw lab before epidural to check for - if what is too low?

low platelets - if platelets are too low, they won't do an epidural.

5 other Ps

Position (Maternal) Psychological Response Philosophy Partners Patience

PSYCHOLOGICAL RESPONSE

BACKGROUND COPING MECHANISMS SUPPORT SYSTEM PREPARATION FOR LABOR SOCIO-CULTURAL INFLUENCES POSITIVE-NEGATIVE INFLUENCES

ischeal spines

If the presenting part is palpated higher than the maternal ischial spines, a negative number is assigned; if the presenting fetal part is felt below the maternal ischial spines, a positive number is assigned, denoting how many centimeters below zero station