Week 4 Intrapartal Period Flashcards by Steven Singh

This stage lasts from beginning of dilation to when the cervix is fully dilated

1st stage of labor

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Lasts from full dilation to birth of infant

2nd Stage

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Lasts from the infants birth to the expulsion of the placenta - typically 30 min max

3rd stage of labor

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1st 2 hours after birth

4th stage of labor

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Name the phases of the 1st stage of labor

Phase I- Latent or early phase -0-3/4 cm
Phase 2- Active phase-4-7 cm
Phase 3- Transitional Phase- 7to 10 cm

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Second stage is ________ cm to _________

10 cm to delivery

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delivery of baby to delivery of placenta is the ____ stage

3rd stage of labor

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4th stage of labor is

Recovery period

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What are the 5p’s of labor?

Powers
Passageway
Passenger
Position of the woman
Psychological Responses

Forces that affect the progress of labor and help to bring about childbirth

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Name factors affecting Labor

Primary Powers UCS
- Effacement
- Dilation
- Ferguson reflex- application of pressure to the Ferguson plexus or cervical and vaginal structures

Secondary Powers: Abdominal MS
Valsalva

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How strong and affective are contractions?

Lot of factors involved

Frequency and duration

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Beginning on one contraction to end of the same contraction

Duration

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Beginning of one contraction to the beginning of another

Frequency

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Resting time between contractions allows for placental perfusion

Interval

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How are contractions measured?

External TOCO

Measured peak to peak

Start from top left of uterus and makes it way down and around

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What are the uterine muscle layers?

Outer

Middle

Inner

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Power=

Contractions + Maternal Pushing

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Uterine contractions are initiated by

Pacemakers - uterotubal junction

Contractions meet at the fundus
Contraction waves progress downward

Shortening of muscle fibers
Retractions
Intra uterine pressure

Additional forces- maternal pushing and intraabdominal pressure= pushing out of fetus

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Contractions of the uterus after the cervix has been stimulated

During labor this causes urge to push

Urge to push is caused by baby pressing onto this plexus of nerves

Ferguson Reflex

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During process of labor the myometrium contracts by positive feedback effect

Ferguson reflex

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Strong contraction of myometrium are influenced by what hormone?

Oxytocin

Secreted by posterior pituitary gland and hormone prostaglandins from the placenta

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These contractions expel the fetus from the uterus into the vagina and also constrict blood supply from the

Placenta

After delivery, myometrium contracts to expel the placenta and reduce blood loss where Criss cross fibers compress the blood vessels

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During childbirth baby’s head pushes against sensors near opening of uterus …

Oxytocin is released- stimulates uterine contractions

More contractions- more oxytocin

Only stops when pushing stops

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Estrogen from ovaries induces

oxytocin receptors on uterus

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Oxytocin from fetus and pituitary stimulates

Uterus to contract Stimulates placenta to make prostaglandins Stimulate more contractions of uterus

Contractions of uterus wall force baby head to cervix Stretching of cervix Receptors stretch sensitive nerve cells in cervix send nerve impulses - Control center brain interprets input and releases oxytocin Hit effector muscles in wall of uterus contract more forcefully Baby body stretches cervix more

Ferguson Reflex Positive feedback Stretching of cervix= more oxytocin

Effects of the cervix in the primigravida

Beginning of labor- no cervical effacement or dilation. Fetal head is cushioned by amniotic fluid. Then as cervix effaces, more amniotic fluid collects below the fetal head. Cervix begins to be about one half effaced and slightly dilated. Increasing amount of amniotic fluid creates hydrostatic pressure. Complete effacement and dilation.

How to gauge cervical dilatation?

Nurse places the index and middle fingers against the cervix and determines the size of the opening. Can NOT insert before labor begins. During labor begins cervix begins to dilate. Goes from 1-10cm.

Name the primary and secondary powers affecting labor

Primary - Effacement - Dilation - Ferguson reflex Secondary - Abdominal MS - Valsalva

Valsalva Maneuver

Same maneuver as you would have a bowel movement Closed glottitis - air pressure increases in lungs increases and exerts force against anterior surface of vertebral column- Erector muscle contraction- Fluid pressure in abdomen increases and exerts force against anterior surface of the vertebral column

The passageway or birth canal is composed of?

Bony Pelvis Soft tissues of cervix Pelvic floor Vagina Introitus - External opening to the vagina

Type of continuous and slightly movable joint

Amphiarthrosis

Connected by broad flattened disks of fibrocartilage, of a more or less complex structure, which adhere to the ends of each bone, as in articulations between the bodies of the vertebrae or the inferior articulation of the two hip bones- aka the pubic symphysis.

Symphysis

Passenger of labor includes

Size of the fetal head Fetal Presentation Fetal lie Fetal attitude Fetal Position

What is the major factor in determining the course of the birth?

Fetal Head When there is a mismatch we call that Cephalopelvic Disproportion

Name the landmarks significant in birth

Sinciput Vertex Occiput Mastoid fontanelle Mentum Sphenoid fontanelle Posterior fontanelle

Typical anteroposterior diameters of the fetal skull

Vertex of the fetus presents and the fetal head is flexed with the chin of the chest Smallest anteroposterior enters birth canal- subocciptobregmatic

Transverse diameters of fetal skull

Biparietal Bitemporal

_________ creates the smallest anteroposterior diameter enters the birth canal

Flexion - subocciptobregmatic

How many cm is vertex presentation?

9.5 cm

How many cm is sinciput presentation?

12 cm

What is cm for brow presentation?

13.5 cm

What is fetal attitude?

Relationship of fetal body parts to self Flexion is normal

Normal fetal attitude is

Head flexed forward Chin resting on the chest Arms and legs flexed

Fetal skull is made up number of bones divided by sutures

True Moulding These bones only fuse after birth

Allows bones to?

Overlap during delivery to decrease the diameter this is called moulding. Moulding allows the pelvis to accommodate the fetal head

Referred to the fetal presenting part. Part of the fetus that enters the pelvis first.

Fetal Presentation Cephalic Breech Shoulder

Presentation of any part of the fetus head during labor

Cephalic Vertex

Relationship of fetal parts to one another all joints in flexion

Fetal Attitude

Relationship of cephalocaudal axis( spinal column) of fetus to the cephalocaudal axis of mother- transverse, parallel

Fetal Lie

Most common fetal presentation Happens 97% of the time

Cephalic Vertex- area between the anterior and posterior fontanelles - most common

Head is in neutral position and top of head is presenting part

Military

Head partially extended and brow is presenting part

Brow - Tough on baby's neck, could have neck or shoulder injuries during delivery

Head is hyperextended and face is presenting part

Face Presentation

Complete flexion of the head allows the subocciptobregmatic diameter to present to the pelvis

Vertex Presentation Presentation refers fetal enter pelvis part of 9.5 cm

Median vertex presentation with no flexion or extension

Military Occipitofrontal diameter presents to the pelvis

Fetal head is in the halfway extension

Brow presentation Occipitomental diameter which is largest diameter of the fetal head presents to the pelvis

Fetal head is complete extension, and the submentobregmatic diamter presents to the pelvis

Cephalic Full extension of the head at 13.5 cm occipitomental diameter

Dorsoanterior is or dorsoposterior

Shoulder presentation

Name 3 types of breech positions

Frank breech Full Breech Single footing breech

Refers to the position of the long axis of fetus in relation to the long axis of mother

Fetal lie 3 lies - Oblique lie - Transverse lie - Longitudinal lie

Refers to the position of an arbitrarily chosen portion of the fetal presenting part to the right or left side of the maternal birth canal

Fetal Position Determining points in vertex, face, and breech presentations are fetal occiput, chin, and sacrum

Fetal position part in either what positions?

Anterior Transversely Posteriorly Six varieties of each 3 positions

Name Fetal vertex presentations

ROP LOP ROT LOT ROA LOA

Categories of fetal presentation

ROA ROT ROP LOA LOT LOP RMA RMP LMA LSA LSP

Anterior Asynclitism

Anterior parietal

Normal synclitism

Pelvic inlet plane Occipital frontal plane

Posterior Asynclitism

Posterior parietal

Fetal head is directed toward the pelvis but can still easily move away from the inlet

Floating

Fetal head dips into the inlet but can be moved away by exerting pressure on the fetus.

Dipping

Biparietal diameter of the fetal head is in the inlet of the pelvis.

Engaged Presenting part is the occiput at level of ischial spine- zero

______________ affects the woman's anatomic and physiologic adaptations to labor

Position Frequent changes in position - Relieve fatigue - Increase comfort - Improve circulation Laboring woman should be encouraged to find positions most comfortable to her

Role of emotions in labor Tension and fatigue Experience, preparation, and culture

Psyche

Process of moving fetus, placenta, and membranes out of the uterus and through the birth canal

Labor

________________ ____________ take place in woman's reproductive system days and weeks before labor begins

Various changes Labor can be discussed in terms of mechanisms involved in process and stages woman moves through

Seven cardinal movements of mechanism of labor that occur in vertex presentation

Engagement Descent Flexion Internal rotation Extension External rotation - Restitution Expulsion- Birth

Woman progresses through stages of labor, various body system adaptations cause her to exhibit both objective and subjective symptoms

Maternal Adaptation

Physiologic Adaptation to Labor

Maternal adaptation - CV changes - Resp. changes - Renal changes - integumentary changes - Musculoskeletal changes - Neurologic changes - GI changes - Endocrine changes

Signs of preceding labor

Lightening Blood show Energy spurt Braxton hicks contractions Loose stools

Onset of true labor can not be ascribed to single cause Many factors involved including changes in maternal uterus, cervix, and pituitary gland

Onset of Labor

Week 4 Intrapartal Period Flashcards

(80 cards)