[13] MIDTERMS | INTRAPARTUM PART 1 (PROCESS OF LABOR & DELIVERY) Flashcards
Refers to a series of events by which uterine contractions & abdominal pressure expel a fetus & placenta from the uterus
LABOR
A.k.a. Childbirth/Parturition
Normal labor
EUTOCIA
Theories of Labor Onset (5)
- Uterine Stretch Theory
- Oxytocin Theory
- Progesterone Deprivation Theory
- Aging Placenta Theory
- Prostaglandin Theory
FACTORS AFFECTING LABOR AND BIRTH PROCESS
- the ____
- the ____
- the relationship between the ____ and ____
- the ____ of labor
- position of the ____
- ____ outlook
- the passage (birth canal)
- the passenger (fetus)
- the relationship between the maternal pelvis and presenting part of the fetus
- the powers of labor
- position of the mother
- psyche/psychological outlook
- the route a fetus must travel from the uterus through the cervix & vagina to the external perineum
- must be of adequate size
PASSAGE
1.PASSAGE
Two pelvic measurements important to determine the adequacy of the pelvic size:
1. ____
2. ____
Two pelvic measurements important to determine the adequacy of the pelvic size:
1. diagonal conjugate (the AP diameter of the inlet)
2. transverse diameter of the outlet
1.PASSAGE
Critical Factors:
* ____
* ____
Critical Factors:
* size of maternal pelvis (diameters of the pelvic inlet, midpelvis, and outlet)
* type of maternal pelvis (gynecoid, android, anthropoid, platypelloid)
1.PASSAGE
Critical Factors:
* ability of the cervix to ____ and ____
* ability of the vaginal canal and the introitus to ____
Critical Factors:
* ability of the cervix to dilate and efface
* ability of the vaginal canal and the introitus to distend
The fetus
PASSENGER
2.PASSENGER
The movement of the fetus, through the birth canal is determined by several interacting factors:
1. ____
2. ____
3. ____
4. ____
5. ____
The movement of the fetus, through the birth canal is determined by several interacting factors:
1. the fetal head
2. fetal attitude
3. fetal lie
4. fetal presentation
5. fetal position
2.PASSENGER
Importance – From an obstetrical point of view, the most important part of the fetus because:
1. It is the largest part of the fetus
2. It is the most frequent presenting part
3. It is the least compressible of all parts
FETAL HEAD
2.PASSENGER
FETAL HEAD
Importance – From an obstetrical point of view, the most important part of the fetus because:
1. It is the ____ of the fetus
2. It is the most frequent ____
3. It is the ____ of all parts
FETAL HEAD
Importance – From an obstetrical point of view, the most important part of the fetus because:
1. It is the largest part of the fetus
2. It is the most frequent presenting part
3. It is the least compressible of all parts
2.PASSENGER
FETAL HEAD
Bones – 7 bones: ____ (2), ____ (2), ____ (2) &
____ (1)
FETAL HEAD
Bones – 7 bones: Frontal (2), parietal (2), temporal (2) &
occipital (1)
2.PASSENGER
FETAL HEAD
* ____ – spaces between cranial bones
- ____ – between 2 frontal bones
- ____ – between frontal & parietal bones
- ____ – between 2 parietal bones (midline suture); MOST IMPORTANT suture – overrides in labor (molding) decreasing biparietal diameter by 0.5 to 1 cm.
- ____ – posterior suture; between parietal & occipital bones
FETAL HEAD
* Sutures – spaces between cranial bones
- Frontal – between 2 frontal bones
- Coronal – between frontal & parietal bones
- Sagittal – between 2 parietal bones (midline suture); MOST IMPORTANT suture – overrides in labor (molding) decreasing biparietal diameter by 0.5 to 1 cm.
- Lambdoidal – posterior suture; between parietal & occipital bones
2.PASSENGER
FETAL HEAD
Membrane-filled spaces called ____ are located where the sutures intersect.
1. ____
2. ____
3. ____
4. ____
FETAL HEAD
Membrane-filled spaces called fontanels/fontanelles are located where the sutures intersect.
1. anterior fontanelle
2. posterior fontanelle
3. sphenoidal fontanelle
4. mastoid fontanelle
2.PASSENGER
FETAL HEAD
Fontanelles:
* ____ – triangular in shape, junction of parietal & occipital bones; closes at 2- 3 months (as early as 2 months & as late as 4 months)
- ____ - diamond- shaped “soft spot” in front of the head, junction between frontal & parietal bones, (closes at 18 months)
FETAL HEAD
Fontanelles:
* Posterior fontanelle – triangular in shape, junction of parietal & occipital bones; closes at 2- 3 months (as early as 2 months & as late as 4 months)
- Anterior fontanelle (BREGMA) - diamond- shaped “soft spot” in front of the head, junction between frontal & parietal bones, (closes at 18 months)
2.PASSENGER
FETAL HEAD
Fontanelles:
* Posterior fontanelle – triangular in shape, junction of ____ & ____; closes at ____ months (as early as ____ months & as late as ____ months)
- Anterior fontanelle (BREGMA) - diamond- shaped “soft spot” in front of the head, junction between ____ & ____ bones, (closes at ____ months)
FETAL HEAD
Fontanelles:
* Posterior fontanelle – triangular in shape, junction of parietal & occipital bones; closes at 2- 3 months (as early as 2 months & as late as 4 months)
- Anterior fontanelle (BREGMA) - diamond- shaped “soft spot” in front of the head, junction between frontal & parietal bones, (closes at 18 months)
2.PASSENGER
- The anterior and posterior fontanelles are clinically useful along with the sutures in identifying the position of ____ in the pelvis and in assessing the ____ after birth. Fontanelle spaces compress during birth to aid in ____ of the fetal head.
- The anterior and posterior fontanelles are clinically useful along with the sutures in identifying the position of fetal head in the pelvis and in assessing the status of the newborn after birth. Fontanelle spaces compress during birth to aid in molding of the fetal head.
2.PASSENGER
FETAL HEAD
Landmarks of the fetal skull:
* ____ – fetal chin
* ____ – upper part of the skull, especially the anterior portion above and including the forehead
* ____ – large diamond-shaped anterior fontanelle
* ____ – area between the anterior and posterior fontanels
* ____
* ____ – area of the fetal skull occupied by occipital bone
FETAL HEAD
Landmarks of the fetal skull:
* Mentum – fetal chin
* Sinciput – upper part of the skull, especially the anterior portion above and including the forehead
* Bregma – large diamond-shaped anterior fontanelle
* Vertex – area between the anterior and posterior fontanels
* Posterior fontanel
* Occiput – area of the fetal skull occupied by occipital bone
2.PASSENGER
FETAL HEAD - HEAD MEASURMENTS
Transverse diameters:
* Biparietal : ____ cm (biggest transverse diameter)
* Bitemporal : ____ cm.
* Bimastoid : ____ cm.
Antero-posterior diameters:
* Occipitomental : ____ cm.
* Occipitofrontal : ____ cm.
* Suboccipitobregmatic : ____ cm (smallest AP diameter)
FETAL HEAD - HEAD MEASURMENTS
Transverse diameters:
* Biparietal : 9.25 cm (biggest transverse diameter)
* Bitemporal : 8 cm.
* Bimastoid : 7 cm.
Antero-posterior diameters:
* Occipitomental : 13.5 cm.
* Occipitofrontal : 11-12 cm.
* Suboccipitobregmatic : 9.5 cm (smallest AP diameter)
2.PASSENGER
relation of the fetal body parts to each other
FETAL ATTITUDE / HABITUS
2.PASSENGER
FETAL ATTITUDE/HABITUS
* ____: head flexed on chest
* ____: head extended, occiput touches the back
FETAL ATTITUDE/HABITUS
* Flexion: head flexed on chest
* Extension: head extended, occiput touches the back
2.PASSENGER
FETAL ATTITUDE
Types:
* ____
* ____
* ____
* ____
FETAL ATTITUDE
Types:
* Complete flexion (occipitobregma)
* Moderate flexion/Military attitude (occipitofrontal)
* Poor flexion (occipitomental)
* Hyperextension (submentobregmatic)
2.PASSENGER
relation of the long axis (spinal column) of the fetus to the long axis (spinal column) of the mother
FETAL LIE
2.PASSENGER
FETAL LIE
* ____: cephalic or breech
* ____: shoulder
* ____ lie: unstable and always becomes longitudinal or transverse during labor
FETAL LIE
* Longitudinal/vertical lie: cephalic or breech
* Transverse/horizontal lie: shoulder
* Oblique lie: unstable and always becomes longitudinal or transverse during labor
2.PASSENGER
The body part of the fetus that enters the pelvic inlet and lead through the birth canal during labor. This is determined by a conbination of fetal lie and the degree of fetal flexion
FETAL PRESENTATION
2.PASSENGER
FETAL PRESENTATION
* most frequent type of presentation
* head presents (vertex, sinciput, brow, and face)
CEPHALIC PRESENTATION
2. PASSENGER
FETAL PRESENTATION
Types of Cephalic Presentation
* ____ - occiput is the presenting part
- ____ - fetal head is partially flexed, with the anterior fontanel, or bregma, presenting
- ____ - fetal head is partially extended; the sinciput (forehead) is the presenting part
- ____ - fetal head is hyperextended; the face is the presenting part
FETAL PRESENTATION
Types of Cephalic Presentation
* Vertex - occiput is the presenting part
- Sinciput - fetal head is partially flexed, with the anterior fontanel, or bregma, presenting
- Brow - fetal head is partially extended; the sinciput (forehead) is the presenting part
- Face - fetal head is hyperextended; the face is the presenting part
2.PASSENGER
FETAL PRESENTATION
Buttocks or feet present
BREECH PRESENTATION
2.PASSENGER
FETAL PRESENTATION
Types of Breech Presentation
* ____ – knees & hips flexed, thighs on abdomen & calves on posterior thighs, buttocks & feet present
* ____ – hips flexed & knees extended, buttocks present
* ____ – hips & legs extended
one foot presents (____)
both feet present (____)
FETAL PRESENTATION
Types of Breech Presentation
* Complete – knees & hips flexed, thighs on abdomen & calves on posterior thighs, buttocks & feet present
* Frank – hips flexed & knees extended, buttocks present
* Footling – hips & legs extended
one foot presents (single footling)
both feet present (double footling)
2.PASSENGER
FETAL PRESENTATION
* Shoulder presents (most frequent one of the shoulders)
* Fetal hand, elbow, back, abdomen, or side may present in the maternal pelvis
SHOULDER PRESENTATION
2.PASSENGER
the relationship of the presenting part to a specific quadrant of the woman’s pelvis
FETAL POSITION
2.PASSENGER
FETAL POSITION
4 quadrants of maternal pelvis
1. ____
2. ____
3. ____
4. ____
FETAL POSITION
4 quadrants of maternal pelvis
1. right anterior
2. left anterior
3. right posterior
4. left posterior
2.PASSENGER
FETAL POSITION
Four parts of fetus as landmarks:
* vertex presentation- ____
* face presentation- ____
* breech presentation- ____
* shoulder presentation- ____
Four parts of fetus as landmarks:
* vertex presentation- occiput
* face presentation- chin (mentum)
* breech presentation- sacrum
* shoulder presentation- acromion process
2.PASSENGER
FETAL POSITION
Indicated by an abbreviation of three letters:
* first letter - defines whether the landmark is pointing to the ____
- middle letter - denotes the ____
- last letter - defines whether the landmark points ____
FETAL POSITION
Indicated by an abbreviation of three letters:
* first letter - defines whether the landmark is pointing to the mother’s right (R) or (L)
- middle letter - denotes the fetal landmark (O for occiput, M for mentum or chin, S/Sa for sacrum & A for acromion process)
- last letter - defines whether the landmark points anteriorly (A), posteriorly (P) or transversely (T)
3.RELATIONSHIP BETWEEN THE MATERNAL PELVIS AND PRESENTING PART OF FETUS
- the settling of the presenting part of a fetus far enough into the pelvis to be at the level of the ischial spines
- can be determined by vaginal examination and leopold’s maneuvers
- Floating; Dipping
ENGAGEMENT
3.RELATIONSHIP BETWEEN THE MATERNAL PELVIS AND PRESENTING PART OF FETUS
ENGAGEMENT
* ____ - occurs when the sagittal suture is midway between the symphysis pubis and the sacral promontory
- ____ - occurs when the sagittal suture is directed toward either the symphysis pubis or the sacral promontory and feels misaligned
ENGAGEMENT
* Synclitism - occurs when the sagittal suture is midway between the symphysis pubis and the sacral promontory
- Asynclitism - occurs when the sagittal suture is directed toward either the symphysis pubis or the sacral promontory and feels misaligned
3.RELATIONSHIP BETWEEN THE MATERNAL PELVIS AND PRESENTING PART OF FETUS
- relationship of presenting part to the level of the ischial spines (IS)
- measure of the degree of descent of the presenting part of the fetus through the birth canal
STATION
3.RELATIONSHIP BETWEEN THE MATERNAL PELVIS AND PRESENTING PART OF FETUS
STATION
- ____ – presenting part above the IS
- ____ – presenting part @ pelvic inlet
- ____ – presenting part above the inlet, in false pelvis
- ____
- ____ – presenting part below the inlet, in true pelvis, no longer moving but not yet engaged
- ____ - presenting part at IS
- ____ – presenting part below IS
- ____ - presenting part at perineum
- ____ – presenting part at pelvic outlet
STATION
- Minus (-) Station – presenting part above the IS
- Station (-5) – presenting part @ pelvic inlet
- Floating (-3) – presenting part above the inlet, in false pelvis
- Dipping (-2)
- Fixed (-1) – presenting part below the inlet, in true pelvis, no longer moving but not yet engaged
- Engaged / Station (0) - presenting part at IS
- Plus (+) Station – presenting part below IS
- Crowning (+4) - presenting part at perineum
- Station (+5) – presenting part at pelvic outlet
- Involuntary and voluntary powers combine to expel the fetus, the fetal membranes and the placenta from the uterus
- Primary power/primary force
secondary power/secondary force
POWERS OF LABOR
4.POWES OF LABOR
- the involuntary uterine contractions
- signals the beginning of labor
- Rhythmic uterine contractions but intermittent. Between contractions there is a period of relaxation.
PRIMARY POWER / PRIMARY FORCE
4.POWERS OF LABOR
PRIMARY POWER
* It is a line of demarcation between the upper and lower uterine segment present during normal labor and cannot usually be felt abdominally
PHYSIOLOGICAL RETRACTION RING
4.POWERS OF LABOR
PRIMARY POWER
* It is the rising up retraction ring during obstructed labor due to marked retraction and thickening of the upper uterine segment while the relatively passive uterine segment is markedly stretched and thinned to accomodate the fetus
- Is seen and felt abdominally as a transverse groove that may rise to or above the umbilicus
PATHOLOGICAL RETRACTION RING (BANDL’S RING)
4.POWERS OF LABOR
PRIMARY POWER
Each contraction has 3 phases:
1. ____
2. ____
3. ____
PRIMARY POWER
Each contraction has 3 phases:
1. increment
2. acme
3. decrement
4.POWERS OF LABOR
PRIMARY POWER
* ____ - beginning to end of one contraction
* ____ - beginning of one contraction to the beginning of the next contraction
PRIMARY POWER
* Duration - beginning to end of one contraction
* Frequency - beginning of one contraction to the beginning of the next contraction
Contractions last for about 60 seconds or 1 minute
4.POWERS OF LABOR
PRIMARY POWER
Terms used to describe uterine contractions during labor:
INTENSITY
* ____ – fundus indents easily & feels like a tip of your nose
- ____ – fundus indents less easily (firm fundus that is difficult to indent) and feels like a chin
- ____ – fundus cannot be indented
& feels like a forehead
PRIMARY POWER
Terms used to describe uterine contractions during labor:
INTENSITY
* Mild intensity – fundus indents easily & feels like a tip of your nose
- Moderate intensity – fundus indents less easily (firm fundus that is difficult to indent) and feels like a chin
-
Strong intensity – fundus cannot be indented
& feels like a forehead
4.POWERS OF LABOR
PRIMARY POWER
Contractions occurring more often than every ____ and persistent contraction duration longer than ____ may reduce ____ and should be reported
PRIMARY POWER
Contractions occurring more often than every two minutes and persistent contraction duration longer than 90 seconds may reduce fetal oxygen supply and should be reported
4.POWERS OF LABOR
PRIMARY POWER
* Responsible for the ____ of the cervix and ____ of the fetus
- ____ - shortening and thinning of the cervix during the first stage of labor
- ____ - enlargement or widening of the cervical opening and the cervical canal that occurs once labor has begun
PRIMARY POWER
* Responsible for the effacement and dilation of the cervix and descent of the fetus
- Effacement - shortening and thinning of the cervix during the first stage of labor
- Dilation/dilatation - enlargement or widening of the cervical opening and the cervical canal that occurs once labor has begun
4.POWERS OF LABOR
- use of abdominal muscles to push during the second stage of labor
- the voluntary bearing down efforts by the woman
SECONDARY POWER / SECONDARY FORCE
4.POWERS OF LABOR
SECONDARY POWER
* As soon as the presenting part reaches the pelvic floor, the contractions change in character and become ____.
- If the cervix is not fully dilated, bearing down can cause ____ (which retards dilatation), possible tearing and bruising of the cervix, and ____
SECONDARY POWER
* As soon as the presenting part reaches the pelvic floor, the contractions change in character and become expulsive.
- If the cervix is not fully dilated, bearing down can cause cervical edema (which retards dilatation), possible tearing and bruising of the cervix, and maternal exhaustion
Frequent changes in position relieve fatigue, increase comfort, and improve circulation
POSITION OF THE MOTHER
5.POSITION OF THE MOTHER
A laboring woman should be encouraged to find positions that are most comfortable to her:
* ____ position
* ____ position
* ____ position
* ____
* ____ position
* ____ position
A laboring woman should be encouraged to find positions that are most comfortable to her:
* Upright position
* Lateral position
* Lithotomy position
* Semirecumbent
* Sitting position
* Kneeling or squatting position
5.POSITION OF THE MOTHER
- All may help stimulate effective contractions
- All use gravity to help baby’s descent
WALKING, STANDING, AND LEANING
5.POSITION OF THE MOTHER
- May relieve back pain
- Helps baby rotate to most favorable position: occiput-anterior
- Relives hemorrhoids
KNEELING
5.POSITION OF THE MOTHER
- Uses gravity to help baby’s descent
- Allows rest between contractions
SITTING
5.POSITION OF THE MOTHER
- Uses gravity to help baby’s descent
- Opens pelvis to provide more room
SQUATTING
- woman’s psychological state or feelings that a woman brings into labor
- a feeling of apprehension or fright and it includes a sense of excitement or awe
PSYCHE/PSYCHOLOGICAL OUTLOOK
