[14] MIDTERMS | INTRAPARTUM PART 2 (SIGNS, RESPONSES, & DANGER SIGNS) Flashcards
SIGNS OF LABOR
PRELIMINARY/PREMONITORY SIGNS OF LABOR
1. ____
2. ____
3. ____
4. ____
5. ____
6. ____
7. ____
PRELIMINARY/PREMONITORY SIGNS OF LABOR
1. Lightening
2. Braxton Hicks Contractions
3. Cervical Ripening
4. Bloody Show
5. Rupture of Membranes
6. Sudden Burst of Energy
7. Other Signs
SIGNS OF LABOR
- descent of the fetal presenting part into the pelvis
- uterus becomes lower and more anterior
- occurs early in primiparas
- occurs on the day of labor or even after labor has begun in multiparas
LIGHTENING
SIGNS OF LABOR
LIGHTENING
the mother may experience the following:
* ____
* increased ____
* increased ____
* increased ____
* increased ____
LIGHTENING
the mother may experience the following:
* shooting leg pains
* increased vaginal secretions
* increased urinary frequency
* increased pelvic pressure
* increased venous stasis
SIGNS OF LABOR
- irregular, intermittent contractions
- felt in the abdomen or inguinal region and patients may mistake them for true labor
BRAXTON HICK’S CONTRACTION
SIGNS OF LABOR
- internal sign which can be determined only on pelvic examination
- throughout pregnancy, the cervix feels softer than normal (Goodell’s sign). At term, the cervix becomes still softer (described as “butter soft”), and it tips forward.
CERVICAL RIPENING
SIGNS OF LABOR
- involve uterine and cervical changes
- surest sign that labor has begun is progressive uterine contractions
TRUE LABOR
SIGNS OF LABOR
RUPTURE OF MEMBRANES
Yellow-green tinged amniotic fluid may indicate the following:
* signals the need for further assessment and ____
* if engagement has not occurred leads to ____
* open pathway into the uterus increases ____
RUPTURE OF MEMBRANES
Yellow-green tinged amniotic fluid may indicate the following:
* signals the need for further assessment and fetal heart rate monitoring
* if engagement has not occurred leads to danger of prolapsed cord
* open pathway into the uterus increases risk of infection
SIGNS OF LABOR
OTHER SIGNS
* weight loss of ____
* ____
* ____
* ____
OTHER SIGNS
* weight loss of 1 to 3 lbs.
* diarrhea
* nausea
* vomiting
SIGNS OF LABOR
- approximately 24 – 48 hours before labor
- increase in activity = increase in epinephrine release
- prepares a woman’s body for the work of labor ahead
SUDDEN BURST OF ENERGY
SIGNS OF LABOR
- the amniotic membranes rupture once labor is well established, either spontaneously or amniotomy
RUPTURE OF MEMBRANES
COMPARISON OF TRUE AND FALSE LABOR
TRUE LABOR
* Contractions increase in ____
FALSE LABOR
* ____
TRUE LABOR
* Contractions increase in frequency, duration and intensity
FALSE LABOR
* Usually no change
COMPARISON OF TRUE AND FALSE LABOR
TRUE LABOR
* Contractions are at ____
FALSE LABOR
* Contractions are ____
TRUE LABOR
* Contractions are at regular intervals
FALSE LABOR
* Contractions are irregular
COMPARISON OF TRUE AND FALSE LABOR
TRUE LABOR
* Intensity usually increases with ____ ( ____ usually increases labor pains)
FALSE LABOR
* Change of activity has ____ on contractions ( ____ may lessen the pain)
TRUE LABOR
* Intensity usually increases with change in activity (walking usually increases labor pains)
FALSE LABOR
* Change of activity has no effect on contractions (walking may lessen the pain)
SIGNS OF LABOR
- pink-tinged secretions signaling that labor will begin within 24 - 48 hrs
- with softening and effacement of the cervix, the mucous plug is often expelled, resulting in a small
amount of blood loss from the exposed cervical capillaries
BLOODY SHOW
SIGNS OF LABOR
RUPTURE OF MEMBRANES
If the membranes rupture at home, note the following:
* ____, ____, and ____ of the amniotic fluid
* contains ____ and ____
* fluid should be ____ and ____
* ____ tinged amniotic fluid = infection or fetal passage of meconium
RUPTURE OF MEMBRANES
If the membranes rupture at home, note the following:
* color, amount, and odor of the amniotic fluid
* contains white specks (vernix caseosa) and lanugo
* fluid should be clear and odorless
* yellow-green tinged amniotic fluid = infection or fetal passage of meconium
MATERNAL RESPONSES
FLUID BALANCE
* increase in rate and depth of respirations and diaphoresis leads to increase in ____
FLUID BALANCE
* increase in rate and depth of respirations and diaphoresis leads to increase in insensible water loss
COMPARISON OF TRUE AND FALSE LABOR
TRUE LABOR
* Intervals between contractions gradually ____
FALSE LABOR
* ____
TRUE LABOR
* Intervals between contractions gradually shorten
FALSE LABOR
* Usually no change
COMPARISON OF TRUE AND FALSE LABOR
TRUE LABOR
* ____ and ____ are progressive
FALSE LABOR
* ____
TRUE LABOR
* Cervical dilatation and effacement are progressive
FALSE LABOR
* No change in the cervix
COMPARISON OF TRUE AND FALSE LABOR
TRUE LABOR
* Pains usually begin in ____
FLASE LABOR
* Pains usually occur in the ____
TRUE LABOR
* Pains usually begin in lower back, radiating to the abdomen
FLASE LABOR
* Pains usually occur in the abdomen
MATERNAL RESPONSES
NEUROLOGIC AND SESNORY RESPONSES
During the second stage of labor, pain is caused by:
1. ____ of the contracting uterine muscle cells
- distension of the ____ and ____
- pressure on ____ structures
NEUROLOGIC AND SESNORY RESPONSES
During the second stage of labor, pain is caused by:
1. hypoxia of the contracting uterine muscle cells
- distension of the vagina and perineum
- pressure on adjacent structures
MATERNAL RESPONSES
CARDIO VASCULAR OUTPUT
* ____ increase in circulating blood volume
- With each contraction ____ ml of blood volume is forced back into the ____
- ____ position, CO lowers;
- ____ position, CO increases
- Contraction blood flow to the uterus
CARDIO VASCULAR OUTPUT
* 50% increase in circulating blood volume
- With each contraction 300 to 500 ml of blood volume is forced back into the maternal circulation
- Supine position, CO lowers;
- Lateral position, CO increases
- Contraction blood flow to the uterus
MATERNAL RESPONSES
GASTROINTESTINAL SYSTEM
* Reduced ____ and ____ of solid food
- Gastric ____ is prolonged and gastric ____ remains increased
GASTROINTESTINAL SYSTEM
* Reduced gastric motility and absorption of solid food
- Gastric emptying time is prolonged and gastric volume remains increased
COMPARISON OF TRUE AND FALSE LABOR
TRUE LABOR
* Contractions do not decrease with ____ or ____
FALSE LABOR
* ____ and ____ lessen contractions
TRUE LABOR
* Contractions do not decrease with rest or warm tub bath
FALSE LABOR
* Rest and warm tub bath lessen contractions
MATERNAL RESPONSES
RESPIRATORY SYSTEM
* increase in cardiovascular parameters increase ____
- ____ increase oxygen consumption
- Using appropriate ____ during labor can help avoid severe hyperventilation.
RESPIRATORY SYSTEM
* increase in cardiovascular parameters increase RR hyperventilation
- 100% increase oxygen consumption
- Using appropriate breathing patterns during labor can help avoid severe hyperventilation.
MATERNAL RESPONSES
INTEGUMENTARY SYSTEM
* vagina and perineum have a great ability to ____
INTEGUMENTARY SYSTEM
* vagina and perineum have a great ability to stretch
MATERNAL RESPONSES
MUSCULOSKELETAL SYSTEM
* Release of ____
- ____ and the ____ become more relaxed and movable
- increase the size of the pelvic ring by ____ cm
MUSCULOSKELETAL SYSTEM
* Release of Relaxin
- symphysis pubis and the sacral/coccyx joints become more relaxed and movable
- increase the size of the pelvic ring by 2 cm
MATERNAL RESPONSES
BLOOD PRESSURE
* increase in systolic and diastolic BP (____ with each uterine contraction)
- 2nd stage of labor: ____ VS. ____ position
BLOOD PRESSURE
* increase in systolic and diastolic BP (15 mmHg with each uterine contraction)
- 2nd stage of labor: Supine vs. upright or side lying position
MATERNAL RESPONSE
TEMPERATURE REGULATION
* increased muscular activity leads to ____
- ____ with accompanying evaporation to cool and limit excessive warming
TEMPERATURE REGULATION
* increased muscular activity leads to slight elevation (1F)
- Diaphoresis with accompanying evaporation to cool and limit excessive warming
MATERNAL RESPONSES
NEUROLOGIC AND SENSORY RESPONSES
* Pain during the third stage results from ____ and ____ as the placenta is expelled
NEUROLOGIC AND SENSORY RESPONSES
* Pain during the third stage results from uterine contractions and cervical dilation as the placenta is expelled
FETAL RESPONSES
ACID-BASE STATUS
* Blood flow is decreased to the fetus at the peak of each contraction = ____
- During the second stage of labor = pH ____ more rapidly
ACID-BASE STATUS
* Blood flow is decreased to the fetus at the peak of each contraction = low in pH status
- During the second stage of labor = pH decreases more rapidly
FETAL RESPONSES
NEUROLOGIC SYSTEM
* increased ____ pressure
- The fetal heart rate (FHR) decreases by as much as ____ during a contraction, as soon as contraction strength reaches ____
NEUROLOGIC SYSTEM
* increased intracranial pressure
- The fetal heart rate (FHR) decreases by as much as 5 bpm during a contraction, as soon as contraction strength reaches 40 mmHg
MATERNAL RESPONSES
URINARY SYSTEM
* increase in maternal ____, ____ activity, and ____
- decrease in ____ during labor & increased insensible water loss leads to ____
- Inc. ____
- reduces ____ or the ability of the bladder to sense filling
- ____
URINARY SYSTEM
* increase in maternal renin, plasma renin activity, and angiotensinogen
- decrease in fluid intake during labor & increased insensible water loss leads to concentrated urine
- Inc. specific gravity
- reduces bladder tone or the ability of the bladder to sense filling
- edema
MATERNAL RESPONSES
IMMUNE SYSTEM AND OTHER BLOOD VALUES
* WBC count increases to ____ during labor and early postpartum period
- increased ____
- ____ levels decrease leads to decrease in insulin requirements
IMMUNE SYSTEM AND OTHER BLOOD VALUES
* WBC count increases to 25,000 to 30,000/mm3 during labor and early postpartum period
- increased neutrophils
- Maternal blood glucose levels decrease decrease in insulin requirements
MATERNAL RESPONSES
NEUROLOGIC AND SENSORY RESPONSES
Pain during the first stage of labor arises from:
1. ____, which is the primary source of pain
- stretching of the ____ segment
- pressure on ____ structures
- ____ of the uterine muscle cells during contractions.
NEUROLOGIC AND SENSORY RESPONSES
Pain during the first stage of labor arises from:
1. dilatation of the cervix, which is the primary source of pain
- stretching of the lower uterine segment
- pressure on adjacent structures
- hypoxia of the uterine muscle cells during contractions.
MATERNAL RESPONSES
NEUROLOGICAL AND SENSORY RESPONSES
Factors on perception and response to pain:
* ____ classes
- ____ and ____
- ____ with pain
- ____
- ____ and ____
NEUROLOGICAL AND SENSORY RESPONSES
Factors on perception and response to pain:
* Childbirth preparation classes
- fatigue and sleep deprivation
- previous experience with pain
- Anxiety
- attention and distraction
MATERNAL RESPONSES
PSYCHOLOGICAL RESPONSES
* ____
* ____
PSYCHOLOGICAL RESPONSES
* Fatigue
* Fear
FETAL RESPONSES
CARDIOVASCULAR SYSTEM
* During a contraction, the arteries of the uterus are ____
- The amount of ____, including ____, exchanged during this time is reduced = slight but inconsequential ____
- Increased ____ pressure caused by uterine pressure on the fetal head serves to keep circulation from falling below normal during the duration of a contraction.
- ____ can occur with intracranial pressures of ____, as the head pushes against the cervix
CARDIOVASCULAR SYSTEM
* During a contraction, the arteries of the uterus are sharply constricted
- The amount of nutrients, including oxygen, exchanged during this time is reduced = slight but inconsequential fetal hypoxia
- Increased intracranial pressure caused by uterine pressure on the fetal head serves to keep circulation from falling below normal during the duration of a contraction.
- Early fetal deceleration can occur with intracranial pressures of 40 to 55 mmHg, as the head pushes against the cervix
FETAL RESPONSES
INTEGUMENTARY SYSTEM
* ____ or ____ areas on a fetus (particularly the presenting part)
- edema of the presenting part (____)
INTEGUMENTARY SYSTEM
* petechiae or ecchymotic areas on a fetus (particularly the presenting part)
- edema of the presenting part (caput succedaneum)
FETAL RESPONSES
MUSCULOSKELETAL SYSTEM
* The force of uterine contractions tends to push a fetus into a position of ____, the most advantageous position for birth
MUSCULOSKELETAL SYSTEM
* The force of uterine contractions tends to push a fetus into a position of full flexion, the most advantageous position for birth
FETAL RESPONSES
RESPIRATORY SYSTEM
* maturation of ____ production by alveoli
- The pressure applied to the chest from contractions and passage through the birth canal helps to clear it of ____
RESPIRATORY SYSTEM
* maturation of surfactant production by alveoli
- The pressure applied to the chest from contractions and passage through the birth canal helps to clear it of lung fluid
FETAL RESPONSES
FETAL SENSATION
* ____ gestation - sensations of light, sound, and touch
- full term - able to hear ____ and the ____
- The term baby is aware of ____ sensations
FETAL SENSATION
* 37 or 38 wks gestation - sensations of light, sound, and touch
- full term - able to hear music and the maternal voice
- The term baby is aware of pressure sensations
FETAL DANGER SIGNS
- High or Low ____
- ____ Staining
- ____
- ____
- High or Low Fetal Heart Rate
- Meconium Staining
- Hyperactivity
- Fetal Acidosis
MATERNAL DANGER SIGNS
- Rising or Falling ____
- Abnormal ____
- Inadequate or Prolonged ____
- Abnormal ____
- Increasing ____
- Rising or Falling Blood Pressure
- Abnormal Pulse
- Inadequate or Prolonged Contractions
- Abnormal lower Abdominal Contour
- Increasing Apprehension
MATERNAL DANGER SIGNS
Occurs under abnormal labor of the uterus
PATHOLOGIC RETRACTION RING (BANDL’S RING)
