Antepartum exam 2 Flashcards
Five factors that affect labor
Powers (contractions) Passageway (birth canal) Passenger (fetus & placenta) Position of mother Psychological response
Explain the movement of Uterine contractions
Coordinated:
Fundus and move toward the cervix
List and describe the parts of the contraction cycle
Increment-begins
peak
decrement-declines
Contractions cause the cervix to:
Effacement: thinning 0-100%
Dilation-streching 0-10cm
Ferguson reflex
neuroendocrine reflex of uterine contractions initiated by:
pressure on cervix/vaginal walls
How are contractions measured
Frequency- minutes=beginnning of one to the beginning of the next one Duration-seconds Intensity- mild (nose) moderate (chin) strong (forehead)
During which stage of labor does the women bear down, or the woman adds her voluntary efforts to propel the fetus through the pelvis?
2nd stage
What can be determined by the social spines of the pelvis?
The position of the baby
What is the most important pelvis in childbirth and list its subdivisions
True pelvis:
Inlet-upper pelvic opening
Midpelvis-pelvic cavity
Outlet-lower pelvic opening
At what number station is the fetal head engaged?
0
fetal station during childbirth is measured in plus and minus where minus is?
bad plus is good
What factors of the Passenger or fetus effect labor?
Size of head Presentation-part that enters inlet Lie- Attitude Position-of head in inlet=vertex, sinciput, brow
List the fetus presentations and describe
Cephalic: head, vertex, brow, or chin
Breech: Frank, full, single footling
Shoulder
fetal head at term measures
9.5 cm
Define fetal lie and Attitude
Lie: Longitude of fetus to longitude of mom
Attitude: relation of fetus body parts to another-flexion is normal
What type of lie can vaginal birth not occur?
transverse
Frequently changing positions of mother relieves
fatigue
increases comfort & circulation
Maternal catecholmines secreted in response to anxiety or fear can?
inhibit uterine contractility and placental blood flow
A woman with a small pelvis (passage) and a large fetus (passenger) can have a normal labor and birth if?
Fetus is ideally positioned
Uterine contractions & bearing down efforts (powers) are vigorous
Signs before labor
Braxton Hicks Lightening Bloody show Increased vaginal secretions due to fetal pressure causing vaginal mucosa congestion Energy spurt Small weight loss
Difference between true labor and false labor
Change in:
Behavior
Contractions
List and describe the stages of labor
Early: 3 cm excited pt
Active: 4-7 cm; Effacement= 100% more serious
Transition: 8-10 cm; short but intense, signs are-urge to push, leg tremors, N & V
7 cardinal signs of labor that occur in vertex presentation
Engagement – Presenting part at ischial spine.
Descent – present part through the true pelvis
Flexion – of head
Internal rotation – allows largest fetal head diameter to match largest maternal pelvic diameter.
Extension – of fetal head as it passes beneath the mother’s symphysis.
Restitution and external rotation – of the fetal head to allow the shoulders to rotate internally to fit the mother’s pelvis
Expulsion (birth) – of shoulders, body and head.
List and describe the stages of labor
1: dilation begins to full dilation
2: full dilation to birth
3: placental separation and expulsion
4: first 2 hours after birth
Traits of the 3rd stage of labor
Firmly contracting fundus Uterus shape change Sudden gush of dark blood Lengthening of umbilical cord Vaginal fullness Shiny Schultz or Dirty Duncan (placenta)
The smallest anterior diameter to help the head fit through the true pelvis is the
Suboccipitobreymatic: complete flexion of head and chest
Define secondary powers
bearing down efforts
List the different degrees of vaginal tears
2: Perineal muscle torn and can see anal sphincter
3: both perineal and sphincter torn
4: Perineal, anal sphincter, and rectum torn
List the assessments for the 4th stage of labor
hemorrhage S&S
VS q15min for first hour
Fundal Checks
Bladder – a full bladder interferes with the contractions of the uterus.
Lochia – saturation of perineal pads (1 per 15 minutes) is a clue that she is bleeding to much.
Most common reason for excessive postpartum bleeding is that the
uterus does not firmly contract and compress the open vessels at the placental site.
What causes supine hypotension in labor
relationship of ascending vena cava to uterus
Common Augmentation methods
Oxytocin
Amniotomy
List the indications for augmentation of labor
39 wks or greater HTN ROM w/o UC worsening condition fetal death IGRI Post term
What are the chemical agents for cervical ripening
Prostaglandin 2 vaginal insert
What are the mechanical methods for cervical ripening?
Foley cath
Hydroscopic dilators-absorb surrounding fluid
Laminaria tents-seaweed
What should a nurse monitor for when giving oxytocin
Placental abruption Uterine rupture C/S Postpartum hemorrhage Infection Fetal hypoxemia & acidemia
What stages of labor is visceral pain felt?
1st & 3rd
somatic pain is localized and felt at which stage in labor
2nd
List nonpharmalogical methods of relieving pain in childbirth
dick-read says to clock fear
Lamaze-relax
bradkey says deep breathing w/ partner
