ch 16 - intrapartum

Question 1

5 factors affecting labor and birth

Answer 1

passageway (bony pelvis, soft tissues)
passenger (fetus)
powers (contractions and pushing)
position (mom)
psyche

Question 2

3 physical considerations of maternal pelvis

Answer 2

-size of pelvis (petite women, adolescents)
-shape of pelvis
-ability of soft tissue to permit passage of fetus

Question 3

4 pelvic shapes

Answer 3

-gynecoid (most common, wide)
-anthropoid (narrow)
-android (flares in)
-platypelloid (flares out)

Question 4

3 regions of pelvis (top to bottom)

Answer 4

-inlet
-midpelvis
-outlet

Question 5

3 changes that must happen in soft tissue of cervix and vagina for birth

Answer 5

-cervix must efface
-cervix must dilate
-vaginal canal must distend
(+pelvic floor muscles facilitate fetal rotation)

Question 6

major bones of fetal skull (4)

Answer 6

-frontal bone (2)
-parietal bone (2)
-occipital bone
-temporal bone

Question 7

sinciput

Answer 7

forehead

Question 8

4 sutures of fetal skull

Answer 8

-sagittal suture (down the middle to left and right)
-coronal suture (crown dividing front and back)
-frontal suture (between two frontal bones)
-lambdoid suture (inverted V by occiput)

Question 9

3 possible presentations

Answer 9

-cephalic
-breech (sacrum or foot)
-shoulder

Question 10

best presentation for baby to be in for birth

Answer 10

vertex = cephalic with occiput presenting

Question 11

preferred fetal attitude

Answer 11

chin on chest

Question 12

fetal position: R/LOP, R/LOT, R/LOA

Answer 12

ROP: right occipitoposterior
ROT: right occipitotransverse
ROA: right occipitoanterior

Question 13

downsides of R/LOP

Answer 13

-back pain
-slower labor

Question 14

fetal station (cm)

Answer 14

-5 to +5
0 = ischial spines (engaged)
-5 = at pubic symphysis
+5 = perineum

Question 15

fergusons reflex

Answer 15

when baby is at +2
irresistible urge to push

Question 16

benefits to frequent changes of maternal position during labor (4)

Answer 16

-relieve fatigue
-increase comfort
-improves circulation
-facilitates fetal descent and labor progress

Question 17

factors impacting woman’s psyche during labor (5)

Answer 17

-her perception of the process (negative attitude, fear)
-psychologic and physical prep for childbirth
-sociocultural heritage
-previous childbirth experience
-support from significant others

Question 18

S+S true labor (5)

Answer 18

-pain in lower back radiates to abdomen
-pain with regular rhythmic contractions
-regular rhythmic contractions
-contractions that intensify with ambulation
-progressive cervical dilation and effacement

Question 19

S+S false labor (3)

Answer 19

-discomfort localized in abdomen
-no lower back pain
-contractions decrease in intensity or frequency with ambulation

Question 20

S+S impending labor (10)

Answer 20

-lightening
-braxton hicks contractions
-cervical changes
-loss of mucus plug (bloody show)
-sudden burst of energy (nesting)
-greater frequency urination
-weight loss 1-3 lbs
-increased backache and SI pressure
-possible N/V/D
-ROM

Question 21

4 stages of labor

Answer 21

stage 1: cervical change and contractions
stage 2: fetal descent and pushing
stage 3: placental
stage 4: recovery

Question 22

describe current way of describing phase 1 of labor

Answer 22

early/latent: 0 cm - 5.9 cm. effacement, some dilation
active: 6 cm - 10 cm. finish dilation and fetal descent

Question 23

describe the old way of describing phase 1 of labor

Answer 23

early/latent: 0 cm - 3.9 cm. slight discomfort
active: 4 cm - 7.9 cm. serious “labor”
transition: 8 cm - 10 cm. intense, painful, loss of control

Question 24

maternal physiologic adaptations to labor

Answer 24

CARDIAC:
-cardiac output (increases 10-15% 1st stage, 30-50% in 2nd stage, peaks 10-30 mins after birth)
-increased HR, RR, temp
-increased bp during contractions

GI:
-N/V
-slowed motility, absorption, stomach-emptying time

RENAL/URINARY:
-decreased awareness of full bladder
-inability to void
-protineuria

OTHER:
-increased WBC
-increased blood glucose
-increased O2 consumption

Question 25

what degrees C/F represent a fever

Answer 25

100.4 F
38.0 C

Question 26

fetal physiologic adaptation to labor

Answer 26

-molding of head

CIRCULATORY:
-preferential streaming through shunts

RESPIRATORY:
-production lung fluid stops and absorption starts
-pressure on fetal thorax during birth helps clearance of fluid from airways
-O2 decreases
-CO2 increases
-pH decreases
-fetal resp movements decrease

Question 27

ability of fetus to compensate for periods of stress (decreased O2)

Answer 27

fetal reserve

Question 28

4 things that help fetus maintain adequate oxygenation during labor (Fetal reserve)

Answer 28

-fetal oxyhemoglobin
-increased RBCs
-increased CO (heart rate)
-preferential streaming (shunts)