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NUR 4020 > ch 16. labor & birth process > Flashcards

ch 16. labor & birth process Flashcards

1
Q

The 5 P’s of pregnancy

A

passageway (pelvis)
passenger (fetus): relationship of maternal pelvis -> presenting part
power: physiologic forces of labor
positioning (of mother)
psychosocial considerations

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2
Q

birth passageway

A

1) true pelvis
- inlet
- midpelvis (pelvic cavity)
- outlet

2) soft tissues of cervix, vagina, pelvic floor

3) types of pelvises:
- gynecoid
- android
- anthropoid
- platypelloid

TIP:
+4 out the door

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3
Q

inlet is also know as

A

linea terminalis

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4
Q

gynecoid

A

inlet ROUNDED with all inlet diameters adequate midpelvis diameters adequate with parallel side walls
- outlet adequate

implications: favorable for vaginal birth

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5
Q

android

A

inlet HEART SHAPED with short posterior sagittal diameter
- midpelvis diameter reduced
- outlet capacity reduced

implications:
- NOT favorable for vaginal birth
- descent into pelvis slow
- fetal head enters pelvis in transverse or posterior position with arrest of labor frequent

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6
Q

anthropoid

A

inlet OVAL in shape, with long anterioposterior diameter
- midpelvis diameters adequate
- outlet adequate

implications:
- favorable for vaginal birth

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7
Q

platypelloid

A

inlet OVAL in shape, with long transverse diameters
- midpelvis diameters reduced
- outlet capacity inadequate

implications:
- fetal head engages in transverse position
- difficult descent through midpelvis
- frequent delay of progress at outlet of pelvis

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8
Q

birth passenger (fetus)

A
  • head
  • attitude
  • lie
  • presentation
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9
Q

fetal head

A

1) fetal skull
2) sutures: fontanelles (presentation determination)
3) key landmarks:
- mentum: fetal chin
- sinciput: anterior area known as the brow (brow -> anterior font.)
- vertex: area between anterior and posterior fontanelles (how baby presents)
- occiput: area of fetal skull occupied by the occipital bone, beneath the posterior fontanelle

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10
Q

fetal attitude

A
  • relation of the fetal body parts to one another
  • normal attitude: general flexion
  • deviations contribute to longer, more difficult labor -> causes fetus to present larger diameters to the fetal head to the maternal pelvis
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11
Q

fetal lie

A
  • relationship of the long, or cephalocaudal, axis (spinal column) of the fetus to the long, or cephalocaudal, axis of the mother
  • longtitudinal lie: cephalocaudal axis of fetal spine is parallel to the mother’s spine (99.5% all births)
  • transverse lie: cephalocaudal axis of fetal spine is at a right angle to the mother’s spine (shoulder presentation, cradle in mom’s pelvis)
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12
Q

fetal lie complete breeched

A
  • attitude: flexed hips/knees
  • presenting part: buttocks
  • landmark: sacrum
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13
Q

fetal lie frank breeched

A
  • attitude: flexed hips, extended knees with legs against abdomen and chest
  • presenting part: buttocks
  • landmark: sacrum
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14
Q

fetal lie footling: single, fouble

A
  • attitude: extended hips and atleast one knee extended with foot in cervical canal
  • presenting part: buttocks
  • landmark: sacrum
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15
Q

fetal lie kneeling: single, double

A
  • attitude: extended hips, flexed knees
  • presenting part: feet (one or two)
  • landmark: sacrum
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16
Q

cephalic fetal presentation

A
  • vertex: when presenting part is the occiput
  • sinciput: fetal head is partially flexed
  • brow presentation: fetal head is partially extended
  • face: fetal head is hyperextended
17
Q

breech fetal presentation

A
  • complete: knees and hips flexed, thighs are on the abdomen, calves are on the posterior aspect of the thighs
  • flank: hips flexed, knees extended
  • footling: hips and legs are extended
18
Q

relationship of maternal pelvis and presenting part

A

1) engagement: presenting part thru pelvis inlet
2) station: ischial spines
3) fetal position (3 notations):
- right (R) or left (L) side of maternal pelvis
- landmark of fetal presenting part: occiput (O), mentum (M), sacrum (S), or acromion process (A)
- anterior (A), posterior (P), or tranverse (T), depending on whether the landmark is in the front, back, or side of the pelvis

TIP:
Right/Left occiput anterior (easiest)

19
Q

physiologic forces of labor: power

A

1) uterine contractions
- increment
- acme
- decrement
- frequency (begin of one contraction to begin of next)
- duration (begin at end of one contraction)
- intensity
- resting tone (need to have rest in between contraction)

20
Q

psychosocial considerations

A
  • readiness of birth and motherhood
  • fears
  • anxieties
  • birth fantasies
  • level of social support
  • perception of birth experience may influence mothering behaviors
21
Q

positive birth experiences

A
  • motivation for the pregnancy
  • attendance at childbirth education classes
  • a sense of competence or mastery
  • self confidence and self esteem
  • positive relationship with mate
  • maintaining control during labor
  • support from mate or other person during labor
  • not being left alone in labor
  • support from mate or other person during labor
  • not being left alone in labor
  • trust in the medical/nursing staff
  • having personal control of breathing patterns, comfort measures
  • choosing a physician/certified nurse midwife who has a similar philosophy of care
  • receiving clear information regarding procedures
22
Q

physiology of labor

A

1) progesterone withdrawal hypothesis
- progesterone produed by the placenta relaxes uterine smooth muscle
- decrease in availability of progesterone to myometrial cells
- yet unknown antiprogestin

2) prostaglandins hypothesis
- prostaglandins known to induce labor? not sure why?

3) corticotropin releasing hormone hypothesis
- known to stimulate synthesis of prostaglandins

TIPS:
- progesterone maintains pregnancy
- decrease in progesterone allows for contractions to occur

23
Q

myometrial activity

A

1) effacement (before dilatation)
- taking up of the internal os and the cervical canal into the uterine side walls
- thinning and shortening (pullback) of the cervix that occurs late in pregnancy or during labor (0-100%)

2) cervical dilatation
- process in which the cervical os and the cervical canal widen from less than 1 cm to approximately 10 cm, allowing the birth of the fetus

24
Q

dilation examples

A

1cm: cherrio
2cm: penny
3cm: banana
4cm: ritz cracler
5cm: babybel
6cm: cookie
7cm: can of pop
8cm: baseball
9cm: doughnut
10cm: bagel

25
Q

musculature changes in the pelvic floor

A
  • muscles in the pelvic floor draw the rectum and vagina upward and forward during each contraction
  • pressure of fetal head thins out perineal structure from 5cm -> 1cm
  • normal physiologic anesthesia is produced due to decreased blood supple to area
26
Q

premonitory signs of labor

A
  • lightening “baby drops”
  • braxton hicks contractions
  • cervical changes
  • blood show: pink tinged mucous plug (release)
  • rupture (release) of membranes
  • sudden burst of energy (nesting, overcleaning)
  • weight loss, N/V/D, indigestion
27
Q

true labor vs. warm up contactions

A

1) true labor:
- contractions at regular intervals
- intervals between contractions gradually shorten
- contractions increase in duration and intensity
- discomfort begins in back and radiates around to abdomen
- intensity usually increases with walking (no effect on false labor)
- cervical dilatation and effacement are progressive
- contractions do NOT decrease with rest or warm tub bath

2) false labor:
- contractions are irregular
- usually no change in contractions
- discomfort usually in abdomen
- walking has no effect on or lessens contractions
- no change in dilatation or effacement
- rest and warm tub baths lessen contractions

28
Q

stages of labor

A

1) first stage: latent, active, transition (0-10cm)

2) second stage: resting, active (10cm - birth)

3) third stage: birth baby -> placenta (5-30 min)
- after birth of infant, uterus contacts firmly, decreased surface area of placental attachment
- placenta begins to separate: bleeding, membranes last to separate
- placental birth: shiny shultz (fetal side), dirty duncan (maternal side)

) fourth stage: 1st hour after birth
- 1-4 hours after birth
- blood loss 250-500 mL vaginal birth
- uterus remains contracted
- mother is starving
- shaking chill (neurological response)
- hypotonic bladder (decreased tone + neural sensation)

TIPS:
first labor: lasts 16-18 hours
labor after that cuts in half
caesarean birth: loss 1 L blood, greater than 1L = hemorrhage

29
Q

signs of placental separation

A
  • globular shaped uterus
  • rise of fundus of uterus in abdomen
  • sudden gush of trickle of blood
  • further protrusion of the umbilical cord out of the vagina
30
Q

maternal systemic response to labor

A

1) cardiovascular: stressed by contacrtions and pain, anxiety
2) blood pressure: increases during contractions
3) fluid and electrolyte balance: diaphoresis
4) respiratory system: increased oxygen demand
5) renal system: polyuria
6) GI system: prolonged gastric emptying time
7) immune systemL increased WBC during labor -> 25,000/mm3 - 30,000/mm3

31
Q

fetal response to labor

A

1) heart rate changes: early decelerations
2) acid base balance in labor: blood flow to fetus slowed during acme of contractions, can lead to slow decrease in fetal pH
3) hemodynamic changes: fetal BP protective mechanisms,
4) behavioral states: sleep and awake
5) fetal sensation: fetus experiences labor (pain, sleep-wake states, as early as 6 months, skin to skin contact can help with pain/comfort)

NUR 4020 (6 decks)

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