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Women's Health Test I > Chapter 12: Processes of Birth > Flashcards

Chapter 12: Processes of Birth Flashcards

1
Q

characteristics of contractions

A
  • coordinated
  • involuntary
  • intermittent: to allow for blood flow in intervillous space, b/c during contraction, no blood flow to baby, and they only have a certain amount of reserve
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2
Q

acme

A

peak of contraction–>where contraction is the strongest

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3
Q

uterine activity during labor

A
  • Uterine Activity during labor is characterized by opposing features.
    • Upper 2/3 actively contracts to push the fetus down.
    • The lower third of the uterus remains less active , promoting downward passage of the fetus.
    • The cervix is passive.
      • The net effect of labor contractions is enhanced because the downward push from the upper uterus is accompanied by reduced resistance to fetal descent in the lower uterus..
  • Myometrial cells in the upper uterus remains shorter at the end of each contractions rather than returning to their original length; myometrial cells in the lower uterus become longer with each contraction.
    • These two characteristics enable the upper uterus to maintain tension between contractions to preserve the cervical changes and downward fetal progress made with each contraction.
  • The opposing characteristics of myometrial contraction in the upper and lower uterine segments cause changes in the thickness of the wall during labor.
    • The upper uterus becomes thicker while the lower uterus becomes thinner and is pulled upward during labor.
  • The physiologic retraction ring marks the division between the upper and lower segment of the uterus.
  • Opposing characteristics of contractions in the upper and lower uterine segments change the shape of the uterine cavity, which becomes more elongated and narrow as labor progresses.
    • This change in uterine shape straightens the fetal body and efficiently directs it downward in the pelvis.
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4
Q

cervical changes during labor

A
  • effacement: thinning of the cervix
    • 0 to 100% OR 3.5 cm to 0 cm
  • dilation: opening of the cervix
    • 0-10 cm
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5
Q

difference in cervical changes during labor in nulliparous and multiparous women

A
  • nullipara: has to efface before dilate
  • multipara: starts to dilate, then gradually goes thru effacement
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6
Q

Maternal CV Response to Labor

A
  • blood flow to placenta dec during contractions
    • 300-500 mL of blood shunted from placenta to maternal system with contractions
      • SO, maternal HR dec and BP inc
      • therefore, take BP when uterus is relaxed
  • Keep mom in LEFT lateral position and semi-Fowler’s
    • avoid supine!
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7
Q

Maternal Respiratory Response to Labor

A
  • rate and depth inc slightly b/c uterus pushing up on diaphragm
    • inc rate if pain and anxiety present
  • hyperventilation–>respiratory alkalosis
    • S/S tingling hands and feet, numbness, dizziness
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8
Q

Maternal GI Response to Labor

A
  • gastric motility reduced
  • thirst remains, but appetite reduced
  • dry mouth
    • need to provide fluids–clear liquids (ice, popsicles, broth)
  • n/v
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9
Q

Maternal Urinary Response to Labor

A
  • reduced sensation as labor progresses
    • potential problem: distended bladder
      • if epidural, often times don’t feel sensation to go
      • full bladder can slow labor and inc risk of injury
      • inhibits descent of fetus
      • encourage patient to void at least every 2 hours
    • intermittent or indwelling catheter may be used
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10
Q

Maternal Hematopoietic Response to Labor

A
  • assess blood loss after delivery
    • vaginal birth: 500 mL is normal
    • C-section: 1000 mL is normal
  • during pregnancy, clotting factors and fibrinogen elevated
    • Hgb of 11 and HCT of 33 or higher gives adequate margin for safety
    • inc clotting and inc risk of thrombophlebitis PP–but helps prevent hemorrhage during delivery
  • WBC elevated:
    • 14,000-16,000 normal during labor
    • early postpartum: can be upwards of 25,000
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11
Q

Fetal Response in Labor: Placental Circulation

A
  • placental circulation exchange takes place b/w contractions in the intervillous spaces
    • placenta has a reserve to fetus usually tolerates the intermittent interruption
    • reduced placental fcn with GDM and HTN so can put stress on fetus during contractions
  • during labor:
    • blood supply dec during contractions and eventually stops temporarily
    • spiral As are compressed by uterine M on contraction
    • placental circulation has enough reserve compared w/ fetal basal needs to tolerate periodic interruption of blood flow
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12
Q

Fetal Response in Labor: CV System

A
  • indicator of fetal well-being
  • average FHR: 110-160
  • alterations in rate and rhythm: from normal labor effects or suggests fetal intolerance of stress of labor
  • Preterm Infant: has a rate at the higher end of 110-160
    • this is b/c the PNS takes longer to develop (peaks at 28 weeks), so before that point, the fetal HR will be higher
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13
Q

Fetal Response in Labor: Pulmonary System

A
  • Fetal lungs
    • production of amniotic fluid allows for normal development
    • lung fluid must be cleared to allow normal breathing after birth
      • labor speeds up the absorption of lung fluid
      • some expelled with birth (thoracic squeeze–chest wall of infant compressed during labor then recoils when borm–>helps initiate breathing)
  • catecholamines: epi and NE
    • produced by fetal adrenal glands in response to stress of labor
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14
Q

What are the 4 factors affecting birth? (The “Critical Factors”)

A
  • Powers
  • Passage
  • Passenger
  • Psyche
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15
Q

What are the three components of uterine contractions?

A
  • Frequency: from beginning of one to the beginning of the next
  • Duration: from beginning of one to the end
  • Intensity: strength during peak or acme
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16
Q

What are the “Powers?”

A
  • they are the forces of labor:
    • contractions: during the 1st stage of labor–>onset to full dilation
      • contractions are the primary force that moves fetus
    • pushing (which utilize the abdominal muscles): during 2nd stage of labor–>full dilation to birth
      • contractions AND maternal pushing efforts help push fetus out
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17
Q

What is the increment of a contraction?

What is the acme?

What is the decrement?

A
  • increment: period of inc strength
    • occurs as contraction begins in fundus
  • acme: peak
    • strongest point
  • decrement: period of dec strength/intensity
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18
Q

What are components of the “Passage?”

A
  • size of pelvis
  • type of pelvis
  • ability to efface and dilate
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19
Q

What are components that dictate the size of the pelvis?

A
  • inlet: upper border of the true pelvis
  • mid-pelvis: pelvic cavity
  • outlet: lower border of the true pelvis
    • pubic arch to ischial tuberosities
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20
Q

What are the 4 types of pelvis? describe them?

A
  • gynecoid
  • android
  • platypelloid
  • anthropoid
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21
Q

what is the weight of the average baby born in the US?

A
  • 7.5 pounds (3.5 kg)
    • range b/w 5.5-10 lbs
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22
Q

What are the 3 components of the “Passenger?”

A
  • fetus
  • membranes
  • placenta
    • presentation
    • fetal lie
    • attitude
    • position
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23
Q

what is fetal lie?

What are the different types?

A
  • fetal lie: orientation of the long axis of the fetus to the long axis of the woman
    • longitudinal: majority of cases
      • head or buttocks of fetus enters pelvis 1st
    • transverse: long axis of fetus is at right angle to woman’s long axis
      • almost always have to have a cesarean section
    • oblique: lie b/w longitudinal and transverse
24
Q

which fetal head diameter is ideal, and how long is it?

A
  • ideally, head would be fully flexed and the AP diameter would be submentobregmatic which is 9.5 cm
25
Q

what does presentation of the fetus mean?

What is the ideal presentation and why?

A
  • presentation: fetal part that enters the pelvis first
    • can be cephalic, breech, or vertex
      • ideally, cephalic presentation w/ head flexed
        • most favorable b/c fetal head is largest part, fetal head can mold to pelvis, and the head is smooth, round, and hard
26
Q

what are the 4 variations of cephalic presentation?

A
  • vertex presentation
  • military presenation
  • brow preseantation
  • face presentation
27
Q

Vertex Presentation

A
  • type of cephalic presenation
  • most common
  • fetal head is fully flexed
  • allows for smallest suboccipitobregmatic diameter
28
Q

Military Presentation

A
  • type of cephalic presenation
  • head in neutral position
  • longer occipitofrontal diameter presenting
29
Q

Brow Presentation

A
  • type of cephalic presentation
  • fetal head is partly extended
  • unstable
  • longest supraoccipitomental diameter presenting
30
Q

Face Presentation

A
  • type of cephalic presentation
  • head is in full extension
  • fetal occiput in near fetal spine
  • submentobregmatic diameter presenting
31
Q

Molding

A
  • sutures and fontanels allow for this
    • it is shaping of the fetal head thru the birth canal
32
Q

What is normal molding?

A
  • Caput should be central
33
Q

What is fetal attitude?

What is normal?

A
  • it is relation of the fetal body parts to one another
  • normal: flexion–>head is flexed toward the chest and arms and legs flexed over thorax
    • back curved in a C shape
34
Q

what is breech presentation?

when is breech presentation most common?

what are the variations in breech presentation?

A
  • breech: fetal buttocks near pelvis first
  • more common w/:
    • preterm births
    • births with hydrocephalus
    • births with placenta previa
  • 3 variations:
    • Frank breech
    • full (complete) breech
    • footling breech
35
Q

describe a Frank breech

A
  • fetal legs extended across abdomen toward shoulders
36
Q

describe a full (complete) breech

A
  • reversal of normal cephalic
  • head, knees, and hips flexed, but buttocks is presenting
37
Q

when is a shoulder presentation most common?

A
  • preterm
  • high parity
  • PROM
  • hydramnios
  • placenta previa
    • MUST have a CS
38
Q

Explain the position of the passenger

A
  • relationship of a fixed landmark on presenting part to front/back and side (L/R) of the maternal pelvis
    • 3 parts to description:
      • presenting part: occiput (vertex position), mentum (face presentation), or sacrum (breech presentation)
      • maternal side: anterior or posterior or transverse
      • maternal side: left or right
    • designate by 3 letter: L O A
39
Q

what is fetal station?

A
  • measurement of descent of the fetal presenting part in relation to the ischial spines on the maternal pelvis
    • Ischial spines is a zero station
    • Numbers above are negative
    • Numbers below are positive
      • Fetus should move from a -5, -4, -3, -2, -1, 0, +1, +2, +3, +4, +5
        • -5 to +5
40
Q

What are the components of “Psyche?”

A
  • anxiety: catecholamines inhibit contractions and placental blood flow
  • fear
    • relaxation augments natural process of labor
  • culture and expectations
  • relationship with partner
  • family presence
  • past experience
  • present pregnant experience
  • safety
  • education
  • technology: maintain focus on mother not technology
41
Q

when will the baby be born?

A
  • term gestation between 38-42 weeks
    • go full 40 weeks if possible, even though elective inductions often at 39 weeks
42
Q

What are the factors that appear to have a role in starting labor?

A
  • changes in ratio of maternal estrogen to progesterone so that estrogen is higher than progesterone
    • Progesterone keeps uterine muscles relaxed
    • As estrogen rises, it makes the uterus more sensitive to PGs and oxytocin and cause and inc in the number of gap junctions
  • PGs secreted by fetal membrane
  • inc secretion of oxytocin maintains labor and oxytocin receptors on the uterus inc
  • likely fetal role in secreting cortisol
  • mechanical factors: stretching, pressure, and irritation
    • feedback loop: fetal head stretches cervix and causes release of oxytocin–>fundus of uterus contracts–>pushes fetal head against cervix–>more fundal contractions
  • protein produced when fetal lungs mature
43
Q

what are the premonitory signs of labor?

A
  • Braxton Hicks (irregular, mild uterine contractions)
  • Lightening (descent of fetus towards pelvis inlet 2-3 wks before labor)
    • may notice easier breathing, inc pressure on bladder, leg cramps and edema
  • ROM
  • cervical ripening (cervix softens)
  • bloody show (effacement and dilation cause expulsion of mucus plug and rupture small cervical capillaries which lead to bloody show)
  • sudden burst of energy (nesting)
  • loss of 1-3 lbs (excretion of fluid r/t altered estrogen progesterone ratio)
44
Q

Compare True Labor and False Labor

A
  • True Labor:
    • begins in back and radiates to abdomen
    • intensity inc with walking
    • inc duration, intensity, frequency of contractions
    • progressive effacement and dilation
    • regular intervals b/w contractions
  • False Labor:
    • discomfort in abdomen nad groin
    • walking has no effect or may dec
    • inconsistent in freq, duration, intensity
    • no effacement, dilation, descent
    • irregular contractions
45
Q

First Stage of Labor

A
  • cervical effacement and dilation occur
  • longest stage
  • Begins with the onset of true labor contractions and ends with complete dilation (10 cm) and 100% effacement
  • rate:
    • nullipara: dilate 1.2 cm/hour
    • multipara: dilate 1.5 cm/hour
46
Q

Phases of the First Stage of Labor

A
  • Latent Phase
  • Active Phase
  • Transition Phase
47
Q

Latent Phase of Labor

A
  • lasts thru first 3 cm of dilation
  • longer for nullipara (7-8 hours) than multipara (4-5 hours)
  • contractions gradually inc in freq, duration, intensity
    • interval b/w contractions should shorten to 5 min as progress to active labor
    • duration inc to 30-40 sec
  • back discomfort which encircles the lower abdomen with each contraction
  • behavior: sociable, excited, cooperative, anxious
48
Q

Active Phase of Labor

A
  • cervix dilates from 4 to 7 cm more quickly than latent phase
  • effacement complete
  • fetus descends and internal rotation begins
  • slightly longer if epidural
  • contractions: 2-5 min apart and 40-60 sec long
  • discomfort inc
  • behavior: anxious, feel helpless, serious inward focus
49
Q

Transition Phase of Labor

A
  • dilate from 8-10 cm and fetus descends further
  • bloody show often inc with complete dilation
  • short but intense phase
  • contractions: 1.5-2 min apart, 60-90 sec
  • leg tremors, n/v, and urge to push
  • behavior: irritability, loss of control
50
Q

Second Stage of Labor

A
  • Begins with complete dilation and full effacement and ends with the birth
  • Varies depending on if a woman had an epidural (nulliparous: no epidural=53-57 min; w/ epidural=79 min; multiparous: no epidural=17-19 min; w/ epidural=45 min)
  • Contractions: 2-3 min apart, 40-60 long
  • as the fetus descends, it places pressure on the rectum and pelvic floor that causes an involuntary pushing response in the mother
  • woman regains a feeling of control and feels tremendous relief and excitement with the birth
51
Q

Third Stage of Labor

A
  • Begins with birth of baby and ends with expulsion of placenta
  • Shortest: lasts about 6 min
  • When the infant is born, the uterine cavity becomes much smaller
    • This causes the placenta to separate from uterine wall which is obvious by 4 signs:
      • Uterus is spherical
      • Uterus rises upward in abdomen as placenta descends
      • Cord descends further from vagina
      • Gush of blood
  • Uterus must contract and remain contracted to compress open vessels and prevent hemorrhage
52
Q

Fourth Stage of Labor

A
  • From placental delivery thru first 1-4 hours after birth
  • Should be able to palpate uterus as a firm, rounded mass about 10-15 cm
    • If feels boggy and increasing in size, then may be assoc with postpartum hemorrhage
  • Lochia: vaginal drainage after childbirth
  • Most women feel chilled after childbirth most likely r/t sudden dec in effort, loss of heat produced by the fetus, dec in intraabdominal pressure, fetal blood cells entering maternal circulation
  • Discomfort caused by birth trauma or afterpains
  • Behavior: excited, tired
  • Ideal time for bonding and best time to initiate breastfeeding
53
Q

What are afterpains?

A
  • Afterpains are intermittent contractions that occur after birth as the uterus begins to return to prepregnancy state—more common if multiparous, women who breastfeed, women who have large babies
54
Q

What are the cardinal movements?

A
  • descent: fetal presenting part moves into true pelvis
  • engagement: when the largest diameter of the fetal presenting part has passed the pelvic inlet and entered the pelvic cavity
    • Usually occurs when the station of the presenting part is 0 or lower
  • flexion
  • internal rotation: occiput rotates so sagittal suture is AP pelvic diameter
  • extension
    • _​_extension of head under symphysis
  • external rotation
    • _​_head turns back to side
    • shoulders rotate to AP position
  • expulsion
    • _​_occurs first as anterior, then posterior, shoulder passes under symphysis
55
Q

what is the most important intervention for AROM?

A
  • listen to FHR–>may indicate a prolapsed cord!

Women's Health Test I (8 decks)

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