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Mother-Baby > Chapter 15 - Family During Labor and Birth > Flashcards

Chapter 15 - Family During Labor and Birth Flashcards

1
Q

Define attitude

A

the degree of head flexion a fetus assumes during labor, or the relation of the fetal parts to each other

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2
Q

Define breech presentation

A

fetal presentation in which either the buttocks or feet are the first body parts to contact the cervix

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3
Q

Define cephalic presentation

A

fetal presentation in which the head is the first body part to contact the cervix

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4
Q

Define dilation

A

widening of the opening of the cervix in labor

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5
Q

Define effacement

A
  • the thinning of the cervix during labor
  • In pramiparous pts effacement occurs before dilation
    • Inform the pt of both dilation and effacement to avoid discouragement with perceived lack of progress
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6
Q

Define engagement

A

The settling of the fetal head into the pelvis to the level of the ischial spines, during labor

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7
Q

Define fetal descent

A

sinking of the fetus in the birth canal just prior to birth

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8
Q

Define fetal position

A

the relationship of the presenting part to a specific quadrant and side of a woman’s pelvis

  • Vertex presentation - Occiput (O) position is chosen
  • Face presentation - Mentum (M) position is chosen
  • Breech presentation - Sacrum (S) position is chosen
  • Shoulder presentation - Scapula or accromion process (A) position is chosen
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9
Q

Define lie

A
  • the relationship between the long axis of the fetus with the long axis of the mother
  • 99% of fetuses present at the longitudinal lie (the axis of the fetus matches the axis of the mother)
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10
Q

Define molding

A

the change in shape of the fetal skull due to uterine contractions pressing the vertex against the not-yet-dilated cervix

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11
Q

Defne ripening

A

softening of the cervix with the approach of labor

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12
Q

Define station

A

the relationship of the presenting part of the fetus to the level of the ischial spines

  • 0 station indicates presenting part has descended to the ischial spines
  • -1 to -4 cm indicates presenting part is that distance above the ischial spines
  • +1 to +4 cm indicates presenting part is that distance below the ischial spines
  • +3 or +4 indicates the head is at the perineum and can be seen if the vulva is separated (crowning)
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13
Q

Define transition

A

the end of the first stage of labor, just before the woman experiences pushing sensations

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14
Q

Define the p’s

A

The four integrated concepts for successful labor are:

  • passage
  • passenger
  • powers
  • psychological outlook
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15
Q

Define passage

A
  • the mother’s pelvis
  • It must be of appropriate size and contour for birth to be successful
  • Uterus - cervix - bony pelvic ring - vagina - external perineum
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16
Q

Define passenger

A

The fetus

It must be of appropirate size should be in good position and presentation for a successful birth

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17
Q

Define powers

A
  • Uterine factors or contractions
  • they must be adequate for optimum birth
  • Assessed according to frequency, duration and strength
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18
Q

Define psychological outlook

A

the mother’s outlook or experience of birth

It should be a positive experience

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19
Q

Define the sinciput

A

the area over the (fetal) frontal bone

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20
Q

Define the occiput

A

the area over the (fetal) occipital bone

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21
Q

Define the (fetal) vertex

A

the space between the two fontanelles

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22
Q

Define the mentum

A

the chin

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23
Q

The common reason for disproportion between fetus and pelvis occurs

A
  • due to pelvic structure
  • fetal disproportion is most often due to presentation rather than head circumference
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24
Q

What is the reason for palpating the fontanelles during labor?

A
  • to determine position of the fetal head and if optimal positioning has been acheived for birth
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25
Q

The attitude when a fetus presents sinciput first is typically

A

fetus is presenting at the forehead

attitude/flexion is moderate; chin not touching the sternum

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26
Q

The attitude when a fetus presents with the brow is

A
  • moderate/military attitude
  • partial extension
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27
Q

The attitude when the fetus presents with the face is

A

poor attitude

poor flexion, complete extension

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28
Q

The attitude when the fetus presents in vertex is

A
  • suboccipitobregmatic presentation
  • full flexion (good attitude!)
  • chin touching sternum
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29
Q

The attitude when the fetus presents at Mentum is

A
  • very poor attitude
  • hyperextension
  • presenting the cranium at the the widest part (occipitomental)
  • vaginal birth may not be possible
30
Q

Define cephalic presentation

A
  • presenting part is the fetal head
  • occurs 95% of births
31
Q

Define caput succedaneum

A
  • edema on the presenting part of the fetus due to pressure applied during labor and birth
32
Q

Define breech presentation

A
  • presentation by the feet or buttocks
  • occur 3% of births
  • good attitude with breech births is knees tucked against abdomen
  • poor attitude is extension of knees and feet
33
Q

Define footling breech

A

presentation of one or both feet

34
Q

Define frank breech

A

presentation of the buttocks with the hips flexed and the knees extended (pike position)

35
Q

Define complete breech

A

presenting with the buttocks and feet with the thighs tightly flexed against the abdomen

36
Q

Define shoulder presentation

A
  • The shoulder, iliac crest, hand or elbow is presenting
  • Occurs 1% of births
  • Fetus is transverse lie
  • Position may be modified, C-section will be necessary in most cases
37
Q

Causes of shoulder presentation include

A
  • pelvic contractions
  • presence of placenta previa
  • relaxed abdominal walls
  • grand multiparity
38
Q

Fetal position is denoted by a three-part abbreviation. In order, letters denote

A
  • Second letter denotes - the fetal landmark presenting
  • First letter denotes - the direction, relative to the mothers body, the fetal landmark is pointing (Left or Right)
  • The third letter denotes - the direction, relative to the mothers body, the fetal landmark is pointing (Anterior or Posterior)
39
Q

The cardinal movements of labor are

A
  1. descent
  2. fexion
  3. internal rotation
  4. extension
  5. external rotation
  6. expulsion
40
Q

Characteristics of Braxton Hicks are

A
  • Irregularity
  • Confined to abdomen and groin
  • Often disappear with ambulation or sleep
  • Do not increase in frequency, duration or intensity
  • No cervical dilation
41
Q

Characteristics of True contractions are

A
  • Regularity
  • First felt in lower back and sweep in a wave to the abdomen
  • Continue regardless of activity
  • Increase in duration, frequency and intensity
  • Cervix dilates
42
Q

The phases of contractions are

A
  • Increment - increasing
  • Acme - maximum strength
  • Decrement - decreasing
43
Q

Describe the changes in contour of the uterus as labor progresses

A
  • the uterus elongates and becomes defined in two zones
  • The upper zone thickens
  • The lower zone thins
44
Q

Define the latent phase of labor

A
  • the first phase of stage 1 labor
  • 0 - 3 cm
  • average time 6hr nullipara, 4.5 multipara
  • encourage activity for the mother
  • Time the duration of the latent phase - prolongment indicates complications
45
Q

Define active phase of labor

A
  • 2nd phase of 1st stage labor
  • cervical dilation 4-7 cm
  • dilation progresses ~1cm/hr nullipara; ~2cm/hr multipara
  • Contraction stronger, duration 40-60 sec q 3-5 min
  • average length 3hr nullipara; 2hr mulitpara
  • Show and spontaneous rupture increase
  • Encourage activity and comfortable positioning (except flat on back)
46
Q

Define the transitional phase of labor

A
  • 3rd phase of 1st stage of labor
  • cervical dilation 8-10cm
  • Contractions peak, duration 60-70 sec q 3-5 min
  • N/V may occur
  • Mother may be anxious, paniced, irritable and experience loss of control
  • irresistable urge to push
47
Q

Define the second stage of labor

A
  • Full dilation and effacement to birth
  • ~1hr w/o complications
48
Q

Define the third stage of labor

A
  • the placetal stage
  • birth of infant to delivery of placenta
  • uterus should be firm and round when palpated after birth
  • 5-30 after birth
  • 300-500mL blood loss
49
Q

Define Schultze presentation

A
  • presentation of the fetal side of the placenta
  • “shiny” Schultze
50
Q

Define Duncun presentation

A
  • presentation of the maternal side of the placenta
  • “dirty” duncun
51
Q

Physiological effects on cardiac output by labor are

A
  • Output increases 40-50% during pushing
  • Birth causes momentary drop of pressure in the vena cava; the body compensates to increase output to ~80% above prelabor levels
  • Output gradually decreases from this value
52
Q

Physiological effects on blood pressure with labor

A
  • systolic pressure rises ~15mmHg with contractions
  • *supine positioning in 2nd stage puts pressure on the vena cava and causes hypotension
  • Hypotension can also result from an epidural w/o sufficient hydration
53
Q

Physiological effects on the hematopoetic system

A
  • leukocytes increase from 5,000-10,000 cells to 25,000-30,000 cells/mm3
54
Q

Physiological effects on the respiratory system

A
  • increasing cardiovascular parameters causes increasing respiratory rates
  • O2 consumption increases by 100% during stage 2 labor
  • risk for hyperventilation
    • breathing techniques
    • breath into paper bag
55
Q

Physiological changes in temperature regulation

A

Slight (1oF) increase; diaphoresis to cool

56
Q

Physiological changes to fluid balance

A
  • Insensible water loss increases (diaphoresis, panting)
  • Sip fluids, ice chips or candy during labor
57
Q

Physiological changes to the urinary system

A
  • Pressure of the fetal head reduces bladder tone or the ability to sense filling.
  • mother should attempt to void q 2hr
  • urine concentration occurs; proteinuria not unusual
58
Q

Physiological changes to the musculoskeletal system

A
  • relaxin, a hormone released by the ovary causes softening of cartilage
  • joints become more flexible
  • pelvic ring will stretch up to 2 cm
  • related pain to back and pubis
59
Q

Physiological changes to GI system

A

activity decreases/ceases

60
Q

Physiological changes to the neurological and sensory responses

A
  • pain
  • increased pulse
  • increased respiratory rate
    *
61
Q

Signs of maternal danger related to blood pressure

A
  • systolic BP >140mmHg or Diastolic BP >90mmHg
  • Increase of systolic BP >30mmHg or diastolic >15mmHg
  • indicates gestational hypertension
  • drop in BP may indicate hemorrhage
62
Q

Signs of maternal danger related to pulse

A
  • Normal rate is 70-80 bpm
  • Rate >100bpm may indicate hemorrhage
63
Q

Signs of Maternal danger related too inadequate or prolonged contractions

A
  • Decreased frequency, intensity or duration
    • uterine exhaustion
  • Contraction durations >70 sec
    • reduced nutrients and hypoxia in the fetus
64
Q

Signs of maternal danger related to abdominal contour

A
  • a bulge on the lower abdomen indicates a full bladder
    • bladder injury possible
    • counterpressure by the bladder may prevent descent
65
Q

Signs of maternal danger related to apprehension

A
  • increasing apprehension
    • psychological - needs may not be met
    • physiological - oxygen deprevation or internal hemorrhage
66
Q

Signs of fetal danger related to heart rate

A
  • HR >160 bpm or <110 bpm indicates fetal distress
67
Q

Fetal danger signs related to meconium staining

A
  • a green color in the amniotic fluid caused by loss of rectal sphincter control
    • may indicate fetal hypoxia
    • not always stress but always report
68
Q

Fetal signs of danger related to hyperactivity

A

may indicate hypoxia

69
Q

fetal signs of danger related to low oxygen saturation

A
  • Normal saturation is 40-70%
    • <40% can cause acidosis
70
Q
A

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