Chapter 16: Giving Birth Flashcards
The ____________ provides oxygen reserve for the fetus while the uterus is contracting.
placenta
Contraction cycle: term for period of rising activity
increment
Contraction cycle: two terms to describe the strongest point of the contraction
peak, acme
Contraction cycle: term for period of decreasing activity
decrement
Contraction cycle: term for the length of the contraction from beginning to end
duration
Contraction cycle: term for strength of contractions described by mild, moderate, or strong
intensity
Contraction cycle: term for the period between the end of one contraction and the beginning of the next
interval (resting tone)
Contraction cycle: term for the period from the beginning of one contraction to the beginning of the next
frequency
Assessment method for palpating a contraction
Place fingertips of one hand at the fundal portion
Palpated mild contractions feel like this body part
tip of nose
Palpated moderate contractions feel like this body part
chin
Palpated strong contractions feel like this body part
forehead
Palpated resting tone in between contractions feels like this
soft
Goal interval time period in seconds
60 seconds
Purpose of contractions
propel baby forward and through birth canal
This portion of the uterine body contracts actively
upper two thirds (upper uterus)
These portions of the uterus are passive during contractions
lower third (lower uterus), cervix
The upper portion of the uterus becomes (thicker, thinner) with contractions
thicker
The lower portion/cervix becomes (thicker, thinner) with contractions
thinner
Term for thinning and shortening of the cervix
effacement
Term for opening of the cervix
dilation
The cervix of the primigravida thins (before, while) it dilates
before
The cervix of the multigravida thins (before, while) it dilates
while
During a contraction, placenta blood flow is ____________, BP slightly ___________, and pulse _____________.
decreased, increases, decreases
During labor, the depth and rate of respirations ______________, increasing the risk for __________________.
increases, hyperventilation (ultimately respiratory alkalosis)
During labor, gastric motility is ____________. The woman in labor should avoid large amounts of __________.
decreased, sugar
During labor, the sensation of a full bladder is ____________, and the bladder fills ___________.
reduced, rapidly
Average blood loss during a vaginal birth is _________ mL
500
During pregnancy, labor, and after delivery, the woman has ____________ levels of clotting factors (fibrinogen)
elevated
Three protective mechanisms the fetus has to tolerate interruption of blood flow during contractions
fetal hemoglobin, fetal hematocrit, high cardiac output
During labor, fetal lung fluid _____________ to facilitate breathing after birth, which is aided by thoracic compression.
decreases
The Power of labor that is active during the FIRST phase of labor to move the fetus through the maternal pelvis
uterine contractions
The Power of labor that is active during the SECOND stage of labor to move the fetus through the pelvis
maternal pushing efforts
Before the mother starts pushing, she must be _____ dilated and ____ station
10 cm (fully), +2
The Passage for the birth of the fetus consists of the ______________ and its _______________.
maternal pelvis, soft tissues
_______ and __________ do not readily yield to the forces of labor, which makes the ______________ more important to the outcome of labor.
bones, joints, bony pelvis
This hormone increases and softens the cartilage that links the pelvic bones
relaxin
The Passenger contains these three things
fetus, membranes, placenta
Term for the fetal head changing shape (from movable bones due to sutures and fontanels) allowing its adaptation to the size and shape of the pelvis
molding
Term for the orientation of the long axis of the fetus to the long axis of the woman
fetal lie
Type of fetal lie in which the head or buttocks of the fetus enters the pelvis first
longitudinal lie
Type of fetal lie in which the long axis of the fetus is at right angles to the woman’s long axis
transverse lie
Type of fetal lie in which the fetus is at an angle between longitudinal and transverse lies
oblique lie
Term for the relation of fetal body parts to each other (degree of flexion or extension)
attitude
Term for the fetal part that enters the pelvis first
presentation (presenting part)
____________ cephalic presentation occurs when the fetal head is completely flexed; this is the most favorable because the smallest part of the head is pointing down
Vertex
___________ cephalic presentation occurs when the head is in a neutral position (neither flexed nor extended), is usually a temporary position
Military
__________ cephalic presentation occurs when the fetal head is partly extended with the longest head diameter is presenting.
Brow
__________ cephalic presentation occurs when the head is fully extended and the fetal occiput (head) is near the fetal spine.
Face
___________ breech presentation occurs when the hips are fully flexed and the fetal legs are extended across the abdomen toward the shoulders.
Frank
___________ breech presentation occurs when the head, knees, and hips are flexed with the buttocks presenting (also known as reversal cephalic presentation)
Full (complete)
_____________ breech presentation occurs when one or both feet are presenting.
Footling
Breech presentation of a fetus increases the risk of developmental _________________
hip dysplasia
Term for the location of a fixed reference point on the presenting part in relation to the four quadrants of the maternal pelvis
position
First letter (2) of the fetal position that describes which side of the mother’s pelvis the fetal reference point is
R (right) or L (left) (may be omitted if neither to the right nor left)
Second letter (3) of the fetal position that refers to the fixed fetal reference point
O (occiput or back of head), M (mentum or chin), S (sacrum or buttocks in breech presentations
Third letter (3) of the fetal position which describes front or back
A (anterior), P (posterior), T (transverse, neither anterior nor posterior but along middle)
In a posterior fetal position, the fetal reference point points toward the maternal ____________.
sacrum
In an anterior fetal position, the fetal presenting part points toward the maternal ____________.
symphysis
In a right or left occipital transverse position, the occiput is facing the ____________
ischial spine (right or left)
The Psyche of labor may be characterized by these three things that can decrease ability to cope with labor pain
anxiety, fear, fatigue
These molecules are secreted in response to anxiety or fear during labor and inhibit uterine contractility and placental blood flow
maternal catecholamines
______________ augments the natural process of labor.
Relaxation
When preparing for labor, the ratio of estrogen and progesterone changes. Which increases?
estrogen
To prepare for labor, the decidua produces ______________
prostaglandins
Term for the energy spurt that is a premonitory sign of labor
nesting
The conclusive difference that distinguishes true labor* (from false labor) is this
progressive effacement and dilation of the cervix
True or false labor: Contractions are inconsistent in frequency, duration, and intensity.
false
True or false labor: A change in activity, such as walking, does not alter contractions, or activity may decrease them.
false
True or false labor: Contractions have a consistent pattern of increasing frequency, duration, and intensity that usually develops.
true
True or false labor: Walking tends to increase frequency and strength of contractions
true
True or false labor: Discomfort felt in the abdomen and groin
false
True or false labor: Discomfort may be more annoying than truly painful.
false
True or false labor: Discomfort begins in lower back and gradually sweeps around to the lower abdomen like a girdle.
true
True or false labor: Back pain may persist in some women. Often feels like menstrual cramps.
true
True or false labor: No significant change in effacement or dilation of the cervix after an observation period of 1-2 hours.
false
True or false labor: Effacement and/or dilation of cervix occurs. Progressive effacement and dilation of cervix are most important characteristics
true
Term for the mechanism of labor in which the presenting part goes down through pelvis; described by station
descent
Term for the mechanism of labor that occurs when the largest diameter of the fetal presenting part has passed the pelvic inlet and entered the pelvic cavity (station is 0 or lower [+])
engagement
As the fetus descends, the fetal head is ___________ farther as it meets resistance from the soft tissues of the pelvis.
flexed (mechanism of labor termed flexion of the fetal head)
Term for the mechanism of labor in which the head gradually turns to an OA position
internal rotation
Term for the mechanism of labor in which the fetal head changes position to negotiate the curve of the pelvis (fetal head pivots and is born like this)
extension of the fetal head
Term for the mechanism of labor in which the born head turns to the side it was in utero while the shoulders internally rotate
external rotation
Term for the mechanism of labor in which the anterior and posterior shoulders pass and the rest of the body follows
expulsion
Put the following mechanisms of labor in order:
- Flexion of the fetal head
- Internal rotation
- Descent
- Expulsion of the fetal shoulders and body
- Engagement of the presenting part
- Extension of the fetal head
- External rotation
3, 5, 1, 2, 6, 7, 4
Term for the spontaneous turn of the fetal head to the same side as it was in utero to realign with shoulders and back
restitution
When charting on a Freedman’s curve, it is expected to see a change every ________.
2 hours
When the placenta has separated, the uterus has a(n) ___________ shape
spherical
When the placenta has separated, the uterus _______________ in the abdomen as the placenta descends into the vagina and pushes the fundus ________.
rises upward, upward
When the placenta has separated, the cord ____________________ from the vagina.
descends further
When the placenta has separated, this appears
gush of blood
Term for the mechanism by which the placenta is expelled with the shiny, fetal side first
Schultze mechanism
Term for the mechanism in which the placenta is expelled with the rough maternal side first
Duncan mechanism (less common)
Lochia rubra should be a(n) _____________ color with _______ clots.
dark red, small
During the postpartum period, the nurse and mother are ____________. Vital signs and fundal checks are done every ____ minutes during the first hour and every ____ minutes during the second hour.
One on one, 15, 30
During the postpartum period, the uterus should feel _____ like a(n) __________. Massage it if it is _______.
firm, grapefruit, soft (boggy)
To relieve suture pain, swelling, and limit hematoma formation to the perineum, apply ___________.
ice/cold packs
To shorten the chill common after birth, apply a(n) _________________.
warm blanket
The purpose of the first Leopold maneuver is to distinguish between these two things
cephalic and breech presentation
The purpose of the second Leopold maneuver is to determine the sides that these two things are on
fetal back, fetal arms/legs
The purpose of the third Leopold maneuver is to confirm the ______________ and whether it is ___________.
presentation, engaged
Four lab tests done during labor and delivery
CBC
T&S (type and screen)
RPR (syphilis)
HIV
FHR must be out of normal range (tachycardia, bradycardia) for ___________ before performing interventions and notifying the provider
10-20 minutes
After amniotic fluid rupture, assess the FHR for at least ____________
one minute
Passage of meconium into amniotic fluid before birth may be a result of ________________
transient hypoxia
A cloudy, yellowish, or foul odor to the amniotic fluid indicates __________.
infection
The interval between contractions should last at least _______________. If contractions are shorter than that, the uterus relaxation is _____________.
60 seconds, incomplete
Persistent contractions (without a long enough interval in between) may decrease placental ___________ and fetal __________, _____________, and _________ exchange.
blood flow, oxygen, nutrient, waste
Signs of impending birth: The mother says this
“The baby’s coming”
Signs of impending birth: mother makes these sounds and/or bears down
grunting sounds
Signs of impending birth: checking this area
perineum
Apgar Score: heart rate (0, 1, 2)
0: absent
1: <100/min
2: 100/min or greater
Apgar Score: respiratory effort (0, 1, 2)
0: no spontaneous respirations
1: slow respirations or weak cry
2: spontaneous respirations with a strong, lusty cry
Apgar Score: muscle tone (0, 1, 2)
0: limp
1: minimal flexion of extremities; sluggish movement
2: flexed body posture; spontaneous and vigorous movement
Apgar Score: reflex response (0, 1, 2)
0: no response to suction or gentle slap on soles
1: minimal response (grimace) to suction or gentle slap on soles
2: responds promptly to suction or a gentle slap to the sole with cry or active movement
Apgar Score: (skin) color (0, 1, 2)
0: pallor or cyanosis
1: bluish hands and feet only
2: pink (light skinned) or absence of cyanosis (dark skinned), pink mucous membranes
