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OB Exam Two > Chapter 7 > Flashcards

Chapter 7 Flashcards

1
Q

When does onset of labor begin

A

38-42 weeks

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2
Q

What factors initiate labor

A

maternal and fetal factors

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3
Q

what have to happen to the moms body for labor

A

cervical softening, uterine excitability (contractions), and cervical dilation

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4
Q

what are some maternal factors that initiate labor

A

: Uterine muscle stretching (causes release of prostaglandins), pressure on the cervix (stimulates release of oxytocin which gradually increases during labor), rising estrogen levels the uterus becomes more excitable and contractions begin

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5
Q

what fetal factors happen to initiate labor

A

placental aging/deterioration trigger the initiation of contractions, fetal cortisol increases which increases the release of prostaglandins, fetal membranes also release prostaglandins which aide in stimulation of uterine contraction

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6
Q

what are the 4 Ps of labor

A

Powers, passegeway, passenger, and psychosocial influences

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7
Q

what are the 2 components of power

A

primary force of labor (uterine contractions), and secondary force of labor (maternal pushing)

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8
Q

what are the 3 phases of uterine contraction

A

increment, acme, and decrement

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9
Q

what is the increment phase of uterine contraction

A

the building up of the contraction, the longest phase where contractions build strength

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10
Q

what is the acme phase of uterine contraction

A

where contractions peak to the strongest points

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11
Q

what is the decrement phase of uterine contraction

A

the relaxation of the contractions when the uterus contractions go back to the resting baseline

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12
Q

what happens to the fundus when contractions start

A

Fundus then spread throughout the uterus pushing fetus downward which in turn puts pressure on the cervix to thin and open

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13
Q

why do we need rest periods during contractions

A

need it because mom needs it and very vital to fetal oxygenation (oxygen is cut off during contractions)

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14
Q

what happens to the uterus during contractions

A

) With each contraction the uterus longates

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15
Q

what are the 3 descriptions used for uterine contractions

A

beginning of one contraction to the next), Duration (beginning of one contraction to the end of the same contraction), and Intensity (mild/moderate/severe for eternal or by mmof mecury for internal

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16
Q

why does the cervix have to be 10cm dilated before pushinf

A

because were worried about cervical damage, edema (they wont be able to push through that and if they can the rip can cause a hemmorrhage

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17
Q

when do women normally feel the urge to push

A

women are usually fully dialated when they feel the urge to push

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18
Q

for the 4 Ps of labor what is included in the passage way

A

maternal pelvis and soft tissue (the cervix and vaginal cannal are also part of passageway made up of soft tissue)

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19
Q

what are the 3 segments of the pelvis

A

Inlet, Midpelvis, and outlet

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20
Q

what determines if a mom can have a vaginal birth

A

The shape and dimension of moms pelvis

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21
Q

in order for the birth to occur what movements must occur

A

cardinal movements

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22
Q

what is engagement and descent for cardinal movements

A

: initial movement of the babies head into uterine inlet

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23
Q

what are the 4 forces that facilitate decent

A

pressure of amniotic fluid. Direct pressure of uterine fundus/contraction of maternal abdominal muscles/ extension and straigtening of fetal body

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24
Q

what is flexion of cardinal movements

A

resistant that’s encountered from the fetal head, meaning the cervix and the pelvic floor- allows the smallest part of the fetal head to pass through the pelvis first

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25
Q

what is internal rotation and how does it happen

A

fetal head rotates from tansverse position to anterioir position

Early in labor the transverse position because the pelvis is widest from side to side, During active labor it rotates to anterior position

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26
Q

what is the most favorable position for labor

A

anterior

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27
Q

if there is no rotation during internal rotation of cardinal movments what does that do

A

labor is prolonged, because the widest part of the head is presenting

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28
Q

if posterior position instead of anterior position happens during internal rotation of cardinal movements what does that do

A

labor is prolonged because the infant has to rotate to get into the anterior prior to birth which is more painful

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29
Q

what is extension of cardinal movements

A

when fetus reaches the pubis arch, it must extend the head to pass under the pubic arch and symphysis pubis – the face is facing down towards the rectum

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30
Q

what is external rotation of cardinal movements

A

birth of head, shoulders must line up with head, anterior shoulder delivers first

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31
Q

what is explosion of cardinal movements

A
  • lateral flexion of shoulder and head occurs and posterior shoulder delivered – rest of body quickly follows
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32
Q

what does passenger include in the 4Ps of labor

A

Refers to fetus: skull, attitude, presentation, position, and station (all affects labor process)

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33
Q

what occurs for fetal skull that help labor

A

cartilage between bones of fetal skull allow for overlapping during labor, molding (the actual over lapping of the cranial bones) or elongating of fetal head also allows for accommodation through the birth canal

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34
Q

what is the anterior fontanelles - soft spots and when does it close

A

diamond shape top of the head, position where sagittal, frontal, coronal sutures – closes around 18 months

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35
Q

what is the posterior fontanelles - soft spots and when does it close

A

triangular shape in the back of the head, positioned where lambdoidal and sagittal sutures meet – closes around 6-8 weeks of age

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36
Q

what is fetal attitude

A

: the relationship of fetus body parts to one another

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37
Q

what is the most common and favorable for vaginal birth position

A

flexion - presents the smallest diameter of fetal skull to the bony pelvis (approx. 9.5cm which is why 10cm for dilation is needed)

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38
Q

what is fetal presentation

A

the fetal part that enters the pelvic inlet first

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39
Q

what is cephalic fetal presentation and what are the different types

A

when the fetal head presents first (largest part of the infant by 96%), Vertex (head is flexed), Military (head is neither flexed nor extended), Brow (partial extension), Face (head full extended)

40
Q

what is a breech fetal position and what can happen because of it

A

feet or buttocks come. First happens in about 4.6% of delievers it cause a much higher risk of baby having cord prolapse, less effecgive cervical dilation, delivery is difficult because the head mold and the butt doesn’t

41
Q

who is more at risk for a transverse or shoulder fetal presentation

A

happens in less then 1% usually preterm high parity, PROM, polyhidrangeous, previa, this breech almost always calls for a c section

42
Q

what does osopite mean

A

back of fetal head

43
Q

where is the narrowest diameter of the pelvis

A

ischial spine

44
Q

what is a position above the ischial spine called

A

minus station

45
Q

what is a position below the ischial spine called

A

a positive station

46
Q

what is a 4+-5+ station mean

A

crowning and delivering

47
Q

what roles play a factor in the moms emotional readiness for labor

A

previous experiences, cultural oriented views of childbirth shape expectations and ongoing perceptions of birth

48
Q

what is a labor process enhanced

A

women feels confident in her ability to cope with the process of labor and when she finds a way to work though the pain of contraction

49
Q

what is a labor process delayed

A

mom is fearful and tense, or she fights the pain and contractions

50
Q

what is the nesting phase

A

energy spurt where mom gets the house ready for baby

51
Q

what is lightening

A

beginning of engagement the head isn’t fully engaged

52
Q

what is a bloody show

A

cervical stretching/softening cause mucous plug to expel blood tinged mucus

53
Q

what should you teach a patient before ROM

A

TACO
Time your water broke, Amount of fluid, Color of fluid, and Odor of fluid

54
Q

how does a AROM (artificial rupture of membrane) happen with a HCP

A

amniotomy

55
Q

how do you know if ROM or just pee

A

only way to tell is if they come in and get it tested via an nitrogene or aminosure kit

56
Q

what is a doula

A

professionally trained person that is experienced in child birth – no clinical role just there to support mom

57
Q

what info should be taken when a mom gets to a birthing center

A

describe contractions, ROM?, any vaginal bleeding, decrease in movement of baby, any changes to your health

58
Q

what is the first thing you need to do when getting a new patient

A

Need to establish a positive relationship, patient centered atmosphere, support of birthing plan if they have one

59
Q

what is included for collection data

A

expectations for birthing, subjective expirence of labor, psychosocial/cultural factors, VS, weight gain, fundal height, FHR

60
Q

what is included in the initial admission assessment

A

if its true labor, is birth imminenet, any factors that increase mom or fetal risk, name of support person, any prenatal care, EDB, ROM, complications, allergies, medications, contractions, smoke/drug use, birth plan

61
Q

what labs should be ran when a mom gets to a birthing center

A

blood type, Rh factor, CBC, Hgb, Hct, blood glucose, urine sample

62
Q

what shoudl be documented when a patient gets to a birthing center

A

patient name and age, FHR, contraction pattern

63
Q

when does the first stage of labor start and end and how long does it last

A

begins with true regular contractions and ends with full dialation of cervix at 10cm- generally lasts 8-20 hours for primips and approx. 5-14 hours for multis

64
Q

what are some factors lengthen labor

A

analgesia, maternal position, moms body size, moms level of fitness

65
Q

what is included in the latent period (early labor)

A

not active begins with the establish of regular contractions, Dilation is 0-3cm, frequency of contractions is about 5 minutes apart, duration of contractions is about 30-45 seconds, contraction intensity is mild, and time is 10-14 hours- it is recommended to be at home during this time and do frequent position changes to facilitate labor changes

66
Q

what is included in the active phase

A

Dilation is 4-7 cm, Contractions: frequency is 3-5 mins, duration is 60+ seconds and intensity is moderate to strong, increasing discomfort primips dilate about 1cm per hour, and multips dilate about 1.5cm/hr

67
Q

what is included in the transition phase

A

Dilation 8-10cm, frequency is every 2-3min, duration of contraction is 60-90 seconds, intensity of contraction is strong

68
Q

what labor phase is decribed as as the most difficult part of labor and often the quickest phase of labor

A

Transition phase

69
Q

what is second stage of labor and when does it start and end

A

characterized by maternal pushing
Starts at 10cm dilation, Ends with birth of infant

70
Q

If a women feels like she needs to poop what should you do

A

don’t let her and check her dilation because shes probably close to ready to push

71
Q

what is the urge to push stimulated by

A

ferguson reflex (as presenting part stretches pelvic floor muscles)

72
Q

what are the two types of pushing

A

closed glottis (involuntary pushing), and open glottis (directive pushing, pushing when you reach full cervical dilation)

73
Q

is burning sensation normal during labor

A

is normal because of the perineal stretching

74
Q

how long does birth take during the second stage of labor for primips and mulipts

A

Primpis take about 1-2 hours, and multips approx. a few pushed to an hour

75
Q

what should you never do during the second stage of labor

A

leave the patient alone during 2nd stage of labor you do want to encourage rest periods between contractions and pushing

76
Q

what is a laceration

A

a tear that happens naturally more common in first time labor moms, can happen on cervix, vagina, and perineal Described by degree

77
Q

what is a first degree laceration

A

perineal skin and vaginal mucous membranes

78
Q

what is a second degree laceration

A

skin, mucous membrane, fascia or perineal body

79
Q

what is a third degree laceration

A

skin, mucous membrane, muscles or the perineum and extended to rectum

80
Q

what is a fourth degree laceration

A

extended to rectal mucous and expose lumen of the rectum

81
Q

what is a episiotomy

A

surgical incision made by HCP

82
Q

what are the complications of an episiotomy

A

cystocele (buldge of the bladder into the vagina), rectocele (tissue wall between the vagina and rectum weaken), dyspareunia (painful intercourse),

83
Q

what is a midline episiotomy purpose

A

2nd degree easily repaired heals quickly but does have a higher risk of 3rd and 4th degree tear

84
Q

what is a mediolateral episiotomys purpose

A

less likely for 4th degree tear but greater blood loss, more difficult surgical repaur and increase perineal pain

85
Q

how can you decrease perineal trauma

A

perineal massage, warm compress, lubricating oil, and manual support

86
Q

can you delay cord clamping

A

– you can delay cord clamping by 30-120 seconds so fetus can get increase blood supply, increased Hct, increased ferritin its controversial

87
Q

what are the risks for delayed cord clamping

A

hyperbillrubin and polycythemia

88
Q

what is the third stage of labor

A

begins at birth of baby and ends with delivery of placenta
o Length is 5-10 minutes up to 30 minutes if longer then it could be a retained placenta

89
Q

what happens to the uterus during third stage of labor

A

Uterus becomes sqherical in shape, uterus rises up as placenta descend into vagina (immediately after birth between umbilical and symphois pubis then itll lower to be at the umbilicus when the placenta is birthed)

90
Q

what happens after the umbilical lengthens

A

– a gush of blood occurs when the placenta detached from uterus

91
Q

what are the two different presentations of the placenta

A

shiny Schulze (placenta separated from fetal size) or a dirty Duncan (placetna seperates from maternal side first)

92
Q

what medications can be given for uterine bleeding

A

oxytocin IV or IM

93
Q

what meds can be given for increased blood loss

A

hemabate, and methergine

94
Q

what is the fourth stage of labor

A

begins immediately after birth of placenta and ends 1-2 hours postpartum

95
Q

what do you want to assess in the fourth stage of labor

A

Want to assess firm uterus, lochia rubra with occasional small clots which is normal , o Watch of excessive amounts of bleeding,

96
Q

if there is an excessive amount of bleeding in the fourth stage of labor what should you do

A

is massage the fundus, ensure oxytocin has been given, and you can put ice on the perineum

OB Exam Two (8 decks)

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