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OB > Chapter 8 - Labor triggers + 5 P > Flashcards

Chapter 8 - Labor triggers + 5 P Flashcards

1
Q

uterine muscles are stretched to the threshold point, leading to the release of…

A

prostaglandin + oxytocin

>stim contraction

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2
Q

increased pressure on the cervix stim the ____ causing the release of ___ by the ___

A

nerve plexus> oxytocin> pituitary gland

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3
Q

progesterone effects

A

-quieting effect on uterus

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4
Q

oxytocin + prostaglandin MOA

A

inhibit calcium binding in muscle cells
>incr intracellular calcium levels
>activate contraction

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5
Q

Maternal labor triggers

A

1 incr estrogen
2 incr oxytocin
3 incr prostoglandins
4 decr progesterone

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6
Q

as placenta ages, it begins to ____, triggering ____

A

deteriorate> invitation of contraction

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7
Q

Fetal labor triggers

A

1 placenta ages/deteriorates
2 synthesis of prostaglandins
3 incr in fetal cortisol> decr progesterone + incr prostaglandin

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8
Q

fetal cortisol

A
  • prod by fetal adrenal glands

- incr + acts on placenta to decr progesterone + incr prostaglandin

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9
Q

Factors affecting labor

[5 P’s]

A 
Powers
Passage
Passenger
Psyche
Position
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10
Q

Power

A

involuntary UC + voluntary pushing/bearing down

-propels + delivers bb + placenta fr uterus

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11
Q

pacemakers in the uterus

A

signals to posterior pituitary to secrete oxytocin + stim contraction

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12
Q

how does contraction affect upper + lower uterine?

A

upper: contracts pushing bb down
lower: less active, becomes thinner

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13
Q

___ is responsible for dilation + effacement of cervix in _____ stage of labor

A

UC> first stage

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14
Q

each contractions has a

A

allows woman + myometrium to pause for a rest

that was temporarily reduced during contraction phase

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15
Q

during the contraction phase, the BF…

A

to the uterus + placenta is temporarily reduced

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16
Q

during the resting phase or uterine relaxation phase

A
  • allows blood flow to return to uterus + placenta
  • much of fetal xchange of O2 + nutrients + wastes occurs
  • rest for mom + myometrium
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17
Q

w every contraction, ___ of blood leaves the _____ + moves back into ____

A

500 mL> utero-placental unit> maternal circulation

–gets rid of waste + replenishes O2

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18
Q

UC is described by…

A
  • frequency
  • duration
  • intensity
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19
Q

UC Frequency

A

time from start of 1 contraction to the start of another

  • in minutes
    ex) occurring Q 3-4 mins
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20
Q

UC duration

A

time from start 1 contraction to end of contraction

  • in seconds
    ex) lasts 40-50 seconds
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21
Q

UC Intensity

A

mild (tip of nose, easily intended)
mod (chin, resistant to indentation)
strong (forehead, cannot be intended)

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22
Q

the cervix is considered fully/completely dilated when it is

A

10 cm

-can no longer be palpated on vaginal examination

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23
Q

effacement

A

the shortening + thinning of the cervix

-measured by percentage

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24
Q

Ferguson reflex

A

the urge to push/bear down

-activated when the presenting part stretches the pelvic floor

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25
Q

effects of estrogen + relaxin during labor

A

softens cartilage + incr elasticity of the ligaments

26
Q

station

A

refers to the relationship of the ischial spines to the presenting part of the fetus
-for assessing fetal descent during labor

27
Q

station 0

A

the narrowest diameter the fetus must pass thru

28
Q

major factors in the birthing process

A

the relationship of the passenger + the passage

29
Q

passenger

A

the fetus

  • affected by fetal skull, attitude, lie, presentation, position, + size
  • *the position of the fetus r/t the birth canal is the most critical
  • size of fetus is less significant
30
Q

any position other than cephalic

A

indicated c section

31
Q

molding

A

ability of fetal head to change shape + accommodate the pelvis

32
Q

fetal skull is composed of…

A

2 parietal bones + 2 temporal bones + frontal _ occipital

33
Q

biparietal diameter [BPD]

A
  • 9.25 cm
  • largest transverse skull measurement
  • most important indicator of head size
34
Q

fetal attitude or posture

A

relationship of fetal parts to one another

-noted by flexion + extension of fetal joints

35
Q

goal fetal attitude/posture during term

A
  • convex fetal back
  • flexed head w chin against chest
  • arms crossed over thorax
  • thighs flexed on abdomen
36
Q

fetal lie

A

refers to long axis (spine) of bb in relation to long axis of women

37
Q

types of fetal lie

A

longitudinal or transverse

38
Q

bb cannot be delivered if fetal lie is…

A

transverse

39
Q

fetal presentation

A

determined by part or pole of the bb that first enters the pelvic inlet

40
Q

times of fetal presentation

A

cephalic (head first)
breech (pelvis first)
shoulder (shoulder first)

41
Q

presenting part

A

specific fetal structure lying nearest to the cervix

42
Q

how to further classify cephalic presentation

A

by degree of flexion or extension of head + neck:

  • vertex
  • frontum/brow
  • face
43
Q

VERTEX cephalic presentation

A

head is sharply flexed, chin tucked

-denominator is occiput

44
Q

FRONTUM/BROW cephalic presentation

A

partial extension of neck + brow

  • presenting is brow
  • denominator is frontum
45
Q

FACE cephalic presentation

A

neck is sharply extended, arching to the back like bb is facing up
-denominator is chin

46
Q

Breech presentation

A

presenting part is butt or feet

47
Q

how to further classify breech presentation

A
  • complete
  • frank
  • footling
48
Q

COMPLETE breech presentation

A
  • flexion of thigh + legs extended over anterior surface

- criss cross apple sauce

49
Q

FRANK breech presentation

A

complete flexion of thighs + legs

-like folding, head to toe

50
Q

FOOTLING breech presentation

A

extension of one or both legs so that one or both feet are presenting

51
Q

Transverse presentation

A

shoulder is presenting part

52
Q

compound presentation

A

fetus assumed unique posture

53
Q

factors that negatively affect PSYCHE

A
  • unrealistic expectation> cause anxiety
  • bad past experience
  • hx of complications
  • recent immigrants w different birth experiences in their countries
  • difficulty conceiving + unplanned pregnancies
54
Q

1st theory of labor support

A

during labor, women feel uniquely vulnerable bc unfamiliar environment, unfamiliar personnel, lack of privacy
»leads to anxiety
»decr in confidence + competence

55
Q

2nd theory of labor support

A
  • enhanced passage by encouraging mobility + using gravity

- decr stressed response

56
Q

anxiiety during labor is assoc w…

A 
-high levels of epinephrine> 
>abnormal FHR
>decr UC
>low apgar score
>longer labor
57
Q

Position

A

maternal positions during labor + birth

58
Q

freedom of mvmt

A

enhance ability to cope w pain

59
Q

upright position

A
  • great for first stage of labor
  • gives advantage of gravity in second stage
  • walking, sitting, kneeling, squatting
60
Q

benefits of upright position

A
  • decr the compression of descending aorta + ascending vena cava
  • aids in descent
  • shorter labors
  • less severe lacerations
  • less need for episiotomies
  • less fatigue
  • improved circulation
61
Q

gravity neutral positions

A

side-lying + hands-knees

OB (18 decks)

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