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Maternal Child Nursing (Exam 1) > Exam 1 (Labor & Birth) > Flashcards

Exam 1 (Labor & Birth) Flashcards

Labor & Birth

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1
Q

Anterior Frontal

A

Anterior is larger and diamond shaped. Closes by 18 months after birth.

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2
Q

Posterior Frontal

A

Posterior is triangular and closes 6 to 8 weeks after birth.

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3
Q

Frontals

A

-Are where sutures intersect -Determines whether baby is vertex (head 1st) on digital exam -Accommodates growth of infant brain -Allows for molding of head for birth process -Allows for passage of head through various shaped pelvic inlets -Head usually resumes normal shape within 3 days

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4
Q

Fetal Presentation

A

Refers to the part of the fetus that enters the pelvic inlet first and leads through the birth canal during labor at term.

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5
Q

Cephalic presentation

A

Head First

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6
Q

Breech presentation

A

Buttocks, feet, or both first

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7
Q

Shoulder presentation

A

Shoulder first

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8
Q

Cephalic (vertex)

A

occipital first. Preferred

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9
Q

Frank Breech

A

Buttocks breech

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10
Q

Footling Breech

A

Foot first

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11
Q

30-35 Weeks position

A

Baby will most likely remain in this position till delivery

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12
Q

Fetal Lie

A

The relation of the long axis (spine) of the fetus to the long axis (spine) of the mother.

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13
Q

Lie (Longitudinal or vertical)

A

The long axis of the fetus is parallel with the long axis of the mother.

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14
Q

Lie (Transverse, horizontal, or oblique)

A

The long axis of the fetus is at a right angle diagonal to the long axis of the mother. Vaginal birth cannot occur when the fetus stays in a transverse lie.

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15
Q

Fetal Attitude

A

The relation of the fetal body parts to one another. The fetus assumes a characteristic posture (attitude) in utero partly because of the mode of fetal growth and partly because of the way the fetus conforms to the shape of the uterine cavity.

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16
Q

General Flexion

A

Back rounded, chin flexed on chest, thighs flexed on abdomen, legs flexed at knees, arms crossed over thorax, umbilical cord between arms & legs. Best for delivery!

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17
Q

Biparietal diameter (BPD)

A

About 9.25cm at term. The largest transverse diameter and an important indicator of fetal head size. Widest part of head entering pelvic inlet.

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18
Q

Suboccipitobregmatic diameter

A

The smallest and most critical of the several anteroposterior diameters. When the fetal head is in complete flexion, this diameter allows it to pass through the true pelvis easily. As the head is more extended, the anteroposterior diameter widens, and the head may not be able to enter the true pelvis.

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19
Q

Fetal Position

A

The relationship of a reference point on the presenting part (occiput, sacrum, mentum [chin], or sinciput [deflexed vertex]). Position is denoted by a three-letter abbreviation.

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20
Q

Fetal Position (1st abbreviation)

A

Denotes the location of the presenting part in the right (R) or left (L) side of the mother’s pelvis.

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21
Q

Fetal Position (Middle abbreviation)

A

Stands for the specific presenting part of the fetus (O for occiput, S for sacrum, M for metonym [chin], and Sc for scapula [shoulder] or Sh=shoulder).

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22
Q

Fetal Position (3rd abbreviation)

A

Stands for the location of the presenting part in relation to the anterior (A), posterior (P), or transverse (T) portion of the eternal pelvis.

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23
Q

Ideal Fetal Positions

A

ROA or LOA or OA is ideal.

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24
Q

Station

A

The relationship of the presenting fetal part to an imaginary line drawn between the maternal ischial spines and is a measure of the degree of descent of the presenting part of the fetus through the birth canal.

Presenting part 1 cm above spines (-1), = to spines (0), and 1 cm below (+1).
Birth is imminent when at +4, +5 (Crowning).

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25
Q

Engagment

A

The term used to indicate that the largest transverse diameter of the presenting part (usually the BPD) has passed through the maternal pelvic brim or inlet into the true pelvis and usually correrponds to station 0.

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26
Q

Passageway (Birth Canal)

A

Composed of the mother’s rigid bony pelvis and the soft tissues of the cervix, the pevic floor, the vagina, and the introitus (the external opening to the vagina).

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27
Q

Bony pelvis (False Pelvis)

A

–Above pelvic brim.
–Plays no role in childbearing
–Iliac crests play no part

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28
Q

Bony Pelvis (True Pelvis)

A

–Inlet (brim)
–Midpelvis (cavity)
–Outlet
True pelvis is the lower portion. Matters the most in childbirth

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29
Q

Four types of pelvic canals?

A
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30
Q

Gynecoid (50%)

A

Classic Female type

Round shaped

Vaginal birth primary

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31
Q

Android (23%)

A

Heart shaped

Commonly deliver by cesarean

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32
Q

Anthropoid (24%)

A

Oval shaped

Vaginal with forceps

33
Q

Platypelloid (3%)

A

Flat shaped pelvis

Vaginal spontaneous

34
Q

Lower uterine segment

A

Thinner than upper segment to allow for opening of cervix

35
Q

Cervix

A

Effaces (thins) & dilates (opens) to allow fetus to be expelled.

36
Q

Pelvic Floor Muscles

A

Muscular layer that seperates the pelvic cavity above from teh perineal space below. This structure helps the fetus rotate anteriorly as it passes through the birth canal.

37
Q

Soft Tissues (Vagina)

A

Thins to allow stretching at time for delivery

38
Q

Introitus

A

Is the opening: if you see the baby is a +4 or +5 then it is crowning.

39
Q

Effaces

A

Measured in percentage: 80% effaceis very thin

40
Q

Contractions (primary powers)

A

Orignate in upper uterus & extend downward.
Reponsible for:

  • Effacement
  • Dilation
41
Q

Effacement

A

The shortening and thinning of the cervix during the first stage of labor.

42
Q

Dilation

A

The cervix is the enlargement or widening of the cervical canal that occurs once labor has begun.

The diameter fo the cervix increases from less than 1 cm to full dilation (approximately 10cm) to allow birth of a term fetus.

43
Q

Ferguson Reflex

A

Pressure on cervix by fetus, creates cervical stretching, which release endogenous oxytocin that triggers the urge to bear down.

44
Q

Open Glottis Pushing

A

Breathing while pushing

45
Q

Closed Glottis Pushing

A

Reduces amount of O2 to fetus.

46
Q

Contractions discriptions

A
  • Frequency
  • Duration
  • Intensity
47
Q

Frequency

A

Beginning of one contraction to beginning of another contraction.

48
Q

Duration

A

Length (measured in seconds)

49
Q

Intensity

A

Strenght of contraction

Measured only in mmMG

50
Q

Secondary Powers (Bearing Down)

A

Result in increased intraabdominal pressure that compresses the uterus on all sides and adds to the power of the explusive forces.

No effect on cervical dilation

51
Q

Valsalva Maneuver

A

Result in fetal hypoxia and acidosis if mother holds her breath for extended periods of time

52
Q

Position of Laboring Woman (Upright Position)

A

Walking, sitting, kneeling, squatting.

–Has an advantage of gravity.
–Contractions are stronger & more efficient.
–Labor is sometimes shorter.
–Improves cardiac output of mother.

53
Q

Position of Laboring Woman (“All fours”)

A

–Relieves backache if fetus is in an OP position.
–May assist in anterior rotation of fetus in shoulder dystocia.
OP babies are sunny side up.

54
Q

Shoulder dystocia

A

When the head has successfully made it through, but the shoulders don’t fit.

If she gets on her hands and knees it can make the pelvis adjust and allow the baby to slide under.

55
Q

Semirecumbent position

A

Sitting with kness to chest and leaning slightly back

Position pushes coccyx forward and reduces (makes larger) pelvic outlet.

56
Q

Lithotomy (Stirrups)

A

Predominant in US

57
Q

Lateral Position

A

–Can help rotate a fetus in posterior position.
–Decreases rate of precipitous delivery.

58
Q

Precipitous delivery

A

when the baby is out of the canal to quickly. A quick crowning.

Put the mother on her side.

59
Q

Lightening

A

–Dropping & tilting forward of uterus
–Usually indicates Fetal engagement
–Usually occurs 2 wks prior to term
–Women feel less congested but have greater urinary frequency.
–Multiparous women don’t usually experience lightening until true labor is in progress.

60
Q

Bloody Show

A

–Brown or blood tinged cervical mucous.
–Caused from cervical capillary rupture from descending fetus.

61
Q

Surge of Energy

A

is an effort to get the baby ready. Usually in the last month.

62
Q

Braxton Hicks contractions

A

False Contractions

Starts around 4 months – helps the body get ready for labor in the future.

Difference is they start lower. Not high then descending.

63
Q

Onset of Labor

A
  • Fetal hormone secreted by baby contribute to onset of labor.
  • Uterine distention, increasing uterine pressure and aging placenta increases uterine irritability.
  • Increasing estrogen & prostaglandin levels & decreasing progesterone levels are thought to stimulate labor.
64
Q

Bishop Score

A

Higher Score = more probable successful induction of labor.

65
Q

Bishop Score

Add 1 pt for:

A
  1. Preeclampsia
  2. Each prior vaginal delivery
66
Q

Bishop Score

Subtract 1 pt for:

A
  1. Postdates pregnancy
  2. Nulliparity
  3. Premature or prolonged ROM
67
Q

Indications for cervical ripening with prostaglandins:

A
  1. Bishop Score <5
  2. Membranes Intact
  3. No regular contractions
68
Q

Indications for Labor Induction with Pitocin

A
  1. Bishop Score >/= 5
  2. Rupture of Membranes
69
Q

Bishop Score Information

A

Score assigned to a patient to tell the caregiver the likelihood of a good response to induction.

Cervix can be dead center. Posterior cervix is not a good thing for induction.

Preeclampsia:

Premature baby= cervix is probably not ready.

Induction is done with protozoan ( done through IV) start at 5 or 6 am.

Prostaglandins: prepare the cervix to dilate for an induction. It’s a preparation.

ROM = ruptured membrane

Stripping the membranes: using a digit to remove the membrane

70
Q

Stages of Labor (Frist stage)

A
  • From onset of regular uterine contractions to full filation of cervix.
  • May be less than 1 hr but up to 18 hrs
  • 3 stages
71
Q

Frist Stage (Latent phase)

A

Effacement > descent

up to 4cm

72
Q

Frist stage (Active Phase)

A

Dilation and descent increase

5-8cm

73
Q

First stage (Transition Phase)

A

Rapid dilation and descent

up to 8-10cm

8-10cm most of the time happens quickly

74
Q

Second Stage of Labor

A

–Full dilation to birth.
–Multiparous - avg 20 minutes
–Nulliparous - avg 50 minutes
–African Americans & Puerto Ricans – have a shortened 2nd stage.
3 stages

75
Q

Second Stage (Latent)

A

From complete dilation when contractions weak or not noticeable

76
Q

Second Stage (Active Phase)

A
  • Contractions resume and strong bearing down efforts are in progress.
    • Pushing occurs here and open glottis is preferred.
  • Fetal station advancing.
  • Crowning until birth
77
Q

Third Stage of Labor

A

–From birth until delivery of placenta.
–May last 3-5 minutes up to 1 hr.
–Longer 3rd stage = greater risk for maternal hemorrhage.

78
Q

Fourth Stage of Labor

A

–2 hrs after placenta delivery.
–Homeostasis reestablished.
–Important to Monitor bleeding.

79
Q

When is hemorrage most likely to happen??

A

During 3rd and 4th stages.

Maternal Child Nursing (Exam 1) (11 decks)

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