Exam 4 Flashcards
Factors factors that affect the process of labor and birth - the 5 P’s
Passenger: Fetus and Placenta
Passageway: Birth canal
Powers: Contractions
Position (of mother)
Psychologic Response
Frank breach
Legs folded ankles to head
Single footling breach
One foot sticking out
Complete breach
Legs crossed, butt first
Shoulder presentation
Type of breach
Shoulder coming out first
Fetal lie
How spine of fetus and mother line up
Longitudinal fetal lie
Most common
Fetus aligned with mother
Transverse fetal lie
Fetus positioned across mother’s pelvis
Most common early in pregnancy
Oblique fetal lie
Baby turned sideways
Spine facing laterally
Vertex presentation
Chin tucked
Type of fetal attitude
Sinciput presentation
Chin neutral position
Type of fetal attitude
Brow presentation
Chin up
Type of fetal attitude
Types of fetal positions
ROA
ROT
ROP
LOP
LOT
LOA
Right/Left
Occipito
Anterior/Posterior/Transverse
Best fetal positions
ROA and LOA
Facedown
Fetal station
Measures the decent of the baby
In relation to ischial spine
x/x/x
dilation/effacement/station
ex. 8/100/0
Types of bony pelvis’
Gynecoid
Android
Anthropoid
Platypelloid
Gynecoid
Optimal pelvis type
Round, wide bone structure
Android
Wedge- or cone-like shape, with a wider top and narrower bottom
Anthropoid
Narrow, oval-shaped pelvis that’s deeper than it is wide
Platypelloid
Flat, wide, and shallow pelvis that’s the least common type. It’s more bean-shaped than heart-shaped
Lower uterine segment
Where contraction occur
Pushes baby down, putting pressure on cervix
Type of soft tissue
Introitus
Vaginal opening
Primary powers
Contractions
Secondary powers
Bearing down
What to measure during contractions
Frequency, duration, intensity
Where to measure contraction
From beginning of one to the beginning of the next
How much time is between the dark lines of the fetal monitoring strip
1 minute
Each box is 10 seconds
Phases of contractions
Increment: Increasing
Acne: Peak
Decrement: Decreasing
Signs preceding labor
Lightening - fetal head drops into pelvis
Bloody show
Losing mucus plug
Persistent low back pain
Braxton Hick’s contractions - no cervical change
Wt loss - 1-3lbs, fluid/electrolyte shifting
Nesting - surge to prepare for baby
Phases in first stage of labor
Latent: 0-3cm
Active: 4-7cm
Transition: 8-10cm
First stage of labor
Events preceding full dilation
Second stage of labor
Time from fully dilated to baby coming out
Third stage of labor
Pushing stage
Fourth stage of labor
Delivery of placenta until mom is stable
Things that initiate the onset of labor
Sex
Nipple stimulation - releases oxytocin
7 Cardinal movements of mechanisms of labor
Engagement
Descent
Flexion
Internal rotation
Extension
External rotation (also called Restitution)
Expulsion
Normal fetal HR
Monitor during labor
110-160
What factors affect fetal HR
Reduction of blood flow d/t HTN (gestational or chronic), hemorrhage, hypotension, anemia
Factors that alter fetal circulation
Compressed of umblilical cord
Fetal head compression
Reduction in blood flow to intervillous space of placenta
Ways to monitor fetal HR
Intermittent auscultation - Usually Q30mins, with doppler, fetoscope, fetal monitor ultrasound
- Does not detect patterns
Electronic fetal monitoring (EFM)
- External or internal
What must happen before internal EFM is used
Water broken
Dilated 1-2cm
Monitors uterine contractions
IUPC - Intrauterine pressure catheter
FSE - Fetal scalp electrode
Sinusoidal pattern
Sawtooth FHR pattern
Not good
When can you determine FHR is brachy or tachy
After 10 minutes
Periodic changes in FHR
Occur in reaction to uterine contractions
Episodic changes in FHR
Not related to uterine contractions
Normal acel for 32+ wk
15x15 acels
For at least 15 seconds
1 box up and over
Cause of early decels
Good thing, indicates progression of labor
Head compression d/t contractions
Peak of contraction should mirror decel (Periodic)
More than 30 seconds
Cause of late decels
Poor oxygenation
Uterine tachysystole, hypertonus
Hypotension
Postterm date
Maternal diabetes
IUGR - small baby
Occurs right after contraction (Periodic)
More than 30 seconds
Nursing interventions for late decels
Turn patient
Oxygen - nonrebreather at 10L
Fluid bolus
Turn off Pitocin
Administer Terbutaline - slow contractions
Cause of variables/variablity
Cord compression
Abrupt onset
For less than 30 seconds
Nursing intervention for variability
Turn pt
Fluids
Turn of Pitocin
Amnioinfusion: Fluid into uterus, more cushioning
Notify HCP
Prolonged decel
Gradual or abrupt
At least 15 beats below baseline, more than 2 mins but less than 10 (after 10 min is considered baseline change)
FHR category 1
HR WNL
Moderate variability
Absent late or variables
Early decels present or absent
Acels present or absent
FHR category 2
Anything between 1 and 3
No acels after stimulation
FHR category 3
Absent baseline variability
Recurrent late decels
Recurrent variable decels
Bradycardia
Sinusoidal pattern
How often to document assessment of pt with epidural vs not
Q15mins
Q30mins
When is fetal monitoring required
When receiving Pitocin
Interuterine rescucitation
Top 3 interventions:
Turning pt, oxygen, and fluids
