Factors Affecting L&D Flashcards
Passageway
Ability of pelvis & cervix to accommodate passage of fetus
Four pelvis types and most ideal
- Gynecoid
- Anthropoid
- Android
- Platypelloid
Passenger refers to
Ability of fetus to complete birth process
Define molding
cranial bones overlap under pressure of the powers of labor and demands of unyielding pelvis
What is the largest transverse diameter of the fetal skull?
Biparietal
What is the smallest transverse diameter of the fetal skull?
Suboccipitobregmatic
Fetal attitude
Relationship of fetal parts to one another, particularly to head
Optimal fetal attitude
Flexed
Fetal lie
refers to relationship fetal spine (cephalocaudal axis) to maternal spine (cephalocaudal axis)
Ideal fetal lie
longitudinal; parallel relation
True or false: if a fetal lie is longitudinal it is not breeched
False; breech refers to presentation
Fetal presentation
Determined by body part of fetus that enters pelvic passage first + fetal lie
What are the 4 general types of fetal presentation?
- cephalic: head
- breech: buttocks
- shoulder
- compound: another part presents first
Which fetal presentation can not be delivered vaginally and why?
Shoulder; it is associated with a transverse or oblique lie
Fetal position
Position of fetus in relation to pelvis; where is occiput aiming in pelvis
What is the ideal fetal position
right or left occiput anterior
Fetal station
relationship of presenting part (head, buttocks) to imaginary line drawn between ischial spines of maternal pelvis
Fetal engagement
presenting part at 0 station/level of the ischial spines is engaged
and/or
largest diameter of presenting part reaches or passes through pelvic inlet
Why must contractions be assessed?
They are expected to decrease uteroplacental blood flow; could adversely affect oxygen delivery to fetus
Contraction timing of false labour
irregular, not occurring close together
Contraction strength of false labour
weak, not getting stronger with time or alternating
Contraction discomfort of false labour
Front of abdomen
Change in activity associated with contractions of false labour
Contractions may stop or slow down with walking or making a position change
What to tell patients when suspected they are experiencing false labor?
Drink fluids and walk around to see if the intensity of the contractions change; if the contractions diminish in intensity after either or both stay home
7 Premonitory Signs of Labour
- Lightening
- Cervical changes - Prostaglandins change cervix from long to short and thin and flexible (ripening)
- Bloody show
- rupture of membranes
- sudden burst of energy
- loss of 0.5-1kg
- diarrhea, indigestion, nausea, vomiting
What occurs in the 1st stage of labor?
Cervical Changes 0-10cm
What physiologic changes occur in the early 1st stage of labour?
- regular mild contractions every 5-10 min
- effacement and dilation begin 0-3cm
What physiologic changes occur in the active 1st stage of labour?
Contractions increase to every 2-5min
Dilation 4-7cm
Fetus begins to descend
What physiologic changes occur in the transition 1st stage of labour?
Contractions increase
Cervix effaces and dilates to 8-10cm
Rapid descend of fetus
N/V, diaphoresis, increased bloody show
What cardiovascular changes occur in labour?
Increased blood pressure with each contraction
What respiratory changes occur in labour?
increase O2 demand and consumption
mild respiratory acidosis
What GI/GU changes occur in labour?
Bladder edema due to pressure from fetal head
Delayed motility/emptying
What hematological and immune changes occur in labour?
WBC increase, glucose decrease
Define the second stage of labour?
10cm to delivery of baby; equated with pushing
What intervention occurs with the delivery of the anterior shoulder?
occurs with the delivery of the anterior shoulder?
3 units IV or 10 units IM oxytocin is given between 2nd and 3rd stage to contract the uterus to prevent hemorrhage and to fully expel placenta.
Define the 3rd stage of labour
Delivery of baby to delivery of placenta
What physiologic changes occur in the 4th stage of labour
- increased pulse and decreased BP r/t * redistribution of blood from uterus and blood loss
- uterus contracted between umbilicus and symphysis pubis
- shaking chill
- urinary retention
