Healthy Pregnancy and Labor Flashcards
What are some preliminary signs of labor?
Lightening
increase in activity
slight loss in weight
backache
Braxton hicks
ripening of cervix
What are some true signs of labor?
- uterine contractions- regular, rhythmic, increase in intensity
- bloody show
- rupture of membranes
- cervical dilation
You dont want membranes ruptured for more than __ hours without the baby born because this can cause infection
no more than 24 hours
What are the 4P components of labor?
Passageway
Passenger
Powers
Psyche
Maternal bony pelvis and vagina as well as cervical tissues. Route that the fetus must travel to deliver.
Passageway
The fetus
Passenger
primary and secondary forces of labor (contractions as well as pushing)
Powers
Psychological components of mother; goal is for the parents to have a positive experience
lots of time is spent here
Psyche
what must be of adequate size in order to vaginally deliver a baby?
pelvis
safe labor and delivery depends on (2)
the structure of the fetal head
alignment w the pelvis
4 methods to determine fetal position, presentation and lie
- abdominal inspection and palpation (Leopolds)
- vaginal exam
- auscultation of FHT
- ultrasounds
what 5 bones of the fetus’s head is most important?
2 frontal, 2 parietal, occipital
what suture of the fetus’s head is most important?
sagittal suture
membranous tissue between bones of the skull
sutures
what occurs when sutures overlap during labor
occurs because of the pressure of the cervix
molding
how long does molding usually occur?
1-2 days
____ are junctions of the main suture lines
fontanelles
what shape is the anterior fontanelle
large and diamond shaped
what shape is the posterior fontanelle
small and triangular shaped
when doing a cervical check on a mom, what fontanelle do we want to feel?
Anterior fontanelle (diamond shaped)
what is the goal of the fetal presenting part?
present the smallest part of the skull to the smallest part of the pelvis
what occurs when an inappropriate presentation of the fetal head occurs?
It can stall, prolong, or stop labor. Won’t allow for engagement
Relationship of the long axis of the fetal body to long axis of the mothers body
Fetal Lie
If a fetus is lying in a mothers abdomen in a horizontal manner, what lie position is this called?
Transverse
Fetal body part that will first contact the cervix or be born first and determined by the combination of fetal lie and degree of fetal flexion (Attitude)
Fetal presentation
What are three fetal presentations that can occur
Cephalic (Occiput)
Breech (Sacrum present)
Shoulder (scapula or acromion process)
if the fetal presentation is the fetus’s shoulder, what are some things we know right away?
fetus is in a transverse lie
can be caused by placenta previa
The relationship of the presenting part to the specific quadrant and size of the pregnant mom’s pelvis
Fetal position
position of presenting part toward one of the 4 quadrants of mom’s pelvis
right anterior
left anterior
right posterior
left posterior
maternal landmarks
If the fetal presenting part is the occiput, what is the letter abbreviation?
O
If the fetal presenting part is the chin, what is the letter abbreviation?
M
(Mentum)
If the fetal presenting part is the sacrum, what is the letter abbreviation?
Sa
If the fetal presenting part is the shoulder(scapula or acromion process) , what is the letter abbreviation?
A
what is the first letter in a fetal position abbreviation meaning?
part of the maternal pelvis the presenting part is toward (R= right, L= Left)
what is the second letter in a fetal position abbreviation meaning?
landmark of the fetal presenting part
(O,Sa, M, F, A)
what is the third letter in a fetal position abbreviation meaning?
location of the presenting part
a= anterior
p= posterior
t= transverse
what are the 2 best fetal positions?
LOA or ROA
settling of fetal presenting part into the pelvis
engagement
if a fetus is not engaged, what is it considered and what is the station score?
Considered “Floating” and a score of -4
relationship of presenting part to the ischial spines
Station
describe the station scores of -4, 0, and +4
-4 floating
0 engaged
+4 at outlet (Crowning)
to present the smallest diameter of fetal head to the smallest part of the birth canal
cardinal movements
movement of the fetal head in the pelvic inlet and beyond the dilated cervix: pressure from the head on sacral nerve causes need to push
decent
as head reaches the pelvic floor flexes forward
flexion
head enters pelvis during decent in diagonal
position. The head then rotates until the occiput is anterior –
shoulders are now in correct position
internal rotation
as occiput is born the neck stops beneath the pubic
arch – acts as a pivot
extension
immediately after head is born, head rotates
back to diagonal – aligns shoulders with outlet
external rotation
if baby is face ___ during delivery birth may be more painful and traumatic
face up
It is typical for a woman to complain of back labor when the
fetus is in the ____ position
posterior
in order for uterine contractions to be effective, what do they need to be?
increase in length and intensity as well as they should be rhythmic
what is a primary power?
uterine contractions
what is a secondary power?
maternal pushing efforts
at what point can a laboring woman bear down?
when cervix is fully dilated
if a laboring woman bears down before she is fully dilated what can occur?
fetal and cervical damage
what are false contractions called
braxton hicks
looking at a uterine contraction strip:
length of contraction
duration
looking at a uterine contraction strip:
from onset of one contraction to onset of the next
frequency
looking at a uterine contraction strip:
strength of contraction
intensity
shortening and thinning of cervical canal (0-100%)
effacement
how does effacement occur?
contractions
_____: enlargement or widening of the cervical canal (0-
10 cm)
- ____ occurs due to contractions and pressure on the cervix
dilation
psychological state or feeling tat women bring to labor
- emotional status
- expectations
-complications of pregnancy
-previous childbirth experience
-support?
psyche
first stage of labor has how many stages?
3
first stage of labor: when cervical dilation is 0-5cm
latent phase
first stage of labor: when cervical dilation is 6-7cm
active phase
first stage of labor: when cervical dilation is 8-10cm
Transition Phase
this stage of labor begins w complete cervical dilation and ends w birth of infant
second stage of labor
stage of labor begins with birth of infant and ends with
expulsion of placenta
third stage of labor
stage of labor is the first 1-4 hours after birth of the
placenta
fourth stage of labor
approximately how long does stage 1 of labor last?
around 12 hours
pain control used in the first stage of labor
distraction
aromatherapy (essential oils)
acupressure
walking
during the active phase of labor how often should they dilate and by how many cm?
1 cm per hour
approximately how long is the active phase of labor in stage one?
2-3 hours
what what stage and phase are contractions at peak intensity occurring every 2-3 minutes and lasting 60-70 seconds
first stage, transitional phase
at the end of transitional phase what urge occurs?
urge to push
what is it called with the fetus descends into the birth canal?
crowning
what phase is it when the laboring woman starts to push
second stage
the placental stage is what stage of labor?
Third stage
approximately how many ml of blood is typically lost w childbirth?
300 - 500 ml of blood
what are some danger signs of labor for the mother?
- high or low BP
- abnormal pulse
- prolonged or inadequate contractions
- abnormal appearance of abdomen
danger signs in labor for fetus examples
- high or low FHR
- meconium staining (Distress)
-hyperactivity
-low O2 saturation
what are 4 ways to determine fetal positioning and lie?
fetal heart tones
Leopold maneuver
vaginal exam
sonography, if needed
ELECTRONIC MONITORING OF FETAL HEART
RATE
No amplitude range detected: indicates the natural pacemaker activity of the fetal heart (sympathetic
and parasympathetic) may be affected. Narcotics and magnesium may cause.
absent
ELECTRONIC MONITORING OF FETAL HEART RATE
Amplitude range is detectable but is 5 beats per minute or fewer
minimal
ELECTRONIC MONITORING OF FETAL HEART RATE
Amplitude range is 6-25 beats per minute (normal)
moderate
ELECTRONIC MONITORING OF FETAL HEART RATE
Amplitude range is greater than 25 beats per minute-may represent an increased sympathetic
response in the neonate due to a stressful intrapartum event
marked
normal fetal heart rate
110 - 160 bpm
- The difference between the highest and lowest heart rate
- Most reliable indicators of fetal well-being
variability
4 types of decelerations
Early Decelerations
* Late Decelerations
* Prolonged Deceleration
* Variable Decelerations
Increase in fetal heart rate by 15 beats and last 15 seconds above the baseline
accelerations
Decrease in fetal heart rate
Decelerations
