Intrapartum 1 Flashcards
Refers to a series of events by which uterine contractions & abdominal pressure expel a fetus & placenta from the uterus
labor
normal labor
eutocia
as the time from the delivery of placenta through the first week’s after the delivery
puerperium
a woman about to give birth
parturient
what trigger the random, painless, braxton hick contraction into strong, corrdinated, productive labor
unknown
uterus stretches with the baby to the maximum and this causes the uterine muscles to start contracting so that the uterus regains its normal size and shape
Uterine stretch theory
Pressure on the cervix stimulates the release of oxytocin from the posterior pituitary gland causing uterine contractions
Oxytocin Theory
suggests that labor begins when progesterone levels in the body decrease and this usually happens towards the end of pregnancy
Progesterone Deprivation Theory
the placenta begins to age and these results in insufficient nutrients reaching the fetus leading to labor
Aging Placenta Theory
-Latter part of pregnancy
-secreted from the fetal membrane.
-A decrease in progesterone amount also elevates the prostaglandin level.
-Synthesis of prostaglandin causes uterine contraction, labor is initiated
Prostaglandin Theory
the route a fetus must travel from the uterus through the cervix & vagina to the
external perineum and must be of adequate size
passage
Two pelvic measurements important to determine the adequacy of the pelvic size
diagonal conjugate, the AP diameter of the inlet
transverse diameter of the outlet
critical factors in the passage
ability of the cervix to __________ and__________
ability of the vaginal
canal and the introitus to ________
dilate & efface
distend
movement of the fetus, through the birth canal is determined by several interacting factors
the fetal head
fetal attitude
fetal lie
fetal presentation
fetal position
the most important part of the fetus
fetal head
fetal head:
It is the ___________ part of the fetus
It is the most ______________ presenting part
It is the ___________ compressible of all parts
largest, frequent, least
fetal head is compose of how many bones?
7 bones
spaces between cranial bones
Sutures
between 2 frontal
bones
frontal suture
between frontal &
parietal bones
coronal suture
between 2 parietal bones (midline suture)
sagittal suture
most important suture overrides in labor (molding) decreasing biparietal diameter by 0.5 to 1 cm
sagittal suture
posterior suture; between parietal & occipital bones
Lambdoidal
Membrane-filled spaces called ________________ are located where the sutures intersect
fontanels/fontanelles
triangular in shape, junction of parietal & occipital bones; closes at 2- 3 months, as early as 2 months & as late as 4 months
Posterior fontanelle(LAMBDA)
diamond- shaped “soft spot” in front of the head, junction between frontal & parietal bones, closes at 18 months
Anterior fontanelle (BREGMA)
what are the four fontanelles
anterior fontanelle
posterior fontanelle
sphenoidal fontanelle
mastoid fontanelle
Mentum
fetal chin
Sinciput
upper part of the skull, especially the anterior portion above and including the forehead
Bregma
large diamond-shaped anterior fontanelle
Vertex
area between the anterior and posterior fontanels
Occiput
area of the fetal skull occupied by occipital bone
9.25 cm: biggest transverse diameter
biparietal
9.5 cm- smallest AP diameter
Suboccipitobregmatic
Indication that a baby is hungry
sunken fontanel of baby
when oxytoxin is given? and why?
after birth to keep the uterus contracted
Normal female pelvis
Most favorable for successful labor and birth
inlet is round and wide
gynecoid
Refers to the flat female pelvis
Less favorable for vaginal delivery due to shape
Inlet is transverse oval
5%
Platypelloid pelvis
Resembles a male pelvis, and common for tall women.
May lead arrest of labor in vaginal delivery due to shape.
inlet is heart shaped
20%
android pelvis
Ideal and large enough passage for vaginal delivery
Inlet is oval
25%
anthropoid
Baby’s head changes shape to pass through the birth canal during a vaginal delivery
molding
Transverse diameters
Biparietal: _____ cm
bitemporal:_____ cm
Bi mastoid:_____ cm
9.25
8
7
Antero-posterior diameters
occipitomental :______cm
occipitofrontal: _______ cm
suboccipitobreagmatic: ______ cm
13.5
11-12
9.5
AP are more _________ than transverse diameters.
wider
relation of the fetal body parts to each other
fetal attitude/habitus
head flexed on chest
flexion
head extended, occiput touches the back
Extension
normal and good attitude in cephalic presentation.
The fetal neck is fully flexed, with the chin touching the chest.
Occiput presenting part
complete flexion
Military or partially flexed
This position may be less favorable than complete flexion
Vertex presenting part
moderate flexion
space between anterior and posterior fontanelle
vertex
Fetal head extends backwards
May complicate delivery leading to potential issues
Forehead presenting part
Fetal head is extended backward significantly
The least favorable position for delivery.
Swollen face
face/brow presenting part
Relation of the long axis (spinal column) of the fetus to the long axis (spinal column) of the mother
fetal lie
cephalic or breech
Longitudinal/Vertical Lie
presenting part is the shoulder
Transverse/Horizontal Lie
Unstable & always become longitudinal or transverse during labor
oblique lie
The body part of the fetus that enters the pelvic inlet first & leads through the birth canal during labor
fetal presentation
Fetal Lie
Degree of Fetal Flexion (Attitude)
fetal presentation
most frequent type or presentation
cephalic
A normal condition in newborns where there is localized swelling (edema) on the scalp due to pressure during delivery
Caput succedaneum
Knees & Hips flexed, thighs on abdomen & calves on posterior thighs, buttocks & feet present
complete breech
Hips flexed & knees extended, buttocks present
frank breech
Hips & legs extended, with one foot present
Single footling
Hips & legs extended, w/ both feet present
double footling
Completely covering the cervix, it can bleed easily, tendency for the baby to be transversed
relaxed abdomen
placenta previa
Breech and shoulder presentations are associated with difficulties during labor, and labor does not proceed as expected; therefore, they are called _____________________
malpresentations
what is the landmark of vertex presentation
occiput
what is the landmark of face presentation
mentum
what is the landmark for breech presentation
sacrum
what is the landmark for shoulder presentation
acromion process
Defines whether the landmark is pointing
To the mother’s right R or L
first letter
it denotes the fetal landmarks
O: For occiput
M: For Mentum or chin
S: Sacrum
A: Acromion Process
middle letter
denotes whether the landmark points
A: Anteriorly
P: Posteriorly
T: Transversely
last letter
recommended fetal position
LOA
Relationship of presenting part of the level of the ischial spine (IS)
Measure of the degree of descent of the presenting part of the fetus through the birth canal.
station
above ischial spine
___ station
Minus(-)
below ischial spine
____ station
plus(+)
baby’s head becomes visible and remains at the vaginal opening during contractions
crowning
on what station when crowing occurs
4+
occurs when the sagittal suture is midway between the symphysis pubis and the sacral promontory
synclitism
occurs when the sagittal suture is directed toward either the symphysis pubis or the sacral promontory and feels misaligned
asynclitism
presenting part
above the inlet, in false pelvis
Floating(-3)
presenting part at
pelvic outlet
Station (+5)
-2 station
dipping
presenting part below the inlet, in true pelvis,
no longer moving but not yet engaged
Fixed(-1)
presenting part at
pelvic inlet
Station (-5)
presenting
part at IS
Engaged /Station O
Involuntary & voluntary powers combine to expel the fetus, the fetal membranes & the placenta from the uterus
powers of labor
primary power/force
involuntary
Secondary power/force
Voluntary, Maternal push with uterine contractions
force responsible for the effacement & dilation of the cervix and descent of the fetus
rhythmic but intermittent
primary
line of demarcation between the upper and lower uterine segment present during normal labor and cannot usually be felt abdominally
physiologic retraction ring
rising up retraction ring during obstructed labor due to marked retraction, the shape of abdomen in obstructed labor
thickening of the upper uterine segment while the relatively passive lower segment is markedly stretched and thinned to accommodate the fetus
BANDL’S RING
how many phases in each contraction?
3
what are the phases of each contraction
increment
acme
decrement
The longest phase where the contraction gradually builds up.
The intensity increases steadily until it reaches its peak.
increment
The peak of the contraction, representing the maximum intensity of the contraction
acme
The phase where the intensity of the contraction decreases after reaching the acme
decrement
Beginning to end of one contraction
duration
Beginning of one contraction to the beginning of the next contraction.
e.g. contractions comes every 5 min and last 60 seconds.
frequency
Fundus indents easily
Feels like a tip of your nose
mild intensity
Fundus indents less easily
Firm fundus that is difficult to indent
Feels like a chin
moderate intensity
- Fundus cannot be indented
Feels like a forehead
strong intensity
Contractions occurring more often than every two minutes & persistent contraction duration not longer 70 seconds may reduce fetal _____________ supply and should be reported
oxygen
Shortening & thinning of the cervix during the first stage of labor
effacement
Enlargement or widening of the cervical opening & the cervical canal that occurs once labor has begun
dilation/ dilatation
Use of abdominal muscles to push during the second stage of labor.
The voluntary bearing down efforts by the woman.
secondary power
it can cause cervical edema (which retards dilatation), possible tearing and
bruising of the cervix, and maternal exhaustion
If the cervix is not ______________ when bearing
down
fully dilated
position that may help stimulate effective contractions
all use gravity to help baby’s descent
walking, standing, leaning
position that relieve back pain
help rotate the baby in the most favorable position
relieves hemorrhoids
kneeling
position the uses gravity to help baby descent
allow rest between contraction
sitting
position that uses gravity to help baby descent
opens pelvis to provide more room
squatting
Woman must be relaxed, aware & participating in the birth process to result for _________ and ____________ labor
shorter and less
