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TEST 2 > Intrapartum > Flashcards

Intrapartum Flashcards

1
Q

Labor is a physiological event, involving sequential changes within the

A

myometrium, decidua, & cervix

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2
Q

Name the 6 signs of PREMONITORY SIGNS OF LABOR

( s/s labor is near)

A
  • Cervical Changes
  • Lightening- Fetus descend into true pelvis
  • INCR. Energy Level
  • Bloody Show
  • Braxton Hicks Contr.
  • SROM
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3
Q

Cervical changes (dilation) occur

A

1 month - 1 hr BEFORE labor begins.

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4
Q

Cervical changes include

A
  • Shortened, thinned segment
  • Effacement - softer, more stretchable
  • Dilation
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5
Q

Lightening may occur

A

2 weeks or more bEFORE labor begins

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6
Q

S/S of lightening occuring

A
  • Improvement in breathing
  • May experience:
    -increase Pelvic pressure
    -Leg cramping
    -Dependent edema Lower extremities
  • Low back discomfort
    -increase Vaginal discharge
  • Urinary frequency
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7
Q

INCREASE in energy levels

A
  • occurs 24 - 48 hrs BEFORE onset of labor
  • Mom begins to prep for childbirth
  • Increase of epinephrine, decr of progesterone
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8
Q

Increased energy levels is called

A

NESTING

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9
Q

BLOODY SHOW sign of labor

A
  • pressure ruptures cervical capillaries
  • Expulsion of Mucous plug
  • Mucus and blood mix= Pink-tinged secretions
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10
Q

What do Braxton Hicks Contractions do?

A
  • become STRONGER AND MORE FREQUENT
  • FUNDUS feels Tightening or pulling sensation
  • felt in abdomen & groin then spread downward
  • Cervix moves from post. to ant. position.
  • Assist w/ cervical ripening & softening
  • Irregular
  • Last 30 secs to 2 min.
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11
Q

Spontaneous Rupture of Membranes (SROM) is

A
  • rupture of membranes with loss of amniotic fluid prior to the onset of labor.
  • begin labor w/i 24 hrs
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12
Q

WHat to expect during SROM sign of labor

A
  • labor begins within 24 hrs
  • Sudden gush or a steady leakage of amniotic fluid
  • Risk for infection & Danger of cord prolapse
  • Advise women to notify HCP & get evaluated
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13
Q

True vs false labor

A
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14
Q

Factors Affecting the Labor Process

A
  • Passanger (Fetus and placenta)
  • PASSAGEWAY (maternal pelvis and soft tissues)
  • POWERS (contraction)
  • Position (moms position)
  • psyche
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15
Q

different types of pelvic shape becomes determining factor for

A

vaginal birth.

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16
Q

Pelvis shape is determined by 4 MAIN SHAPES

A
  1. GYNECOID
  2. ANTHROPOID
  3. ANDROID
  4. PLATYPELLOID
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17
Q

TYPE OF PELVIS:

  • True female pelvis
  • Less common in men
  • Most favorable for VB
  • Allows early & complete fetal internal rotation during labor
A

GYNECOID PELVIS

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18
Q

TYPE OF PELVIS:

  • Common in men & non-white women.
  • ‘Deep pelvis’- oval inlet & long sacrum
  • Wider AP diameter than transverse)
A

ANTHROPOID PELVIS

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19
Q

TYPE OF PELVIS:

  • Male-shaped pelvis
  • Funnel shape
  • Slow fetal head decent
  • Failure of fetus to rotate
  • Poor prognosis for VB, lead to CS
A

ANDROID PELVIS

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20
Q

TYPE OF PELVIS:

  • Least common type
  • Difficult for fetus to descend
  • Labor prognosis is poor
  • Frequent arrest at inlet
  • Not favorable for VB
A

PLATYPELLOID (FLAT) PELVIS

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21
Q

Important PASSANGER factors are -

A
  • Fetal head (size & presence of molding)
  • Fetal attitude (POSTURING: degree of body flexion)
  • Fetal lie (SPINE of fetus vs SPINE of mother)
  • Fetal presentation (first body part in inlet- Presentation part)
  • Fetal position (relationship to maternal pelvis)
  • Fetal station
  • Fetal engagement (head in pelvic inlet)
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22
Q

Fetal Head factors

A
  • Cranial bones
    -Not fused, soft & pliable
    -2 frontal, 2 parietal, & 1occipital bone
  • Sutures present (gaps b/t cranial bones)
  • Molding: elongated shape of fetal sjull at birth
  • Caput Succedaneum- Fluid collection in the scalp
  • Cephalohematoma- Blood collection beneath scalp
    -reabsorbed over 6-8 weeks
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23
Q

Fetal head diameter include

A
  1. Occipitofrontal
  2. Occipitomental
  3. Suboccipitobregmatic (9.5 cm)
  4. Biparietal (9.25 cm at term)
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24
Q

Fetal Head Diameters:

  • Largest transverse diameter of fetal skull
  • Distance between two parietal bones
A

Biparietal diameter
9.25 cm at birth

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25
Q

What is CEPHALIC PRESENTATION

A
  • HEAD-FIRST presentation- in pelvis
  • occurs in 95% of all term births.
  • “Vertex”
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26
Q

Most common Fetal attitude

A

Flexion:

* All joints flexed
-Back rounded
-Chin on chest
-Thighs flexed on abdomen
* Legs flexed at knees
* Most favorable for vaginal birth
* Smallest fetal parts presents to pelvis first

anything outside these norms is considered ABNORMAL

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27
Q

There are 3 possible Fetal Lies

A
  1. longitudinal
  2. transverse
  3. oblique
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28
Q

Which Fetal Lie is the MOST COMMON

A

longitudinal

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29
Q

THe main 3 FETAL PRESENTATIONS

A
  1. CEPHALIC/VERTEX (head fist)
  2. BREECH (pelvis/butt first)
  3. SHOULDER (scapula /shoulder first)
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30
Q

Cephalic (also known as the VERTEX) presentation has 3 different variations.

Name them

A
  1. Military
  2. brow
  3. Face

basically 3 ways the baby’s head can come out during the CEPHALIC presentation

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31
Q

Most common fetal presentation is?

A

Cephalic presentation.

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32
Q

Breech fetal presentation is when

A

Fetal buttocks or feet come FIRST

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33
Q

Challenges at birth with a breeched baby

A
  1. Largest part (skull) becomes stuck in pelvis
  2. umbilical cord compressed (stops O2 to baby)
  3. buttocks are not cervical dilators (pelvis does not open more)
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34
Q

Breeched babys are associated with

A
  • prematurity
  • placenta previa
  • uterine abnormalities (fibroids)
  • congenital anomalities
  • possible trauma to head.
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35
Q

Shulder fetal presentation

A
  • Presents shoulders
  • Turtle sign- head slowly emerges into perineum but then retrachs back into vagina
  • TRANSVERSE LINE POSITION
  • Rare: 1 in 300
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36
Q

The relationship of a given POINT ON THE PRESENTING PART of the fetus to a designated POINT ON THE MATERNAL PELVIS

A

fetal position.

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37
Q

Fetal position:

The landmark fetal PRESENTING PARTS include:

4 total

A
  • Occipital bone (O) - Vertex
  • Chin (Mentum [M]) - Face
  • Buttocks (Sacrum [S])- Breech
  • Scapula (Acromion [A]) - Shoulder
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38
Q

Documenting:

Vertex Fetal presentation

A

Occipital bone (O)

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39
Q

Documenting:

Chin Fetal presentation

A

Mentum [M]-
FACE

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40
Q

Documenting:

Buttocks fetal presentation

A

Sacrum [S]
“Breech”

41
Q

Documenting:

Shoulder fetal presentation

A

Acromion [A]-
Scapula

42
Q

Fetal position:

Maternal pelvis is divided in 4 quadrants

A
  • Right anterior (RA)
  • Left anterior (LA)
  • Right posterior (RP)
  • Left posterior (LP)
43
Q

Fetal position FIRST LETTER is

A

First letter:

  • Left (L)
  • Right (R)
44
Q

Fetal position SECOND LETTER is

A

SECOND LETTER:

  • O - Occiput
  • S - Sacrum
  • M - Mentum
  • A - Acromion Process
  • D -Dorsal (fetal back)
45
Q

Fetal position THIRD LETTER is

A

Third letter

  • Anterior (A)
  • Posterior (P)
  • Transverse (T)
46
Q

Relationship of fetal presenting part to level of maternal pelvic ischial spines

A

FETAL STATION

47
Q

Fetal station is measured in

A

cm

48
Q

above ischial spine the numbers are

A

negative -1 to -4

49
Q

below ischial spine the numbers are

A

positive
+1 to +4

50
Q

The entrance of largest fetal presenting part into smallest diameter of maternal pelvis.

A

Fetal head engagement

51
Q

Fetal head engagement

A
  • Engaged AT zero station.
  • Determined by pelvic exam
  • largest diameter of fetal head = biparietal diameter
  • Transverse diameter of maternal pelvis
52
Q

Fetal HEAD Engagement occurs

A

typically occurs in:
* PRIMIGRAVIDAS 2 weeeks before term
or
* multiparas- several weeks BEFORE onset of labor or not until labor starts.

53
Q

When fetal engagement has not occurred bc the presenting part is still freeliny moving above pelvic inlet

A

FLOATING

54
Q

Fetal positional changes as it travels through the passageway

A

CARDINAL MOVEMENTS

55
Q

Name the 6 cardinal movements

A
  1. Descent
  2. flecion
  3. internal rotation
  4. extension
  5. external rotation (restitituion)
  6. expulsion
56
Q

Cardinal movement:

downward movmnt of fetal heat.

A

Descent

57
Q

What causes DESCENT movement

A
  • contractions
  • Pressure of amniotic fluid
  • Pressure of fundus on fetus’s buttocks or head
  • Contractions of abdominal muscles (2nd stage)
  • Extension & straightening of fetus
58
Q

Cardinal movement:

  • vertex meets resistance from cervix, walls of pelvis or pelvic floor.
  • Chin TO fetal thorax
A

Flexion

59
Q

Cardinal movement:

  • fetal heat (occiput part) meets resistance from one side of pelvic floor.
  • Head then rotates 45 degrees anteriorly to the midline under symphasis

q

A

Internal rotation

60
Q

Cardinal movement:

  • Head emerges under symphysis pubis along with shoulders
A

extension

61
Q

cardinal movements:

  • Allows internal rotation of shoulders to fit maternal pelvis
A

external rotation

62
Q

cardinal movements:

  • Reducing risk of perineal injury
  • Manual control of fetus expulsion
  • Perineal support by HCP
A

EXPULSION

63
Q

The primary powers in labor are

A

uterine contractions
(involuntary)

64
Q

the secondary powers in labor are

A

use of intra-abdominal pressure

65
Q

What can interfer with intra-abdominal pressure?

A
  • sedated or extremely anxious
  • compromise effectiveness of powers.
66
Q

what is EFFACEMENT

A

the cervix stretches and gets thinner

67
Q

Effacement:

  • 2 cm cervix lenght=
  • 1 cm cervix length =
  • 0 cm cervix length =
A
  • 0% effaced
  • 50% effaced
  • 100% effaced
68
Q

What is Dialation

A

the diameter of the Cervical os increases from 1 cm to 10 cm.

69
Q

Uterine contractions:

Early Labor – (Mild) contractions:

A
  • Last 30 secs
  • Occur every 5 to 7 min.
70
Q

Uterine contractions:

As labor progresses – (Moderate to High) contractions:

A

Last 60 secs, Occur Q 2 to 3 min.

71
Q

Information to ask when monitoring and assessing uterine contractions

A
  • Frequency - How often
  • Duration - How long it lasts
  • Intensity - How Strong
72
Q

best labor maternal POSITION

A

LITHOTOMY

73
Q

2 ways to manipulate and speed up the process of labor through medical means.

A
  1. AROM (amniotomy)
  2. Synthetic Oxytocin (Pitocin)
74
Q

Induction of labor:

Used when Fetal head is -2 station or lower with cervix dialated at 3 cm

A

AROM
artificial rupture of membranes
(amniotomy)

75
Q

Induction of labor:
* Stimulates uterin contractions.
* administered piggyback into primary IV lines w/ an infussion pump titrated to uterine activity

A

Synthetic Oxytocin (pitocin)

76
Q

Pain management

A
  • Pain universal
  • No negative effect on Fetus
77
Q

Maternal Physioilogic responses include INCREASE of what VS

A
  • HR - 10 to 20 bpm.
  • CO - 12% to 31% , 50% 2nd stage
  • BP - 35 mm Hg with contractions
  • WBC - 25,000 to 30,000 cells/mm3
  • RR
  • Temp.
  • BMR
78
Q

Maternal Physioilogic responses include DECREASE of what VS

A
  • Blood glucose
  • Gastric motility & food absorption
  • Gastric emptying & gastric pH
  • Muscular aches and cramps
79
Q

Respiratory changes during labor prepare fetus for

A

extrauterine respiration immediately after birth.

80
Q

labor is divided into _____ stages

A

4 stages.

  • 1st stage
  • 2nd stage
  • 3rd stage
  • 4th stage
81
Q

FIRST stage has two phases

A

latent phase
Active phase.

82
Q

what happens in first stage- latent phase?

A
  • From start of reg. cont. to cervical dilation
  • Cervix dilates 6 cm (sedation prolongs)
  • Contractions:
    -Q 5 to 10 min.
    -Last 30 to 45 secs
    -Mild pain
  • Effacement of cervix - 0% to 40%.
  • May stay home
  • Contacting their hcp
83
Q

What happens in first stage-

active phase?

A
  • Complete (10 cm) Cervical dilation
  • Effacement complete
  • Rate of 1.2 to 1.5 cm/hr
  • Fetus descends in pelvis.
  • Contractions:
    -Q 2 to 5 mins
    -Last 45 to 60 secs
    -Moderate to strong
  • Use relaxation & paced breathing
84
Q

2nd stage is called the

A

pushing stage

85
Q

What happens in the 2nd stage

A
  • From complete dilation to birth of infant
  • Lasts up to 3 hours
  • Contractions:
    -Q 2-3 min or less,
    -Lasts 60-90 sec.
    -Strong Intensity
    -Urge to Push
86
Q

Two ways of conducting the second stage of labor.

2 ways of pushing

A
  1. Directive pushing
  2. spontaneous pushing
87
Q

Pushing directed by caregiver
epidural associated
May be harmful

A

directed pushing

88
Q

Pushing that:
* Follow mother’s natural urge
* Natural way of managing second stage
* Delay pushing until woman feels an urge to push

A

spontaneous pushing

89
Q

Stage that begins with the birth of newborn and ends with separation and birth of placenta.

A

Third stage

90
Q

Third stage consists of two PHASES

A
  1. placental separation
  2. placental expulsion
91
Q

What to know about placental separation

A
  • Within 5-30 min post-delivery
  • Contractions cause the placenta to pull AWAY from uterine wall.
  • Signs of separation that placenta is ready to deliver:
    -Uterus rises upward
    -Umbilical cord lengthens
    -Sudden gush or trickle of blood
    -Change in uterine shape

f

92
Q

Placental expulsion:

A
  • Expelled within 2 to 30 minutes
  • Massage uterus till FIRM
  • Normal blood loss - Over 1,000 ml - SEVERE
  • If placenta DOES NOT deliver, HCP will assist with removal called MANUAL EXTRACTION
93
Q

SPONTANEOUS DELIVER OF PLACENTA OCCURS IN TWO WAYS

A
  1. fetal side or
  2. maternal side
94
Q

Placenta delivery:

  • shiny gray side presenting first
  • Called the SHINY SCHULTZ
A

fetal side placental delivery

95
Q

Placenta delivery:
* red raw side
* ridges
* Called duncan mechanism (dirty duncan)

A

maternal side

96
Q

Begins with completion of the expulsion of the placenta and membranes and ends with the physiologic adjustment and stabilization of the mother.

A

FOURTH STAGE.

97
Q

FOURTH STAGE

A
  • 1-4 Hrs POST birth
  • initiates POST PARTUM period
  • Uterus: Should be firm & well contracted
98
Q

Focus of Care during FOURTH STAGE

A
  • Monitor uterus & bleeding
  • Watch for bladder distention & Venous thrombosis
  • Attachment promotion

TEST 2 (6 decks)

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