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nurs 335: women > intrapartum pt 1: 5 P's of labor & its signs > Flashcards

intrapartum pt 1: 5 P's of labor & its signs Flashcards

EXAM 2 content

1
Q

what are the 5 P’s in labor (in order)?

A
  1. passageway
  2. passenger
  3. powers
  4. position of the mom
  5. psychological response
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2
Q

Passageway: where is the false pelvis?

A

above the brim of the pelvis

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3
Q

Passageway: what parts are in the true pelvis and where are they located?

A
  1. inlet: upper margin of pubic bone
  2. midpelvis: short anterior wall & long curved posterior wall
  3. pelvic outlet: formed by the ischial tuberosities laterally
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4
Q

Passageway: what are the different pelvic shapes?

A
  • gynecoid classic: circle
  • android resembles: heart
  • anthropoid: vertical oval
  • platypelloid: horizontal oval
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5
Q

Passageway: what does it mean if a woman has a gynecoid classic pelvic shape?

A

50 % of women have it
- all parts of true pelvis are adequate

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6
Q

Passageway: what does it mean if a woman has a android resemble pelvic shape? what can that lead to?

A

20% of women have it
- midpelvis has conversion side walls
–> trouble birthing –> might have to vacuum baby out

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7
Q

Passageway: what does it mean if a woman has an anthropoid pelvis shape?

A

20% have it
- midpelvis is a problem
- same issues as android

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8
Q

Passageway: what does it mean if a woman has a platypelloid pelvis shape? what can that lead to?

A

5% have it
–> more problems with vaginal delivery –> head can not get out –> c section

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9
Q

what do we need to consider in the Passenger stage?

A

the fetus;
- head
- attitude
- lie
-presentation
- position
& placenta

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10
Q

Passenger: what parts of the baby’s skull can hinder or facilitate child birth?

A
  • sutures
  • fontanelles
  • molding
  • overriding sutures
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11
Q

Passenger: how many sutures does a baby’s skull have? what are they called?

A

4 sutures
- frontal
- coronal
- sagittal
- lambdoid

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12
Q

Passenger: how many fontanelles does the skull have? what are they called?

A

2 fontanelles
- anterior
- posterior

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13
Q

Passenger: what does it mean if the fontanels are sunken?

A

dehydrated

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14
Q

Passenger: if the sutures are bulging, what does that mean?

A

too much fluid

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15
Q

Passenger: what are overridng sutures?

A

sutures are separated or overlapping
- resolves in a day

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16
Q

Passenger: what is fetal lie?

A

the relationship of how the baby is laying in the uterus to the mom

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17
Q

Passenger: what are they two types of fetal lie?

A
  • longitudinal lie: parallel to mom - vertex or breech
  • transverse lie: horizontal to mom
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18
Q

Passenger: what does a transverse lie indicate?

A

not a good sign & we need to move them to longitudinal

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19
Q

Passenger: what is fetal attitude and what do we want?

A

the relation of the fetus’s body parts to each other – we want everything to be flexed before birth

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20
Q

Passenger: why does the baby need to be in flexed position, especially the head?

A

by the head flexing, the occipital bone can be pushed out first –> helping the head mold

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21
Q

Passenger: what is fetal presentation? what does presenting part mean?

A

during a vaginal exam before birth, what is showing out first? the head? a hand?

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22
Q

Passenger: what is the presenting part in fetal presentation determined by?

A

fetal lie & fetal attitude

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23
Q

Passenger: what does station mean in fetal presentation?

A

relation to the showing part outside of the vagina to the imaginary line of the pelvis, line being at 0

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24
Q

Passenger: what are the types of presentations?

A
  • cephalic or vertex (95%, most common)
  • breech: frank, complete, footling
  • transverse lie: shoulder
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25
Q

Passenger: what is fetal position?

A

relationship where the fetus’ head is in comparison to the 4 quadrants of the mom’s pelvis

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26
Q

Passenger: what is the POV of the fetal position?

A

it is based on where the BACK (occipital bone) of the baby’s head is facing

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27
Q

Passenger: what is the most common fetal position?

A

ROA & LOA (right or left occipitoanterior)

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28
Q

Primary Powers: what are contractions? what is the goal of them? what is happening to the fetus when contractions happen?

A

they are period of intensity w relaxation of the uterus in between. their goal is to dilate & efface the cervix
- fetus’ O2 stops –> mom needs rest between contractions for the baby to replenish O2 stores

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29
Q

Primary Powers: what are the phases & characteristics of contractions?

A
  1. increment
  2. acme (peak)
  3. decrement
    Icebergs Are Done
  • frequency, duration & intensity
30
Q

Primary powers: what happens to the uterus when contractions happen?

A
  • the top of the uterus gets thicker
  • lower part of uterus / cervix starts to thin out –> opens
31
Q

Primary powers: what is the term for thinning of cervix?

A

effacement

32
Q

Primary powers: what is the term for opening of cervix?

A

dilation

33
Q

Primary Powers: what is the ratio of dilation/effacement/station?

A

2/50/-1

34
Q

Primary powers: what goes first? effacement or dilation?

A

effacement happens before dilation

35
Q

Primary powers: what can you compare a 1 cm to?

A

cheerio

36
Q

Primary powers: what can you compare 3 cm to?

A

banana slice

37
Q

Primary powers: what can you compare 4 cm to?

A

cracker

38
Q

Primary powers: what can you compare 7 cm to?

A

top of soda can

39
Q

Primary powers: what can you compare 10 cm to?

A

bagel

40
Q

Secondary powers: what consists of this? what is it?

A

pushing: mom contracting her abdomen muscles in correlation with contractions

41
Q

Secondary powers: when should a mom start contracting?

A

only when cervical dilation is complete

42
Q

Secondary powers: what can happen if mom pushes even though cervix is not completely dilated?

A
  • cervical swelling / edema
  • lacerations
  • cervical bruising
  • maternal exhaustions
43
Q

Secondary powers: what is valsalva

A

forceful attempt of exhalation against a closed airway by closing one’s mouth and pinching one’s nose shut while expelling air

44
Q

Maternal Positions: what are the different kinds?

A
  • upright
  • lateral
  • semi-recumbent
  • hands & knees
45
Q

Maternal positions: how does the upright position help the mom?

A
  • gravity helps fetal descent
  • facilitates dilation & effacement
  • reduces pressure of major mom structures
46
Q

Maternal positions: how does lateral position help mom?

A
  • incr cardiac output
  • improves perfusion to organs
  • removes pressure of major maternal structures
  • helps with back pain
  • facilitates counter pressure
47
Q

Maternal positions: how does semi recumbent position help mom?

A
  • helps with fetal monitoring & exams
  • NOT great for labor
48
Q

Maternal positions: how does hands & knees position help mom?

A
  • helps back labor
  • facilitates internal rotation of fetus
  • good for R/LOP presentation
49
Q

Psychological Response: what can influence a mom’s response to labor?

A
  • knowledge & preparation
  • past experience
  • stress response
  • support
  • social factors
  • cultural factors
  • fear
50
Q

what are the theories of labor?

A
  • progesterone
  • estrogen
  • oxytocin
  • prostaglandin
  • fetal cortisol
  • uterine distention
51
Q

what does progesterone do?

A
  • maintains pregnancy
  • STOPS contractions
  • reduces during labor
52
Q

what does estrogen do?

A

when progesterone lowers –> estrogen rises
- INCR contractions

53
Q

what does oxytocin do?

A

increases contractions

54
Q

what does fetal cortisol do?

A

stimulates oxytocin
- increases its release during labor

55
Q

what does prostaglandins do?

A

facilitates contractions
- also in semen

56
Q

what is uterine distention?

A

the stretching of uterus
- twins and triplets can cause early labor because of stretch

57
Q

what are some of the preliminary signs of labor?

A
  • lightening
  • sudden burst of energy
  • braxton hicks contractions
  • cervical ripening
58
Q

what is lightening? what can it cause for the mom?

A

dropping of fetus into pelvic inlet, a sign that the baby is preparing to be born
–> mom can breathe easier
–> leg cramps/pain
–> incr. pelvic pressure
–> incr. venous stasis –> LE edema
–> incr urine frequency
–> incr vaginal secretions from congestion of vaginal mucous membranes

59
Q

what is another name for a sudden burst of energy? when does it happen?

A

nesting syndrome - happens 24 - 48 hours prior to labor onset

60
Q

what are braxton hicks contractions?

A

practice contractions - irregular contractions throughout pregnancy
- disappears or stops with change of activity
- cervical dilation does NOT occur
- increases closer to term

61
Q

what influences braxton hicks?

A
  • dehydration –> more likely for braxton hicks
  • more babies –> more sensitive to braxton hicks
62
Q

what is cervical ripening?

A

softening of cervix –> allows for stretch and dilation

63
Q

what enzymes allow for cervical ripening? what do they do?

A

collagenase & elastase - inhibits ability of collagen fibers to bind

64
Q

what is the true sign of labor?

A

progressive dilation & effacement of cervix

65
Q

what is bloody show?

A

PINK blood tinged secretions that happens with the expulsion of the cervical mucus plug
- shows onset of true labor within 24 to 48 hours

66
Q

what is the cervical mucus plug?

A

a protective mechanism that seals the cervix during pregnancy that prevents bacteria

67
Q

what is ROM?

A

rupture of membranes
- some experience it prior to labor onset
- most who experience ROM will experience true labor in 24 hours

68
Q

what happens if labor doesn’t happen within 12-24 hours of ROM?

A

mom may be induced to avoid infection
- if ROM happens before induced, umbilical cord can be washed –> prolapsed cord

69
Q

what are the 4 types of ROM?

A
  • SROM (spontaneous)
  • AROM (artificial)
  • PROM (premature)
  • PPROM (preterm premature)
70
Q
A

nurs 335: women (5 decks)

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