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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
Passenger: what is fetal position?
relationship where the fetus' head is in comparison to the 4 quadrants of the mom's pelvis
26
Passenger: what is the POV of the fetal position?
it is based on where the BACK (occipital bone) of the baby's head is facing
27
Passenger: what is the most common fetal position?
ROA & LOA (right or left occipitoanterior)
28
Primary Powers: what are contractions? what is the goal of them? what is happening to the fetus when contractions happen?
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
29
Primary Powers: what are the phases & characteristics of contractions?
1. increment 2. acme (peak) 3. decrement Icebergs Are Done - frequency, duration & intensity
30
Primary powers: what happens to the uterus when contractions happen?
- the top of the uterus gets thicker - lower part of uterus / cervix starts to thin out --> opens
31
Primary powers: what is the term for thinning of cervix?
effacement
32
Primary powers: what is the term for opening of cervix?
dilation
33
Primary Powers: what is the ratio of dilation/effacement/station?
2/50/-1
34
Primary powers: what goes first? effacement or dilation?
effacement happens before dilation
35
Primary powers: what can you compare a 1 cm to?
cheerio
36
Primary powers: what can you compare 3 cm to?
banana slice
37
Primary powers: what can you compare 4 cm to?
cracker
38
Primary powers: what can you compare 7 cm to?
top of soda can
39
Primary powers: what can you compare 10 cm to?
bagel
40
Secondary powers: what consists of this? what is it?
pushing: mom contracting her abdomen muscles in correlation with contractions
41
Secondary powers: when should a mom start contracting?
only when cervical dilation is complete
42
Secondary powers: what can happen if mom pushes even though cervix is not completely dilated?
- cervical swelling / edema - lacerations - cervical bruising - maternal exhaustions
43
Secondary powers: what is valsalva
forceful attempt of exhalation against a closed airway by closing one's mouth and pinching one's nose shut while expelling air
44
Maternal Positions: what are the different kinds?
- upright - lateral - semi-recumbent - hands & knees
45
Maternal positions: how does the upright position help the mom?
- gravity helps fetal descent - facilitates dilation & effacement - reduces pressure of major mom structures
46
Maternal positions: how does lateral position help mom?
- incr cardiac output - improves perfusion to organs - removes pressure of major maternal structures - helps with back pain - facilitates counter pressure
47
Maternal positions: how does semi recumbent position help mom?
- helps with fetal monitoring & exams - NOT great for labor
48
Maternal positions: how does hands & knees position help mom?
- helps back labor - facilitates internal rotation of fetus - good for R/LOP presentation
49
Psychological Response: what can influence a mom's response to labor?
- knowledge & preparation - past experience - stress response - support - social factors - cultural factors - fear
50
what are the theories of labor?
- progesterone - estrogen - oxytocin - prostaglandin - fetal cortisol - uterine distention
51
what does progesterone do?
- maintains pregnancy - STOPS contractions - reduces during labor
52
what does estrogen do?
when progesterone lowers --> estrogen rises - INCR contractions
53
what does oxytocin do?
increases contractions
54
what does fetal cortisol do?
stimulates oxytocin - increases its release during labor
55
what does prostaglandins do?
facilitates contractions - also in semen
56
what is uterine distention?
the stretching of uterus - twins and triplets can cause early labor because of stretch
57
what are some of the preliminary signs of labor?
- lightening - sudden burst of energy - braxton hicks contractions - cervical ripening
58
what is lightening? what can it cause for the mom?
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
what is another name for a sudden burst of energy? when does it happen?
nesting syndrome - happens 24 - 48 hours prior to labor onset
60
what are braxton hicks contractions?
practice contractions - irregular contractions throughout pregnancy - disappears or stops with change of activity - cervical dilation does NOT occur - increases closer to term
61
what influences braxton hicks?
- dehydration --> more likely for braxton hicks - more babies --> more sensitive to braxton hicks
62
what is cervical ripening?
softening of cervix --> allows for stretch and dilation
63
what enzymes allow for cervical ripening? what do they do?
collagenase & elastase - inhibits ability of collagen fibers to bind
64
what is the true sign of labor?
progressive dilation & effacement of cervix
65
what is bloody show?
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
what is the cervical mucus plug?
a protective mechanism that seals the cervix during pregnancy that prevents bacteria
67
what is ROM?
rupture of membranes - some experience it prior to labor onset - most who experience ROM will experience true labor in 24 hours
68
what happens if labor doesn't happen within 12-24 hours of ROM?
mom may be induced to avoid infection - if ROM happens before induced, umbilical cord can be washed --> prolapsed cord
69
what are the 4 types of ROM?
- SROM (spontaneous) - AROM (artificial) - PROM (premature) - PPROM (preterm premature)
70

nurs 335: women (5 decks)

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