L&D I Flashcards
What are the Four P’s?
Powers, passage, passenger, psyche
_____________________________ favor efficient passage of the fetus through the mother’s pelvis
Natural mechanisms of labor
_________________________ further describe the relation of the fetus (passenger) to the maternal pelvis
Presentation and position
Labor contractions are ____________ to give baby a rest, bp increases bc blood is shunted away from uterus
intermittent
how often should moms go to the bathroom to urinate during labor? if she is not progressing –check to see if she went to the bathroom,
every 2 hours at least
What is normal blood loss during pregnancy?
500-1000 mL
during pregnancy, blood volume increases ________, as long as they have a hemoglobin of ____ and hematocrit of ___ we are happy. most pregnant people are anemic. levels of fibrinogen are elevated
40-45%, 11, 30
Maternal Physiologic effect of birth process: Supine hypotension
causes hypotension, _______
tilt hips with pillow
Maternal Physiologic effect of birth process: Hyperventilation -pain, anxiety, help them ____ calmly, she may feel dizzy. try to get her to ____.
breathe, focus
Maternal Physiologic effect of birth process: Reduced gastric motility
typically moms will be on ______, bc of reduced gastric motility –possible c section
clear liquids
t/f: . most pregnant people are anemic. levels of fibrinogen are elevated
true
Fetal Physiologic Effects of the Birth Process: Placenta circulation -__________ can impair placental circulation, ______ –can make babies not tolerate labor well
diabetes and hypertension, fetal anemia
Fetal Physiologic Effects of the Birth Process: Cardiovascular system
reacts quickly, we care about decels, how we can tell if baby is doing well, Normal FHR in utero is ______.
110-160
Fetal Physiologic Effects of the Birth Process: Pulmonary system
babies breath in utero, the process of labor helps ______ out of lungs, approximately 35% of maximum amount of fluid is in lungs (some is absorbed in the circulatory or lymph system) –vaginal birth helps squeze fluid out. __________ are at a higher risk for respiratory distress (be prepared to reseccitate), crackles can be heard on an infant
squeeze fluid, C –section babies
Powers: During the first phase of labor (onset through dilation) ______________ are the primary force moving the fetus through thematernal pelvis.
uterinecontractions
Powers:
During the second stage of labor (dilation through birth) the ____________________ to add power to the contraction and push the fetus through the pelvis.
woman uses her voluntary pushing efforts
contractions push baby down and cause ________________
effacement happens first with ______________ and takes longer than with ________________.
______ –is not completed a pregnancy past 20 weeks gestation.
dilation and effacement. , primigravida, a multigravida, nolipara
What are the two determinants of Passage? Which is more important?
maternal pelvis and soft tissues. Maternal pelvis (if it doesnt give -possible c section)
______ is the normal pelvic shape and sets us up for a good delivery.
gynecoid pelvis
_______ can deliver vaginally but might be OP (will be opposite posterior).
_______________ cannot deliver vaginally (well they can but its hard).
anthropoid, android and platypelloid
what is the best positionn to labor?
OA. can be LOA, OA, or ROA
What happens with OP?
will take longer and moms will have back pain.
after fetal head, ______ are next
typically if we can get the _____ out, we can get the shoulders out as well.
shoulders, (shoulder dystocia),
head
lie is either longitudinal or transverse
we want ______.
if baby is transverse she will probably have a ________.
__________–where they attempt to move the baby into the right position. ___________ is a huge risk with this. 95% of the time youre going to prepare for a c section.
longitudinal, c section, external version, placental abruption
attitude is ____________________
__________ is what we want.
_________ is not ideal –we could deliver baby vaginally.
extension or flexion., flexion, extension,
WHat are the different types of cephalic presentation?
VMBF -vertex military, brow, face
What is the most common breech position? What is going to happen with this presentation?
frank breech is most common –we are never going to deliver this via a c section.
What makes the breech position more likely?
placenta previa, multiple gestations, hydrocephaly
What letter abbreviates breech position?
S -sacrum
________________________will help baby get into OA position
different position changes (move the mom around)
physiologically things happen with ____ that do not allow her to actually progress in labor.
fear
What helps decrease anxiety and fear?
prenatal class, hospital tour, classes, what epidural looks like.
What is our goal considering culture?
do everything we can to get them the labor they desire while still staying safe is our goal.
Premonitory Signs of Labor:
______________________
______________________
______________________
“Bloody show”
Energy spurt (nesting)
Small weight loss
Braxton Hicks contractions
Lightening
Increase in clear and nonirritating
vaginal secretions
Premonitory Signs of Labor:
Braxton Hicks contractions
Lightening
Increase in clear and nonirritating vaginal secretions
______________________
______________________
______________________
“Bloody show” (from mucus plug)
Energy spurt (nesting)
Small weight loss (1-3 pounds)
The patient should enter the birth center for evaluation if she is uncertain or has concerns during which we will?
will keep moms for 1 hour to look at cervical change. put on monitor, do SVE, wait an hour, do another SVE
Felt in the abdomen and groin.
false labor contractions
Begins in lower back and gradually sweeps around to the lower abdomen like a girdle.
true labor contractions
What does latent labor begin and end with?
onset of regular contractions
until the active phase in which cervical dilation accelerates, which usually occurs at 5 cm dilation.
What is the longest phase with primagravas ? and it is also the longest regardless of previous children as well
latent phase
When does the active first stage of labor begin and end?
6cm to 9 cm
What are signs that active phase of stage one are over?
irritability, inability to cope, shakiness, increased perspiration and bloody show
what stage does a gush of blood occur?
third stage after the placenta delivers
List the cardinal movements
descent of presenting part through true pelvis
engagement of part reaching the ischial spines in the pelvis (0 station)
flexion of head
internal rotation
extension of head
external rotation
expulsion of fetal shoulders and fetal body
What stage is best for education?
latent first stage
What stage are they most at risk for hemorrhaging?
fourth stage
