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OB Exam 2 > Labor & Birth Proceses > Flashcards

Labor & Birth Proceses Flashcards

1
Q

6 Ps

A
  • Powers: contractions
  • Passenger: fetus & placenta
  • Passageway: birth canal
  • Position of mother
  • Psyche/People
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2
Q

Primary Powers

A
  • Involuntary uterine contractions
  • Signal beginning of labor
  • Forces generated by uterine musculature (fundus)
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3
Q

How are Uterine Contractions Measured

A
  • Frequency: the time from the beginning of one contraction to beginning of next
  • Amplitude/Intensity: strength of contraction at its peak
  • Duration: length of contraction
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4
Q

Primary Powers - Responsibility

A
  • Effacement: shortening & thinning of cervix during 1st stage of labor
  • Dilation of Cervix: enlargement or widening of cervical opening & cervical canal
    > occurs once labor has begun, 1cm-10cm
  • Descent of Fetus
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5
Q

Powers Assessment - Manual Palpation

A
  • Palpate the fundus throughout a contraction to determine intesnity
  • As well as observation
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6
Q

Powers Assessment - Tocodynamometry

A

Used to measure frequency, intensity, and duration of uterine contractions

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7
Q

Powers Assessment - Intrauterine Pressure Catheter (IUPC)

A

A device placed into the amniotic space during labor in order to measure the strength of uterine contraction

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8
Q

Secondary Powers

A
  • Once the cervix is dilated, then the mother can begin VOLUNTARY bearing down efforts to actively aid in the expulsion of fetus
  • No effect on cervical dilation
  • Incrd intraabdominal pressure tht compresses the uterus on all sides and adds power of expulsive forces of fetus
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9
Q

What Causes Maternal Urge to Bear Down/Ferguson Reflex

A

Stretch receptors in posterior vagina cause release of endogenous oxytocin

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10
Q

Passenger

5

A
  • The way the passenger (fetus) moves through the birth canal is determined by:
    > the size of the fetal head (major factor)
    > fetal presentation
    > fetal lie
    > fetal attitude
    > fetal position
  • Placenta is considered a passenger too bc it passes through the birth canal
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11
Q

After the Rupture of Membranes through Palpation of the Fontanels & Sutures they can Determine

A
  • Fetal presentation
  • Position
  • Attitude
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12
Q

Fontanels

A

The area where two or more bones meet

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13
Q

During Labor Fontanels/Sutures Accomodate How

A
  • Sutures & fontanels are flexible to accomodate the infant’s birth
  • Slight overlapping or modeling occurs during labor to allow for accomodation of the fetal head through bony pelvis
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14
Q

Fetal Position

A
  • A relationship of a reference point on the presenting part to the 4 quadrants of the mother’s pelvis
  • R: right of mother’s pelvis
  • L: left of mother’s pelvis
  • O: occiput
  • S: scarum
  • M: mentum (chin)
  • Sc: scapula
  • A: anterior
  • P: posterior
  • T: transverse
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15
Q

Station

A
  • The relationship of the presenting fetal part to an imaginary line drawn btwn the maternal ischial spines & is measure of the degree of descent of the presenting part of fetus through birth canal
  • Bottom of Symphysis pubis is 0
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16
Q

When is Birth Imminent

A

When the presenting part is at 4-5+ cm

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17
Q

When Should the Station of the Presenting Part be Determined

A

When labor begins so the rate of descent of the fetus during labor can be assessed accurately

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18
Q

Fetal Lie

A
  • Longitudinal axis (spine) of fetus relative to longitudinal axis (spine) of uterus/mother
  • Preferred Direction: longitudinal (vertical)
    > head down
  • Transverse/horizontal/oblique lie cannot have a vaginal birth
    > fetus spine at 90 degrees to mom’s spine
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19
Q

Fetal Presentation

A
  • Fetal part tht enters the pelvic inlet 1st and leads through the birth canal during labor at term
  • Vertex presentation
    > fetal head down
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20
Q

3 Fetal Presentations

A
  • Cephalic: head, preferable
  • Breech: butt/feet first
  • Shoulder: rare
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21
Q

Fetal Presentations - Compound

A
  • Presence of 1 fetal part over pelvic inlet
    > like a hand on the face
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22
Q

Fetal Presentation - Attitude

A
  • The relation of the fetal body part (head) to one another (spine)
  • General Flexion: the arms are crossed over the thorax, umbilical cord lies btwn arms & legs
  • Flexion allows smallest diameter of fetal head to present at pelvic inlet
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23
Q

Fetal Presentation - The Presenting Part

A
  • The part of the fetus tht lies closest to the internal os of the cervix
  • Part of the fetal body 1st felt by examining finger during a vaginal exam
  • Factors tht Determine Presenting Part:
    > fetal lie
    > fetal attitude
    > extension/flexion of fetal head
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24
Q

Fetal Size

A
  • Abdominal palpation or ultrasound
  • Macrosomia (>4500g) associated w/ failure to progress
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25
Q

Passageway - Pelvis

A
  • True Pelvis: part involved in birth
  • False Pelvis: part above the brim and plays no part in childbearing
  • Classic female pelvis = Gynecoid
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26
Q

Passageway - Soft Tissues

A
  • Cervix: contractions of the uterine body push fetus into cervix
    > the cervix effacement (thins) and dilates (opens) to allow the fetus to pass into vagina
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27
Q

Passageway - Pelvic Floor

A

Helps the fetus rotate anteriorly as it passes through birth canal

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28
Q

Position

A
  • Maternal positions can promote comfort and enhance labor progress
  • Frequent movement relieves fatigue, incrs comfort, and promotes circulation
  • The best thing for labor is movement
    > if no epidural
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29
Q

Passageway - Preferred Angle

A
  • Subpubic Angle: a rounded wide arch is preferred for birth
  • Determined at the 1st prenatal appointment
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30
Q

Psyche & People

A
  • Psyche
    > how she copes
    > perceives pregnancy/labor
  • People
    > support system
  • Education
    > prenatal care
    > preconception counseling
    > breastfeeding classes
    > baby basic classes
    > childbirth classes
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31
Q

Signs of Preceding LABOR

A

LABOR
- Lightening/Lower back pain
> uterus sinking downward & forward; more bladder pressure
> abt 2 weeks before labor
- A drop in weight (0.5-1.5kg)
> water loss
- Bloody show
> incrd vaginal discharge
- Owl’s like nesting behaviors
> burst of energy
- Ripening of cervix
> soft/dilate

32
Q

Stages of Labor Consist of

A
  • Regular progression of uterine contractions
  • Progressive effacement & dilation of cervix
  • Progressive descent of presenting part
33
Q

First Stage of Labor

A
  • Onset of uterine contractions until full effacement/dilation of cervix
  • Early (Latent): more progress in effacement of cervix & little incr in descent
    > 3cm of dilation
  • Active: more rapid dilation of cervix & an incrd rate of descent of presenting part
    > 4-7cm of dilation
  • Transition:
    > restless/irritable
    > urge to push
    > rectal pressure
    > most difficult part of labor
    > 8-10cm of dilation
  • Nursing Intervention: determine if its true or false labor
34
Q

What is the Longest Phase of Labor

A

1st - Early (latent)

35
Q

1st Stage - True vs False Labor

A
  • True
    > begins in lower back & extends from back to abdomen
    > incrses in intesity, frrequency, duration
    > change in cervix: softening, effacement, dilation, more anterior position
  • False
    > confined to lower abdomen
    > does not incr in intensity, frequency, duration
    > no change in cervix
    > walking/position may relieve discomfort
    > presenting part may not be engaged
36
Q

Labor Definition

A

Regular uterine contractions tht cause cervical change (dilation)

37
Q

1st Stage of Labor - Assessment

A
  • 1st Priority: FHR - tocotransducer/ultrasound
    > maternal vital signs
  • Gathering Data
    > last meal; important for surgery
    > OB/prenatal hx
    > group b strep (GBS) status: start antibiotics if positive
38
Q

Vaginal Exam

A
  • Effacement: measure in percentages
  • Dilation: measure in cm
39
Q

1st Stage of Labor - Phsyical Assessment

A
  • Phsyical Exam
    > mom’s VS & FHR + pattern
    > uterine contractions
    > vaginal exam: same person checks her time to prevent false reading its subjective
  • Leopold Maneuvers
    > performed through abdominal palpation, determines fetal location
40
Q

1st Stage of Labor - Labs/Diagnostic Test

A
  • Urine test
  • Blood test
  • Assessment of amniotic membranes/fluid
41
Q

1st Stage of Labor - Nursing Intervention

A
  • Oral intake
  • IV intake
  • Voiding
  • Catheterization
  • Bowel elimantion
  • Ambulation
  • Positioning
  • Support to pt & fam
  • General hygiene
42
Q

2nd Stage of Labor

A
  • Cervix fully dilated (10cm) & 100% effacement to complete birth of fetus
  • Latent: passive fetal descent through birth canal, body does the work
    > contractions help force baby further down birth canal
  • Active (Descent): pushing phase
    > urge to push/bear down (voluntary power)
43
Q

Optimal Conditions for Descent

A
  • Spontaneous urge
  • Position: occiput anterior (OA)
  • Quality of contraction
  • Station >+1
    > ideally +3
44
Q

2nd Stage of Labor - Care Management

A
  • Preparing for Birth
    > Mom: maternal position, bearing down efforts, support of father
    > Fetus: FHR & pattern
  • Optimal Position for Mother
    > squatting, makes pelvis wider
    > lithotomy is typical position
45
Q

Mechanism of Birth - What Presentation do we Want

A

Vertex presentation

46
Q

Bearing Down - Directed/Closed Glottis

A
  • Mom
    > PUSH
    > exhaustion
    > holding breath
    > counting
    > physiological & emotional effects
  • Fetus
    > dcr oxygen to fetus
47
Q

Bearing Down - Spontaneous/Open Glottis

A
  • Mom
    > women push several times during contractions
    > fewer pelvic floor complication
    > efforts vary in intensity/duration
    > less fatigue
  • Fetus
    > fewer operative births
    > less fetal acidosis
48
Q

2nd Stage of Labor - Assessment

A
  • Assessment
    > bulging perineum
    > labial separation
    > visible caput (head), obvious descent
  • Perineal trauma r/t childbirth
    > perineal lacerations
    > vaginal & urethral lacerations
    > cervical injuries
    > episiotomy
49
Q

3rd Stage of Labor

A
  • Birth of infant to delivery of placenta
  • Shortest stage: 5-10 minutes
50
Q

How do we Know 3rd Stage is Almost Complete

A
  • Firmly contracting fundus
  • Sudden gush of dark blood from introitus
  • Vaginal fullness
  • Apparent lengthening of umbilical cord
  • Shape of uterus changes
51
Q

3rd Stage of Labor - Interventions

A
  • Mom’s VS q15mins
  • Assess for placental separation & amnt of blood
  • Assist mom w/ bearing down to facilitate expulsion of placenta
52
Q

4th Stage of Labor

A

Delivery of placenta to when mother becomes stable
typically 1 hour

53
Q

4th Stage of Labor - Assessment

A
  • Fundus/bleeding
  • Perineum
    > laceration/episiotomy
  • VS/pain
54
Q

4th Stage of Labor - Newborn Assessment

A
  • Thermoregulation
    > skin to skin w/ mom is best
  • Breastfeeding
    > begin bf at this time
55
Q

4th Stage of Labor - Intervention

A
  • Active management
  • Greatest risk is hemorrhage
    > priority!
56
Q

Labor Refers to

A

The process of moving the fetus, placenta, and membranes out of the uterus & through birth canal

57
Q

Multiparous Woman Lightening Occurs When

A

May not take place until uterine contractions are established & true labor is in progress

58
Q

Mechanism of Labor

A
  • Refers to the fetal adaptations it must make during its descent through birth canal
  • (A) Engagement
  • (A) Descent
  • (B) Flexion
  • (C) Internal Rotation
  • (D) Extension
  • (E) Restitution/External Rotation
  • (F) Expulsion
59
Q

Engagement

A

When the biparietal diameter of head passes pelvic inlet, head is said to be engaged in pelvic inlet

60
Q

Descent

A
  • Refers to progressing part through pelvis
    > pressure by amniotic fluid
    > pressure exerted by sontracting fundus on fetus
    > force of contraction of maternal diaphragm/abdominal mm in 2nd stage of labor
    > extension & straightening of fetal body
61
Q

Flexion

A

Once pressure is felt from cervix, pelvic wall, or pelvic floor the fetus flexes so the chin is brought closer to chest

62
Q

Internal Rotation

A
  • The maternal pelvic inlet is widest in transverse diameter
  • Fetal head passes inlet into true pelvis in occipitotransverse position
  • Head must rotate
    > begins at ischial spine
63
Q

Extension

A
  • Occiuput passes under lower border of symphysis pubis 1st then head emerges bu extension
  • Occiput > Face > Chin
64
Q

Restitution

A
  • After head is born, it rotates briefly to position it occupied when it was engaged in inlet
  • External Rotation: occurs as the shoulders engage
65
Q

Expulsion

A
  • After birth of shoulders
  • Head & shoulders are lifted up toward the mother’s pubis bone
  • Trunk of baby is born by flexing laterally in direction of symphysis pubis
66
Q

Physiological Adaptations - Fetal

A
  • Fetal HR Fluctuates in Response to
    > fetal movement
    > vaginal exam
    > fundal pressure
    > uterine contractions
    > fetal head compression
    > normal FHR: 110-160bpm
  • Fetal Circulation is Affected by
    > maternal position
    > uterine contractions
    > BP
    > umbilical cord blood flow
    > most healthy fetuses can compensate for these changes
67
Q

Physiological Adaptations - Fetal Respiration

A
  • Fetal lung fluid
    > cleared through air passages as infant passes birth canal & vagina
    > the process of labor helps absorb some of the fluid before birth
  • ABGs
    > PO2 dcrs, PCO2 incrs, arterial pH dcrs, HCO3 dcrs
  • Fetal Respirations
    > movements dcr during labor
68
Q

Physiological Adaptations - Maternal: Cardiovascular Changes

A
  • Heart
    > Incrd SV; 300-500mL is shunted from uterus to vascular syst w/ contractions
    > carbon dioxide during contractions incrs by 50% above baseline
    > carbon dioxide peaks 10-30 mins post birth & returns to pre-labor baseline in 1st hr of postpartum
  • Vascular
    > BP incrs during contractions & returns to baseline btwn contractions
  • Blood Cells
    > WBC incr; stress of labor
69
Q

Physiological Adaptations - Maternal: Respiratory Changes

A
  • Incrd O2 consumption
  • Hyperventialtion turns into resp alkalosis, hypoxia, hypocapnia
70
Q

Physiological Adaptations - Maternal: Endocrine Changes

A
  • What hormones trigger labor
    > dcrd progesterone
  • What hormones incr during labor
    > incrd estrogen
    > incrd prostaglandins
    > incrd oxytocin
  • Blood Sugar Response
    > glucose lvls dcr w/ the work of labor
71
Q

Supine Hypotension

A

Occurs when ascending vena cava & descending aorta are compressed

72
Q

Physiological Adaptations - Maternal: Renal Changes

A
  • Difficulty voiding
  • Proteinuria +1 is normal
    > Muscle breakdown
73
Q

Physiological Adaptations - Maternal: Integumentary Changes

A

Vaginal introitus (entrance to vagina) results in stretching/distention

74
Q

Physiological Adaptations - Maternal: Musculoskeltal Changes

A
  • Incrd stress
  • Progesterone/Relaxin
  • Backache, joint aches, leg cramps
75
Q

Physiological Adaptations - Maternal: Neuro Changes

A
  • Sensorial changes
    > euphoria
  • Endorphins
  • Physiologic anesthesia of perineum
76
Q

Physiological Adaptations - Maternal: GI Changes

A
  • Dcrd absorption & motility of gut
    > N/V/D

OB Exam 2 (11 decks)

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