Labor Part 2 (Components - Stages) Flashcards
enumerate the mechanism of labor in order
engagement descent flexion internal rotation extension external rotation and restitution expulsion
term used if the presenting part is in the ischial spine
engagement
term if the fetal head goes down to the pelvic floor as a result of ______ (3)
descent; as a result of uterine contractions, abdominal contractions and amniotic fluid pressure
descent is in what station? how about engagement?
descent +1
engagement 0
this allows the widest part of the fetal head to fit through the widest part of the pelvic inlet
engagement
how does cervical flexion occur
when the fetal head comes in contact with the pelvic floor
cervical flexion allows the presenting part to be _____
sub-occipito bregmatic
in this position, the fetal skull has a smaller diameter which assists passage through the pelvis
sub-occipito bregmatic
what is the change of position in internal rotation
from occipito-transverse to occipito-anterior
this is the encirclement of fetal skin in the birth canal
crowning
delivery of the head is via _____, where the occiput is born
extension
the baby goes back to its initial position (transverse)
external rotation
refers to the alignment of the shoulders to the fetal head
restitution
TRUE OR FALSE
when the baby is out, they encourage the mother to push
false
how do the doctors deliver the baby in external rotation and restitution?
pull upward to deliver the posterior
downward to deliver the anterior (this is delivered FIRST)
delivery of the entire body of baby
expulsion
what is power in 4ps
uterine contractions
uterine contractions serve as the ______ of labor
force of labor
increment
increasing intensity of UC
acme
peak of UC; uterus is hard and firm
decrement
decreasing intensity of UC
frequency
start of one UC until start of another UC; measured in minutes
duration
how long one contraction lasts; start and end of one UC; measured in seconds
interval
space between 2 UC; resting phase
contour of cervix (3)
upper portion is thick and active
lower portion is thin and passive
from round to ovoid to elongated ;
elongated - baby is controlled
TRUE OR FLASE
discourage mother to push in acme
false
normal length of labor in HOURS in nullipara and multipara
latent phase
nulli- ave. 8.6 | UN 20
multi - ave 5.3 | UN 14
normal length of labor in HOURS in nullipara and multipara
active phase
nulli- ave. 5.8 | UN 12
multi - ave 2.5 | UN 6
normal length of labor in HOURS in nullipara and multipara
second stage
nulli- ave. 1 | UN 1.5
multi - ave 0.25 | UN -
shortening and thinning of the cervix
cervical effacement
widening of the diameter of the cervix
dilatation
effacement and dilatation in primipara and multipara
primi - effacement first, then dilatation
multi - dilatation first then effacement
refers to the psychological state or feeling that women undergo
psyche
part responsible for uterine contractions
myometrium
what are observed in pregnant clients (psyche) 6
culture preparation support system previous births current pregnancy pain, fear, anxiety - observed in primiparas
1st stage of labor
start of uterine contraction until FULL cervical dilatation
latent phase nursing interventions
Let the patient ambulate, change of position, squat
Allow the client to eat, drink fluids, chew ice chips
The couple needs to participate in care
Encourage client to void q 2 hrs, VS monitoring q 30-60 mins except temp (4hrs) including FHT UC Perineum
No analgesia
The couple should be updated on the progress of the labor
what happens in active phase (4)
rapid dilatation of the cervix
mother feel helpless, anxious
show
spontaneous rupture of membrane
transition phase nursing interventions
Transfer the client to the delivery room (nulli - 10 cm; multi- 8 cm) and cold compress on forehead
Rest in between contractions
Assist effective breathing that is level 3 - shallow and more rapid
Note for the rupture of membrane regarding time and color
Sensitive, irritable and out of control
Ice chips and fluids
Take VS every 15-30 mins, UC q 10-15 mins, perineum q 15 mins
Intense discomfort
Offer ointment on dry lips
Nasuea and vomiting
second stage of labor (2)
full cervical dilatation to the delivery of the baby
mechanisms of labor is observed
third stage of labor
delivery of the baby until the delivery of the placenta/ placental delivery
happens when umbilical cord is pulled when there is no contraction.
uterine inversion
this refers to the pelvis, route for the baby to travel from the uterus down to the perineum
passage
android pelvis
male pelvis, heart shape, narrow or small, poor prognosis
anthropoid pelvis
oval shaped pelvis, longer apd , shorter td, good prognosis
plattypoid pelvis
flat , smaller apd, longer td, poor prognosis
gynecoid pelvis
has equal APD (anterio-posterior) and TD (transverse diameter) good prognosis
passenger
baby
bones that comprise the head (8)
4 superior bones
(frontal, 2 parietals, occupital)
4 other bones
(ethmoid
sphenoid
2 temporals)
active phase nursing interventions
Ambulation is required if still tolerable
Comfort measures
The surrounding should be quiet
Ice chips, fluids, foods
Void q 2 hrs, VS q 30-60 mins, FHT and UC q 15-30 mins, perineum 30 mins
effective breathing that is level 2 (lighter and more rapid)
test in identifying what fluid is coming out during rupture of membrane
nitrazine test
blue-amniotic
yellow-urine
what is the position of client when giving birth
semi-upright
cervical dilatation/hour of primipara in second phase; multipara
primi- 1 cm per hr
multi - 1.5 cm per hr
what is the breathing pattern for second stage of labor
level 4 - pant blow breathing/ 3-4 quick/ with a sound of choo choo
Second stage labor nursing interventions
Stay with your patient at all times
Encourage effective breathing that is level 4 - pant blow/ 3-4 quick breaths/ choo choo
Closely monitor the fetal heart rate, mechanisms of labor, vital signs every 5 mins
Observe sterile technique
No Valsalva maneuver
Discourage pushing until the cervix is dilated
signs of placental separation 5
sudden gush of blood
lengthening of the umbilical cord
change in the shape of uterus or calkin’s sign
presence of firm contractions in the uterus
appearance of placenta in the vaginal opening
AMTSL
Active management of the third stage of labor
3 intervention in AMTSL
oxytocin admin. (check BP first)
cord traction with counter traction or crede’s maneuver
uterine massage (one hand on symphysis; one hand on fundus)
fetal side of placenta
Shultz;shiny
detaches from center to edges
maternal side of placenta
Duncan;dirty
detaches from edges to center
Locate uterus
midway of symphysis pubis and umbilicus
do this immediately after delivery
third stage labor nursing interventions
The vital signs monitoring is q 15 mins
Have the client and the baby feel warm
Inspect the placenta, membrane, and location of the uterus, umbilical cord
Refer to the doctor
Do not pull umbilical cord when uterus in not contracted
fourth stage
delivery of placenta until the first 4 hours postpasrtum
they move and overlap each other in order to facilitate the passing of fetal head to birth canal
suture lines
where is the sagittal suture lines located
between 2 pareitals
where is thecoronal suture lines located
between paretals and frontal
where is the lambdoidal suture lines located
between parietals and occipital
these are spaces in between the suture lines
fontanelle
anterior fontanelle is known as _____
bregma
what forms the bregma? what is the shape?
sagittal and coronal suture lines; diamond shape
APD and TD of anterior fontanelle
closing time?
APD 3-4 cm
TD 2-3 cm
closes at 12 to 18 months
posterior fontanelle is known as
lambda
lambda is formed by _____. The shape is _____.
parietal and occipital; triangular shape
APD and TD of lambda.
closing time?
APD 2 cm TD 2 cm
closes at 2 months
space in bet. 2 fontanelles
vertex
what is the sinciput
frontal
- narrowest diameter
- most favorable measurement
- facilities easy delivery
how many cm?
Suboccipitobregmatic
9.5 cm
bridge of nose to occipatal prominence
how many cm?
Occipitofrontal
12 cm
widest anterioposyerior diameter, from chin to posterior fontanelle
how many cm?
Occipitomental
13.5 cm
denotes the body part that is in first contact to the cervix
fetal presentation
relationship bet. long axis of baby and mother
fetal lie
degree of flexion of fetal head
fetal attitude
what is a good fexion (4)
baby’s thighs are flexed to the abdomen
arms flexed and folded on chest
head is bended forward wherein chin is touching the chest
back is convex (VERTEX) narrowest diameter; subocciptobregmatic
what is a moderate flexion
baby is in military position, chin is not touching chest
what is partial flexion
baby tries to present the brows , somewhat tilted
what is poor flexion
bad attitude of baby
neck is hyperextended
presenting part is chin or face
back is concave occipitomental presentation (face and lips is edematous; prevents the baby to do sucking)
this is where the doctor can determine if the baby is engaged and identify the relationship between presenting part to the ischial spine
station
-1 to -5 station
not yet engaged -ABOVE ischial spine
+1-+5
BELOW ischial spine, starting to descend
-1
the baby is 1 cm above the ischial spine - near to be engaged
-2
baby is floating
+1
baby is 1 cm below the ischial spine
+3
crowning
+4
baby head out
change in the shape of fetal head that is brought by not dilated cervix and ineffective uterine contraction; it will return to its normal shape after 1-2 days
molding
presence of blood on the scalp
Cephalohematoma
presence of edema/swelling in skull , related on the manner of how the mother pushes
Caput succedaneum
Is the relationship of the presenting part to a specific
quadrant of the woman’s pelvis
fetal position
defines the landmark of the mother
- right (R) left (L)
1st letter
denotes fetal landmark
O- occiput
M- mentum
A- acromium
Sa- sacrum
2nd letter
defines whether the landmark points are Anteriorly (A). Posteriorly (P), Transversely (T)
3rd letter
ideal fetal position
LOA
the ideal degree of rotation (fetal position)
90 degrees anteriorly
fetal position towards the maternal abdomen; prone position
anterior
fetal position of the baby when it is in a supine position
posterior
