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Obs > Labour and Birth > Flashcards

Labour and Birth Flashcards

1
Q

oxytocin role in initiation of labour

A

number of oxytocin receptors in the uterus increases at the end of pregnancy. This creates an increased sensitivity to oxytocin (released from posterior pituitary)

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2
Q

explain change in estrogen to progesterone ration in initiating pregnancy

A
  • During the last trimester of pregnancy, estrogen levels increase, and progesterone levels decrease.
  • This change leads to an increase in the number of myometrium gap junctions. Gap junctions are proteins that connect cell membranes and facilitate coordination of uterine contractions and myometrial stretching.
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3
Q

prostaglandins role in initiation of labour

A

lead to additional contractions, cervical softening, gap junction induction, and myometrial sensitization, thereby leading to a progressive cervical dilation

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4
Q

progesterone may be given to pts who go into labour early because

A

it helps suppress uterine contractions

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5
Q

2 main functions of uterine contractions

A

(1) to dilate the cervix and
(2) to push the fetus through the birth canal

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6
Q

cervical changes before labour

A

cervical softening and possible dilation with descent of the presenting part into the pelvis occur

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7
Q

softening and dilation of cervix can occur ________ to _______ before actual labour begins

A

1 month to 1 hour

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8
Q

what is essential for effacement and dilation of cervix

A

ripening and softening of the cervix

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9
Q

lightening occurs when

A

the fetal presenting part begins to descend into the true pelvis

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10
Q

during lightening the uterus depresses and moves into a more ___________ position

A

anterior position

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11
Q

increased energy level before labour is referred to as

A

nesting

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12
Q

during pregnancy the mucous plug fills

A

the cervical canal during pregnancy

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13
Q

at onset of labour or before the mucous plug is expelled as a result of

A

cervical softening and increased pressure of the presenting part

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14
Q

the mucous plug being expelled results in the release of

A

a small amount of blood that mixes with mucous resulting in pink-tinged secretions

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15
Q

characteristics of braxton hicks contractions

A
  • lasting as little as 30 sec or persisting as long as 2 minutes
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16
Q

why do braxton hicks contractions occur

A

As birth get closer the uterus becomes more sensitive to oxytocin

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17
Q

braxton hicks aid in moving the cervix from a

A

posterior to an anterior position

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18
Q

braxton hicks also help in ____________ the cervix

A

ripening

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19
Q

although much of the amniotic fluid is lost when rupture of membranes occurs a continuous supply is produced to ensure

A

protection of fetus at birth

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20
Q

five P’s of labour

A

powers
passageway
passenger
position
psyche

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21
Q

powers of labour include the

A

contractions

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22
Q

two types of contractions

A

false and true

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23
Q

false labour

A
  • occurs in latter weeks of some pregnancies in which irregular uterine contractions are felt but the cervix is not affected
  • False labour, prodromal labour, and Braxton hicks are all names for contractions that do no cause a measurable change in the cervix
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24
Q

true labour

A
  • Characterized by contractions occurring at regular intervals that increase in frequency, duration, and intensity
  • True labour contractions bring about cervical dilation and effacement
  • Contractions will continue with rest and activity
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25
Q

characteristics of contractions

A

increment, acme, decrement

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26
Q

increment of contractions is the

A

building up of the contraction

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27
Q

acme of contractions is the

A

strongest, top portion of contraction

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28
Q

decrement of contractions is the

A

rapid diminishing of contraction

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29
Q

abdominal muscles are the ________ _______ in labour

A

secondary powers

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30
Q

abdominal muscles in labour involve the use of

A

intra-abdominal pressure (voluntary muscle contractions) exerted by the client when pushing and bearing down during the second stage of labour

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31
Q

when assessing contractions we want to assess the

A

frequency
duration
intensity
relaxation

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32
Q

how long is frequency of contractions assessed

A

assess for at least ten minutes

33
Q

how is duration of contractions assessed

A

beginning of one contraction to end of same contractions

34
Q

how is intensity of contractions assessed

A

palpate at fundus
mild feels like tip of nose
moderate feels like chin
severe feels like forehead

35
Q

what is tachysystole

A

– when not enough relaxation between contractions

36
Q

how is tachysystole characterized

A

More than 5 contractions in 10 mins, can be contractions lasting longer than 90 secs, resting tone of less than 30 seconds

37
Q

the passage way or brith canal consists of _______ and ______

A

bony pelvis and soft tissues

38
Q

_________ is considered the true female pelvis

A

gynecoid

39
Q

3 planes of pelvis

A

inlet, mid pelvis, outlet

40
Q

inlet of the pelvis is

A

entrance from false pelvis to true pelvis

41
Q

mid pelvis is the

A

space between the inlet and outlet, fetus must travel through this to reach the outside

42
Q

outlet of the pelvis is

A

where fetus passes through to get to the outside

43
Q

soft tissue factors of passageway include the

A

cervix, pelvic floor muscles, and the vagina

44
Q

characteristics of cervix in the passageway

A

Through effacement the cervix effaces (thins) to allow the presenting fetal part to descend into the vagina

45
Q

characteristics of pelvic floor muscles in the passageway

A

Pelvic floor muscles help the fetus to rotate anteriorly as it passes through the birth canal

46
Q

characteristics of vagina in passageway

A

Soft tissue of vagina expand to accommodate the fetus during birth

47
Q

in passenger of labour we consider the fetal

A

head, attitude, lie, presentation, position, station, and engagement, attitude

48
Q

importance of sutures in fetal head

A

they allow the cranial bones to overlap in order for the head to adjust in shape (elongate) when pressure is exerted on it by uterine contractions or the bony pelvis

49
Q

most common fetal attitude when labour begins

A

The most common fetal attitude when labour begins is with all joints flexed

50
Q

fetal lie refers to the

A

the relationship of the long axis (spine) of the fetus to the long axis (spine) of the pregnant person

51
Q

fetal station refers to

A

relationship of the presenting part to the level of the pelvic ischial spines

52
Q

fetal engagement signifies the

A

entrance of the largest diameter of the fetal presenting part (usually the fetal head) into the smallest diameter of the pelvis

53
Q

fetal presentation

A

the body part of the fetus that enters the pelvic inlet first (the “presenting part”)

54
Q

by term, approx 97% of infants actively turn to a ___________ presentation

A

cephalic

55
Q

fetal position describes the

A

relationship of a given point on the presenting part of the fetus to a designated point of the pelvis

56
Q

non-breech fetal positions

A

1) Left occiput posterior (LOP)
2) Left occiput transverse (LOT)
3) Left occiput anterior (LOA)
4) Right occiput posterior (ROP)
5) Right occiput transverse (ROT)
6) Right occiput anterior (ROA)

57
Q

The use of any upright or lateral position, compared with supine or lithotomy positions, may

A
  • Reduce the length of the first stage of labour
  • Reduce the duration of the second stage of labour
  • Reduce the number of assisted deliveries (vacuum and forceps)
  • Reduce the incidence of episiotomies and perineal tears
  • Contribute to fewer abnormal fetal heart rate patterns
  • Increase comfort/reduce requests for pain medication
  • Enhance a sense of control by the mother
  • Alter the shape and size of the pelvis, which assists in descent
  • Assist gravity to move the fetus downward
58
Q

the state of mind throughout the labor and birth process is critical to bringing

A

a positive outcome

59
Q

additional P’s in labour

A

1) Philosophy – low tech, high touch
2) Partners – support caregivers
3) Patience – natural timing
4) Patient preparation – childbirth knowledge base
5) Pain management – comfort measures

60
Q

there are _____ stages of labour

A

4

61
Q

the first stage of labour has 3 phases:

A

latent phase
active phase
transition phase

62
Q

latent phase

A
  • 0-3 cm
  • Contractions mild and short (30 – 45 sec) Q5-10 minutes
  • Cervical effacement from 0% to 40%
63
Q

active phase

A
  • 4-7 cm
  • Contractions stronger (40 – 60 sec) Q2-5 minutes
  • Cervical effacement from 40% to 80%
64
Q

transition phase

A
  • 8-10 cm
  • Contraction at peak intensity (60 – 90 sec) Q1-2 minutes
  • Cervical effacement from 80% to 100%
65
Q

second stage has two phase the

A

pelvic phase and the perineal phase

66
Q

pelvic phase

A

Period of fetal descent

67
Q

perineal phase

A
  • Phase of active pushing
  • Contraction lasting 60 – 90 sec Q2-3 minutes or less
  • Strong urge to push during the later perineal phase
68
Q

third stage includes

A

placental separation and placental expulsion

69
Q

placental separation is the

A

Detaching from uterine wall

70
Q

placental expulsion is the

A

Coming outside the vaginal opening

71
Q

fourth stage

A
  • Pts body begins to stabilize after the hard work of labour and loss of products of conception
  • Sometimes not recognized as a true stage but is critical period for physiologic transition as well as new family attachment
  • Close monitoring of both mom and baby are essential during this stage
72
Q

not admitted until in _______ labour at ___cm dilated

A

active labour at 4 cm dilated

73
Q

questions to ask during admission when going into labour

A
  • Labour?
  • Due date?
  • GTPAL?
  • Membranes?
  • Blood show?
  • Fetal activity?
  • History?
74
Q

assessment during labor

A
  • Review prenatal history
  • Urine specimen
  • Temp, HR, BP, FHR
  • Address presenting history
  • Vaginal exam (RN or MD)
75
Q

Birth sequence form crowning through birth of the newborn

A

A. Early crowning of the fetal head. Notice the bulging of the perineum.

B. Late crowning. Notice that the fetal head is appearing face down. This is the normal OA position.

C. As the head extends, you can see that the occiput is to the client’s right side—ROA position.

D. The cardinal movement of extension.

E. The shoulders are born. Notice how the head has turned to line up with the shoulders; the cardinal movement of external rotation.

F. The body easily follows the shoulders.

G. The newborn is held for the first time.

76
Q

4 parts of Leopold’s maneuvers

A

uterine fundus
fetal orientation
fetal presentation
degree of descent

77
Q

Leopold’s maneuvers: uterine fundus

A

What fetal part (head or buttocks) is at the fundus
o Head: round, more mobile
o Breech: larger, nodular mass

78
Q

Leopold’s maneuvers: fetal orientation

A

Palpate and support down the side of the abdomen
o One side will feel soft – that’s the back; if smooth side on left then baby’s on left and vice versa
o Other side will feel bumpy – that’s the legs, feet, arms

Obs (8 decks)

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