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1900 > Labour and Childbirth > Flashcards

Labour and Childbirth Flashcards

1
Q

When does the process of labour start?

A
  • When the cervix starts to dilate

- ask pt. for s&s to determine onset

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2
Q

What are contractions?

A
  • Intermittent tightening of the uterine muscles
  • primary power needed for labour and birth
  • forms regular pattern interspersed with rest periods
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3
Q

What changes in the last few weeks of pregnancy indicates that mother is preparing for childbirth?

A
  • cervix softens, thins, move forwards, can begin to open
  • fetus moves to the pelvis
  • prodromal labour begins
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4
Q

What is prodromal labour?

A

Contractions that present as achy sensations or pressure in the lower abdomen or back during last few weeks of pregnancy

  • highly variable
  • regular or irregular
  • mild or strong
  • last for few hours to days
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5
Q

What’s lightening?

A

Fetal engagement into the maternal pelvis

  • abdomen changes shape as uterus drops forward
  • decreased fundal height measurement
  • occurs suddenly
    • 10-14 days before labour for women giving birth for the first time
    • after labour has already started for women who’ve given birth before
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6
Q

What’s lightening?

A

Fetal engagement into the maternal pelvis

  • abdomen changes shape as uterus drops forward
  • decreased fundal height measurement
  • occurs suddenly
    • 10-14 days before labour for women giving birth for the first time
    • after labour has already started for women who’ve given birth before
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7
Q

S&S of lightening

A
  • sudden
  • relieved of abdominal tightness and diaphragmatic pressure
  • relief in one direction results in greater pressure below
  • shooting pains down legs due to pressure on sciatic nerves
  • increased vaginal discharge
  • increased urinalysis frequency due to uterine pressure on bladder
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8
Q

Backache approaching labour

A
  • result of postural changes
  • 2/3 of pregnant women experiences low back pain
  • can come from mild, early pelvic contractions
  • develops from pressure on sacroiliac joint
    • related to influence of relaxin hormone on pelvic joint
  • suggestive of labour if
    • fluctuates frequently
    • increases intensity
    • pelvic pressure or cramping
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9
Q

Bloody show approaching labour

A
  • pinkish vaginal discharge, often mixed with mucus
  • results from
    • dislodgement of the mucous plug that seals cervix
    •rupture of cervical capillaries as engagement and dilation begins
  • first sign women notice
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10
Q

Braxton Hicks contractions

A
  • caused by increased estrogen levels and uterine distension
  • irregular
  • painless
  • doesn’t lead to cervical changes that indicate true labour
  • when frequent and intense, it’s associated with other signs of approaching labour like low, mild backache
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11
Q

SROM

A

Natural breaking of amniotic sac (bag of waters) before or during labour

  • first indication
  • trickle or gush
  • slightly straw-coloured amniotic fluid from vagina
  • sometimes has whitish particles of vernix
  • risk for umbilical prolapse
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12
Q

How long after SROM do women go into labour

A

24 hours

If not then risk of intrauterine infection

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13
Q

Diarrhea approaching labour

A
  • increased bowel activity and mild diarrhea before labour
  • Associated with release of prostaglandin during labour
  • empty bowels so digestive system not competing for energy during childbirth
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14
Q

Weight loss approaching labour

A

Changes in estrogen and progesterone levels
• causes electrolyte shift
• decreased body fluid

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15
Q

Weight loss approaching labour

A

Changes in estrogen and progesterone levels
• causes electrolyte shift
• decreased body fluid

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16
Q

What is false labour?

A
  • inaccurate

- women in prodromal or very early labour

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17
Q

S&S of false labour

A
  • contractions don’t progress in frequency, intensity or duration
  • no progressive cervical dilation
  • prodromal labour decreases with position or activity
  • fatigue and discouragement is common
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18
Q

What should be done during false labour?

A
  • woman needs guidance and reassurance
  • ask woman and partner to record contraction characteristics
    • note contraction changes with position or activity
  • obtain adequate nutrition and fluids
  • do not say ‘false labour’
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19
Q

What should be done during false labour?

A
  • woman needs guidance and reassurance
  • ask woman and partner to record contraction characteristics
    • note contraction changes with position or activity
  • obtain adequate nutrition and fluids
  • do not say ‘false labour’
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20
Q

S&S of true labour

A
  • contractions increase in frequency, intensity, strength and duration
    • occuring 4-6 mins, lasting 30-60 secs
    • constant intervals b/w contractions
  • not affected by position change or activity
    • can progress with walking
  • contractions, vaginal pressure and discomfort start at back and radiate to lower groin
  • results in cervical effacement and dilation
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21
Q

S&S of true labour

A
  • contractions increase in frequency, intensity, and duration
    • occuring 4-6 mins, lasting 30-60 secs
    • constant intervals b/w contractions
  • not affected by position change or activity
    • can progress with walking
  • contractions, vaginal pressure and discomfort start at back and radiate to lower groin
  • results in cervical effacement and dilation
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22
Q

emotional experience approaching labour

A
  • restless or sleepless nights
  • increased tension, fatigue, anxiety
  • sensitive to small stimuli
  • worried about ability to cope with labour
  • worried about weight loss approaching labour
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23
Q

What is labour?

A

series of events that leads to expulsion of the products of conception from mother’s body

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24
Q

What is the traditional definition of labour?

A

period when regular uterine contractions are associated with cervical effacement and dilation

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25
Q

Issues with traditional definition of labour

A
  • some define labour as
    • time of admission to birth unit, OR
    • when cervix dilates 3-4 cm, OR
    • women’s self report of onset of symptoms

none of these are entirely accurate

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26
Q

The Ps of Labour?

A

Power - uterine contractions and maternal pushing
Passageway - maternal pelvis and soft parts
Passanger - fetus

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27
Q

What do powers consist of?

A

Uterine Contractions

Pushing

28
Q

uterine contractions

A

intermittent contractions of the myometrium

29
Q

throughout labour, muscles in the upper segment are ____ than the lower segment

A
  • more active

- contracting more intensely and for longer

30
Q

What are normal uterine contractions composed of?

A
  • an increment (building up or ascending)
  • an acme (the peak)
  • a decrement (coming down or descending)
31
Q

contraction frequency

A

time from beginning of one contraction to beginning of next

32
Q

contraction duration

A

time from beginning to end of same contraction

33
Q

contraction intensity

A

strength

34
Q

why are intervals of rest important b/w contractions?

A
  • maternal comfort

- allows for re-oxygenation of placenta to promote fetal welfare

35
Q

Pushing

A
  • provides intrabdominal force
  • reserved for 2nd stage of labour, after effacement and dilation
  • ‘bearing down’
  • effective with controlled exhalation or holding breath briefly
36
Q

Issues with pushing with a closed glottis

A
  • called the Valsalva manoeuvre
  • increases intrathoracic pressure
  • impairs blood return to lower extremities
  • initial increase then decrease of BP
  • affects uteroplacental blood flow and perfusion
37
Q

Prolonged and forceful Valsalva manoeuvre results in

A
  • fetal hypoxia and resultant acidosis

- maternal pelvic or perineal damage

38
Q

what does the passageway consist of?

A
  • hard passage (bony pelvis)

- soft passage (maternal soft tissue structure)

39
Q

what is the pelvis?

A

-bony ring called the hip girdle that separated lower extremity from trunk

40
Q

what does the pelvis do?

A
  • transmits body weight to lower extremities

- passageway for fetus to be born

41
Q

what are the major pelvic bones?

A

1) innominate bones
2) sacrum
3) coccyx

42
Q

what are the innonminate bones?

A

fusion of the ilium, ischium and pubis around the acetabulum

43
Q

division of pelvis for obstretic purpose?

A
  • into halves called false and true pelvis
44
Q

what is the linea terminalis

A
  • imaginary line that divides pelvis into true and false pelvis halves
  • extends from symphysis pubis to sacral prominence
45
Q

false pelvis

A
  • wide, broad area b/w iliac crest
  • supports uterus
  • directs fetus to true pelvis to engage
46
Q

true pelvis

A
  • below linea terminalis
  • bony birth passage
  • entrance is called pelvic inlet
  • shape is curved
47
Q

why is the true pelvis curved?

A
  • while descending through pelvic outlet (lower border of true pelvis), fetus moves down then up over the sacrum
  • implications for positioning of women during expulsion
48
Q

what are the four pelvic types?

A

1) gynecoid - best for vaginal birth
2) android
3) anthropoid - difficult or impossible for vaginal birth
4) platypelloid - difficult or impossible for vaginal birth

women have mixture of two types

49
Q

pelvic diameter

A
  • affects fetal ability to pass through
50
Q

how to determine pelvic diameter?

A

measure diameter of pelvic inlet, midpelvis and pelvic outlet in the antepartal period, often on the first prenatal visit

51
Q

Soft tissues that stretch to allow passage of fetus

A

cervix
vagina
perineum

52
Q

progesterone and relaxin

A
  • facilitate softening

- increase muscle and ligament elasticity

53
Q

estrogen

A
  • promotes growth of
    • vaginal mucosa
    • undderlying tissues
  • increases cellular glycogen
54
Q

changes in the maternal soft part in the last few weeks of pregnancy

A
  • cervix softens, effaces, more elastic
  • ripening due to braxton hicks and engagement of the fetal head
  • vagina
    • more stretchable throughout pregnancy
    • increased vascularity thickens and lengthens vaginal walls
    • these changes helps passage of fetus
  • perineum muscles soften and more stretchable
55
Q

factors that influence mechanism of labour

A

fetal head size and rigidity

• since head is the largest part that passes through vaginal opening

56
Q

division of the fetal head

A
  • face and base of skull - ossified and unified

- cranial vault

57
Q

cranial vault bones are

A
  • relatively thin
  • poorly ossified
  • loose connection to each other by membranous attachments
58
Q

what is moulding

A
  • flexibility of cranial vault allows for movement and overriding as fetal head adapts to maternal pelvis
  • manifests as elongated head in newborns
  • disappears few days after birth
59
Q

cranial vault made up of

A

2 frontal bones
2 parietal bones
1 occipital bone

60
Q

biparietal diameter

A
  • distance between two parietal bones
  • widest transverse diameter of fetal head
  • 9.25 cm
61
Q

Other fetal diameters

A
  • suboccipitobregmatic
  • submentobregmatic
  • occipitofrontal
  • occipitomental
62
Q

sutures

A
  • membranous attachments
    • sagittal - parietal bones
    • lambdoidal - parietal and occipital
    • occipitomental - parietal and frontal
63
Q

fontanelles

A

the enlarged point of intersection of sutures

64
Q

what are the two major fontanelles

A
  • diamond shaped anterior (bregma)
    • won’t close until 18 months
  • triangular shaped posterior
    •won’t close until 6-8 weeks
65
Q

cranial vault is divided into

A

three sections

  • vertex: lies b/w anterior and posterior fontanelle
  • occiput: area of occipital bone
  • brow: lies b/w large anterior fontanelle and eye socket
66
Q

fetopelvic relationships

A 
lie
presentation
presenting part
attitude
denominator
position
station
67
Q

mechanisms of labour

A 
descent
flexion
internal rotation
extension
restitution
external rotation
birth of shoulders and expulsion

1900 (1 decks)

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