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Nursing 387/388 > Labour & Birth > Flashcards

Labour & Birth Flashcards

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1
Q

Process of Labour ?

A

Moving the fetus, placenta, and membranes out of the uterus and through the birth canal.

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2
Q

Various changes take place in a woman’s reproductive system in the days and weeks before labour begins.

Signs of labour include? And what are they?

A

Lightening- “dropping” , presenting part of fetus (usually head) drops downward into the true pelvis; usually occurs 2-4 weeks before term in first time pregnancies & during labour in multiparous

Braxton Hicks- strong, frequent; and irregular contractions

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3
Q

Onset of labour

A

Distinction of the uterine muscles causing > prostaglandin. Connective tissue loosens to permit softening thinning and opening of cervix

Change in biochemistry of fetal membrane leads : progesterone; prostaglandins, estrogen stimulating contractile response of fetus , resulting in strong, regular, rhythmic uterine contractions

Muscles of upper uterine segment shorten and exert an upward pull on cervix

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4
Q

Signs of impending labour besides lightening and Braxton Hicks

A 
Possible rupture of membrane 
Increase vaginal discharge ; bloody show
Weight loss 
GI upset
sudden burst of energy 
Low backache
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5
Q

False labour

A

Irregular contractions

Walking relieves contractions

Bloody show not present

No cervical change in effacement and dilation

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6
Q

True labour

A

Contractions regular and increase in frequency duration and intensity

Contractions are stimulated with walking

Discomfort in lower back / abdomen

Bloody show

Progressive effacement and dilation I’d cervix

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7
Q

Factors affecting labour (5 Ps)

A

Passenger, passageway, powers, position, psychological

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8
Q

Assess the passenger, you use:

A

Leopoldo maneuver - determine the position of the fetus:

1) determine fetal lie (longitudinal)and presentation
Identify part occupying the Fundus

2) palmar- feel for fetal back and irregularities (bumps/ lumps) identifies fetal presentation in breetch presentation FHR is above umbilicus

3) feeling uterus with fingers and thumb- slightly pressed
If head is presenting (not engaged) determine the attitude (flexed or not)

4) turn to face woman’s feet use both hands to outline the fetal head, cephalic prominence are with the irregularities
If the cephalic prominence with back= presenting face first

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9
Q

Fetal lie

A

Position of the baby in relation to the woman’s pelvis /spine

Longitudinal (vertical)

Cephalic (97) breetch is 3 and transverse oblique is 0.5

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10
Q

Presentation

A

Part of the fetus that enters the pelvic inlet

Cephalic- head first

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11
Q

Vertex presentation

A

Back part of the head. Flexed

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12
Q

Siniput

A

Military style presentation

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13
Q

Brow presentation

A

Brows presenting

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14
Q

Face presentation

A

Literally what it means

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15
Q

Frank presentation

A

Breetch presentation - everything is flexed except knees and legs

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16
Q

Complete position

A

Flexion I’d hope and knees - legs crossed

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17
Q

Footling

A

Extended hips and knees

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18
Q

Attitude

A

Relation of the fetal body parts to one another

Flexion

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19
Q

Stationary

A

Level of the head of fetus in relation to ischial spine

Relationship if the presenting part of the fetus to an imaginary line drawn between the ischial spine and is the measure of the degree of decent of the presenting part through the birth Canal

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20
Q

Fetal position

A

Reference point in the presenting part to the four quadrants of the mother’s pelvis
LOA LOP ROA ROP

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21
Q

Factors affecting passenger

A 
Size of the fetal head 
Fetal presentation (lie and attitude)
Fetal position
Engagement
Cardinal movements
Placenta
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22
Q

Fetal head

A

Palpating reveals presentation position and attitude
Mcranium vault - 2 frontal 2 parietal 2 temporal and occipital
United by membranous/ suture lines (sagittal, coronal, frontal, lamboid
Where the sutures intersect = frontanelles

23
Q

Anterior fonteanelle closes at …

A

18 months

24
Q

Posterior fontenelle closes at

A

6-8 weeks

25
Q

Shape of the fetal head adapts in labour called

A

Moulding

26
Q

Engagement

A

Largest part of presenting part reaches of passes through pelvic inlet

27
Q

Primigravida

Multigracida

A

Pregnant for the first time (2 weeks before term)

Pregnant multiple times - several weeks to labour

28
Q

Electronic fetal monitoring

A

Monitor continuously

Used when assessing to see fetal oxygenation

29
Q

Intermittent auscultation

A

Listening every —- interval

30
Q

Cardinal movements

A

Descent- process of the fetus through pelvis

Flexion- fetal chin in contact with chest

Internal rotation - occipitalanterior position come out straight

Extension- fetal head reaches perineum

Restitution- after head is born

External rotation- shoulders rotate to midline

Expulsions- birth!

31
Q

passageway composed of

A

Bony pelvis- inlet; brim, mid pelvis; cavity, outlet

Soft tissue- lower uterine segment , cervix, pelvic floor muscles, vagina opening

32
Q

Bony pelvis

A

True pelvis -“bony canal” : inlet, pelvic cavity and outlet

Pelvis widens and stretches

Progesterone and relaxin facilitate softening and increase elasticity of muscles ligament and pelvic joints

Whether or not the birth canal can accommodate presenting part of fetus determines whether vagina birth is possible

33
Q

4 pelvis shape

A

1) gynecoid - classic female shape
2) Android - resembles male pelvis
Anthropoid- ape
-platypellod1 flat pelvis

34
Q

Factors affecting birth- powers

Primary forces

A

Uterine muscular contractions cause effacement and dilation of cervix ; signal beginning of labour

Involuntary rhythmic intermittent to allow rest and restore iteriolacental circulation

35
Q

Secondary power

A

Use of abdominal muscles to push 2nd stage of labour - adds to primary force after full dilation of cervix

-bearing down efforts (trigger by endogenous oxytocin release)intraabdomjnal pressure compresses uterus leading to expulsion

36
Q

Effacement

A

Drawing up of internal is and cervixal ealls into side walls of uterus

37
Q

Position of women during labour

A

Affects woman’s anatomical and physiological adaptions to labour

Frequent changes in position
Relieve fatigue
Increase comfort
Improve circulation

Labouring women find position comfortable for her

38
Q

Impact of stress

A

Adrenaline

Causes : lack of control and feeling judged

Muscles tighten energy sent to limp increased sensitivity to pain,

Signs, tension, high pitched voice

39
Q

Impact of stress

Oxytocin and endorphins

A

Muscles relax
Energy sent to uterus
Decreased sensitive to awareness of pain

Feels loved, safe and supported

40
Q

1 stage or labour: latent

A

Mild regular contractions with increasing in frequency duration and intensity defined as 0-3 dilated

41
Q
  1. Active stage of birth: active phase
A

Anxiety increases intensity, nulliparous- 4 cm

Multiparous- 4-5 cm

42
Q

Primary goals of 1st stage labour

A

Safety of mother and infant
Interventions based in the needs of the mother/ partner

Assessment;

FHR and contractions at least every hour

Assess maternal status

Assess status of fetal membrane

Assess psychosocial state and ability to cope

Provide physical and psychological care

Communicating labour progress to family and team

43
Q

Maternal adaption

A

Estrogen prostaglandins oxytocin increases

Increases in endorphins- sedating and raises pain threshold

Increase CO

Heart rate WBC BP systolic, systolic and diastolic

Elevated temp. And oxygen consumption doubles

Higher metabolism

44
Q

Fetal adaptions to labour

A

Fetal health surveillance- oxygen; FHR to uterine activity

Fetal circulation: maternal position, uterine contractions, BP and umbilical coed flow

Fetal respiration- changes prepare fetus for initiating respirations immediately after birth

45
Q

Emotional support

A

Less fearful and anxious

  • interferes with progress of labour; reduce blood flow, increase pain
46
Q

Assessing progress of labour

A

Bishops score

To see if induction of labour is required

Dilation
Effacement
Position of cervix
Consistency
Station
47
Q

2nd stage of labour

A

Completed cervical dilation and ends with birth of fetus

  • descent of fetal presenting part
  • bulging of perineum, uncontrollable urge to bear down, intraabdominal pressure increase bloody show

Discomfort; contracting uterine muscle cells, distension of vagina and perineum and pressure of fetus

48
Q

Crowning

A

Fetal head is encircled by external opening on the vagina

49
Q

Nursing interventions for stage 2 labour

A 
Emotional support
Take vitals q15
Fetal heart test Q 15 if healthy ( mother no risk of birth complications) 
Access ability to buss
Prepare of dil erg
Change position of breathing
50
Q

3rd stage of labour

A

Births of placenta

After infant born, uterus contracts firmly and placenta start to separate from wall

51
Q

Signs of separation of labour

A

Globular shapes uterus

Rise in fundus

Sudden trickle of blood
Exclusion <30

Cord protrusion

52
Q

4th stage of labour

A

1-2 hours after birth

Physiologic readjustment if mother body - homestasis

Mother may feel energize

Optimal time for infant bonding- a

53
Q

Nursing role for 4th stage of labourers

A

Infant assessment

First period is reactivity - skin to skin contact

Provide comfort measures

Okay anaesthesia q15

Promote family relationships

54
Q

Post partum assessment

A

BUBBLLEE

Breast 
Uterine fundus
Bladder 
Bowel
Lochia 
Legs (peripheral edema) 
Episiotomy 
Emotional support

Nursing 387/388 (2 decks)

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