Labour & Delivery Flashcards
What defines true labour?
increase in frequency, duration and strength of contractions
How many phases of labour are there in the 1st stage of labour? and what are they called?
- latent
- active
- transition
In the latent stage of labour how many cm’s does the cervix stretch to?
1-3cm
In the active stage of labour how many cm’s does the cervix stretch to?
4-8cm
In the transition stage of labour how many cm’s does the cervix stretch to?
8–10cm
What happens during the 2nd stage of labour?
pushing and birth of baby
How long can pushing last for primips vs multips?
primip - 2 hours
multips - 15min - 1 hour
What happens during the 3rd phase of labour?
between birth of baby and the delivery of the placenta
When does the 4th stage of labour happen?
1-4 hours after the delivery of the placenta
watching for hemorrhaging
How long does the latent phase typically last for in a primip vs a multip?
primip: 8.6 hours
multip: 5.3 hours
How many cms/hour does the cervix dilate in a primip vs a multip?
primip: 1.2 cm/hour
multips: 1.5 cm/hour
How long does the active phase typically last for in a primip vs a multip?
primip: 4.6 hours
multip: 2.4 hours
How long does the transition usually last for in a primip vs. a multip?
primip: 3 hours
multip: less then 1 hour
When can you tell if someone is in false labour? what is the name for these contractions?
when there is no increase to strength, length and duration. Random contractions and tightening of uterus.
Braxton-hicks contractions
What are a few benefits of “passive decent” (natural birth)?
- decreased FHR decels, better fetal O2 levels
- cost effective
- decreased length of pushing time
- decreased maternal fatigue
What are signs a woman in labour should be going to the hospital?
regular contractions - 5 mins apart bleeding water broken (breaks) painful contractions lightening - baby drops lower
What theory describes the onset of labour as being the uterus can only stretch so big and then PE2 (prostaglandins) are released and start labour?
Mechanical theory
What theory suggests that the pressure on the cervix releases oxytocin and then contractions begin?
Neurological theory
What theory suggests that the increase in estrogen then stimulates contractions and more irritability on the uterus?
Progesterone Withdrawal Hypothesis
Which theory focuses on the amnion and decidua?
prostaglandin hypothesis
What is the theory that has an increased CRH hormone throughout prenancy with a sharp increase at term? CRH is also known to stimulate what?
corticotrophin releasing hormone (CRH) hypothesis
known to stimulate synthesis of prostaglandin
Was is the length of time a contraction can last from?
30 - 90 secs
The intensity can be measured as mmHg. For example at rest the measurement is 10-12mmHg. Describe the measurements at the following stages and describe their intensity: early labor active labor transition pushing
early labor: 25-40 mmHg - mild
active labor: 50-70 mmHg - moderate
transition: 70-90 mmHg - strong
pushing: 70-100 mmHg - strong
What are the critical factors during labor known as the 5 P’s?
- passage - pelvis & soft tissue, joints, inlet, outlet, perineum, vagina, pelvic floor
- passenger - baby longitudinal, lie, presentation, presenting part , position
- relationship of passage & passenger
- physiological forces (contraction and pushing)
- psychosocial
What are 6 psychosocial considerations? and give examples
- mental preparedness - readings and prenatal class
- physical preparedness - prenatal fitness
- socio-cultural values & beliefs - do their beliefs assist or impede?
- previous reproductive experience - horrific experience may afftect 2nd birth (positive or negative)
- support from signifciant others - positive influences?
- emotional status - reactions, responses towards labor - what are they bringing with them emotionally?
What are the 7 cardinal movements (mechanism of labour) a fetus takes through the birthing canal?
- decent
- flexion
- internal rotation
- extension
- restitution
- external rotation
- expulsion
What is happening in the 1st stage of labour in terms of mechanism of labour?
decent and flexion
What is happening in the 2nd stage of labour in terms of mechanism of labour?
decent & flexion internal rotation extension restitution external rotation expulsion
What happens during the 3rd stage of labor?
placenta separation and expulsion
What are the signs of placental separation?
- globular shaped uterus
- rise of the fundus in the abdomen
- sudden gush or trickle of blood
- further protrusion of umbilical cord out of the vagina
What is the placenta known as when it delivers with the fetal (shiny) side presenting?
shiny schultz
What is the placenta known as when it delivers sideways with maternal surface delivering first?
dirty duncan
Which area of the uterus controls the bleading after the placenta is delivered?
the middle layer of the myometrium
How often is the mother monitored in the 4th stage of labour?
every 5 mins for 1-4 hours
What is the first thing to check in the initial care of the newborn?
check neck for umbilical cord
While the cord is being clamped and cut where is the baby?
being kept at level of vagina with head down
Once baby dried off where is he/she placed?
under radiant heat or directly on mom
What is the apgar system evaluating?
the physical condition of the newborn at birth
When is the newborn rated with the apgar system?
1 minute and at 5 minutes after birth
If the apgar score is less than 7 at 5 minutes what should happen?
the test should be repeated every 5 minutes up to 20 minutes
What 5 things are being assessed in the apgar test?
heart rate respiratory effort muscle tone reflex irritability skin color
If a baby shows a heart rate of less than 100 bpms what needs to happen?
immediate resuscitation
The blood from the cord is obtained for what purpose?
to test the blood gases, group, type and possible stem cells
If a newborn scores anywhere between 7-10 what does this indicate?
newborn is in good condition
What does an apgar score of 4-7 indicate?
indicates need for stimulation
If score is less than 4 what may this indicate?
possible resuscitation
If score is less than 3 at 5 minutes what may this indicate?
neonatal mortality
