labour & delivery, neonatal Flashcards
(117 cards)
1
Q
what is the passage?
A
fetus and placenta-
impacted by the size of fetal head, fetal presentation, fetal lie, fetal attitude, fetal position
2
Q
what has the most impact on the birthing process?
A
size of fetal head due to size and rigidity
3
Q
what are fontanelles?
A
located where sutures intersect, palpation of fontanelles reveals presentation, position, and attitude
4
Q
anterior fontanelle?
A
larger, diamond shaped, closes by 18 months
5
Q
posterior fontanelle?
A
triangular, closes at about 6-8 weeks
6
Q
what is fetal presentation?
A
part of fetus that enters the pelvic inlet first and leads through the birth canal during labour
7
Q
what is the presenting part?
A
part of fetus that lies closest to the internal os of cervix
8
Q
what are the three presentations?
A
cephalic, breech, shoulder
9
Q
cephalic presentation is?
A
head first, presenting part is the occiput
10
Q
breech presentation is?
A
buttocks or feet first, presenting part is sacrum
11
Q
shoulder presentation is?
A
presenting part is scapula
12
Q
what is fetal lie?
A
the relation of long axis (spine) of the fetus to the long axis (spine) of the mother
13
Q
two main lies?
A
longitudinal/vertical OR transverse/oblique
14
Q
what is the longitudinal lie?
A
spine is parallel to mothers, either cephalic or breech presentation
15
Q
what is the transverse lie?
A
long axis is perpendicular or at an angle to the mothers
-cannot be birthed vaginally
16
Q
what is fetal attitude?
A
relation of fetal body parts to one another- characteristic posture (attitude) in utero is due to the fetal growth and the way the fetus conforms to the shape of the uterine cavity
17
Q
what is general flexion?
A
back is rounded, chin is flexed down to chest, legs are tucked into abdomen, arms are crossed over the thorax
18
Q
what is biparietal diameter?
A
largest transverse diameter of fetal head (usually around 9cm), widest part entering pelvic inlet
19
Q
what is suboccipitobregmatic diameter?
A
most critical diameter, when head is in complete flexion, this diameter allows fetal head to pass through true pelvis easily
20
Q
what is anteroposterior diameter?
A
increases as the head extends. can cause head to be too large to pass through
21
Q
what is fetal position?
A
relationship of a reference point on the presenting part (occiput, sacrum, mentum (chin), or sinciput (deflexed vertex) to the 4 quadrants of the mothers pelvis
22
Q
what is the first letter of the fetal position system
A
LOCATION of presenting part in mothers pelvis (side to side)
- R= right
- L= left
23
Q
what is the second letter of the fetal position system
A
PRESENTING PART O- occiput S- sacrum M- mentum (chin) Sc- scapula
24
Q
what is the third letter of the fetal position system
A
LOCATION of presenting part
A- anterior
P- posterior
T- transverse
25
what is station?
relationship of the presenting part to an imaginary line drawn between the maternal ischial spines and is a measure of the degree of descent through birth canal- measured in cm above or below the ischial spine
26
-1 is 1cm....____ the spine
above the spine
27
when is birth imminent?
when the presenting part is at 4+ to 5+
28
what is engagement?
indicates the largest transverse diameter of the presenting part has passed through the maternal pelvic brim into the true pelvis (usually corresponds to station 0)
-occurs in the weeks leading up to labour in the nullipara and occurs during labour in the multipara
29
what is the passageway?
the birth canal. composted of:
| mothers rigid bony pelvis
30
what are the 4 pelvic joints?
symphysis pubis, right and left sacroiliac joints, and sacrococcygeal joints
31
what are the two parts of the pelvis?
true pelvis: below brim/inlet, involved in birth
| false pelvis: part above the brim, no role in child-bearing
32
what are the 4 types of pelves?
gynecoid: classic female type
android: male pelvis
anthropod: anthroid apes
platypelloid: flat
33
what is the pelvic floor?
muscular layer that separates the pelvic cavity from the perineal space below
- helps rotate fetus anteriorly
34
what are powers?
contraction (involuntary and voluntary!)
35
involuntary (primary powers)?
- originate at the pacemaker points in the uterine wall
- described in terms of frequency, duration, intensity
- responsible for effacement and dilation of cervix
36
what is effacement
shortening and thinning of cervix
37
is the cervix palpable when fully dilated?
NO
38
what is the ferguson reflex?
stretch receptors in posterior vagina cause release of endogenous oxytocin that triggers maternal urge to bear down
39
what are voluntary secondary powers?
presenting part reaches pelvic floor, contractions change in character, become expulsive
involuntary urge to push
aid expulsion of fetus
compression of diaphragm and abdominal muscles compress fetus downwards
40
what are signs preceding labour?
- lightening (presenting part descends into true pelvis)
- vaginal mucus more profuse
- cervix softens (ripens) partially effaced
- membranes may rupture
- losing 0.5-1.5 kg in weight due to water loss
- surge of energy
- nausea, vomiting, indigestion, and diarrhea
41
onset of labour is?
not linked to a single cause!
other factors:
-changes in maternal uterus, cervix, pituitary gland
-hormones produced by normal fetal hypothalamus
-uterine distension
-increased intrauterine pressure, increased estrogen, decreased progesterone
42
what does the normal labor consist of?
regular progression of uterine contractions
- effacement and progressive dilation of cervix
- progress in descent of the presenting part
43
what is the first stage of labour?
lasts from onset of regular uterine contractions to full dilation of cervix
-active labour= more rapid dilation of cervix
44
what is the second stage of labour?
cervix fully dilated to birth of the fetus
- latent phase: no strong urge to push, fetus descends passively
- active phase: strong urge to push
45
what is the third stage of labour?
lasts from birth of fetus to birth of placenta
| -placenta usually separates with the third or fourth contraction after fetus is delivered
46
what is the fourth stage of labour?
lasts from 2 hours after delivery of the placenta
| -recovery, hemostasis is recovered
47
what are the 7 cardinal movements of labour?
- engagement
- descent
- flexion
- internal rotation
- extension
- external rotation
- birth by expulsion
48
what is the psyche?
psychological outlook is preserved
- knowledge
- fear
- support
- trust
- beliefs, values, culture
49
psychological assessment of the labouring woman should include?
verbal interactions (does she ask questions?)
perceptual ability (understanding the nurse?)
body language
discomfort level
50
what is the postpartum period?
interval between the birth of the newborn and the return of reproductive organs to normal nonpregnant state
- approx 6 weeks
- also known as puerperium or fourth trimester
51
what is prodromal labour?
false labour
- contractions do not increase in frequency, duration, or intensity
- cervix does not dilate or efface
52
what is true labour?
```
contractions rhythmic and regular
increase in freq duration intensity
pattern does not change
increase in discharge
cervix begins to dilate or efface
```
53
nurses role in labour?
- assess onset and pattern of contraction
- assess contraction freq, duration, strength
- provide info related to maternal self care
- reassurance
54
three stages of first stage of labour?
latent (0-3 cm)
active (3-7cm)
transition (7 to 10cm)
55
cardiovascular responses to labour
cardio output increases
increased WBC
peripheral vascular changes (cold hands and feet)
compression of vena cava may cause dizziness nausea anxiety
56
resp response to labour
increase in O2 consumption due to uterine activity
| increase in resp rate
57
gastrointestinal response to labour
gastric motility decreases, emptying time of stomach increases
clear fluid and light diet recommended
58
physiological change: lochia
separation of uterine decidua into 2 layers
new endometrium forms inner layer of uterus
outer layer sloughs off
59
physiological change: perineal changes
intact perineum
- odematous, tender bruised
- possible haemorrhoids
60
physiological change: circulatory
- blood loss at delivery
- increased WBC
- increased plasma fibrinogen
- increased diuresis due to excess fluid in pregnancy
61
psychological change, three phases of transition in parenthood?
taking in (time of reflection)
taking hold
letting go
62
taking in phase
- relies on nurse more
- tired
- wants to talk about pregnancy and birth
- wants rest, getting to know baby
63
taking hold phase
- more assertive
- interested in learning about newborns needs
- seeks assistance
- looks for guidance
64
letting go phase
- begins to define new role
- lets go of previous role
- make adjustments
65
what are the postpartum blues
occur between days 3-5, no apparent reason
| mood swings, anxiety
66
uterus: postpartal change
involution begins immediately, contracts back to normal size
- encourage mom to empty bladder often
- breast feeding helps contractions go faster
67
fundus: postpartal change
may rise 1 cm above umbilicus (12 hours pp), then descends 1 to 2 cm every 24 hours
-not palpable after 2 weeks
68
afterpains: postpartal change
less with first time mothers, more in stretched uterus
69
cervix: postpartal
remains open after birth for over 1 week, infection risk
70
ovaries: postpartal
menstruation begins in 6 to 10 weeks, 8 weeks to 18 months in breastfeeding mothers
71
perineum: postpartal
tender, does not return to prepregnant state
72
endocrine system: postpartal
prolactin for breast milk increases, estrogen and progesterone decreases, thyroid levels return to normal
73
normal blood loss for birth?
500 vaginal 1000 C section
74
VS return to normal quick after birth however...
stroke volume, cardiac output, end-diastolic and end-systemic vascular resistance remain elevated for 12-24 weeks
75
joints stabilize by?
6-8 weeks
76
en face position
direct eye contact is beginning of attachment
77
engrossment
father and mother gazing for prolonged periods of time at baby
78
melesma is?
chosma or mask of pregnancy, usually disappears, remains in 30% of woman
79
3 postpartum changes that protect woman by increasing blood volume
- elimination of uteroplacental circlation reduces size of maternal vascular bed
- loss of placental endocrine function removes stimulus for vasodilation
- mobilization of extravascular water stored during pregnancy
80
when is plasma volume replenished
3rd postpartum day
81
colostrum is
clear yellow early milk
82
postpartal: urinary system
decreased urge to void, may result in bladder distension
| -kidney function returns to normal within 1 month
83
does external os regain prepregant state
no, loses circular shape, becomes jagged slit
84
lochia rubia=
mainly blood and debris, dark red colour
85
lochia serosa=
old blood, leukocytes, debris, 4 to 10 days.
| -pinkish brown
86
lochia alba=
whitish yellow, 10 to 28 days
87
involution?
return of uterus to non pregnant state
88
what is apgar scoring?
rapid assessment of newborns transition to extrauterine existence on basis of 5 signs
89
5 signs in apgar scoring
```
heart rate
resp rate
muscle tone
reflex irritabiliy
generalized skin colour
```
90
0-3 apgar score=
severe distress
91
4-6 apgar score=
moderate difficulty
92
7-10 apgar score=
minimal difficulties
93
when is apgar scoring done
at 1 to 5 minutes after nurse
94
when is apgar reassessed and why
at 10 to 20 mins if score is less than 7 at five minutes
95
infant who has difficulty clearing mucus can be temporary placed in
side lying position until secretions are cleared
96
ideal way of promoting warmth for baby
skin-to-skin contact on mothers chest with blanket!
97
administration of vitamin K is done how?
intramuscularly to prevent hemorrhagic disease
either 0.5 or 1.0 mg depending on weight
-given 6 hrs after birth
98
a more thorough physical assessment should occur when?
12 to 18 hours after birth
99
temp, HR and RR for newborn
temp 37
HH 110 to 160
RR 30 to 60
BP not usually taken, very high after birth, varies with activity
100
typical weight of babies
2500 to 4000g
101
infants whose weight is appropriate for gestational age is?
between tenth and ninetieth percentiles, persumed to have grown at a normal rate
102
ballard scale?
measures gestational age
-assesses 6 external and 6 neuromuscular signs
each sign has a number score and a cumulative score
-9 possible categories AGA, SGA, LGA term preterm posterm
103
preterm or premature
before 37 weeks gestation
104
late preterm
between 34 0/7 and 36 6/7
105
early preterm
between 37 and 38 +6 weeks
106
full term
week 39 and end of week 40 +6
107
late term
41st week
108
post term
after 42 week
109
postmature
after completion of week 42, showing effects of progressive placental insufficiency
110
what is caput succedaneum
edema of scalp, resolves in a few days
111
cephalohematome
collection of blood between periosteum and skull bone due to birth trauma. may take few weeks to resolve
112
craniotabes
softening of cranial bones in utero, may take several months
113
hyperbilirubinemia
very common, jaundiced skin.
- best therapy is prevention
- goal is to reduce newborns serum levels of unconjugated bilirubin
114
thermoregulation of infant
very important- can lose lots of heat through evaporation conduction, convection, radiation; skin to skin is important
115
cold stress..
can increase need for oxygen and may deplete glucose stores
| -infant may react to exposure to cold by increasing resp rate and becoming cyanotic
116
can a healthy baby become hypothermic
yes. many reasons why. rapid warming however can cause apnea and acidosis, warming process must be monitored
117
what is hypoglycemic
BS of <2.5 mmol/L
