labour & delivery, neonatal Flashcards
what is the passage?
fetus and placenta-
impacted by the size of fetal head, fetal presentation, fetal lie, fetal attitude, fetal position
what has the most impact on the birthing process?
size of fetal head due to size and rigidity
what are fontanelles?
located where sutures intersect, palpation of fontanelles reveals presentation, position, and attitude
anterior fontanelle?
larger, diamond shaped, closes by 18 months
posterior fontanelle?
triangular, closes at about 6-8 weeks
what is fetal presentation?
part of fetus that enters the pelvic inlet first and leads through the birth canal during labour
what is the presenting part?
part of fetus that lies closest to the internal os of cervix
what are the three presentations?
cephalic, breech, shoulder
cephalic presentation is?
head first, presenting part is the occiput
breech presentation is?
buttocks or feet first, presenting part is sacrum
shoulder presentation is?
presenting part is scapula
what is fetal lie?
the relation of long axis (spine) of the fetus to the long axis (spine) of the mother
two main lies?
longitudinal/vertical OR transverse/oblique
what is the longitudinal lie?
spine is parallel to mothers, either cephalic or breech presentation
what is the transverse lie?
long axis is perpendicular or at an angle to the mothers
-cannot be birthed vaginally
what is fetal attitude?
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
what is general flexion?
back is rounded, chin is flexed down to chest, legs are tucked into abdomen, arms are crossed over the thorax
what is biparietal diameter?
largest transverse diameter of fetal head (usually around 9cm), widest part entering pelvic inlet
what is suboccipitobregmatic diameter?
most critical diameter, when head is in complete flexion, this diameter allows fetal head to pass through true pelvis easily
what is anteroposterior diameter?
increases as the head extends. can cause head to be too large to pass through
what is fetal position?
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
what is the first letter of the fetal position system
LOCATION of presenting part in mothers pelvis (side to side)
- R= right
- L= left
what is the second letter of the fetal position system
PRESENTING PART O- occiput S- sacrum M- mentum (chin) Sc- scapula
what is the third letter of the fetal position system
LOCATION of presenting part
A- anterior
P- posterior
T- transverse
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
-1 is 1cm….____ the spine
above the spine
when is birth imminent?
when the presenting part is at 4+ to 5+
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
what is the passageway?
the birth canal. composted of:
mothers rigid bony pelvis
what are the 4 pelvic joints?
symphysis pubis, right and left sacroiliac joints, and sacrococcygeal joints
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
what are the 4 types of pelves?
gynecoid: classic female type
android: male pelvis
anthropod: anthroid apes
platypelloid: flat
what is the pelvic floor?
muscular layer that separates the pelvic cavity from the perineal space below
- helps rotate fetus anteriorly
what are powers?
contraction (involuntary and voluntary!)
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
what is effacement
shortening and thinning of cervix
is the cervix palpable when fully dilated?
NO
what is the ferguson reflex?
stretch receptors in posterior vagina cause release of endogenous oxytocin that triggers maternal urge to bear down
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
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
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
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
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
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
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
what is the fourth stage of labour?
lasts from 2 hours after delivery of the placenta
-recovery, hemostasis is recovered
what are the 7 cardinal movements of labour?
- engagement
- descent
- flexion
- internal rotation
- extension
- external rotation
- birth by expulsion
what is the psyche?
psychological outlook is preserved
- knowledge
- fear
- support
- trust
- beliefs, values, culture
psychological assessment of the labouring woman should include?
verbal interactions (does she ask questions?)
perceptual ability (understanding the nurse?)
body language
discomfort level
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
what is prodromal labour?
false labour
- contractions do not increase in frequency, duration, or intensity
- cervix does not dilate or efface
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
nurses role in labour?
- assess onset and pattern of contraction
- assess contraction freq, duration, strength
- provide info related to maternal self care
- reassurance
three stages of first stage of labour?
latent (0-3 cm)
active (3-7cm)
transition (7 to 10cm)
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
resp response to labour
increase in O2 consumption due to uterine activity
increase in resp rate
gastrointestinal response to labour
gastric motility decreases, emptying time of stomach increases
clear fluid and light diet recommended
physiological change: lochia
separation of uterine decidua into 2 layers
new endometrium forms inner layer of uterus
outer layer sloughs off
physiological change: perineal changes
intact perineum
- odematous, tender bruised
- possible haemorrhoids
physiological change: circulatory
- blood loss at delivery
- increased WBC
- increased plasma fibrinogen
- increased diuresis due to excess fluid in pregnancy
psychological change, three phases of transition in parenthood?
taking in (time of reflection)
taking hold
letting go
taking in phase
- relies on nurse more
- tired
- wants to talk about pregnancy and birth
- wants rest, getting to know baby
taking hold phase
- more assertive
- interested in learning about newborns needs
- seeks assistance
- looks for guidance
letting go phase
- begins to define new role
- lets go of previous role
- make adjustments
what are the postpartum blues
occur between days 3-5, no apparent reason
mood swings, anxiety
uterus: postpartal change
involution begins immediately, contracts back to normal size
- encourage mom to empty bladder often
- breast feeding helps contractions go faster
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
afterpains: postpartal change
less with first time mothers, more in stretched uterus
cervix: postpartal
remains open after birth for over 1 week, infection risk
ovaries: postpartal
menstruation begins in 6 to 10 weeks, 8 weeks to 18 months in breastfeeding mothers
perineum: postpartal
tender, does not return to prepregnant state
endocrine system: postpartal
prolactin for breast milk increases, estrogen and progesterone decreases, thyroid levels return to normal
normal blood loss for birth?
500 vaginal 1000 C section
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
joints stabilize by?
6-8 weeks
en face position
direct eye contact is beginning of attachment
engrossment
father and mother gazing for prolonged periods of time at baby
melesma is?
chosma or mask of pregnancy, usually disappears, remains in 30% of woman
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
when is plasma volume replenished
3rd postpartum day
colostrum is
clear yellow early milk
postpartal: urinary system
decreased urge to void, may result in bladder distension
-kidney function returns to normal within 1 month
does external os regain prepregant state
no, loses circular shape, becomes jagged slit
lochia rubia=
mainly blood and debris, dark red colour
lochia serosa=
old blood, leukocytes, debris, 4 to 10 days.
-pinkish brown
lochia alba=
whitish yellow, 10 to 28 days
involution?
return of uterus to non pregnant state
what is apgar scoring?
rapid assessment of newborns transition to extrauterine existence on basis of 5 signs
5 signs in apgar scoring
heart rate resp rate muscle tone reflex irritabiliy generalized skin colour
0-3 apgar score=
severe distress
4-6 apgar score=
moderate difficulty
7-10 apgar score=
minimal difficulties
when is apgar scoring done
at 1 to 5 minutes after nurse
when is apgar reassessed and why
at 10 to 20 mins if score is less than 7 at five minutes
infant who has difficulty clearing mucus can be temporary placed in
side lying position until secretions are cleared
ideal way of promoting warmth for baby
skin-to-skin contact on mothers chest with blanket!
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
a more thorough physical assessment should occur when?
12 to 18 hours after birth
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
typical weight of babies
2500 to 4000g
infants whose weight is appropriate for gestational age is?
between tenth and ninetieth percentiles, persumed to have grown at a normal rate
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
preterm or premature
before 37 weeks gestation
late preterm
between 34 0/7 and 36 6/7
early preterm
between 37 and 38 +6 weeks
full term
week 39 and end of week 40 +6
late term
41st week
post term
after 42 week
postmature
after completion of week 42, showing effects of progressive placental insufficiency
what is caput succedaneum
edema of scalp, resolves in a few days
cephalohematome
collection of blood between periosteum and skull bone due to birth trauma. may take few weeks to resolve
craniotabes
softening of cranial bones in utero, may take several months
hyperbilirubinemia
very common, jaundiced skin.
- best therapy is prevention
- goal is to reduce newborns serum levels of unconjugated bilirubin
thermoregulation of infant
very important- can lose lots of heat through evaporation conduction, convection, radiation; skin to skin is important
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
can a healthy baby become hypothermic
yes. many reasons why. rapid warming however can cause apnea and acidosis, warming process must be monitored
what is hypoglycemic
BS of <2.5 mmol/L
