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NURS 330: Obstetrics > LEC 1: Factors Affecting Labour and Delivery > Flashcards

LEC 1: Factors Affecting Labour and Delivery Flashcards

1
Q

What are the 6 P’s of Labour?

A
  1. Passage
  2. Passenger
  3. Position
  4. Powers
  5. Psychology
  6. People
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2
Q

The 6 P’s: Passage

A
  • Maternal pelvis and soft tissues
  • Ability of pelivs and cervis to accommodate passage of fetus
  • Four clasical pelvis types:
    • Gynecoid
      • 50% of population
    • Android
    • Anthropoid
      • 25% of population
    • Platypelloid
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3
Q

What are the 4 classical pelvis types?

A
  • Gynecoid
    • 50% of population
  • Android
  • Anthropoid
    • 25% of population
  • Platypelloid
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4
Q

Gynecoid Pelvis

A
  • Cnnsidered the true female pelvis
  • Occurs in about 50% of all women
  • Vaginal birth is most favourable with this type of pelvis because the inlet is round and the outlet is roomy
  • The optimal diameters in all three planes of the pelvis
  • Allows early and complete fetal internal rotation during labour
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5
Q

Anthropoid Pelvis

A
  • Occurs in 25% of women
  • The pelvic inlet is oval and the sacrum is long, producing a deep pelvis than side to side
  • Vaginal birth is more favourable with this pelvic shape compared with the android or platypelloid shape
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6
Q

Android Pelvis

A
  • Considered the male-shaped pelvis and is characterized by a funnel shape
  • Occurs in around 20% of women
  • THe pelvic inlet is heart-shaped and the posterior segments are reduced in all pelvic planes
  • Desent of the fetal head into the pelvis is slow, and failure of the fetus to ritate is common
  • The pronosis for labour is poor, subsequently leading ot cesaren birth
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7
Q

Platypelloid Pelivs

A
  • The least common type of pelvic structure among men and women, with an approximate incidence of 5%
  • The pelvic cavity is shallow but widen at the pelvic outlet, making it difficult for the fetus to descend through the midpelivs
  • It is not favourable fir a vaginal birth unless the fetal head can pass through the inlet
  • Women with this type of pelvis usually require cesarean birth
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8
Q

The 6 P’s: Passanger

A
  • Fetus, membranes, placenta
  • Ability of fetus to complete birth process
  • Molding: Cranial bones overlap under pressure of the powers of labour and demands of unyielding pelvis
  • The suboccipotobrematic comes out of the vagina first- smallest part of the head
    • Even with the smallest diamete of the head coming out, there will still be molding
  • The passage and the passanger need to work together
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9
Q

The 6 P’s: Position- Fetal Position

A
  • Lie
    • Refers to the relationship of fetal caphalocaudal axis (spine) to maternal cephalocaudal axis (spine)

Longitudinal, trasverse, oblique

  • Attitude
    • Relationship of fetal parts to one another
    • Head can be extended, brow, flexed
  • Presentation
    • Determined by fetal lie and by body part of fetus that enters pelvic passage first; presenting part
    • CEPHALIC = head
    • Vertex, brow, face, chin (depending of attitude)
    • BREACH = buttocks
    • Complete, frank, incomplete
    • SHOULDER - Shoulder is presented (cannot deliver vaginaly)
    • COMPOUND - more than one body part is coming out at the same time
  • Position
    • Position of fetus in relation to pelvis
    • R: Right
    • L: Left
    • O: Occiput
    • S: Sacral
    • M: Mentum
  • Station
    • Relationship of the presenting part (head, buttocks) to imaginary line drawn between ischial spines of maternal pelvis
    • Head at 0 station is engaged
    • Engagment: Largest diameter of presenting part reaches or passes through pelvic inlet
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10
Q

What are the different presentations?

A
  • Cephalic
    • Head
  • Breach
    • Buttokcks
  • Shoulder
    • Shoulder is presented
    • Cannot deliver vaginaly
  • Compound
    • More than one body part coming out at the same time
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11
Q

The 6 P’s: Position- Maternal Position

A
  • Certain maternal positions can promote comfort and enhance labour progress
  • Repeated position change is often helpful
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12
Q

The 6 P’s: Powers

A
  • Uterine contractions/ pushing
  • Characteristics of contractions and effectivenss of expulsion methods
  • Primary and secondary powers that work together ot achieve birht of fetus, fetal membranes, placenta
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13
Q

Primary Power

A

Uterine muscular contractions

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14
Q

Secondary Power

A

Use of abdominal muscles to push during second stage of labour

  • Only asking to push during contractions
  • Need to be fully dilated before pushing
  • If not fully dilated can cause damage
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15
Q

Contractions

A
  • Pressure of fetal head increases cervical dilation and effacement
  • Woman experience a range of physical sensations- each deliver, each woman, each baby are unique
  • Can range from very mild- menstraul carmp- to severe discomfort, some don’t feel any discomfort at all (rare)
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16
Q

Why do we need to assess contractions?

A
  • Normal contractions decrease uteroplacental blood flow
  • Most healthy fetuses tolerate this well
  • Identify abdnomral contraction patterns that might adversely affect oxygen delivery to the fetus
17
Q

How do we assess contractions?

A
  • Timing
    • How far apart, how ling, how strong are they, how many
  • Frequency (Interval)
    • Duration from start of one contraction to start of next (usally reported in minutes OR number of contractions/ 10 minutes)
  • Duration (Length)
    • From start to end (usually reported in seconds)
  • Intesity (Strength)
    • How strong are the contractions (weak, moderate, strong)
  • Resting Tone of Uterus
    • Important because it is a way to determine if there is a break between contractions so that the fetucs can be re-oxygenated
18
Q

Acme

A
  • Peak of contractins
  • Fetal oxygenation is at risk for the fetus
19
Q

The 6 P’s: Psychology

A
  • Stress/ relaxation and progress
  • Understanding and preparation for childbirth experience
  • Hisotry and experiences
    • Previous pregnancies
    • This pregnancy
  • Present emotional status
  • Beleifs and values
  • Age, general wellness
20
Q

The 6 P’s: People

A
  • Family, friends, healthcare, and providers
  • Amount of support rom support persons
  • Support from healthcare providers
  • Types of suppoer (are they actually supportive?)
21
Q

Premonitory Signs of Labour

A
  • Lightinening
    • Fetus descends into pelvid inlet
    • Engaged
  • Braxton Hicks Contractions
    • Irregular, intermittent, ‘practice’ contractions that occur throughout pregnancy, painless, no cervical change
  • Vaginal Mucous Increase
  • Cervical Changes
    • Cervix begins to soften and weaken (ripening)
  • Bloody Show
    • Loss of cervical mucous plug
    • Causes blood-tinage discharge
  • Rupture of Membranes
    • If rupture prior to onset of labout in a term pregnancy
    • Good change labour will begin within 24 hours
  • Sudden Burst of Energy
    • “Nesting”
    • Usually occurs 24 to 48 hours before
  • Loss of 0.5 to 1 kg
  • Diarrhea, indigestion, nausea, vomiting
22
Q

Differences Between True and Flase Labour

A
  • Contraction Timing
    • True Labour: Regular, becoming closer together, usually 4 to 6 minutes apart, lasting 30 to 60 seconds
    • False Labour: Irregulat, not occuring close otgether
  • Contraction Strength
    • True Labour: Become stronger with time, vaginal pressure is usually felt
    • False Labour: Frequently weak, not getting stronger with time or alternatin (a stron one followed by weker one)
  • Contraction Discomfort
    • True Labour: Starts in the back and radiates around toward the front of the abdomen
    • False Labour: Contractions may stop or slow down with walking or making a position change
  • Any Change in Activity
    • Ture Labour: Contractions continue no matter what positional change is made
    • False Labour: Contractions may stop or slow down with walking or making a position change
  • Stay or go?
    • True Labour: Stay home until contractions are 5 minutes apart, last 45 to 60 seconds, and are strong enough so that a conversation during one is not possible- then go to the hospital or birthing center
    • False Labour: Drink fluids and walk around to see if there is any change in the intensity of the contractions; if the contractions diminish in intensity after either or both- stay home
23
Q

First Stage of Labour: Cervical Dilation

A
  • Latent Phase → 0 to 3 cm
    • Physiological Changes
      • ​Regular, mild contractions begin and increase in intensity and frequency (q5 to 10 hours)
      • Cervical effiacement and dilation begin
      • 0 to 3 cm
    • Psychological Changes
      • ​Relief that labour has begun
      • High excitement with some anxiety
    • Important to differentiate from FALSE LABOUR
  • Active Phase → 4 to 7 cm
    • Physiologic Changes
      • ​Contractions increase in intensity, frquency, and duration (q 2 to 5 hours)
      • Cervical dilation 4 to 7 cm
      • Fetus begins to descend into the pelvis
    • Psychological Changes​
      • Fear of loss of control
      • Anxiety increases
  • Transition Phase → 8 to 10 cm
    • Physiologic Changes
      • Contractions increase in intensity, duration, and frequency
      • Cervix thins and stretches to 8 to 10 cm
      • Fetus descends rapidly into the birth passage
      • Nausea and/or vomiting, diaphoretic, increased bloody show
    • Psychological Changes
      • May experience trembling, restless, anxious, irritable, feeling overwhelmed or loss of control
24
Q

Physiological Changes of Labour

A
  • Cardiovascular
    • ​Blood pressure increases each contraction
    • May increase further with pushing
  • Respiratory
    • ​Increase in oxygen demand and consumption
    • Mild respiratory acidosis can occur time of birth
  • Gastrointestinal/ Genitourinary
    • ​Edema in bladder due to pressure from fetal head
    • Delayed gastric motility and fastric emptying
  • Hematological and Immune
    • ​WBC increases
    • Blood glucose decreases
25
Q

Second Stage of Labour: 10 cm Dilatation to Birht of Infant

A
  • Physiologic Changes
    • ​Pushing due to pressure of fetal head on nerves
    • Woman uses intra-abdominal pressure to push
    • Perineum bulge, flatten, move anteriorly as fetus descends
    • Corwning- head visible,d oes not retract between contractions-pain
  • Psychological Changes
    • ​May feel a sens of puprose
    • Pushing may feel better than pressure
    • May feel out of control, frightened, irritbale, panicky
    • Tired and exhausted
26
Q

Third Stage of Labour: 5 to 30 minutes: Delivery of Placenta

A
  • Physiologic Changes
    • ​Placental separation
    • Strong uterine contractions
    • Lengthening of the cord
    • Slight blood loss
    • Uterus smaller, rounder and firmer
    • Fundus rises in abdomen, harder an dincreased mobile
    • Woman may feel pressure to bear down
    • Placental delivery (may need slight cord traction)
  • Psychological Changes
    • ​Relief at completion of birth
    • Twilight
    • Focus don welfare of baby
    • May not recognize that placental expulsion is occuring
      • Bounding
      • Family time
27
Q

Fourth Stage of Labour: Recovery and Stabilization: 1 to 4 Hours

A
  • Physiologic Changes
    • ​Increased pulse and decreased blood pressure due to redistribution of blood from uterus and blood loss
    • Uterus contracted btween imbilicus and symphysis pubis
    • Woman may experience a shaking chill
    • Urinary retention related to decreased bladder tone and possible trauma to the bladder
      • Impact on uterus
  • Psychological Changes
    • ​May be euphoric and neergized at birht of child
    • May be TIRED
    • Thirst and hungry
    • Breastfeeding
    • Bonding

NURS 330: Obstetrics (19 decks)

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