M7.1 Labour and Birth Flashcards
1
Q
what are the 3 P’s and what do they stand for?
A
Passageway: birth canal
Passenger: fetus
Powers: physiologic forces of labour
2
Q
what are the 5 factors in the process of labour and birth?
A
- birth passage
- fetus
- Relationship between passage and fetus
- Physiological forces of labour
- Psychosocial considerations
3
Q
What is the leopold maneuver used for?
A
Leopold maneuvers for determining fetal head position, presentation, and lie
4
Q
What are you looking for in first leopold’s maneuvers
A
- RN facing mom face
- Palpating upper abdomen: Feel bum or head
5
Q
What is the difference between palpating for head and bum?
A
Head (breech): firm, hard, round, moves independently from trunk
Bum(cephalic): softer, moves with the trunk
6
Q
What are you looking for in 2nd leopold’s maneuver?
A
- Still facing mom
- Location of fetal back: right or left of maternal abdomen
- Back is firm and smooth
- Validate by palpating fetal extremities on opposite side of abdomen
7
Q
What are you looking for in 3rd leopold’s maneuver?
A
- Identify what fetal part is lying above inlet by grasping lower abdomen above symphysis pubis
- Should be opposite of first maneuver
- If head is presenting and not engaged, may be gently pushed back and forth
8
Q
What are you looking for in 4th leopold maneuver?
A
- RN at head of mom, facing feet
- looking for cephalic prominence or brow
- assess the descent of presenting part
9
Q
What is fetal attitude?
A
refers to relation of fetal body part to one another
Describes posture the fetus assumes as it conforms to the shape of the uterine cavity
10
Q
What is a normal fetal attitude?
A
- General flexion: normal attitude
- Head flexed, chin is on chest with arms crossed over chest and legs flexed at knees with thighs on abdomen
11
Q
T or F: Changes in fetal attitude (specifically head) cause fetus to present larger diameter of fetal head to maternal pelvis = longer or difficult labour
A
True
12
Q
What is fetal lie?
A
- Lie considers the fetal spine in relation to the mother’s spine.
- Can be parallel, transverse, oblique
13
Q
What is this fetal lie: axis of fetus is parallel to womens spine
A
Longitudinal lie
14
Q
What is a transverse lie? and what is it associated with?
A
axis of fetal spine is at a right angle to woman’s spine
- associated w/ shoulder presentation = complications
15
Q
What is oblique lie?
A
baby’s head on the side of mother’s hip (pelvic inlet)
16
Q
What types of fetal lie will require a C/S?
A
transverse and oblique
- if not changed by external cephalic version (ECV)
17
Q
What is fetal presentation?
A
refers to body part of the fetus that enters the maternal pelvis first and leads through the birth canal during labour
- determined by fetal lie
18
Q
Define: portion of fetus that is felt though cervix on examination, determines presentation
A
Presenting part
19
Q
What is a cephalic presentation and what are the types?
A
- head first
-types: vertex, sinciput, brow, face
20
Q
Describe vertex presentation
A
- Fetal head completely flexed into chest
- presenting part: occiput
- best position
21
Q
Describe sinciput presentation
A
head partially flexed, top of head is presenting part
22
Q
describe brow presentation
A
- head is partially extended
- chin is presenting part
23
Q
Describe face presentation
A
head is hyperextended (complete extension)
- face is presenting part
24
Q
What is a breech presentation and what are the types?
A
feet or buttocks first
types: complete, frank, footling
25
Describe the types of breech presentations
- Complete: fetal knees and hips are both flexed, the thighs are on the abdomen, and the calves are on the posterior aspect of the thighs. The buttocks and feet of the fetus present to the maternal pelvis
Frank: Hips flexed, knees extended, butt present to the maternal pelvis. Folded like sandwich
Footling: Hips and legs extended. Feet present to maternal pelvis (like standing)
26
What is a shoulder presentation?
Fetal shoulder is presenting part
In transverse lie and acromion process of scapula is landmark
27
Define fetal position
Relationship of landmark on presenting fetal part to the anterior, posterior, or sides of the maternal pelvis
28
T or F: The most common fetal position is occiput anterior
True
29
What does R or L refer to in fetal position?
Right (R) or left (L) side of the maternal pelvis
30
What does the O refer to in fetal position?
The landmark of the fetal presenting part: Occiput (O)
31
What does A, P, T refer to in fetal position?
Anterior (A), posterior (P), or transverse (T), depending on whether the landmark is in the front, back, or side of the pelvis
32
What is this fetal position? The occiput (area over the occipital bone on the posterior part of the fetal head) is in the left anterior quadrant of the woman’s pelvis. When the fetus is in ___, the posterior fontanelles (located just above the occipital bone and triangular in shape) are in the upper left quadrant of the maternal pelvis
Left occiput anterior (LOA)
33
Describe LOP fetal position
The posterior fontanelle is in the lower left quadrant of the maternal pelvis.
34
What is this fetal position? The posterior fontanelle is in the upper right quadrant of the maternal pelvis.
Right occiput anterior (ROA)
35
What is this fetal position? The posterior fontanelle is in the lower right quadrant of the maternal pelvis.
Right occiput posterior (ROP)
36
When does engagement occur?
when largest diameter of presenting part reaches or passes through the pelvic inlet
37
How do you know if the presenting part is floating (ballottable) - not engaged
when it is freely moveable above the inlet
38
What is station?
relationship of presenting part to an imaginary line drawn between the ischial spines of the maternal pelvis
39
T or F: ischial spine mark widest diameter that fetus must pass
False
- it is the narrowest diameter fetus must pass
40
Where is station 0?
at ischial spines
41
When can you use internal fetal monitoring?
cervix must be dilated at least 2 cm, the presenting fetal part must be accessible by vaginal examination, and the membranes must be ruptured
42
What is electronic fetal monitoring?
Method of placing a fetal monitor on the fetus in order to obtain a continuous tracing of the fetal heart rate, which allows its many characteristics to be observed and evaluated (external)
43
How do you measure a FHR baseline?
approximating the mean FHR during a 10 minute period
Round to increments of 5 bpm
44
What is this called and is it an issue?
FHR greater than 160 bpm in 10 min period
tachycardia
Tachycardia with good variability is not sign of fetal distress
45
What is bradycardia? Is it an issue?
less than 110bpm for 10 min period
Accompanied with decreased variability, late decels, = sign of fetal compromise
46
What is a moderate variability and is it good?
Moderate: changes in FHR by a range of 6-25 bpm
- this is normal
47
What are episodic patterns?
not associated with uterine contractions
48
T or F: Periodic patterns are those associated with uterine contractions
True
49
What is minimal or absent variability?
range of <5 in FHR for <40 mins
- this is a concern
50
What is considered an acceleration?
increase of 15 bpm or more lasting 15 seconds from onset to return to BL
51
What is a prolonged acceleration?
acceleration that lasts 2 mins or more but less than 10 mins
- more than 10 minutes = baseline change
52
T or F: accelerations are a bad sign for FHR
False
Accelerations are generally benign because they are associated with an intact fetal nervous system, lack of fetal hypoxia, and acidosis
patterns are considered reassuring, thus no intervention is required
53
what is an early deceleration caused by?
result of vagal nerve stimulation caused by fetal head compression that occurs during UCs
54
What is an early deceleration?
a gradual decrease in FHR (onset to lowest point is ≥30s). Mirrors contraction, lowest point is the same as the peak of contraction
depth of the deceleration is rarely more than 30 to 40 beats/min
55
When are early decelerations not reassuring?
viewed as reassuring unless they are seen with the lack of descent of the fetal head into the pelvis
56
What is a late deceleration?
a gradual decrease in FHR (onset to lowest point is ≥30s). The duration of the decel occurs after the contraction, FHR does not recover by the end of contraction
shallow, typically 10 to 20 beats/min; however, it may approach 30 to 40 beats/min below the BL
57
What can cause late decelerations?
due to uteroplacental insufficiency and are a result of decreased blood flow or oxygen transfer to the fetus
58
Late decels are also due to ______ positioning of labouring woman. What should you do?
- can also be due to supine positioning
Interventions:
- Reposition her to side (left) and provide O2
- Stop oxytocin
59
T or F: late decels are reassuring
False
They are nonreassuring
indicate fetal hypoxia and acidemia and require prompt attention and intervention
60
What is a Nonstress test (NST)?
test involves using an external electronic fetal monitor to obtain a tracing of the fetal heart rate (FHR) and observation of acceleration of the FHR with fetal movement
61
Is this a reactive or nonreactive NST: lacks sufficient FHR accelerations over a 40-minute period
nonreactive NST
62
What does a nonreactive NST indicate?
uteroplacental perfusion problems
63
What is a reactive test? (NST)
- there are two or more fetal heart accelerations within a 20-minute period, with or without fetal movement discernible by the woman.
- The FHR acceleration must be at least 15 beats/min above the baseline and last 15 seconds from baseline to baseline
64
When can you get a NST?
at 26 weeks AOG and above
65
Define: rhythmic tightening and shortening of uterine muscles during labour
uterine contraction
66
What are the phases of contraction?
- Increment: building up of contraction (longest phase)
- Acme: peak of contraction
- Decrement: letting up of contraction
67
Why does there need to be a period of relaxation in between contractions?
- Allows uterine muscles to rest and provides respire for labouring women
- Restores uteroplacental circulation = important for fetal oxygenation and circulation in uterine blood vessels
68
How do we usually assess intensity?
- Intensity/strength assessed by palpation or an intrauterine pressure catheter (IUPC)
-IUPC is a catheter that is inserted into the uterine cavity through the cervical os
69
Describe the different types of intensity
- Mild = If the uterine wall can be indented easily (nose)
- Moderate: between mild and strong (chin)
- Strong = when the uterine wall cannot be indented (forehead)
70
What is the frequency of a contraction?
time between beginning of one contraction and beginning of next
- duration + relaxation
71
What is the duration of a contraction?
measured from beginning of contraction to completion of contraction
- only phases of contraction
72
Define: the “taking up or drawing up of the internal os and the cervical canal into the uterine side walls (thinning of cervix)
Cervical effacement
73
What does effacement usually lead up to?
Dilation
74
What are the cervix changes in effacement?
Cervix changes from long thick structure to tissue-paper thin
75
Uterus ______ (shortens/lengthens) with each contraction = pulls lower uterine segment ____ (upward/downward)
shortens, upward
76
What does shortening do?
Shortening causes flexion of fetal body = thrust presenting part down to cervix
77
Define: cervical os and cervical canal widen from less than 1cm to about 10 cm
cervical dilation
78
What is dilation caused by?
hydrostatic pressure of fetal membranes and action of uterus being pulled upward
79
When is the cervix no longer palpable?
completely dilated and retracted up in lower uterine segment
80
What is the bishop score?
scoring system determining the softness of the cervix
81
What does the bishop score include?
dilation, effacement, station, cervical consistency and cervical position
- highest score is 13
82
When is the bishop score used and what does a high score mean?
- Bishop score is used most often when the care provider is considering indication of labour
- higher the score for all the elements, the more likely it is the woman will go into labour
83
Bishop score: Dilation (cm)
0: Closed
1: 1-2
2: 3-4
3: 5+
84
Bishop score: Effacement (%)
0: 0-30
1: 40-50
2: 60-70
3: 80+
85
Bishop score: station
0: -3
1: -2
2: 0, -1
3: +1 or more
86
Bishop score: Cervical position
0: posterior
1: mid position
2: anterior
86
Bishop score: Cervical consistency
0: firm
1: medium
2: soft
