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NURS3112 > M7.1 Labour and Birth > Flashcards

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

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2
Q

what are the 5 factors in the process of labour and birth?

A
  1. birth passage
  2. fetus
  3. Relationship between passage and fetus
  4. Physiological forces of labour
  5. Psychosocial considerations
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3
Q

What is the leopold maneuver used for?

A

Leopold maneuvers for determining fetal head position, presentation, and lie

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4
Q

What are you looking for in first leopold’s maneuvers

A
  • RN facing mom face
  • Palpating upper abdomen: Feel bum or head
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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

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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
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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
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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
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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

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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
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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

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12
Q

What is fetal lie?

A
  • Lie considers the fetal spine in relation to the mother’s spine.
  • Can be parallel, transverse, oblique
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13
Q

What is this fetal lie: axis of fetus is parallel to womens spine

A

Longitudinal lie

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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
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15
Q

What is oblique lie?

A

baby’s head on the side of mother’s hip (pelvic inlet)

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16
Q

What types of fetal lie will require a C/S?

A

transverse and oblique

  • if not changed by external cephalic version (ECV)
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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
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18
Q

Define: portion of fetus that is felt though cervix on examination, determines presentation

A

Presenting part

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19
Q

What is a cephalic presentation and what are the types?

A
  • head first

-types: vertex, sinciput, brow, face

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20
Q

Describe vertex presentation

A
  • Fetal head completely flexed into chest
  • presenting part: occiput
  • best position
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21
Q

Describe sinciput presentation

A

head partially flexed, top of head is presenting part

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22
Q

describe brow presentation

A
  • head is partially extended
  • chin is presenting part
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23
Q

Describe face presentation

A

head is hyperextended (complete extension)

  • face is presenting part
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24
Q

What is a breech presentation and what are the types?

A

feet or buttocks first

types: complete, frank, footling

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25
Q

Describe the types of breech presentations

A
  • 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)

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26
Q

What is a shoulder presentation?

A

Fetal shoulder is presenting part

In transverse lie and acromion process of scapula is landmark

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27
Q

Define fetal position

A

Relationship of landmark on presenting fetal part to the anterior, posterior, or sides of the maternal pelvis

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28
Q

T or F: The most common fetal position is occiput anterior

A

True

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29
Q

What does R or L refer to in fetal position?

A

Right (R) or left (L) side of the maternal pelvis

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30
Q

What does the O refer to in fetal position?

A

The landmark of the fetal presenting part: Occiput (O)

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31
Q

What does A, P, T refer to in fetal position?

A

Anterior (A), posterior (P), or transverse (T), depending on whether the landmark is in the front, back, or side of the pelvis

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32
Q

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

A

Left occiput anterior (LOA)

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33
Q

Describe LOP fetal position

A

The posterior fontanelle is in the lower left quadrant of the maternal pelvis.

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34
Q

What is this fetal position? The posterior fontanelle is in the upper right quadrant of the maternal pelvis.

A

Right occiput anterior (ROA)

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35
Q

What is this fetal position? The posterior fontanelle is in the lower right quadrant of the maternal pelvis.

A

Right occiput posterior (ROP)

36
Q

When does engagement occur?

A

when largest diameter of presenting part reaches or passes through the pelvic inlet

37
Q

How do you know if the presenting part is floating (ballottable) - not engaged

A

when it is freely moveable above the inlet

38
Q

What is station?

A

relationship of presenting part to an imaginary line drawn between the ischial spines of the maternal pelvis

39
Q

T or F: ischial spine mark widest diameter that fetus must pass

A

False

  • it is the narrowest diameter fetus must pass
40
Q

Where is station 0?

A

at ischial spines

41
Q

When can you use internal fetal monitoring?

A

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
Q

What is electronic fetal monitoring?

A

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
Q

How do you measure a FHR baseline?

A

approximating the mean FHR during a 10 minute period
Round to increments of 5 bpm

44
Q

What is this called and is it an issue?
FHR greater than 160 bpm in 10 min period

A

tachycardia

Tachycardia with good variability is not sign of fetal distress

45
Q

What is bradycardia? Is it an issue?

A

less than 110bpm for 10 min period

Accompanied with decreased variability, late decels, = sign of fetal compromise

46
Q

What is a moderate variability and is it good?

A

Moderate: changes in FHR by a range of 6-25 bpm
- this is normal

47
Q

What are episodic patterns?

A

not associated with uterine contractions

48
Q

T or F: Periodic patterns are those associated with uterine contractions

A

True

49
Q

What is minimal or absent variability?

A

range of <5 in FHR for <40 mins

  • this is a concern
50
Q

What is considered an acceleration?

A

increase of 15 bpm or more lasting 15 seconds from onset to return to BL

51
Q

What is a prolonged acceleration?

A

acceleration that lasts 2 mins or more but less than 10 mins

  • more than 10 minutes = baseline change
52
Q

T or F: accelerations are a bad sign for FHR

A

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
Q

what is an early deceleration caused by?

A

result of vagal nerve stimulation caused by fetal head compression that occurs during UCs

54
Q

What is an early deceleration?

A

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
Q

When are early decelerations not reassuring?

A

viewed as reassuring unless they are seen with the lack of descent of the fetal head into the pelvis

56
Q

What is a late deceleration?

A

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
Q

What can cause late decelerations?

A

due to uteroplacental insufficiency and are a result of decreased blood flow or oxygen transfer to the fetus

58
Q

Late decels are also due to ______ positioning of labouring woman. What should you do?

A
  • can also be due to supine positioning

Interventions:
- Reposition her to side (left) and provide O2

  • Stop oxytocin
59
Q

T or F: late decels are reassuring

A

False

They are nonreassuring

indicate fetal hypoxia and acidemia and require prompt attention and intervention

60
Q

What is a Nonstress test (NST)?

A

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
Q

Is this a reactive or nonreactive NST: lacks sufficient FHR accelerations over a 40-minute period

A

nonreactive NST

62
Q

What does a nonreactive NST indicate?

A

uteroplacental perfusion problems

63
Q

What is a reactive test? (NST)

A
  • 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
Q

When can you get a NST?

A

at 26 weeks AOG and above

65
Q

Define: rhythmic tightening and shortening of uterine muscles during labour

A

uterine contraction

66
Q

What are the phases of contraction?

A
  • Increment: building up of contraction (longest phase)
  • Acme: peak of contraction
  • Decrement: letting up of contraction
67
Q

Why does there need to be a period of relaxation in between contractions?

A
  • 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
Q

How do we usually assess intensity?

A
  • 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
Q

Describe the different types of intensity

A
  • 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
Q

What is the frequency of a contraction?

A

time between beginning of one contraction and beginning of next

  • duration + relaxation
71
Q

What is the duration of a contraction?

A

measured from beginning of contraction to completion of contraction

  • only phases of contraction
72
Q

Define: the “taking up or drawing up of the internal os and the cervical canal into the uterine side walls (thinning of cervix)

A

Cervical effacement

73
Q

What does effacement usually lead up to?

A

Dilation

74
Q

What are the cervix changes in effacement?

A

Cervix changes from long thick structure to tissue-paper thin

75
Q

Uterus ______ (shortens/lengthens) with each contraction = pulls lower uterine segment ____ (upward/downward)

A

shortens, upward

76
Q

What does shortening do?

A

Shortening causes flexion of fetal body = thrust presenting part down to cervix

77
Q

Define: cervical os and cervical canal widen from less than 1cm to about 10 cm

A

cervical dilation

78
Q

What is dilation caused by?

A

hydrostatic pressure of fetal membranes and action of uterus being pulled upward

79
Q

When is the cervix no longer palpable?

A

completely dilated and retracted up in lower uterine segment

80
Q

What is the bishop score?

A

scoring system determining the softness of the cervix

81
Q

What does the bishop score include?

A

dilation, effacement, station, cervical consistency and cervical position

  • highest score is 13
82
Q

When is the bishop score used and what does a high score mean?

A
  • 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
Q

Bishop score: Dilation (cm)

A

0: Closed
1: 1-2
2: 3-4
3: 5+

84
Q

Bishop score: Effacement (%)

A

0: 0-30
1: 40-50
2: 60-70
3: 80+

85
Q

Bishop score: station

A

0: -3
1: -2
2: 0, -1
3: +1 or more

86
Q

Bishop score: Cervical position

A

0: posterior
1: mid position
2: anterior

86
Q

Bishop score: Cervical consistency

A

0: firm
1: medium
2: soft

NURS3112 (10 decks)

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