Maternity week 3-2

Question 1

optimal time for pregnancy - age

Answer 1

20-35 years

Question 2

spontaneous abortion - causes (acres of spontaneity)

Answer 2

20% with increased age (check this), gest. diabetes, c-section, placenta acreta (placenta grows through uterine wall into abdomen and connects to bladder, intestines, etc)

Question 3

5 Ps

Answer 3

passenger, passage, powers, position, psychological adapations

Question 4

passageway

Answer 4

Pelvis structure
Birth Canal (Soft Tissues) Laboring Positionf

Question 5

true pelvis measures from..

Answer 5

symphaiss pubis to top of coccyx

Question 6

false pelvis

Answer 6

look this up

Question 7

pelvis structure

Answer 7

biggest reason women can not have a vaginal birth

Question 8

2nd most common reason woman can’t have vaginal birth - birth canal (2nd most common cervix)

Answer 8

if cervix is still there, can’t have baby.

Question 9

diagnonal conjucate

Answer 9

this is the symphaiss pubis to top of coccyx. should be 11.5 cm

Question 10

different shapes of pevlic bone (platepus is short)

Answer 10

gynecoid (this is the good one), android (20% of women) (more like a male pelvis - poor labor progress), anthropoid (25%) (oval), platypelloid (3%) (short and wide, difficult descent)

Question 11

soft tissues - cervix

Answer 11

can create huge barrier if not dilated all the way

Question 12

soft tissue - pelvic floor muscles

Answer 12

create some resistience and help rotate the baby

Question 13

soft tissue - vagina

Answer 13

might have some lacerations due to size

Question 14

power

Answer 14

contractions

Question 15

labor is defined

Answer 15

cervical change from regular contr. that increase in strength, cervical change - either effacement and dilation (usually occurs at the same time, but not necessarily. the more babies a women has had, it will go down, maybe 50.***ON TEST

Question 16

SIGNS PRECEDING LABOR

Answer 16

LIGHTENING (uterus and fetus)
BLOODY SHOW (blood in the mucus)
RUPTURED MEMBRANES (PROM - ruptures before labor)
BRAXTON - HICKS CONTRACTIONS BURST OF ENERGY (nesting syndrome)
FALSE LABOR (not changing cervix w/ contractions makes them false)
INCREASED VAGINAL DISCHARGE PROM

Question 17

True Labor - where is the pain located? (it’s truly in my back to my abdomen)

Answer 17

UC’s- regular, stronger longer, closer, more intense if walking
Cervix- effaces and dilates (we won’t get into this) , anterior position
Fetus becomes engaged
Felt in low back radiate to abdomen (can be a sign of true labor, baby hasn’t rotated yet and she feels head hitting lower back)

Question 18

False Labor - where is it felt?

Answer 18

UC’s- irregular or regular temporarily, may stop with position change
Cervix- no change in efface & dilatation
Fetus- not usually engaged
felt in back or abdomen above naval cervix

Question 19

category 2

Answer 19

slower baseline, good variability. absent

Question 19

copy page 9

Answer 19

here

Question 19

category 3

Answer 19

absent baseline variability. recurrent late decelerations. this is critical - call provider and prepare for a c-section immediately.

Question 20

category 1

Answer 20

baseline - 110 - 160

Question 20

late decelerations - the number (30 min late)

Answer 20

gradual onset - > 30 seconds from onset to nadir

Question 21

nadir

Answer 21

lowest point of contraction

Question 22

late and early are

Answer 22

ok, decelerations

Question 23

primary powers

Answer 23

uterine contractions, involunarty, signal beginning of labor

Question 24

secondary powers (abdomen is second)

Answer 24

abdominal muscles, voluntary bearing down

Question 25

contractions

Answer 25

can you feel when they are notices on a graph (goes up)

Question 26

presentation

Answer 26

is the part of the body that enteres teh pevlic first.
cephalic (vertex)
breech
shoulder (baby is laying transversely)

Question 27

presenting part is

Answer 27

the part of the fetal body felt first on the exam

Question 28

fetal lie is the

Answer 28

relation of the spine of the fetus to the spine of the mother. longitudinal/vertical, transvers, bolique

Question 29

we don’t want

Answer 29

extension - too hard to get baby out.

Question 30

attitude is the

Answer 30

realtionship of fetal parts to itself. general flexion and extension

Question 31

position is the

Answer 31

relationshiop fot he presenting part to the 4 quadrants of the motehr pelvis

Question 32

position - 3 letters

Answer 32

side of pelvis (R or L)
presenting part (O, M, Sa, A)
relation to anterior or posterior (A or P or T)
we want it to be anterior.

Question 33

MECHANISMS OF LABOR: 7 CARDINAL MOVEMENTS THAT OCCUR IN A VERTEX PRESENTATION -

Answer 33

just know there are 7.

Question 34

SIGNS PRECEDING LABOR

Answer 34

LIGHTENING
BLOODY SHOW
RUPTURED MEMBRANES
BRAXTON - HICKS CONTRACTIONS BURST OF ENERGY
FALSE LABOR
INCREASED VAGINAL DISCHARGE PROM

Question 35

4 stages of labor

Answer 35

1-4 (these will be on exam)

Question 36

stage 1 - from what to what?

Answer 36

onset of regular contractions to the full dilateion of cervix

Question 37

stage 2

Answer 37

full cervical dilateion to the birth of the baby

Question 38

stage 3

Answer 38

birth fo baby to birth of placenta

Question 39

stage 4

Answer 39

brith of placenta to reestablish homeostasis

Question 40

PHYSIOLOGIC ADAPTATION TO LABOR

Answer 40

Heart rate 110-160
HR provides information about oxygenation of the fetus and uteroplacental blood
flow
Responds to changes in PCO2, PO2 and other factors

Question 41

PHYSIOLOGIC ADAPTATION TO LABOR -
MATERNAL

Answer 41

Heartrate increases
WBC increases
Respiratory Rate increases
Renal – paresthesia, difficulty voiding Neuro- endorphins
GI- hypomotility
Endocrine-hormone changes
Cardiac output increases (30-50% 2nd stage) BP increases

Question 42

PHYSIOLOGIC ADAPTATION TO LABOR

Answer 42

WBC up to 25,000 – normal
Renal-difficulty voiding, loss of sensation,
Neuro- euphoria, amnesia, elation. Raises the pain threshold.
GI- Nausea, vomiting, belching
Endocrine-decreased progesterone, increased estrogen, prostaglandins, oxytocin, increased metabolism, decreased blood glucose
Supine hypotension

Question 43

PHYSIOLOGIC ADAPTATION TO LABOR

Answer 43

WBC up to 25,000 – normal
Renal-difficulty voiding, loss of sensation,
Neuro- euphoria, amnesia, elation. Raises the pain threshold.
GI- Nausea, vomiting, belching
Endocrine-decreased progesterone, increased estrogen, prostaglandins, oxytocin, increased metabolism, decreased blood glucose
Supine hypotension

Question 44

POSITION OF LABORING WOMAN - what about squatting?

Answer 44

CHANGE POSITIONS FREQUENTLY *RELIEVES TENSION AND FATIGUE *INCREASE COMFORT
*IMPROVE CIRCULATION
UPRIGHT POSITION:
* GRAVITYASSISTSWITHFETUSDESCENT * STRONGERCONTRACTIONS
* IMPROVES MATERNAL CARDIAC OUTPUT

squatting - increased risk of lacerations

Question 45

draw lab before epidural to check for - if what is too low?

Answer 45

low platelets - if platelets are too low, they won’t do an epidural.

Question 46

5 other Ps

Answer 46

Position (Maternal) Psychological Response Philosophy
Partners
Patience

Question 47

PSYCHOLOGICAL RESPONSE

Answer 47

BACKGROUND
COPING MECHANISMS SUPPORT SYSTEM
PREPARATION FOR LABOR SOCIO-CULTURAL INFLUENCES POSITIVE-NEGATIVE INFLUENCES

Question 48

ischeal spines

Answer 48

If the presenting part is palpated higher than the maternal ischial spines, a negative number is assigned; if the presenting fetal part is felt below the maternal ischial spines, a positive number is assigned, denoting how many centimeters below zero station