Midterm - Mod 4 Flashcards
Four interrelated components called the four “Ps” make up the process of labour and birth. What are the four P’s?
Powers, Passage, Passenger, Psyche
(4 p’s) What is the powers of labour? What are the two powers?
forces that cause the cervix to open and that propel the fetus downward through the birth canal.
- Two powers: uterine contractions (primary power) and the mother’s pushing efforts
what are the effects of contractions on the cervix?
What are the three phases of contractions and what happens?
Efface (thin) and Dilate (open)
•Increment: period of increasing strength
•Peak: period of greatest strength
•Decrement: period of decreasing strength
Intensity is the Approx. strength of contraction and described as mild, moderate, and firm contractions. Describe each
- Mild – fundus is easily indented with the fingertips; fundus of the uterus feels similar to tip of nose
- Moderate – fundus can be indented with the fingertips but with more difficulty; the fundus of the uterus feels similar to chin
- Firm – fundus can not be readily indented with fingertips; fundus feels similar to foreheard
How are contractions measured and what are the numbers we want for frequency, increment peak decrement, and relax period?
Contractions are measured from start of one contraction to the end of that contraction, and then relaxing period.
- No more frequent than 2 min
- Increment peak decrement: no longer than 90 secs
- 60 sec rest break between contractions
the Passage of labour consists of?
The pelvis is divided into what two major parts?
Consists of the mother’s boney pelvis and soft tissues.
•True pelvis (lower part): Directly involved in childbirth is further divided
o Inlet, Midpelvis, Outlet
•False (upper, flaring part)
What are the 4 passengers?
Fetus, placenta, amniotic membranes and amniotic fluid
How is “Lie” described
how the fetus is oriented to the mothers spine
- Most common orientation is the longitudinal lie, in which the fetus is parallel to the mother’s spine
What is the normal fetal attitude?
normally the head is flexed forward and the arms and the legs are flexed; if extension occurs labour may be prolonged
Presentation refers to the fetal part that enters the pelvis first. Cephalic presentation is most common, there are variations that can occur - Vertex, military, brow, face, breech. Describe each
Vertex- fetal head is fully flexed
Military- fetal head is neither flexed nor extended
Brow- fetal head is partly extended
Face- fetal head is fully extended
Breech legs and buttocks are entering pelvis first
Position refers to
how a resting point on the fetal presenting part is oriented within the mother’s pelvis
Psyche in labor refers to
Impact of the woman’s entire being on the birthing process
What are the signs of impending labour
- Braxton Hicks contractions
- Increased vaginal discharge
- Bloody show
- Rupture of the membranes
- Energy spurt
- Weight loss
Reassuring FHR patterns are: Baseline FHR in a normal range of____.
Are accelartions of FHR normal or abnormal?
110 to 160 beats/min, with no periodic changes and a moderate baseline variability
- Accelerations of FHR with fetal movement are normal patterns
Nonreassuring FHR patterns
- Baseline FHR <110 or >160 beats/min
• Decreased or absent variability; little fluctuation in rate
• Late decelerations
• Variable decelerations
False or true labor: Contractions irregular
False labor
Signs of true labor
- Contractions gradually develop a regular pattern
- Contractions become stronger and more effective with walking
- Discomfort in lower back or abdomen
- Bloody show often present
- Progressive effacement and dilation of cervix
What is the first stage of labour and its 3 phases
dilation and effacement (can last 4 to 6 hours)
•Latent phase: up to 3 cm of dilation (not very painful, happy. Contractions are far apart)
•Active (labor) phase: 4 to 7 cm of dilation (pain, not happy)
•Transition phase: 8 to 10 cm of dilation (lots of pain, not happy)
(dilate/contract cervix. Longest stage)
what occurs in the second stage of labour
expulsion of fetus (30 minutes to 2 hours)
- ends with birth of infant
what occurs in the third stage of labor? Nurses responsibilities?
expulsion of placenta (5 to 30 minutes) – sometimes theres a massage to help expulsion
- cord is cut
Nurses responsibility to assess the placenta and monitor woman’s vital signs
what is the fourth stage of labor and what is the nursing care?
Recover stage - 1-4 hrs after birth of placenta
Nursing care:
- Identifying and preventing hemorrhage
• Evaluating and intervening for pain
• Observing bladder function and urine output
• Evaluating recovery from anesthesia
• Providing initial care to the newborn infant
• Promoting bonding and attachment between the infant and family
What are Nonpharmacologic Pain Relief Measures during labor?
- Relaxation techniques
- Skin stimulation: Effleurage
- Sacral pressure
- Thermal stimulation
- Positioning
- Diversion and distraction
- Breathing
Difference Between Analgesic and Anesthetic?
Monitor mother for signs off…
• Analgesic blocks pain
• Anesthetic blocks both pain and motor responses
- Monitor mother for signs of hypotension and respiratory depression
Indications for Labor Induction
- Gestational hypertension
- Ruptured membranes without spontaneous onset of labor
- Infection within the uterus
- Medical problems in the woman that worsen during pregnancy
- Fetal problems such as slowed growth, prolonged pregnancy, or incompatibility between fetal and maternal blood types
- Placental insufficiency
- Fetal death
Pharmacologic Methods to Stimulate Contractions
- Cervical ripening – physical softening of the cervix that leads to effacement and dilation
- Oxytocin stimulates contractions
- Prostaglandin E2, Prostaglandin E1 : soften cervix
what are the benefits of using forceps during labour?
when is it used?
• Provides traction and rotation of the fetal head when the mother’s pushing efforts are insufficient to accomplish a safe delivery
o Used at end of second stage of labor in vaginal delivery
Vacuum labour uses suction applied to the fetal head so the physician can assist the mother’s expulsive efforts. When should it be used?
Used only with occiput presentation and at end of second stage of labor
Preparation for Cesarean Birth
- Clinical lab studies to identify anemia and blood-clotting abnormalities
- CBC, coagulation studies, blood typing
- Baseline vital signs, including fetal heart rate
- Position woman for comfort
- IV line
- Foley catheter inserted
Emergencies During Childbirth: what is a Prolapsed umbilical cord
o Complete: The cord is visible at the vaginal opening.
o Palpated: The cord cannot be seen but can be felt as a pulsating structure when a vaginal examination is done.
o Occult: The prolapse is hidden and cannot be seen or felt; it is suspected based on abnormal fetal heart rates.
Emergencies During Childbirth: what is a Placenta accreta
An abnormal attachment of the placenta to the uterine wall
Emergencies During Childbirth: uterine rupture, describe complete, incomplete, dehiscence
Complete- whole from uterine wall into the abdominal cavity
Incomplete- uterus tears into a nearby structure such as a ligament
Dehiscence- an old uterine scare separates
