Module 2 INTRAPARTUM - LECTURE 5

Question 1

check slide 3 Must and 5 and 11-13-17-24- 56-59- 62

Answer 1

Based on the provided information, here’s a summary of the clinical assessment and plan for the 29-year-old pregnant patient at 39 2/7 weeks gestation:

Clinical Assessment:

G3T1P0A1L1 (Gravida 3, Term 1, Para 0, Abortus 1, Living 1).
Contractions every 5 minutes, lasting 60-70 seconds, for the past 10 hours.
Cervical exam at presentation: 4cm dilated, 50% effaced, +1 station, bulging amniotic sac.
Fetal heart rate tracing (EFM) showing a category 1 tracing.
Blood type B, Rh factor negative with Anti D antibodies.
Hemoglobin (Hgb) 11.0, Hematocrit (Hct) 31, WBC 19, Platelets (Plts) 230.
Negative STIs (Sexually Transmitted Infections) and diabetes.
Positive for Group B Streptococcus (GBS).
Previous postpartum hemorrhage and episiotomy.
Plan:

Admission for Labor and Delivery: The patient is to be admitted for labor and delivery due to active labor (4cm dilated) and positive progress (now 5cm dilated) during the second cervical exam.

Continuous Fetal Monitoring: Continuous electronic fetal monitoring (EFM) is in place, and the tracing shows a category 1 tracing, indicating that fetal well-being is reassuring.

Rhogam Administration: Rhogam was administered at 28 weeks gestation, as the patient is Rh-negative and had Anti D antibodies.

Epidural Request: The patient has requested an epidural for pain management during labor. The CRNA (Certified Registered Nurse Anesthetist) has been called to provide epidural anesthesia.

Breastfeeding Plan: The patient plans to breastfeed her infant and requests immediate skin-to-skin contact and no interventions to the infant until after the first feeding. This is consistent with breastfeeding best practices and the baby-friendly initiative.

Management of GBS: Given the positive Group B Streptococcus (GBS) status, the patient will likely receive intrapartum antibiotics to reduce the risk of neonatal GBS infection.

Previous Postpartum Hemorrhage and Episiotomy: The patient’s history of postpartum hemorrhage and episiotomy should be considered in labor management and delivery planning. The healthcare team should be prepared to address potential complications and minimize the risk of excessive bleeding.

Ongoing Monitoring: The patient should continue to be closely monitored throughout labor and delivery, with appropriate interventions and support provided as needed.

Question 2

Maternal age and its effect on pregnancies outcomes

Answer 2

Adolescent Pregnancy (12-19 years of age):

Adolescents are still growing and developing themselves, and their bodies may not be fully prepared for pregnancy and childbirth.
Risks associated with adolescent pregnancy include a higher likelihood of preterm birth, low birth weight, and an increased risk of high blood pressure and anemia during pregnancy.
Adolescents may also face challenges in accessing prenatal care and may have limited social and financial support.

20 - 35 years of
age:
This age group is generally considered to be in the “optimal” childbearing age range, as women in their 20s and early 30s are more likely to have healthy pregnancies and fewer complications.
Pregnancy outcomes are often favorable in this age range, with a lower risk of preterm birth and birth defects compared to both younger and older mothers.
However, individual health and lifestyle factors can still influence pregnancy outcomes.
Advanced Maternal Age (>35 years of age):

Advanced maternal age pregnancies are those occurring in women over 35.
Risks associated with advanced maternal age include a higher likelihood of gestational diabetes, preeclampsia, and chromosomal abnormalities (e.g., Down syndrome).
There is also a slightly increased risk of infertility and the need for fertility treatments in this age group.
Advanced maternal age may be associated with a higher rate of cesarean section deliveries.

Question 3

Passageway cock 6 lol

Answer 3

Pelvis Structure:

The maternal pelvis is a bony structure that forms the framework for the birth canal. It consists of the hip bones (ilium, ischium, and pubis), sacrum, and coccyx.
The shape and size of the pelvis can vary among individuals, and these variations can impact the ease or difficulty of labor and childbirth.
The pelvis is divided into different types based on its shape, with the gynecoid type being the most favorable for childbirth.
Birth Canal (Soft Tissues):

The birth canal consists of both bony and soft tissue structures that the baby must pass through during delivery.
The soft tissue components of the birth canal include the cervix (which dilates and effaces during labor), the vagina (which expands to accommodate the baby’s head), and the perineum (the area between the vagina and the anus).
Laboring Position:

The position in which a person labors and gives birth can influence the progress of labor and the ease of passage through the birth canal.
Upright positions, such as standing, squatting, or being on hands and knees, can be advantageous as they can utilize gravity to aid the baby’s descent through the birth canal.
Different laboring positions can also alleviate discomfort and pressure during contractions.

Question 4

Pelvic examination check 7-8-9

Question 5

Soft Tissues

Answer 5

Cervix:

The cervix is a cylindrical structure that connects the uterus to the vagina.
It serves as a passage for menstrual blood to exit the uterus and for sperm to enter during sexual intercourse.
During pregnancy, the cervix remains closed and acts as a protective barrier until it softens, thins, and dilates to allow for the passage of the baby during childbirth.
Pelvic Floor Muscles:

The pelvic floor muscles are a group of muscles located at the base of the pelvis.
They provide support to various pelvic organs, including the bladder, uterus (in women), and rectum.
These muscles are important for maintaining urinary and fecal continence and play a role in sexual function.
Weak pelvic floor muscles can lead to conditions such as urinary incontinence or pelvic organ prolapse (انزلاق).

Vagina:
The vagina is a muscular tube-like structure that connects the external genitalia to the uterus.
It serves several functions, including the passage for menstrual blood and as the birth canal during childbirth.
The vaginal walls contain mucous membranes and are lined with numerous blood vessels and nerve endings.
The vagina also plays a role in sexual intercourse, as it provides lubrication and is involved in sexual pleasure.

Question 6

GTPAL

Answer 6

G = total number of times pregnant (Gravida)
T = number of term infants born
P = number of preterm infants born
A = number of abortions
L = number of children currently living

G (Gravida): This represents the total number of times a woman has been pregnant, regardless of the outcome (whether the pregnancies resulted in a live birth, stillbirth, or abortion). It counts all pregnancies.

T (Term births): This represents the number of pregnancies that resulted in full-term births. A full-term pregnancy typically lasts about 40 weeks.

P (Preterm births): This represents the number of pregnancies that resulted in preterm births, meaning the baby was born before reaching full term (usually before 37 weeks of gestation).

A (Abortions or miscarriages): This represents the number of pregnancies that ended in abortion or miscarriage before the fetus reached viability (usually before 20 weeks of gestation).

L (Living children): This represents the number of children a woman has who are currently alive.

Question 7

Naegele’s rule is the standard formula for determining an EDD based on the LMP: First day of LMP – 3 months + 7 days.

Answer 7

Start with the First Day of the Last Menstrual Period (LMP): Begin by noting the date of the first day of the woman’s LMP.

Subtract 3 Months: Subtract three months from the LMP date. This accounts for the typical duration of three menstrual cycles.

Add 7 Days: After subtracting three months, add seven days to the result. This compensates for the extra week that is often added when calculating pregnancy weeks.

Question 8

How does gestational age affect pregnancy outcomes

Answer 8

Full-Term Pregnancy (39-40 Weeks):

A full-term pregnancy is generally considered to be between 39 and 40 weeks of gestation.
Babies born at full term are more likely to have fully developed organs, including the lungs, which are crucial for breathing.
They are typically of a healthier weight and have a lower risk of complications such as respiratory distress syndrome and jaundice.
Full-term babies tend to have a better ability to regulate their body temperature and feed effectively.
Preterm Birth (Before 37 Weeks):

Preterm birth refers to babies born before 37 weeks of gestation.
Preterm infants may face a higher risk of health issues, including respiratory problems, feeding difficulties, and infections, due to the immaturity of their organs.
They may require specialized care in a neonatal intensive care unit (NICU) to support their development and health.
Late Preterm Birth (34-36 Weeks):

Babies born late preterm (between 34 and 36 weeks) are at a higher risk of certain complications compared to full-term babies.
While they are more developed than extremely preterm infants, they may still face challenges with breathing, temperature regulation, and feeding.
Extremely Preterm Birth (Before 28 Weeks):

Extremely preterm infants, born before 28 weeks, are at the highest risk for complications.
They may experience severe respiratory distress syndrome, brain and neurological problems, and long-term developmental issues.
Care in a highly specialized NICU is essential for their survival and well-being.
Post-Term Pregnancy (After 42 Weeks):

Babies born after 42 weeks of gestation are considered post-term.
Post-term infants may have an increased risk of complications, including meconium aspiration, a condition where the baby inhales their first stool, and macrosomia (being too large), which can lead to difficulties during childbirth.

Question 9

Pregnancy wheel

Answer 9

Estimating Due Date (EDD): The primary purpose of a pregnancy wheel is to estimate the due date of the pregnancy. The healthcare provider aligns the wheel with the known LMP date or the approximate gestational age determined through ultrasound. Once aligned, the wheel provides the estimated due date.

Trimesters and Weeks: Pregnancy wheels are often divided into trimesters, with the corresponding weeks of gestation labeled on the wheel. This allows healthcare providers to quickly determine which trimester a pregnant person is in and how far along they are in weeks.

Fetal Development: Some pregnancy wheels provide information about fetal development at different stages of pregnancy. They may include illustrations or descriptions of the baby’s growth and development for educational purposes.

Prenatal Care Schedule: Pregnancy wheels can indicate important prenatal care milestones and appointments. They may note when certain prenatal tests or screenings should be conducted.

Fetal Heart Rate: Some pregnancy wheels also include a reference for the expected fetal heart rate at various stages of pregnancy.

Conception Date: By using the LMP or the EDD, the wheel can help approximate the likely conception date, which may be of interest to the pregnant individual or healthcare provider.

Quick Reference: Pregnancy wheels are handy tools for healthcare providers to quickly calculate and communicate important information to their patients during prenatal visits.

Question 10

How is labor defined?

Answer 10

Contractions:

Contractions are rhythmic, tightening and relaxing movements of the uterine muscles. These contractions are essential for the progression of labor.
During the early stages of labor, contractions may be irregular and not very intense. However, as labor progresses, contractions become more regular and increase in intensity.
Dilation:

Dilation refers to the opening of the cervix. It is measured in centimeters (cm) and expressed as the cervical dilation, such as “3 cm dilated.”
The cervix needs to dilate to 10 cm to allow for the passage of the baby’s head through the birth canal.
Cervical dilation is one of the primary ways healthcare providers monitor the progress of labor.
Effacement:

Effacement, also known as cervical effacement or thinning, refers to the shortening and thinning of the cervix.
Effacement is expressed as a percentage. For example, “50% effaced” means that the cervix is halfway thinned out.
As labor progresses, the cervix continues to efface, allowing the baby to descend further into the birth canal.

Question 11

SIGNS PRECEDING LABOR (Signs of beginning of labor)

Answer 11

Lightening: Also known as “dropping” or “engagement,” this occurs when the baby’s head descends into the pelvis. This can relieve pressure on the diaphragm, making it easier to breathe, but it may also increase pressure on the bladder, causing more frequent urination.

Bloody Show: This refers to the discharge of a small amount of blood-tinged mucus from the cervix. It can be a sign that the cervix is starting to dilate and efface (thin out) in preparation for labor.

Ruptured Membranes (PROM): When the amniotic sac surrounding the baby ruptures, it is often referred to as “water breaking.” This can lead to a gush of fluid or a slow leak. If this happens, it’s important to contact your healthcare provider as it can be a sign that labor is imminent.

Braxton-Hicks Contractions: These are practice contractions that can occur throughout pregnancy. However, as labor approaches, Braxton-Hicks contractions may become more frequent and intense. True labor contractions are typically regular, become stronger over time, and are associated with other signs of labor.

Burst of Energy: Some women experience a burst of energy shortly before labor begins. This burst of energy is often referred to as the “nesting instinct” and can lead to a sudden urge to clean, organize, or prepare for the baby’s arrival.

False Labor (Braxton-Hicks Contractions): False labor contractions can mimic the sensations of true labor but do not lead to cervical dilation or effacement. These contractions tend to be irregular and don’t progress in intensity or frequency.

Increased Vaginal Discharge: As labor approaches, some women may notice an increase in vaginal discharge. This discharge may be clear or slightly tinged with blood.

Question 12

TRUE VS. FALSE LABOR (True)

Answer 12

It seems you are describing some characteristics of true labor in contrast to false labor. True labor refers to the actual process of childbirth, while false labor, often referred to as Braxton Hicks contractions, are practice contractions that do not result in cervical changes or labor progression. Here are the characteristics of true labor:

True Labor:

Uterine Contractions (UC’s): Contractions in true labor are regular, meaning they occur at consistent intervals. They also become progressively stronger, longer in duration, closer together, and more intense if the laboring person walks or changes positions.

Cervix Changes: In true labor, the cervix undergoes changes. It effaces (thins out) and dilates (opens) to allow the baby to pass through the birth canal. The cervix is typically in an anterior (forward-facing) position during true labor.

Engagement of the Fetus: The baby’s head or presenting part usually becomes engaged in the mother’s pelvis during true labor. This means the baby descends into the pelvis in preparation for birth.

Sensation Location: Contractions in true labor are typically felt in the lower back and may radiate to the front of the abdomen. This is often described as a tightening or cramping sensation.

Question 13

TRUE VS. FALSE LABOR (False)

Answer 13

False Labor (Braxton-Hicks Contractions):

Contractions (UC’s):

Contractions may be irregular in their timing.
They can be temporarily relieved or stopped by changes in position or activity.
Contractions are typically less intense and do not become progressively stronger.
Cervix:

There is typically no significant change in cervical effacement (thinning) and dilation (opening) during false labor.

Fetus:

The baby is usually not engaged (descended into the pelvis) during false labor. The baby may still be in a higher position in the uterus.
Sensation Location:

Contractions may be felt in the back or the abdomen above the navel (umbilicus) rather than originating from the lower uterus or pelvis.

True Labor:

Contractions (UC’s):

Contractions are regular in their timing, becoming progressively stronger and occurring at regular intervals.
Contractions are usually not relieved by changes in position or activity.

Cervix:

During true labor, there is a progressive change in cervical effacement and dilation as the cervix prepares for birth.

Fetus:

In true labor, the baby’s head typically engages and descends into the pelvis as labor progresses.
Sensation Location:

Contractions in true labor are typically felt in the lower abdomen and pelvis and radiate to the lower back.

Question 14

Dilatation and Effacement

Question 15

Slide videos : 23 - 25

Question 16

Electronic fetal monitoring

Learn at the end

Answer 16

Slide 26 Electronic fetal monitoring must check then learn how to read graphs 26-

Question 17

Powers:

Answer 17

Primary Powers: These are the primary uterine contractions that drive the progression of labor. They are involuntary contractions of the uterine muscles that serve to:

Dilate (open) the cervix by applying pressure on it.
Efface (thin) the cervix by pulling its edges upward.
Push the baby down through the birth canal.
Signal the beginning of labor when they become regular, frequent, and progressively stronger.
These contractions are coordinated by hormonal signals and are the main forces responsible for moving the baby through the birth canal.

Secondary Powers: Secondary powers are additional forces that can aid in the process of childbirth. They are usually under the control of the pregnant person and include:

Abdominal Muscles: Voluntary contractions of the abdominal muscles can help push the baby further down the birth canal during the second stage of labor (the pushing stage). These voluntary bearing-down efforts work in conjunction with the involuntary contractions of the uterus.
Voluntary Bearing Down: The pregnant individual can actively participate by pushing or bearing down during the second stage of labor when they feel the urge to do so. This is often guided by the healthcare provider and can aid in the descent and birth of the baby.

Question 18

Presentation is the part of the body that enters the pelvic inlet first

Answer 18

You’ve provided an accurate description of different fetal presentations during childbirth:

Cephalic (Vertex) Presentation: This is the most common and favorable presentation where the baby’s head is the first to enter the maternal pelvis. It is typically the ideal presentation for a vaginal delivery because the baby’s head is well-suited to pass through the birth canal.

Breech Presentation: In a breech presentation, the baby’s buttocks or feet enter the pelvis first, instead of the head. Breech presentations are less common than cephalic presentations and may require additional considerations and sometimes a cesarean section for a safe delivery.

Shoulder Presentation: In a shoulder presentation, one of the baby’s shoulders enters the pelvis first. This is a rare presentation and can be associated with complications, as the shoulders are wider than the head and may become stuck during delivery.

The “presenting part” refers to the specific part of the fetal body that is felt first during a medical examination. It helps healthcare providers determine the baby’s presentation and plan for the safest mode of delivery. The presenting part can be the head, buttocks, or shoulder, depending on the baby’s position within the uterus.

Question 19

FETAL LIE IS THE RELATION OF THE SPINE OF THE FETUS TO THE SPINE OF THE MOTHER.
- LONGITUDINAL/VERTICAL
- TRANSVERSE
- OBLIQUE

Answer 19

Longitudinal (Vertical) Lie: In a longitudinal lie, the fetal spine is parallel or aligned with the maternal spine. This means that the baby is positioned vertically within the uterus, with the head or buttocks being the presenting part. Longitudinal lie is the most common and favorable lie for vaginal delivery.

Transverse Lie: In a transverse lie, the fetal spine is perpendicular to the maternal spine. The baby is positioned horizontally across the mother’s abdomen. This is an unfavorable lie for vaginal delivery, and a cesarean section is typically required in such cases.

Oblique Lie: In an oblique lie, the fetal spine is positioned at an angle between longitudinal and transverse. The baby is neither fully vertical nor horizontal but positioned diagonally within the uterus. Oblique lies are less common and may necessitate interventions to facilitate a safe delivery, depending on the specific positioning.

Question 20

ATTITUDE IS THE RELATIONSHIP OF FETAL PARTS
TO ITSELF.
GENERAL FLEXION
EXTENSION

Answer 20

Attitude, in the context of obstetrics and fetal positioning, refers to the relationship of the fetal body parts to one another. Specifically, it describes the flexion or extension of various fetal body parts in relation to each other. The two primary attitudes used to describe fetal positioning are:

General Flexion: In general flexion, the fetal body is flexed or curved inward. This is the normal and most common fetal attitude for childbirth. In this position, the baby’s head is flexed, with the chin tucked into the chest, the arms and legs flexed, and the back rounded. This flexed posture allows the smallest diameter of the baby’s head to present during birth, making it easier to navigate through the birth canal.

Extension: In extension, the fetal body is extended or straightened. This is not the typical attitude for childbirth and can present challenges during labor and delivery. In this position, the baby’s head may be extended backward, away from the chest, which can make the head and body present in a less favorable manner for passage through the birth canal.

Question 21

POSITION IS THE RELATIONSHIP OF THE PRESENTING PART TO THE FOUR QUADRANTS OF THE MOTHER’S PELVIS.

Answer 21

Side of the Pelvis (R or L):

R stands for Right side of the mother’s pelvis.
L stands for Left side of the mother’s pelvis.
Presenting Part (0, M, Sa, A):

0 (Zero) is used when the presenting part is not engaged in the pelvis or when the presenting part is high and not specifically identified.
M stands for Mentum (chin), which refers to the fetal head in a vertex (head-down) presentation.
Sa stands for Sacrum, which indicates that the fetal sacrum is presenting (common in breech presentations).
A stands for Acromion, which refers to the fetal shoulder.
Relation to Anterior or Posterior (A or P or T):

A stands for Anterior, indicating that the presenting part is facing towards the front of the mother’s pelvis.
P stands for Posterior, indicating that the presenting part is facing towards the back of the mother’s pelvis.
T stands for Transverse, suggesting that the presenting part is in a horizontal position, neither fully anterior nor fully posterior.

Question 22

MECHANISMS OF LABOR: 7 CARDINAL MOVEMENTS THAT OCCUR IN A VERTEX (best) PRESENTATION
watch maybe video 47

Answer 22

Engagement: In this initial movement, the baby’s head enters the pelvic inlet (the upper opening of the maternal pelvis). The widest part of the baby’s head (the biparietal diameter) aligns with the widest part of the maternal pelvis to engage in the optimal position for birth.

Descent: The baby’s head continues to move downward through the birth canal, progressing further into the pelvis. Descent is facilitated by uterine contractions and the pressure applied by the contracting uterus.

Flexion: As the baby descends, the head naturally flexes forward, bringing the chin closer to the chest. This allows the smallest part of the head (the suboccipitobregmatic diameter) to pass through the pelvis more easily.

Internal Rotation: As the baby’s head reaches the lower part of the pelvis (the mid-pelvis), it rotates to align with the curve of the birth canal. This movement helps the head navigate the narrow passages of the maternal pelvis.

Crowning: Crowning occurs when the widest part of the baby’s head (the head’s largest diameter, or the occipitofrontal diameter) passes through the vaginal opening. It’s a visible sign that the baby is about to be born, and the head is often seen at the vaginal opening.

Extension: After crowning, the baby’s head extends to allow the baby’s face to pass under the mother’s pubic bone. This movement helps the head exit the birth canal.

External Rotation: Once the baby’s head has passed through the vaginal opening, it typically rotates back to its original position to facilitate the delivery of the baby’s shoulders and body. This external rotation allows the baby to emerge fully from the birth canal.

Question 23

Leopold’s maneuvers

Answer 23

Leopold’s maneuvers are a series of four systematic and standardized abdominal palpation techniques used by healthcare providers, particularly obstetricians and midwives, to assess the position, presentation, and engagement of the fetus in the uterus during pregnancy. These maneuvers are typically performed during the second and third trimesters of pregnancy to gather important information about the baby’s placement in the womb. Leopold’s maneuvers can help determine the baby’s position and presentation, which is valuable for prenatal care and childbirth preparation. Here are the four maneuvers:

First Maneuver: This involves palpation of the upper abdomen to determine the location of the baby’s head. The healthcare provider gently places their hands on the pregnant person’s abdomen and tries to identify the firm, rounded head, which is typically found in the fundal area.

Second Maneuver: In the second maneuver, the healthcare provider assesses the sides of the abdomen to determine the baby’s back. They use their hands to feel for a smooth, firm surface, which indicates the baby’s back. This maneuver helps determine whether the baby is positioned with their back facing the mother’s front (anterior position) or her back (posterior position).

Third Maneuver: The third maneuver involves palpation of the lower abdomen to locate the baby’s buttocks or feet. The healthcare provider uses their hands to feel for a softer, irregular shape in the lower part of the abdomen. Identifying the location of the baby’s buttocks or feet helps determine whether the baby is in a head-first (vertex) or breech presentation.

Fourth Maneuver: In the fourth maneuver, the healthcare provider assesses the descent of the baby’s head into the pelvis (engagement). They place their hands on the sides of the mother’s lower abdomen and gently push upward toward the pelvic inlet to check if the baby’s head is engaged in the pelvis or still free-floating.

Leopold’s maneuvers are a valuable clinical tool for healthcare providers to gain insights into the fetal position and presentation,

Question 24

Video slide 49

Question 25

FOUR STAGES OF LABOR

Answer 25

The four stages of labor are typically described as follows: Stage 1: This stage begins with the onset of regular contractions and lasts until the full dilation of the cervix. It is further divided into three phases: early labor, active labor, and transition. Stage 2: Stage 2 begins when the cervix is fully dilated and ends with the birth of the baby. This is the stage during which the mother actively pushes to deliver the baby. Stage 3: Stage 3 begins after the baby is born and continues until the birth of the placenta. During this stage, the placenta detaches from the uterine wall and is expelled from the uterus. Stage 4: Stage 4 encompasses the period from the birth of the placenta to the re-establishment of homeostasis, or the stabilization of the mother's vital signs and uterine contractions. It's the immediate postpartum period during which healthcare providers monitor the mother for any signs of complications and ensure that she is stable after giving birth.

Question 26

PHYSIOLOGIC ADAPTATION TO LABOR

Answer 26

Fetal Heart Rate Range: The normal fetal heart rate typically falls within the range of 110 to 160 beats per minute (bpm) during labor. FHR can vary within this range due to factors like fetal activity and sleep cycles. Oxygenation and Blood Flow: The fetal heart rate provides valuable information about the oxygenation of the fetus and the adequacy of uteroplacental blood flow. A consistent and appropriate FHR pattern indicates that the baby is receiving sufficient oxygen and nutrients through the placenta, which is vital for growth and development. Responsiveness to Changes: The fetal heart rate responds to various factors, including changes in the levels of carbon dioxide (PCO2), oxygen (PO2), and other physiological factors. If there is a decrease in oxygen supply to the fetus (hypoxia), the FHR may change in response, typically showing signs of distress, such as decelerations.

Question 27

PHYSIOLOGIC ADAPTATION TO LABOR -Maternal

Answer 27

Heart Rate Increases: During labor, the heart rate typically increases. This is a response to the physical exertion and stress of labor, as the body works to support both the mother and the baby's increased oxygen needs. White Blood Cell (WBC) Count Increases: An elevation in the WBC count is a normal response to the stress and physical demands of labor. It is part of the body's natural defense mechanisms. Respiratory Rate Increases: The respiratory rate may increase during labor, potentially in response to the increased oxygen demand and metabolic activity associated with contractions. Renal Changes: Some individuals may experience paresthesia (tingling or numbness) and difficulty voiding (urinating) during labor, often due to pressure on nerves and the bladder caused by the baby's descent through the birth canal. Neurological Changes: The release of endorphins during labor can contribute to a sense of well-being and reduced perception of pain. This natural pain relief mechanism helps the mother cope with the intensity of contractions. Gastrointestinal (GI) Hypomotility: Hypomotility, or reduced movement of the gastrointestinal tract, can occur during labor. This is thought to be a protective mechanism to prevent bowel movements during delivery. Endocrine Hormone Changes: Labor is associated with significant hormonal changes, including increased levels of oxytocin (which stimulates uterine contractions) and other hormones involved in labor progression. Cardiac Output Increases: During the second stage of labor (the pushing stage), cardiac output increases significantly (typically by 30-50%). This increase in cardiac output is necessary to supply more blood and oxygen to the muscles involved in pushing, as well as to the baby. Blood Pressure Increases: Blood pressure may increase during labor due to the physical exertion and stress of the process. It's important for healthcare providers to monitor blood pressure to ensure it remains within a safe range.

Question 28

PHYSIOLOGIC ADAPTATION TO LABOR continues

Answer 28

White Blood Cell (WBC) Count: An increase in the WBC count, up to 25,000, is considered normal during labor. This elevation is part of the body's natural response to the stress of labor and is often related to the inflammatory processes that occur during childbirth. Renal Changes: Some pregnant individuals may experience difficulty voiding (urinating) during labor, and this can be attributed to pressure on the bladder from the descending baby. Additionally, there may be a loss of sensation in the pelvic area due to the stretching and pressure on nerves. Neurological Changes: Neurological adaptations during labor can include euphoria (a feeling of intense happiness or elation) and amnesia (forgetfulness). These changes are thought to be related to the release of endorphins and other neurochemicals in response to pain and stress. They can help raise the pain threshold, making labor more manageable for some individuals. Gastrointestinal (GI) Symptoms: Nausea, vomiting, and belching can occur during labor, primarily due to the hormonal changes and the physical stress of contractions. These symptoms are part of the body's response to the stress of labor. Endocrine Changes: Labor is associated with significant hormonal changes. These include decreased levels of progesterone, increased levels of estrogen, the release of prostaglandins (which help initiate and regulate contractions), and increased production of oxytocin (which stimulates uterine contractions). These hormonal shifts play crucial roles in the progression of labor. Increased Metabolism: The energy demands of labor increase metabolism. The body requires additional energy to sustain contractions and support the birthing process. Decreased Blood Glucose: Labor can lead to a decrease in blood glucose levels. It's important for pregnant individuals to maintain adequate nutrition and hydration during labor to help support their energy needs. Supine Hypotension: This refers to a drop in blood pressure that can occur when a pregnant person lies flat on their back (in a supine position) during labor. It's due to pressure on the vena cava, a major vein that returns blood to the heart. To mitigate supine hypotension, many healthcare providers recommend laboring and giving birth in positions other than the supine position.

Question 29

POSITION OF LABORING WOMAN

Answer 29

The position of a laboring woman during childbirth can have a significant impact on her comfort, the progress of labor, and the overall birthing experience. Healthcare providers often encourage laboring individuals to change positions frequently to optimize the process. Here are some key points regarding the position of a laboring woman: Changing Positions Frequently: Frequent changes in position during labor can help relieve tension and fatigue. It allows the laboring woman to find a comfortable and supportive posture as labor progresses. Relieving Tension and Fatigue: Labor can be physically demanding, and changing positions can help reduce muscle tension and prevent fatigue, which can be especially important during long labors. Increasing Comfort: Different positions can provide relief from discomfort and pain associated with contractions. Women often find certain positions more comfortable than others, and these preferences can change throughout labor. Improving Circulation: Changing positions can help improve blood circulation, reducing the risk of complications like supine hypotension (a drop in blood pressure when lying flat on the back) and helping maintain oxygenation to the baby. Upright Position: An upright position, such as standing, walking, squatting, or being on hands and knees, is often encouraged during labor. This position takes advantage of gravity, which can assist with the descent of the baby through the birth canal. It can also lead to stronger contractions and improved maternal cardiac output because the heart doesn't have to work as hard against gravity to pump blood to vital organs. Squatting: Squatting is a position that many women find helpful during the pushing stage of labor. It can help open the pelvis and facilitate the baby's descent. Use of Props: Laboring individuals can use props like birthing balls, squat bars, and supportive pillows to aid in maintaining different positions and finding comfort. Adaptive Positioning: The best position during labor may vary from person to person and may change as labor progresses. Healthcare providers will work with the laboring woman to adapt positions to her specific needs and comfort. Continuous Monitoring: Depending on the individual's medical condition and the baby's well-being, continuous monitoring of the baby's heart rate and contractions may influence position choices.

Question 30

Look at slide 55

Question 31

Prenatal Labs?

Answer 31

Prenatal labs refer to a set of blood tests and laboratory assessments conducted during pregnancy to monitor the health and well-being of both the pregnant individual and the developing fetus. These tests help healthcare providers detect and manage potential issues, ensure a healthy pregnancy, and prepare for any necessary interventions or treatments. The specific prenatal labs that may be recommended can vary depending on various factors, including the individual's medical history, risk factors, and the stage of pregnancy. Common prenatal labs include: Blood Type and Rh Factor: Determining the pregnant person's blood type and Rh factor is essential for identifying any potential blood compatibility issues between the mother and baby. Complete Blood Count (CBC): A CBC measures different components of the blood, including red blood cells, white blood cells, and platelets. It can help identify conditions like anemia or thrombocytopenia (low platelet count). Blood Glucose Testing: Glucose testing is used to screen for gestational diabetes, a temporary form of diabetes that can develop during pregnancy. Screening for Infectious Diseases: Tests for sexually transmitted infections (STIs) like syphilis and HIV, as well as hepatitis B and C, are conducted to identify and manage potential risks to the baby. Rubella Immunity: Checking for immunity to rubella (German measles) is crucial, as rubella can cause birth defects if contracted during pregnancy. Urinalysis: Urinalysis helps monitor kidney function and can detect conditions like gestational hypertension and preeclampsia. Group B Streptococcus (GBS) Screening: This test is done later in pregnancy to check for the presence of GBS bacteria, which can be harmful to the newborn if transmitted during childbirth. Ultrasound: While not a blood test, ultrasound is an essential part of prenatal care. It helps assess fetal growth, development, and overall health, as well as identify any potential complications.

Question 32

PHYSIOLOGIC ADAPTATION TO LABOR. FETAL: Respiration

Answer 32

The physiologic adaptation to labor includes a series of complex changes that occur in both the maternal and fetal bodies to facilitate the process of childbirth. One of these adaptations involves the fetal respiratory system preparing for the transition from an environment where oxygen is supplied through the placenta to an environment where the baby will need to breathe air independently. Here's a breakdown of the fetal respiratory adaptation during labor: Respiratory Message Transmission: As labor progresses and the baby moves through the birth canal, various physiological signals are sent to the fetal body to prepare it for breathing air. These signals originate in response to the stress and pressure placed on the baby during labor. Stimulation of Diaphragm: The respiratory center in the fetal medulla (part of the brainstem) is stimulated to prepare for respiration. This stimulation triggers the diaphragm, a muscle essential for breathing, to contract. Changes in Blood Gases and pH: Changes in the levels of oxygen (PO2), carbon dioxide (PCO2), and pH within the fetal blood, as well as other factors, can affect the chemoreceptors in the fetal respiratory center. These chemoreceptors are sensitive to fluctuations in these blood gases and pH levels. First Breath: As the baby is born and emerges from the birth canal, they are exposed to the outside air. The sensation of air on their face and the change in environmental factors trigger the infant's first breath. Internal Stimuli: The internal stimuli mentioned here refer to the various physiological processes within the fetal body that collectively prepare the baby's respiratory system for the transition to breathing air. These internal processes help ensure that the baby's first breath is successful.

Question 33

Evidence based practice

Answer 33

EBP Definition: EBP is defined as the integration of the best current evidence with clinical expertise and patient/family preferences and values for the delivery of optimal healthcare. This definition emphasizes the importance of combining scientific evidence, healthcare professionals' expertise, and the patient's values and preferences to provide the highest quality of care. Nurses' Unique Position: Nurses play a unique and crucial role in EBP as they have direct contact with patients and are often involved in care coordination. They are well-positioned to explore a woman's preferences and advocate for the use of the best available evidence and clinical expertise to deliver optimal healthcare. Suggestions to Foster EBP: To promote EBP in clinical settings, the following suggestions are provided: a. Describe and Locate Reliable Sources: Nurses should be able to describe and identify reliable sources of evidence reports and clinical practice guidelines. This includes staying informed about reputable resources and research findings that inform evidence-based care. b. Question Rationale for Routine Approaches: Nurses should critically question the rationale for routine approaches to care that may not yield desired outcomes or may lead to adverse events. This involves a willingness to challenge established practices and seek improvements. c. Base Care Plans on Patient Values: Individualized care plans should be based on a combination of patient values and preferences, clinical expertise, and evidence. This person-centered approach ensures that care aligns with the patient's needs and desires. The emphasis on EBP in nursing is crucial for delivering safe, effective, and patient-centered care. It involves an ongoing commitment to staying informed about the latest research and guidelines, critically assessing and adapting practices, and involving patients in decision-making to ensure that care is evidence-based and aligns with their unique needs and preferences.

Question 34

Must slide 64

Question 35

PSYCHOLOGICAL RESPONSE Not physio - brain

Answer 35

Background: An individual's personal history, prior experiences with pregnancy or childbirth, and overall mental health can significantly influence their psychological response to pregnancy. For example, a history of trauma, previous pregnancy complications, or mental health conditions may affect how a person emotionally processes pregnancy. Coping Mechanisms: Coping mechanisms are strategies individuals use to manage stress and emotions during pregnancy. These can vary widely and may include seeking support, practicing relaxation techniques, exercise, journaling, or mindfulness. Effective coping mechanisms can promote emotional well-being during pregnancy, while unhealthy coping strategies can lead to stress and anxiety. Support System: A strong support system, including partners, family, friends, and healthcare providers, plays a crucial role in a person's psychological response to pregnancy. Having emotional and practical support can reduce stress and foster a positive pregnancy experience. Preparation for Labor: Preparing for labor through childbirth education classes, reading, and discussions with healthcare providers can help individuals feel more confident and in control, reducing anxiety and fear related to childbirth. Knowing what to expect can positively impact psychological well-being. Socio-Cultural Influences: Socio-cultural factors, such as cultural beliefs and societal norms, can shape how a person perceives pregnancy and childbirth. Cultural expectations around childbirth practices and the role of women during pregnancy may influence a person's psychological response. Positive and Negative Influences: Positive influences may include feeling excited, supported, and empowered during pregnancy, leading to a positive psychological response. Negative influences could encompass factors such as pregnancy complications, financial stress, or unsupportive environments, which can contribute to anxiety, depression, or feelings of uncertainty.

Question 36

5 other P’s

Answer 36

Philosophy: A woman's personal philosophy or beliefs about childbirth can influence her birth plan and choices during labor. Some may have a preference for natural childbirth, while others may opt for medical interventions. Understanding a woman's childbirth philosophy helps healthcare providers tailor care to her preferences. Partners: The presence and involvement of a laboring woman's partner, spouse, or support person can significantly impact the birth experience. Partners can provide emotional support, comfort, and encouragement during labor, making them an essential part of the birthing process. Patience: Labor can be a lengthy process, and patience is often required. Both the laboring woman and the healthcare team should be patient as they monitor progress, make decisions, and support the natural progression of labor. Patience is essential in allowing the labor to unfold as naturally as possible. Privacy: Providing a sense of privacy during labor can enhance the woman's comfort and feelings of safety. Many laboring individuals prefer a private and quiet environment, and healthcare providers should respect their need for privacy when possible. Preparation: Adequate preparation for labor and childbirth is crucial. This includes childbirth education, creating a birth plan, and discussing pain management options. Being well-prepared helps the laboring woman and her partner make informed decisions and feel more confident during the birthing process.

Question 37

so we don't know how the baby is going to position themselves until the last minute ? meaning during labor ? In many cases, the exact position of the baby within the uterus, including their presentation (cephalic, breech, etc.), may not be definitively known until labor begins or even until labor progresses further.

Question 38

In obstetrics, the "5 P's" are often used to describe various factors that can influence the progress of childbirth. These factors are crucial for healthcare providers to consider when assessing the course of labor and delivery. The 5 P's are: Passenger: The passenger refers to the baby itself. This includes factors such as the baby's size, position in the womb, and any anomalies or conditions that might affect the baby's passage through the birth canal. For example, a baby in a breech (feet-first) position may present different challenges during delivery than a baby in a head-first position. Passageway: The passageway refers to the birth canal, which consists of the mother's pelvis and the soft tissues surrounding it. The size and shape of the pelvis, as well as any obstructions or abnormalities, can impact the ease or difficulty of the baby's descent through the birth canal. Powers: Powers refer to the contractions of the uterus and the woman's pushing efforts during labor. The strength, frequency, and duration of contractions play a vital role in moving the baby through the birth canal. Inadequate contractions or pushing efforts can slow down labor progress. Position: The position refers to the mother's posture during labor and delivery. The mother's position can affect the effectiveness of contractions, the baby's descent, and the comfort of the mother during labor. Different positions, such as lying down, squatting, or kneeling, can be utilized during labor to optimize the birthing process. Psychological Response: The psychological response refers to the mother's emotional and psychological state during labor. Fear, anxiety, and stress can influence the progression of labor and the perception of pain. A supportive and positive emotional environment can contribute to a smoother labor experience. These 5 P's provide a framework for healthcare providers to assess and manage the various factors that can impact the process of childbirth. By considering each of these elements, obstetricians and midwives can make informed decisions about the best course of action during labor and delivery to ensure the safety and well-being of both the mother and the baby.

Answer 38

Passenger, Passageway, Powers, Position, Psychological Response

Question 39

Passenger, Passageway, Powers, Position, Psychological Response

Answer 39

5 P original

Question 40

A 28-year-old primigravida client presents to the unit in early labor. The record reveals the client is 5 ft (1.5 m) tall, 95 lb (43 kg), and has gained 25 lb (11.3 kg) over a normal, uneventful pregnancy. The nurse predicts this client will have which type of pelvis upon assessment? a) platypelloid b) android c) cannot be determined d) gynecoid ChatGPT Based on the information provided, the nurse can predict that the client will have a gynecoid pelvis upon assessment. Here's why: Height and Weight: The client's height and weight are within a normal range, indicating that she has a generally typical body structure for a woman of her age. Weight Gain During Pregnancy: The client has gained a reasonable amount of weight during her pregnancy (25 lb or 11.3 kg). This suggests that her body is adapting to the demands of pregnancy in a healthy manner. Primigravida: Being a primigravida (first-time pregnant) suggests that she has not experienced any previous pregnancies or deliveries that might have affected her pelvic shape. A gynecoid pelvis is considered the most favorable type of pelvis for childbirth, as it is typically well-suited to accommodate the passage of the baby's head during labor and delivery. It is often described as having a round or oval shape, which facilitates the ease of childbirth. The other pelvis types mentioned: Platypelloid: This type of pelvis is typically flatter and wider, which can make childbirth more challenging. Android: An android pelvis is more heart-shaped and not as favorable for childbirth. Cannot be determined: The information provided allows for a prediction of the pelvis type based on the client's characteristics. In this case, the client's height, weight gain, and status as a primigravida suggest a gynecoid pelvis.

Question 41

fetus is at 0 station ? meaning ChatGPT When the fetus is at "0 station" in the context of labor and childbirth, it means that the baby's head is level with the ischial spines of the mother's pelvis. The station is a measurement used to describe the position of the baby's presenting part (usually the head) in relation to the maternal pelvis during labor. Here's how station measurements work: Negative Stations: When the presenting part of the baby (usually the head) is above the ischial spines, it is measured in negative numbers (e.g., -1, -2, -3). For example, if the baby's head is just above the ischial spines, it might be measured as -1 station. Zero Station: When the presenting part of the baby is level with the ischial spines, it is measured as "0 station." This is often considered the point at which the baby's head is engaged in the mother's pelvis and is at the "center" of the pelvis. Positive Stations: When the presenting part of the baby is below the ischial spines and has descended deeper into the birth canal, it is measured in positive numbers (e.g., +1, +2, +3). The station measurement is a valuable tool for healthcare providers to assess the progress of labor and the descent of the baby through the birth canal. It helps them determine the baby's position and monitor how the baby is advancing during labor. A station of 0 is often considered a significant milestone as it indicates that the baby's head has descended into the pelvis and is well-positioned for delivery.

Question 42

Duration: Duration refers to how long a single contraction lasts. It is typically measured from the beginning (increment) of the contraction to the end (decrement) of that same contraction. Duration is usually expressed in seconds or minutes. Intensity: Intensity refers to the strength or power of a contraction. This can be determined by manual palpation (feeling the uterus during a contraction) or, in some cases, by using an internal intrauterine catheter to measure the pressure within the uterus. Intensity is often assessed subjectively on a scale, with terms like mild, moderate, and strong used to describe the intensity. Frequency: Frequency refers to how often contractions occur. It is measured from the beginning (increment) of one contraction to the beginning (increment) of the next contraction. Frequency is typically expressed in contractions per unit of time, such as contractions per hour. Peak or Acme: The peak or acme of a contraction refers to the highest point of intensity reached during that contraction. This is when the uterine muscles are contracting most forcefully. The peak intensity is usually when the woman may feel the most discomfort or pain during the contraction. These terms are crucial in obstetrics for monitoring labor progression and assessing the well-being of both the mother and the baby. Healthcare providers use these measurements to determine if labor is progressing appropriately and to make decisions about the timing and management of labor and delivery.

Question 43

Your description outlines the cardinal movements of labor and childbirth, which are essential for understanding the process of spontaneous vaginal delivery. These cardinal movements help the baby navigate through the birth canal. Let me provide a more detailed explanation: Engagement: This is when the baby's head (or occasionally the buttocks in breech births) enters the mother's pelvis. Engagement usually occurs a few weeks before the due date for first-time mothers and may happen later for subsequent pregnancies. It's a significant sign that labor is approaching. Flexion: As the baby descends into the birth canal and encounters resistance from the soft tissues and muscles of the pelvic floor, its head naturally flexes forward. This movement allows the smallest part of the baby's head (the suboccipitobregmatic diameter) to align with the smallest diameter of the maternal pelvis, making it easier for the baby to pass through. Descent: The baby continues to move down the birth canal during labor. This downward movement is facilitated by uterine contractions and the mother's pushing efforts. Internal Rotation: Once the baby's head is engaged and descending, it often undergoes internal rotation. This movement helps the baby align with the curve of the birth canal. Extension: As the baby progresses through the birth canal, the head reaches a point where it starts to extend. During this phase, the baby's head is well flexed with its chin tucked against its chest. This position allows the baby's head to pass through the vaginal opening. Restitution and External Rotation: After the baby's head emerges, it typically rotates to align with the shoulders. This rotation, known as restitution and external rotation, helps the baby's shoulders align with the mother's pelvic bones. Expulsion: Finally, the baby's shoulders and body are delivered after the head. Once the anterior and posterior shoulders have passed through the birth canal, the rest of the baby quickly follows, and the baby is born.

Question 44

Monitoring vital signs and other physiological changes during labor is a crucial part of obstetric nursing care. However, it's important to note that the specific parameters and changes mentioned in your statement can vary among individuals, and not all laboring clients will exhibit these exact changes. Monitoring should be individualized based on the client's baseline health, their stage of labor, and any medical conditions they may have. Here's a more detailed breakdown of the mentioned points: Heart Rate (HR): It is common for a laboring client's heart rate to increase by 10 to 20 beats per minute (bpm) compared to their baseline. Monitoring the heart rate helps assess the client's response to labor and any potential complications, such as fetal distress. Systolic Blood Pressure (SBP): Blood pressure can increase during labor, with systolic blood pressure rising by as much as 35 mm Hg. This increase is usually transient and should be carefully monitored to ensure it doesn't become excessively high, which could indicate a problem. Respiratory Rate: The respiratory rate may increase during labor due to the increased physical exertion and discomfort. Monitoring respiratory rate helps ensure that the client is getting adequate oxygenation. Body Temperature: A slight elevation in body temperature can occur during labor due to increased muscle activity and the stress response. However, a significant fever during labor may be indicative of infection, which should be promptly addressed. Gastric Emptying and pH: Gastric emptying may slow down during labor due to decreased gastrointestinal motility. This can lead to an increased risk of vomiting, which, if aspirated, can be dangerous. Monitoring gastric pH can help assess the risk of aspiration.

Question 45

The terms "android," "gynecoid," "platypelloid," and "anthropoid" are used in obstetrics and gynecology to describe different types of pelvic shapes in humans, particularly in females. These pelvic shapes can have an impact on childbirth and may require different approaches during labor and delivery. Here's a brief overview of each: Android Pelvis: The android pelvis is often described as "male-like" because it resembles the shape of the male pelvis. It is characterized by a heart-shaped inlet with a narrower pubic arch and a prominent sacrum. Android pelvises are less favorable for childbirth, especially vaginal delivery, because of their narrow dimensions. Gynecoid Pelvis: The gynecoid pelvis is considered the most common and favorable type for childbirth in females. It has a round or oval-shaped inlet with a wider pubic arch and a less prominent sacrum. The gynecoid pelvis allows for easier passage of the fetal head during labor, making it well-suited for vaginal deliveries. Platypelloid Pelvis: The platypelloid pelvis is characterized by a flat and oval-shaped inlet. It is considered less favorable for childbirth because the baby may have difficulty navigating the flattened shape during the birth process. Women with a platypelloid pelvis may have a higher risk of complications during labor and may require medical intervention or a cesarean section. Anthropoid Pelvis: The anthropoid pelvis has an oval-shaped inlet similar to the gynecoid pelvis but is longer front to back. This type of pelvis is more common in certain populations, such as some African and Indigenous groups. While it is not as ideal for childbirth as the gynecoid pelvis, it is still more favorable than the android or platypelloid pelvises.

Question 46

You are absolutely correct. The station in obstetrics refers to the position of the fetal presenting part (usually the head) in relation to the ischial spines within the maternal pelvis during labor. It is an important measure used to assess the progress of labor and the descent of the baby through the birth canal. Here's a breakdown of the station measurements: Negative Station: When the presenting part (usually the baby's head) is above the level of the ischial spines, it is considered a negative station. For example, if the measurement is -2 cm, this means the baby's head is 2 centimeters above the ischial spines. Zero Station: When the presenting part is at the same level as the ischial spines, it is considered a zero station. This indicates that the baby's head is at the midpoint of the maternal pelvis. Positive Station: When the presenting part is below the level of the ischial spines, it is considered a positive station. For example, if the measurement is +2 cm, this means the baby's head is 2 centimeters below the ischial spines.

Question 47

The client in labor undergoes numerous psychologic adaptations during labor. During the latent phase, the client is often talkative and happy, and yet anxious. During active phase, the client may show fear and anger. Both the latent and active phases occur during stage 1. During stages 2 and, the client may remain positive, but the work of labor is very intense.