Module 3 Exam Flashcards
What are the 5 Ps of labor?
Passageway Passenger Psyche Powers Position
Passageway
pelvic canal: the inlet, the pelvic cavity (midpelvis), the outlet
What are the 4 types of pelvis?
Gynecoid: female, most common, + vaginal delivery
Android: - vaginal delivery, pelvic descent slow, fetal head enters in transverse or posterior position, arrest of labor
Anthropoid: + vaginal delivery
Platypelloid: - vaginal delivery, fetal head engages in transverse position, difficult descent through midpelvis, delay of progress at the outlet of the pelvis.
Passenger
- the fetus
- sufficient passage of the passenger depends on: fetal head, fetal attitude, fetal lie, and fetal presentation
Fetal head
- the least compressible and largest part of the fetus.
- fetal skull has 3 parts: face, base of the skull, vault of cranium (roof)
- bones of the base are not fused, allowing the head to mold as it passes through the narrow portions of the pelvis.
Fetal attitude
- refers to the relation of the fetal parts to one another.
- it is the fetal position
- it is how the baby is flexed
- normal attitude is moderate flexion of the head, flexion of the arms onto the chest, and flexion of the legs onto the abdomen (fetal position)
Fetal lie
- refers to the relationship of the cephalocaudal (spinal column) axis of the fetus to the cephalocaudal axis of the woman
- the fetus will assume either a longitudinal or a transverse lie.
- longitudinal is vertex or breech
- transverse is shoulder presentation
Fetal presentation
- determined by fetal lie and by the body part of the fetus that enters the pelvic passage first.
- this portion of the fetus is referred to as the presenting part
- fetal presentation may be cephalic, breech, or shoulder
- most common presentation is cephalic
- breech and shoulder presentations are associated with difficulties during labor; called malpresentations
Vertex presentation
- most common
- head flexed to the chest, occiput is presenting part
- Suboccipitobregmatic diameter is 9.5 cm
- occiput is the area of the fetal skull occupied by the occipital bone, beneath the posterior fontanelle.
Sinciput presentation
- the fetal head is not flexed or extended
- top of head is presenting part
- “military presentation”
- Bregma (anterior fontanelle) is the large diamond-shaped anterior fontanelle
- occipitofrontal diameter is 11.75 cm
Brow presentation
- fetal head is partially extended
- sincipt or forehead is presenting part
- largest AP diameter
- occipitomental diameter is 13.5 cm
- sinciput is the anterior area known as the brow.
Face presentation
- the fetal head is hyperextended
- face is presenting part
- submentobregmatic diameter is 9.5 cm
- sphenoid fontanelle is right behind the eyes and the sinciput
Complete breech presentation
- knees and legs are flexed
- buttocks and feet are presenting parts
Frank Breech presentation
- hips flexed, knees extended
- buttocks presenting part
- baby appears to be folded in half with feet by face and butt presenting
Footling breech presentation
- hips and legs are extended
- foot/feet are presenting part
- this baby appears to be standing
Engagement
- occurs when largest diameter of the presenting part reaches or passes through the pelvic inlet
- an engaged fetus will not move
Ballottable
-fetus is not engaged and can be easily moved
Station
- the relationship of the presenting part to the maternal ischial spines.
- Zero station is at the level of the ischial spines
- Above spines is negative
- Below spines is positive
- *Fetal position is the relationship of the fetal presenting part (ie head) and the maternal pelvis.**
Landmarks of the presenting part are:
O - occiput (vertex position)
M - mentum (face presentation)
S - sacrum (breech)
A - acromion (shoulder presentation)
A - anterior
P - posterior
T - transverse
Powers/Physiologic Force
Primary Force: contractions that contribute to cervix dilation and effacement
Secondary Force: abdominal muscles pushing
Phases of a contraction
- increment - build up
- acme - the peak
- decrement - letting up
Characteristics of contractions
Frequency (min) Duration (seconds) Intensity (measured during acme) ** you want 5 or less per 10 minutes** **timed from beginning of contraction to beginning of contraction**
Contraction Assessment
Palpation: feeling with hands the frequency, duration and intensity. Mild: nose, Moderate: chin, Strong: forehead
External monitoring: TOCO. Provides continuous contraction frequency and duration.
Internal monitoring: IUPC. Measures all 3 (F/D/I)
Psyche
- a woman’s emotional readiness for the labor process
- Can affect entire experience
- Includes fears, anxieties, birth fantasies, level of support, preparedness
Progesterone Withdrawal Hypothesis
- Progesterone is decreased toward the end of pregnancy
- Available estrogen is now the dominant hormone and causes uterine muscle contractility
Prostaglandin Hypothesis
- prostaglandin release from the membranes stimulate ctx
- manual release or synthesis related to increased estrogen and decreased progesterone levels
Corticotropin-Releasing Hormone Hypothesis
- released from hypothalamus
- increases near the end of pregnancy
- stimulates synthesis of prostaglandins
Leopold’s Maneuver 1st
- palpate the fundus
- fetal head is firm, hard and round
- the buttocks is softer and has bony prominences
- should start feeling at about 30 weeks gestation
Leopold’s Maneuver 2nd
- determine location of fetal back
- fetal back will feel firm and smooth
- fetal extremities will feel small and knobby
Leopold’s Maneuver 3rd
- determine which fetal part is lying in the pelvic outlet
- grasp abdomen just above symphysis pubis, should confirm opposite what was found with 1st maneuver.
Leopold’s Maneuver 4th
- Attempt to locate the cephalic prominence
- A fetal head that is well flexed, will have the cephalic prominence on the opposite side of the back
Where is the external EFM placed in relation to Leopold’s/fetal position?
- FHR hears most clearly at the fetal back
- Cephalic: lower quadrants of maternal abdomen
- Breech: at or above maternal umbilicus
- Transverse: just above or below maternal umbilicus
What is a nurse feeling/assessing for when performing a sterile vaginal exam (SVE) as part of the intrapartum nursing assessment?
- cervical effacement
- dilation
- fetal station
- presenting part
- fetal descent
- position of the fetus
FHR baseline
- the average FHR rounded to increments of 5 bpm observed during a 10-minute period of monitoring.
- excluded episodic changes, marked variability, and segments that differ by more than 25 bpm.
- you need at least 2 min w/in 10 min and they do not need to be consecutive.
- Normal FHR 110-160