[Module 4.2] Intrapartum Flashcards
an involuntary physiologic process whereby the contents of the gravid uterus are expelled through the birth canal into the external environment
Labor
What are the Five [5] theories why labor begins?
- Uterine stretch theory
- Low progesterone theory
- Oxytocin theory
- Estrogenic, fetal hormones & prostaglandins theory
- Theory of aging placenta
The sinking of the fetal head into the true pelvis
lightening
As progesterone level falls, more fluid is excreted, slightly lowering body weight. what signs and symptoms of labor is this?
Additionally, how much weight can actually be loss?
Slight loss of weight
Between 1 to 3 lbs
signs and symptoms of labor where a burst of adrenaline to provide energy for labor
Excess energy
signs and symptoms of labor showing the beginning but unrecognized uterine contractions
Backache
In primiparas, lightening approximately occur how many days before the labor begins?
10-14 days
in multiparas, lightening occurs how many days before the labor begins?
usually occurs on the day of labor
or a day before labor.
As the fetus sinks lower into the pelvis, what are the things that a woman may experience?
- Shooting leg pains from the increased pressure on a sciatic nerve
- Increased amounts of vaginal discharge
- Urinary frequency from pressure on her bladder
This is the sign of a true beginning of labor
uterine contractions
the characteristic of braxton hicks contraction to the mother is that is enables the dilation of cervix. [T or F]
False, they do not dilate the cervix
This is know as false labor contractions and is irregular in nature
Braxton Hicks
how can you relieve braxton hicks?
Through walking and enema
when the bag of water of the mother is ruptured, it is an indication of ______.
Moreover, this kind of event is associated with the risk such as ____ and _____
Hospitalization
intrauterine infection, prolapse of the umbilical cord.
it is characterized as a blood-tinged mucus discharged from the cervix, shortly before or during labor
Show
Give the characteristic of true labor in terms of:
- Contraction
- Discomfort
- Effects on Cervix
- Effects of walking
- Enema
- Show
Contraction
Regular, Progressive
- Discomfort
Lumbo-sacral, radiating to the front; increasing the intensity - Effects on Cervix
Dilated: most important sign - Effects of walking
Intensifies the contractions - Enema
Intensifies contractions - Show
Present and increasing
Give the characteristic of false labor in terms of:
- Contraction
- Discomfort
- Effects on Cervix
- Effects of walking
- Enema
- Show
Contraction
irrregular, non-Progressive
- Discomfort
Abdominal - Effects on Cervix
No dilation - Effects of walking
No effect - Enema
No effect - Show
Absent
What are the components of labor process [5Ps]
Power
Passenger
Passageway
Position
Psychologic Response
refers to the route a fetus must travel from the uterus through the cervix and vagina to the external perineum
Passageway
serves to support and protect the reproductive organs. A bony ring formed by four united bones:
Pelvis
refers to the fetus in the 5Ps
passenger
structure of the fetal skull described as uppermost portion of the fetal skull, is composed of
8 bones
Cranium
what are the four superior bones in the fetal skull>
1 frontal
2 pareital
1 occipital
this is where the bones
of the skull meet
suture lines
a membranous inter-space that joins the parietal bones
sagittal suture
the line of junction of the frontal bone and the two parietal bones
Coronal suture
the line of junction of the occipital bone and the two parietal bones
lambdoid suture
the membranes that are
found at the junction of the main
suture line.
fontanelles
the anterior fontanelle is also known as the?
bregma
lies in the junction of the coronal and sagittal sutures and in diamond shape
anterior fontanelle
the anterior fontanelle measures ___ cm.
(anterior-posterior), and ___ cm (transverse) in diameter
3-4, 2-3
lies at the junction of the lambdoid
and sagittal sutures.
posterior fontanelle
the posterior fontanelle is also known as the?
lambda
is overlapping of skull bones along the suture lines, which causes a change in the shape of the fetal skull to one long and narrow
Molding
describes the degree of flexion a fetus assumes during labor or the relation of the fetal parts to each other
Fetal Attitude
what causes molding
force of uterine contractions as the vertex of the head is pressed against the not yet dilated cervix
the relationship of the long (cephalocaudal) axis of the fetus to the long (cephalocaudal) axis of the woman’s body.
fetal lie
fetal lie where the - head is the presenting part (Vertex or Occiput, Brow and Face or mentum)
Cephalic
fetal lie where the buttocks or feet are presented. [Complete, Frank, Footling (single or double)
Breech
this denotes the body part that will first contact the cervix or be born first
fetal presentation
this is determined by the combination of fetal lie and the degree of fetal flexion (attitude)
fetal presentation
a type of cephalic presentation where the head is sharply flexed, making the parietal bones or the space between the fontanelles the presenting part.
Vertex cephalic presentation
cephalic presentation where head is only moderately flexed, the brow or sinciput becomes the presenting part
Brow
cephalic presentation where the face is the presenting part
face
cephalic presentation where the head has completely hyperextended to present the chin.
Mentum
occurin approximately 4% of births
breech presentation
type of breech presentation where thighs are tightly flexed on the abdomen
complete breech presentation
type of breech presentation where both the buttocks are tightly flexed feet present to the cervix.
complete
type of breech presentation where hips are flexed, but the knees are extended to the rest of the chest. the buttocks alone present at the cervix.
frank
type of breech where neither thighs nor lower legs are flexed. foot is the presenting part.
footling
presenting part: one of the shoulders (acromion process) an iliac crest a hand, or an elbow
shoulder presentationt
this type of presentation usually affects the contour of the mother’s abdomen at term may appear fuller side to side rather than top to bottom
shoulder presentation
what causes shoulder presentation to happen during pregnancy?
- Pelvic contractions
- Placenta previa
- Relaxed abdominal walls from grand multiparity, which allow the unsupported uterus to fall forward
the relationship of the presenting part of the fetus to the level of the ischial spines.
station
the presenting part is at the level of the ischial spine.
station 0
what station where the presenting part is at the perineum seen if the vulva is separated (crowning)
station 3-4
Mechanisms (Cardinal Movements) of Labor
Engagement
Descent
Flexion
Internal Rotation
Engagement
External Rotation
Expulsion
refers to the settling of the presenting part of a fetus far enough into the pelvis that it rests at the level of the ischial spines, the midpoint of the pelvis.
Engagement
A presenting part that is not engaged is said to be “_______”
Floating
One that is descending but has not yet reached the ischial spines may be referred to as “_______.”
Dipping
is the downward movement of the biparietal diameter of the fetal head within the pelvic inlet.
Descent
when does full descent occur?
when the fetal head reaches the when the fetal head protrudes beyond the dilated cervix and touches the posterior vaginal floor
the twisting of the neck action
restitution
it is considered as the primary power of labor and is supplemented by the use of abdominal muscles after full dilatation.
powers
it is accomplish by the fundus of the
uterus by contraction.
pwers
explain the origin of the uterine contractions.
begins at pacemaker at the myometrium, goes down to over the uterus as a wave, after a short rest period, another contraction is initiated and the downward sweep begins again.
what are the phases of contraction
increment
acme
decrement
shortening and thinning of the cervical canal
effacement
enlargement or widening of the cervical canal
dilatation
in primiparas, which is accomplished first. effacement or dilatation
EFFACEMENT
T OR F multiparas also needs to accomplish effacement before dilatation begins.
f - dilatation may proceed before effacement is complete
what are the 4 stages of labor.
Dilatation
Delivery of the baby
Delivery of the Placenta
Recovery Stage
This is the onset of the
first true labor contraction up to full
cervical dilatation ( 0-10cm)
Dilatation stage
1-4cm dilation, what phase is this.
latent phase
what is the common duration in the latent phase
30 seconds average
what is the frequency in latent phase of dilation stage
over 10 minutes, but can also be within 5-8mins
what is the nursing intervention during latent phase
proper positioning [side lying]
Backrub
Bring Support system
Cervix dilate 4-8cm [1cm/hr] / what phase of dilation is this?
active phase
what is the duration and frequency of the contractions in the active phase of dilation stage?
45-60 seconds [duration
3-5minutes [Frequency
identify what phase of the dilation phase is this:
Less talkative: more anxious
active phase
identify what phase of the dilation phase is this:
May not want to be alone:
active phase
in this phase, the mother may experience hyperventilation
active phase
if unmanaged, hyperventilation may result to?
Respiratory Alkalosis
what are the nursing intervention that may be applicable during the active stage?
Warm shower
Monitor FHB and V/S
Breathing technique
Kept the bladder empty
what is the duration and frequency of contractions during the transition phase?
60-90 secs duration
every 2-3mins frequency
what phase is this maternal behavior.
Increased perspiration, n/v, cramps
transition
what phase is this maternal behavior.
Restlessness, panic, irritability
transition
what phase is this maternal behavior.
Amnesia at intervals, lost control of labor
transition
what phase is this maternal behavior.
Tends to push during contractions & circumo
transition
The mother in transition phase may have a
strong desire to push, but she should not. Why?
As pushing when the cervix is not yet fully dilated
can result in caput succedaneum
what phase is this maternal behavior.
increase in anxiety with skin warm and flushed
active phasse
identify what phase comes with this nursing intervention.
Provide physical comfort with dry linens and cool
clothes
transition
identify what phase comes with this nursing intervention.
Clean up vomitus
transition
identify what phase comes with this nursing intervention.
Coach on breathing pattern- Pant-blow pattern of
breathing
transition
identify what phase comes with this nursing intervention.
backrubs
transition and latent
identify what phase comes with this nursing intervention.
Provide psychologic comfort: help focus on the task, be understanding of her irritability
transition
this stage is characterized as a spontaneous pushing with contractions, panting at
interval and at crowning time
Delivery Stage
described as from fully dilated cervix to the delivery or
expulsion of the baby
Delivery stage
what is the hallmark of the delivery stage?
crowning
When the head crowns, the mother is advised to jsut pant and do not push, why?
to prevent meconium aspiration and to avoid perinial lacerations
: progress from irritability to participation,
eagerness and excitement is one of the maternal behavior in this stage
Delivery stage
Perineum bulges
Increase bloody show
BOW-Ruptures
Delivery stage
in the second stage, it is important for the nurse to support the mother using the PREIST method. what is this?
P-raise
R-eassurance
E-ncouragement
I-nform mother of progress
S-upport system
T-ouch
what cm should you transfer the patient to the DR?
Primigravida: cervix 10cm w/ certain degree of bulges
Multigravida: 8-9cm
Period from the delivery of the baby to the
delivery of the placenta
Placental stage
Period of recovery, stabilization, usually____ hours up to __ hours
1-2, 4hrs
what stage is the nursing intervention:
Monitor v/s every 15 min, check the perineum (appearance, swelling etc
recovery
what stage is the nursing intervention:
Palpate the fundus every 15 min
recovery
what stage is the nursing intervention:
Assess for the lochia (rubra, serosa and alba)
recovery
what stage is the nursing intervention:
Administered oxytocin if needed
recovery
what stage is the nursing intervention:
check episiotomy site
recovery
Give the 3 Active management of Third Stage of labor
- Administration of uterotonic within 1 min. after the
delivery of the baby. - Controlled traction with countertraction
on the uterus. - Uterine massage
Coaching the mother to push is recommended
no
to alleviate the pain of the mother during the second stage, a nursing intervention that can be done is to massage the perineal area.
no
it is vital to put fundal pressure during the
second stage to assist the mother in the delivery
no
