OB Chapter 16: Labor and Birth Process Flashcards
The Intrapartum period begins with __________ and ends with _______________
Regular Uterine Contractions; the delivery of the placenta
Process is called _________
labor
______________ is conclusion of pregnancy to start of extrauterine life for newborn.
Childbirth
Maternal Factors that trigger Labor:
- ________ which causes release of prostaglandins which brings on ________
- Pressure on the cervix which stimulates the release of __________ by the maternal___________
- _______ increases, bringing on uterine response
- ________ decreases and helps relax smooth muscles
- _______ and ________ work together to to inhibit calcium binding and in muscle cells to increase intracellular Ca levels which activate uterine contractions
- Uterine muscle stretching; uterine contractions
- Oxytocin; posterior pituitary gland
- estrogen
- progesterone
- oxytocin; Progesterone
When _______ levels are inhibited it causes uterine contractions that serve the purpose of dilating and effacing the cervix
Calcium levels
Fetal Factors that Contribute to Labor Onset:
- ________ and deterioration triggers the initiation of contractions
- ____________ increases and decreases placental _______ and increases the release of _______
- Fetal membranes produce ________ which stimulate uterine contractions
- Placental aging
- Fetal cortisol concentration; progesterone; prostaglandins
- prostaglandins
_________ is the descent of the fetus into the bony pelvis about two weeks before the onset of labor.
Lightening
_______ do not usually experience lightening
multigravidas
__________ are irregular, false labor contractions
Braxton Hicks
The purpose of Braxton Hicks:
increase oxygenation of the uterine muscle and get the uterus ready for labor
_______ also known as nesting, refers to the need to put everything in order
Maternal energy surge
Cervical changes that suggest impending labor include:
1.
2.
3.
- Ripening (softening)
- dilating
- Bloody show/ loss of mucus plug
GI changes that suggest impending labor include:
1.
2.
3.
- Diarrhea
- Indigestion
- Nausea
Lower backache leading up to delivery is caused by ______ and ______
hormone called Relaxin; the fetus being lower
5 P’s of factors affecting labor:
- Powers (physiological forces)
- Passageway (maternal pelvis)
- Passenger (fetus and placenta)
- Psyche (woman’s response to labor)
- position (mother and baby)
What is included in “powers”
physiological forces of labor including uterine contractions and maternal pushing efforts
What is meant by “passageway”
maternal pelvis (gynecoid), soft tissues (vaginal rugae), and pelvic station
What is meant by the “passenger”
Everything about the fetus and the placenta: how many fetuses, size, gestational age, and position
what is meant by “psyche”
the woman’s psychological responses to labor, preparation, sedation, and anesthesia
what is meant by “position”
maternal labor positions used to promote labor (upright, walking, ball-bouncing etc)
Uterine contractions are described by:
1.
2.
3.
- Frequency (in minutes)
- duration (in seconds)
- intensity (mild, moderate, strong)
How is the duration of uterine contractions measured
beginning to end of a single contraction
how is the frequency of contractions measured
beginning of one contraction to the beginning of the next contraction
uterine relaxation between contractions is important because:
it allows fetal oxygenation by allowing blood flow from the uterus to the placenta to be restored
Measuring the intensity of the contractions is done by palpating the fundus during_______
acme (peak of the contraction)
what will a mild, moderate, and strong intensity contraction feel like when palpating the fundus
mild: tip of your nose
moderate: chin
strong: forehead
external contraction monitoring uses _______which is a pressure sensitive device that is applied to the uterine fundus
tocodynamometer
external contraction monitoring gives information about _____ and ______ but might not give accurate information about _______
frequency; duration; intensity
intrauterine pressure catheter is inserted when and where?
after the membranes have ruptured the IUCP is inserted through the cervix
how is IUCP measured ? (units)
mmHg
___________ is opening of the cervical Os and is expressed in centimeters (0-10)
dilation
________ is the shortening and thinning of the cervix
effacement
the amount of cervical effacement is usually measured in _________ related to ________
percentage; the length of the cervical canal as compared with a non-effaced cervix.
a cervix that has thinned to 3/4 of the normal length of a cervix would be ________ % effaced
25%
the first stage of labor begins with ______ and concludes when______
onset of true labor; cervical effacement and dilation are complete
______ usually efface before they dilate
primiparas/ nulliparas
_______ usually efface and dilate at the same time
multiparas
three phases of stage 1 of labor:
1.
2.
3.
- early: 0-3 cm
- middle: 4-7 cm
- transition: 8-10 cm
normal female pelvis that is best suited for childbirth is:
Gynecoid
_____ pelvis resembles a typical male pelvis and has a triangular or heart shaped inlet
android
_______ refers to the level of the presenting part in relation to the maternal ischial spine
Station
ischial spine = station:
0
when the presenting part lies above the ischial spine it is:
at a minus station
a station of -5 means:
the presenting part is at the pelvic inlet
a positive station indicates:
the presenting part has descended past the ischial spines
a station of +4 means:
the presenting part is at the pelvic outlet
soft tissue of pelvic floor allows for_________
fetus anterior rotation
how to strengthen Rugae
Kegals
_________ is normal fetal presentation
cephalic
a cephalic presentation means:
the fetal head will be the first part to come into contact with the maternal cervix
four types of cephalic presentation:
- vertex
- military
- brow
- face
in this cephalic presentation the fetal head is fully flexed (chin is tucked down to chest). It is most frequent and optimal position
vertex
in this cephalic presentation the fetal head presents in a neutral position (not flexed or extended). top of the head will be the presenting part
military
in this cephalic presentation the fetal head is partly extended- unstable and converts to flexed or fully extended position eventually
brow
in this cephalic presentation the fetal head is fully extended (back of head is near extended toward fetal spine)
face- babies face will be the presenting part
Components of vertex presentation: 1. 2. 3. 4.
- head enters birth canal first
- fetal face is backward (toward mom’s spine)
- arms crossed
- chin and neck bent forward toward chest
______ is the fetal head’s ability to change shape in order to come through the birth canal
molding
__________ refers to fetal position and the relationship of fetal parts to one another
fetal attitude (posture)
_________ refers to the spine of fetus in relation to the spine of the mother
fetal lie
__________ refers to the part of the fetus that enters the pelvic inlet
fetal presentation
________ is the largest part of the fetus to come through birth canal
fetal head
the fetal skull is made up of:
2 parietal bones; 2 temporal bones; 1 occipital bone
_______ are membranous spaces between bones that are used to determine positioning of the head
sutures
________ are intersections of the sutures
fontanelles
normal biparietal diameter of fetus (BDP)
9.25-9.5 cm
a ______ presentation occurs when the fetal buttocks enters the maternal pelvis first
breech
with ___________ there is an increased risk for umbilical cord prolapse
breech presentation
the three types of breech presentation include:
- frank
- complete (full)
- footling
______ is the most common type of breech presentation and is when the fetal legs are completely extended upward toward the fetal shoulders
Frank
_______ is a breech position when the fetal legs are flexed (crisscrossed)
complete
________ is a breech position when the fetal legs are extended and one or both feet are the presenting parts
footling
four landmarks on the fetus that are used to describe position
- occiput
- mantum (chin)
- sacrum
- acromion process
for a vertex presentation we use _ to describe fetal position
O- occiput
for a face presentation we use _ to describe fetal position
M- mantum (chin)
for a breech presentation we use _ to describe fetal position
S- sacrum
for a shoulder presentation (transverse) we use _ to describe fetal position
A- acromion position of the shoulder
what does “R/L” refer to when describing fetal position
right or left side of the maternal pelvis
what does “A/P/T” stand for when describing fetal position
whether the presenting part is Anterior, Posterior, or Transverse in relation to the maternal pelvis
side effects of Lightening (5 major s/e)
- leg cramps
- increased pelvic pressure
- increased urinary frequency
- increased venous stasis (peripheral edema)
- increased vaginal secretions
amniotic fluid should be ______ and _____ when amniotic sac ruptures
clear; odorless
yellow-green tinged amniotic fluid might indicate______ or ________
infection; fetal passing of meconium
three different tests used to confirm presence of amniotic fluid:
- Nitrazine tape test
- AmniSure
- fern
weight loss leading up to labor
there is a reduction of fluid retention toward the end of pregnancy because of changes in levels of estrogen and progesterone so mommy can lose up to 3 pounds
true labor versus false labor
true labor contractions lead to progressive dilation and effacement of the cervix
true labor contractions occur with regularity and increase in frequency, duration, and intensity
