OB exam 2 - Intrapartum Flashcards
what determines the birth passage
-size & type of the maternal pelvis
-ability of the cervix to dilate and efface
-ability of canal & the external opening to distend
what pelvic shape is a CPD more likely to occur
android
what pelvic shape is more likely to have a baby inn a transverse lie
platypelloid
what pelvic shape is more likely for the baby to be in an occipital posterior position
anthropoid
effacement
the gradual thinning, shortening and drawing up of the cervix, measured in percentages from 0-100%
the shortening between the internal and external cervical os
dilation
the gradual opening of the cervix measured in centimeters from 0-10cm
when does the anterior fontanel close
18 wks after birth
when does the posterior fontanel close
6-8wks after birth
fetal attitude
refers to the relation of the fetal parts to one another
usually rounded back, chin is flex to the chests, thighs are flexed on the abdomen, legs are flexed at the knees & arms are crossed
what is BPP an important indicator of
fetal head size
fetal lie
the relationship between the fetal long axis vs the long axis of the mom
longitudinal lie (vertical)
-head down (cephalic)
-buttocks down (breech)
transverse lie (horizontal)
shoulder position
cephalic: suboccipitobregmatic
most desired head presentation because it makes the smallest head diameter & chin is flexed in
cephalic: occipitofrontal
“military presentation”
the chin is not flexed inwards
cephalic: occipitomental
“brow presentations”
eyebrows presenting first and are very hard to delivery vaginally
cephalic: submentobregmatic
“face presentation”
uncommon- fetus does not move down, usually occurs after multiple births, and baby’s face can be bruised and edemas
frank breech
hips are flexed, knees are extended, and bottom is first presenting part
complete breech
hips & knees are flexed, thighs on abdomen, butt + feet present first
footling breech
hips & legs are extended, and feet present first
what are the parts of position
station, engagement and fetal position
station
negative: above ischial spine
zero: at ischial spine
positive: below ischial spine
when does engagement occur
when presenting part researches zero station
what are the 3 landmarks of fetal position
-right or left of maternal pelvis
-presenting part
-anterior, posterior or transverse in relation to pelvic
what side do we want the baby to be facing
anterior
facing the ground
memory trick for fetal position
R = head is facing my right side
L = head is facing my left side
back is always opposite
T= i can see the nose
P= i can see the eyebrow
A = ear is centered
SA= back
SA = front
two categories of powers
primary and secondary
primary power
-responsible for cervical effacement and dilation
-involuntary uterine muscular contractions until complete dilation
-described by frequency, duration & intensity
-phases: increment, acme, decrement
increment phase of contraction
as the contraction increases
acme phase of contraction
peak of contraction
decrement phase of contraction
when the contraction starts to loosen and go down
secondary power
-voluntary forces by the abdominal muscles
“bearing down “
ferguson reflex
the maternal urge to bear down that’s caused by the release of endogenous oxytocin when stretch receptors are activated in the vagina
how does gravity help during labor
-makes contractions stronger
-increases cardiac output which increases blood flow to our placenta & uterus & kidneys
how does positioning help with labor
-affects the anatomic and physiologic labor adaptations
-frequent changes help to relieve fatigue, increase comfort, and increases circulation
Psyche
-fear & anxiety
-excitement
-exhaustion
-level of social support
premonitory signs of impending labor
-lightening: when the presenting part gets into the true pelvis, gradual & relieves pressure on diaphragm
-braxton hicks: false labor, uterus is practicing
-cervical changes
-bloody show/expulsion of mucus plug
-ROM: water breaking
-sudden burst of energy
-wt loss
-GI upset
true labor
-regular contractions
-contraction intervals shorten
-contractions increase in duration & intensity
-discomfort starts in back and radiate to abdomen
-cervical dilatation & effacement are progressive
-contractions do not decrease w/ rest or warm bath
stages of labor
first: onset of labor until full dilation (has 3 pahses)
second: full dilation to birth of baby
third: birth of baby until the delivery of the placenta
fourth: after the placenta is delivery & up to 4hrs PP
what are the phases of the first stage of labor
latent
active
transition
latent phase
“early labor” & longest phase
-usually dilated between 0-3 cm
-8ish hrs for a prim/nulli pare & 5ish for a multi
-contractions are every 10-30 min, lasting 30sec, mild to mod
be aware of procedure that could effect length of this stage
psychological adaptations: latent phase
-feels able to cope w/ discomfort
-may be relieved that labor has finally started
-able to recognize & express feelings of anxiety
-excitement is high, eager to talk
active phase
-dilated 4-7 cm
-4ish hrs for a prim/nulli pare & 2ish for a multi
-contractions are every 2-5min, lasting 40-60sec, palpate moderate to strong
psychological adaptations: active phase
-anxiety increases
-sense of need for energy & focus
-fears loss of control
-may have decreased ability to cope
-helplessness
-if supported: greater satisfaction & less anxiety
transition phase
-dilated 8-10cm
-3ish hrs for a prim/nulli pare & <1 hr for a multi
-contractions are every 1.5 to 2 min, lasting 60-90 sec and strong by palpation
psychological adaptations: transition phase
-w/draws into herself to focus
-acutely aware of intensity of contractions
-doubts ability to cope
-apprehensive, restless & irritable
-frequent change of position
-terrified of being alone
-does not want anyone to talk to her or touch her
second stage
“pushing stage”
-urge to push
-baby is crowning
-up to 3ish hrs for a prim/nulli pare & ~15mins for a multi
-contractions every 1.5-2 mins, lasting 60-90secs, strong by palpation
psychological adaptations: second stage
-relieved acute pain is over
-relieved she can push
-sense of control because actively involved
-may become frightened
-fatigue
mechanism of labor: engagement & descent
when the largest part of the fetal presenting part passes through the pelvic inlet, which leads to descent which is affected by pressure of the amniotic fluid, contractions, pushing effort and extension of the fetus
mechanism of labor: flexion
when the head and chin are brought closer to the chest so that the small head diameter is presenting to the pelvic outlet
mechanism of labor: internal rotation
occurs when the fetal head rotates from occiput transverse to occiput anterior
mechanism of labor: extension
when the occiput comes, then the face and then the chin delivers
mechanism of labor: external rotation & expulsion
when the head rotates to the OT position & the provider will deliver the anterior than the posterior shoulder which will result in expulsion & birth of the baby
benefits of kangaroo care
“skin to skin”
-helps regulate body temp & heart rate
-increases bonding
-increases oxytocin released by the mother
-stimulates mother’s breasts
third stage
-should last no longer than 30 min or risk for hemorrhage and placenta retention
-pitocin IV bolus infusion begun after delivery of placenta to decrease blood loss
-fundal massage to see if continues to be firm
signs of placental separation
-globular uterus rises in abdomen
-gush or trickle of blood
-increased protrusion of umbilical cord
what is the purpose of pitocin (oxytocin)
induce labor & prevent bleeding after birth
fourth stage
-vaginal delivery average blood loss is 250-500 ml
-C/s average blood loss <1000ml
-check: fundus, peritoneum and vaginal bleed every 15 mins during the 1st hour, temperature @ beginning and end of recovery period and bladder fullness
physiologic readjustment
-thirsty & hungry
-shaking
-fluid & heat loss (give warm blanket)
-bladder is often hypotonic (so bedpan or in&out cath)
-uterus should remain contracted
