Parturition and Labor Flashcards
Responsible to stimulate corpus
luteum to produce progesterone to
maintain pregnancy and stimulate
ovaries to produce elevated levels of
estrogen and progesterone till 1st
trimester
HCG (Human
Chorionic
Gonadotropin)
Is necessary for
appropriate brain development and
thyroid function of growing fetus
Thyroid Hormone
Allows breast
tissue development and milk
production
Prolactin Hormone
Placenta releases additional _______ which
further releases ____ and ______
Thyroid
Releasing
Hormone (TRH),
Thyroid
Stimulating
Hormone (THS),
and Prolactin
Hormone
Found in corpus luteum and placenta
in pregnant women
Softens birth canal, allows
connective tissue remodeling, for
mammary growth and differentiation
and inhibits uterine contraction
Relaxin
What hormone allows systemic vasodilation and
decreasing blood pressure during
pregnancy
Relaxin
Cardiovascular effect: _____ heart rate
Inc
Cardiovascular effect: _____ stroke volume and cardiac output
Inc
When does CO increase 75% due to
relief of inferior vena cava compression
At the End of Pregnancy
Cardiovascular effect: ____ vascular resistance (=____ in blood pressure)
Dec; Dec
Cardiovascular effect: ______ventricular wall mass, myocardial
contractility, and cardiac compliance
Inc
Respiratory effect: ______ Functional Residual Capacity (FRC) and Expiratory Reserve Volume (ERV)
Dec
Respiratory effect:_____ Inspiratory Reserve Volume (IRV)
Increase
Respiratory effect: _____ vital capacity
No change
Respiratory effect: ____ progesterone = ____ tidal volume; _____ respiratory rate
Inc; Inc; No change
Hematologic effect: _____ in RBC mass and _____ in blood flow to the uterus
Inc; Inc
Hematologic Effect: _____ demand for iron throughout pregnancy (____ to _____ mg/day during ____ trimester)
Inc; 3 to 7.5 mg/day; 3rd trimester
Renal Effect: ____ cardiac output
Inc
Renal Effect: _____ in the serum concentration of creatinine, urea, and uric acid
Dec
Renal Effect: fluid retention leads to _________ ___________
physiologic hydronephrosis
Renal Effect: _____ hormone and _____ hormone acts on smooth muscles causing dilation of the urinary collecting system occurs, which can lead to ______ _____
progesterone and relaxin; urinary stasis
Renal Effect: ______ in predisposition for urinary tract infections and _______ with ______ _______ in pregnancy
inc; pyelonephritis; asymptomatic bacteriuria
Gastrointestinal Tract: ______ _______ ______ is common in pregnant patients
Gastroesophageal reflux disease (GERD)
Hematologic Effect: ______ state due to elevation of _______ , which makes pregnant patients _______ prone to develop DVT
Hypercoagulable; estrogen; 5x
Gastrointestinal Tract: _______ progesterone in pregnancy leads to
reduced resting muscle tone of the lower
esophageal sphincter (LES)
Inc
Gastrointestinal Tract: _____ gastric emptying
Delayed
Gastrointestinal Tract: ____ small bowel transit time
Increased
Gastrointestinal Tract: Compression from a gravid uterus, predispose to GERD. What is the treatment for this?
Upright position and some also prefers to be in a slanted position (parang elevated backrest ng bed)
Integumentary System: _____ hormone (estrogen or progesterone) stimulate _____ melanin production
Elevated; Excess
Integumentary System: Hyperpigmented line running down the center of the abdomen
Linea Nigra
Integumentary System: Inc pigmentation of the _____, _____, and ____
Areolae, axillae, and genitals
Musculoskeletal: What are the affected concepts?
Posture, Articular changes, and muscular changes
What happens to the posture of a pregnant pt?
COG shifts anteriorly, inc lumbar lordosis and thoracic kyphosis, and anterior pelvic tilting
What happens to the articular changes of a pregnant pt?
○ Laxity (from altered hormones) due to
breakdown of collagen which is replaced by
modified form that contains high water content
○ Lead to joint instability
○ Symphysis pubis and sacroiliac laxity
What are the muscular changes in pregnant patients?
Linea alba separation (Diastasis Recti)
Can be arbitrarily divided into _____ overlapping
phases that correspond to the major physiological
transitions of the myometrium and cervix during
pregnancy
Four
What are the four phases of parturition?
Prelude, Preparation, Labor, and Recovery
How many stages are there in 3rd phase of parturition? And what are they?
3:
Stage 1 (process of dilation to fully dilated; consists of latent to active phases)
Stage 2 (fetal delivery)
Stage 3 (placenta delivery)
generally defines as beginning at the point at which the
woman perceives regular uterine contractions (usually 5 to
20 minutes apart) and stronger
At this stage, the cervix may dilate from 1 to 4 cm
Latent Phase of Stage 1 of Labor
The progressive
shortening and thinning
of the cervix during labor
Cervical Effacement
The increase in diameter of the
cervical opening measured in
centimeters
Cervical Dilation
Classically starts when the effaced (thinned) cervix is 4cm
dilated
● Greater intensity of contractions (short interval: 3 to 4
minutes apart) (longer duration)
● Expulsion of mucus plug “bloody show”
● May or may not rupture amniotic fluid
Active Phase
Cervix dilates 8 to 10cm
● Contractions are very strong lasting 60 to 90 seconds and
occurring every few minutes
● Mothers feel the urge to push
● Shortest phase but most intense
Transition
● Since the transverse diameter is ______ than the
________ diameter in the pelvic inlet, the widest
circumference of the fetal head descends in a __________ position
● However, when it gets closer to the __________, the nature
of the pelvic floor muscles encourages the fetal head to
rotate from ______ to an _________
position, as the AP diameter is greater than the transverse
diameter
greater; antero-posterior; transverse
pelvic outlet; transverse to an anterior-posterior
What are the Mechanisms of Labor Cardinal Movement? (9 mechanisms)
- Descent
- Engagement
- Flexion
- Internal Rotation
- Crowning
- Extension
- ER and restitution
- Internal Rotation
- Delivery of Shoulder and Body
What are the 3Ps ?
Power, Passenger, Passages
What are the common clinical findings in women with ineffective labor?
● Fetopelvic disproportion
- Excessive fetal size
- Inadequate pelvic capacity
- Malpresentation or position of the fetus
● Inadequate cervical dilation of fetal descent
- Protracted labor - slow progress
- Arrested labor - no progress
- Inadequate expulsive effort - ineffective
pushing
● Literally means “difficult labor” or “dysfunctional
labor”
○ Abnormally slow labor progress
● Arises from 3 distinct abnormalities (3PS) that may
exist singly or combination
Labor Dystocia
What is the first stage of the mechanisms of Dystocia?
● The fetal head must encounter a relatively thick lower
uterine segment and undilated cervix.
● Uterine contractions, cervical resistance, and the
forward pressure exerted by the leading fetal part are
the factors influencing the progress of first stage
labor.
What is the second stage of the mechanisms of Dystocia?
● After complete cervical dilation, the mechanical
relationship between the fetal head size and position
and the pelvic capacity, namely, fetopelvic
proportion, becomes clearer as the fetus descends.
● Because of this, abnormalities in fetopelvic
proportions become more apparent once the second
stage is reached.
Abnormalities of Expulasive Forves: Two types of Uterine Dysfunction
Hypotonic and Hypertonic Uterine Dysfunction
No basal hypertonus and uterine contractions
have a normal gradient pattern (synchronous),
but pressure during a contraction is insufficient
to dilate the cervix.
Hypotonic Uterine Dysfunction
“incoordinate uterine dysfunction”
Hypertonic Uterine Dysfunction
Either basal tone is elevated appreciably or the
pressure gradient is distorted
● Gradient distortion may result from more
forceful contraction of the uterine
midsegment than the fundus or from
complete asynchrony of the impulses
originating in each cornu or a combination of
these two.
What are the types of active phase disorders?
Protraction and arrest disorders
● Protraction disorder: a slower-than-normal
progress
● Arrest disorder: a complete cessation of progress
● A woman must be in the active phase of labor with
cervical dilation to at least 3 to 4cm to be diagnosed
with either of these.
Protraction or arrest disorder
What criteria should be met according to the American College of Obstetricians and Gynecologists (2013)?
Before the
diagnosis of first-stage labor arrest is made, specific
criteria should be met:
- First, the latent phase has been completed
and the cervix is dilated 4cm or more
- Uterine contraction pattern of 200 montevideo
units or more in a 10-minute period has been
present for 2 hours without cervical change.
What are the three reported causes of uterine dysfunction?
Epidural Analgesia, Chorioamniotis, Maternal Position during Labor
Uterine Dysfunction: ● Can slow labor
● Associated with lengthening of both first and second
stage labor with slowing of the rate of fetal descent
Epidural Analgesia
Uterine Dysfunction: ● Infection diagnosed late in labor was found to be a
marker of cesarean delivery performed for dystocia
● This was not a marker in women diagnosed as
having chorioamnionitis early in labor
Chorioamnionitis
Uterine Dysfunction: Who and when was it stated that contracts more frequently but
with less intensity with the mother lying on her back rather than on her side? Contraction frequency and intensity have been
reported to increase with sitting or standing Who and when was it stated that there is no conclusive
evidence that upright maternal posture or
ambulation improves labor?
Miler (1983); Luper and Gross (1986)
The pelvic inlet usually is considered to be
contracted if its shortest anteroposterior (AP)
diameter is <10 cm or if the greatest transverse
diameter is <12 cm; Usually defined as a diagonal conjugate <11.5 cm
Contracted Inlet
Contracted Inlet: After membrane rupture, ______ pressure by the
head against the cervix and lower uterine segment predisposes to less effective contractions and dilation may proceed very slowly or not at all.
Absent
In women with contracted pelvis, ______
presentations are encountered ______ times more
frequently, and the cord prolapses _____ to ________ times
more often.
face and shoulder; three; four to six
● More common than inlet contraction
● Causes transverse arrest of the fetal head, which
potentially can lead to a difficult mid forceps
operation or to cesarean delivery
Contracted Midplane/Midpelvis
The midpelvis is contracted when:
- The sum of the interspinous and posterior sagittal diameters of the midpelvis (normally, 10.5 plus 5
cm, or 15.5cm) falls to _______
- its inter_______ diameter _______
13.5 or less; interspinous; <8 cm
Three suggestions of contraction
- The spines are prominent
- The pelvis side walls converge
- Sacrosciatic notch is narrow
● Narrowing of the inter______ diameter can be
anticipated when the inter_______ diameter is
narrow. A normal inter_________ diameter,
however, does not always exclude a narrow
inter______ diameter.
interspinous; intertuberous; intertuberous; interspinous
● Intertuberous diameter of 8 cm or less
● Contracted outlet often gives rise to perineal tears
Contracted Outlet
Passenger: Because of these presentation term size fetuses are more common when there is some
degree of pelvic inlet contraction, cesarean delivery
frequently is indicated
Face Presentation;
Note: attempts to convert a face presentation
manually into a vertex presentation (manual or
forceps rotation of a persistently posterior chin to
mentum anterior position) and internal podalic
version and extraction are dangerous and should not
be attempted
A relaxed and pendulous abdomen allows the uterus to fall forward, deflecting the long axis of the fetus away from the axis of the birth canal and into an
oblique or transverse position
Transverse Lie
What are the common causes of Transverse Lie?
○ Abdominal wall relation from high parity
○ Preterm fetus
○ Placenta previa
○ Abnormal uterine anatomy
○ Hydramnios
○ Contracted pelvis
● An extremity prolapses alongside the presenting part
and both present simultaneously in the pelvis
Compound Presentation
Compound Prerntation: In most cases, the prolapsed part should be left _____
along, because often it will not interfere with labor
arm
Compound Presentation: If the arm is prolapsed alongside the head, the
condition should be observed closely to ascertain
whether the arm retracts out of the way with descent of the presenting part.
● If it fails to retract and if it appears to prevent
descent of the head, the prolapsed arm should be pushed gently ______ and the head simultaneously
_______ by ______.
upward; downward; fundal pressure
Compound presentation: In general, rates of perinatal mortality and morbidity
are increased as a result of ______ preterm
delivery, _____ cord, and ______ _____ procedures.
Concomitant preterm delivery, prolapsed, traumatic obstetrical
What are the indications for cesarean section? (7)
● Previous cesarean section
● Malpresentation
● Major degree placenta previa
● Multiple pregnancy
● Cephalopelvic disproportion
● Preeclampsia
● Fetal distress
What are the WHO guidelines to all pregnant women and postpartum women without contraindications?
● Undertake regular physical activity throughout
pregnancy and postpartum period
● Accumulate at least 150 min of moderate-intensity
physical activity throughout the week
○ Incorporate a variety of aerobic (eg. brisk
walking, swimming, stationary cycling,
low-impact aerobics, jogging, modified yoga and modified Pilates) and resistance training
activities (body weight exercises eg. squats,
lunges, push-ups)
● Incorporate a variety of aerobic and
muscle-strengthening activities. Adding
What is the triad symptom of preeclampsia and eclampsia?
High BP, protein in the urine (proteinuria), and edema
What are the absolute contraindications of PT in pregnancy?
● Ruptured membranes
● Active preterm labor
● Unexplained vaginal bleeding
● Placenta previa after 28 weeks
● Severe pre-eclampsia
● Incompetent cervix Intrauterine growth restriction
● Higher-order multiple pregnancy (e.g., twins, triplets
etc.)
● Uncontrolled high blood pressure, type 1 or type 2
diabetes or thyroid disease
● Uncontrolled or severe arrhythmia
● Other serious cardiovascular, respiratory or systemic
disorders
Causes of Eclampsia and preeclampsia
● First pregnancy
● Mothers > 35 years old
● Multiple gestation
● History of hypertension
and diabetes
● Weight gain/ obesity
● Autoimmune disease
Signs and Symptoms of Eclampsia and preeclampsia
● *High blood pressure
● *Protein in the urine
(proteinuria)
● Change in vision
(blurriness, flashing light)
● Headache
● Vomiting
● *Edema
● Epigastric pain
* triad
What are the common MSK problems in pregnant women?
Back pain, Diastasis Recti Abdominis, and Pelvic Floor Weakness
Possible Interventions for Diastasis Recti Abdominis
Abdominal compressions, pelvic tilts, toe taps, heel slides, single-leg stretches, and bridges with belly scooping
Pelvic Floor weakness can lead to:
● Vaginal prolapse or uterine prolapse
● Urinary incontinence
Causes (risk factors) and signs and symptoms of back pain among pregnant women
Causes:
● Increase hormone
● Change in center of
gravity
● Weight gain
● Decline in posture
Signs and Symptoms:
● Posture
● Joint alignment
● Muscle strength
Flexibility
● Nerve involvement
