Physiology/Management of Labor

Question 1

What is the parametrium?

Answer 1

Loose connective tissue around uterus

Question 2

What is the myometrium?

Answer 2

Smooth muscle containing adrenergic receptors responsible for ctx

Question 3

What is the endometrium?

Answer 3

Innermost glandular layer/lining of uterus

Question 4

What is required to form gap junctions that spread the nerve impulses that cause ctx?

Answer 4

Estrogen and prostaglandins

Question 5

What are the three functions of the placenta?

Answer 5

Respiration: O2/CO2 exchange
Excretion: waste products from fetus transfer
Endocrine: hormones produced
hCG- keeps corpeus luteum active
hPL- promoted growth of mammary glands,
regulates maternal glucose, protein,
and fat to have available to fetus
Estrogen- promotes uterine growth
Progesterone- maintains endometrium,
keeps uterus quiet

Question 6

What are the maternal factors thought to initiate labor?

Answer 6

Inc estrogen
Inc oxytocin
Inc prostaglandins
Dec progesterone

Question 7

What is the perimetrium?

Answer 7

Outer serosa layer of uterus

Question 8

What are the fetal factors thought to initiate labor?

Answer 8

Inc fetal cortisol
Fetal secretion of oxytocin
Uterine distention

Question 9

What are the 4 forces of labor?

Answer 9

Powers
Passage
Passenger
Psyche

Question 10

What are the six components to “passenger” assessment?

Answer 10

Fetal size
Fetal lie
Presentation
Attitude
Position
Station

Question 11

What are the different fetal lies?

Answer 11

Longitudinal
Oblique
Transverse

Question 12

What are the different fetal presentations?

Answer 12

Cephalic
Breech- frank, complete, footling
Compound
Funic (cord)
Other- shoulder, arm, knee, etc

Question 13

What are the different fetal attitudes?

Answer 13

Occiput (vertex): full flexion
Neutral (military): no flexion or extension
Sinciput or frontum (brow): partial extension
Mentum (face): full extension

Question 14

What are the three letters of fetal position?

Answer 14

Laterality, part, direction

Anything that is not ROA, LOA, or OA is considered malpresentation

Question 15

What is acynclitism?

Answer 15

Sagittal suture tilted towards one shoulder

*side lying leg hang to help

Question 16

What are the landmarks to assess fetal station?

Answer 16

Ischial spines

Question 17

What are the four steps of leopolds maneuvers?

Answer 17

Palpate fetal part in fundus
Locate fetal back
Pawlicks grip: what part above pelvic inlet?/is 
    it engaged?
Fetal attitude- head flexed or extended?

Question 18

What are the six cardinal movements?

Answer 18

Engagement
Descent
Flexion
Internal rotation
Extension
External rotation/restitution
Expulsion

Question 19

What is the first stage of labor?

Answer 19

Latent phase: generally up to 3-4cm
UC q5-10min, 30-45sec, mild to moderate
Good time to teach

Active phase: generally 4-7cm
UC q2-5min, 45-60sec, mod to strong
Progress usually 1.2-1.5cm/hr

Transition phase: 8-10cm
UC q2-3min, 60-90sec, strong
GI symptoms common, pt irritable

Question 20

What is the second stage of labor?

Answer 20

Full dilation through delivery of infant

Latent phase: passive decent, laboring down
Ctx frequency my slow down

Active phase: ferguson reflex (presenting part stimulated stretch receptors in pelvic floor releasing more oxytocin-urge to push)
Do not leave pt, coach on pushing

Transition phase: ring of fire

Question 21

What is the third stage of labor?

Answer 21

Delivery of infant to delivery of placenta
Usually no longer than 30 minutes

Signs of placental separation:
Gush of blood
Lengthening of cord
Change in shape of fundus/ elevation of fundal ht

Question 22

What is the fourth stage of labor?

Answer 22

First two hours after delivery of placenta
Involution begins
Pt gets second wind
Vs/fundal/lochia checks q15min x 2hr minimum
Common to have bradycardia (inc in circulating blood volume no longer perfusing placenta)