Powerpoints Test 2 module 3 Flashcards
stages of labor
Stage 1:
0-10 cm dilation
Phase 1-3= latent , active, and transition dilation
Stage 2 of labor
10 cm dilated (complete) to the delivery of the infant
Stage 3 of labor
Delivery of infant to delivery of the placenta
Stage 4 of labor
First hour to four hours after placental delivery
Phase 1 of delivery
Latent phase - dilation of 0-3 cm
Phase 2 of delivery
Active dilation 4 to 7 cm
Phase 3 of delivery
Transition phase
Dilation is 8 to 10 cm
What are the Ps of labor
Woman/fetus-
Power Passageway Passenger Position Psyche
What are the Ps of labor
for providers support persons
Patients
Persistence
Practice/pain relief
Psyche
power-
The uterus is stretched to threshold point leading to what?
Synthesis and release of prostaglandin
Pressure on the cervix causes what?
The release of oxytocin
Oxytocin stimulation in blood Does what during pregnancy?
Increases
Estrogen in progesterone ratio does what during pregnancy?
The ratio changes and estrogen increases
And progesterone decreases
and excites her uterine response
Placental aging and deterioration triggers what?
Contractions
during pregnancy Fetal cortisol concentration rises and causes the placenta to do what?
Reduce progesterone
Prostaglandin is produced by fetal membrane during pregnancy and stimulates what
Contractions
Power -contractions move downward over the uterus, which portion is contracted for the longest time ?
Upper part of uterus
What is responsible for effacement and dilation of the first stage of labor ?
Myometrial Activity -The myometrium is the middle layer of the uterine wall, consisting mainly of uterine smooth muscle cells (also called uterine myocytes), but also of supporting stromal and vascular tissue.
Its main function is to induce uterine contractions.
Myometrial activity increases with what?
Good blood flow to the uterus (walking/activity and relaxation to eliminate fight or flight response)
How to assess contractions?
Duration - (length beginning to end)
Frequency- time between start of one contraction to the start of the next )
Intensity - palpate uterus
Resting tone- palpate uterus
When manually palpating the uterus, for a contraction assessment, what does
Mild
Moderate
Strong
look/feel like?
Mild- uterine wall is easily indented
Moderate-Uterine wall demonstrates resistance to pressure, some indention
Strong- uterine wall can not be indented
What is the external machine monitoring contractions called?
And what does it do?
Risks?
Tocotransducer
It measures increased intraabdominal pressure
(Not intrauterine pressure)
No known risks
Internal machine monitoring such as FSE (fetal scalp electrolode)-heart monitor or iucp Intrauterine pressure catheter does what ?
Risks
Direct measurement of intrauterine pressure
Include infection and uterine rupture
What do Montevideo units do in a contraction assessment
Measurement and quantify uterine work
Expressed by the number of contractions in 10 minutes multiplied by their intensity
**Measures Intensity of contractions
How to measure intensity of contractions in montevideo units ?
Review 10 minutes of the contractions strip
Count each contraction peek from baseline, total all contraction peak values in 10 minute period
This total peak value equals the MVU
What is a normal range of contraction/intensity Montevideo units ?
180-300 = Adequate contractions
Passageway-
Normal female pelvis
Labor progresses good
Most common
Rounded
Gynecoid
Labor progresses poor
Flat-oval side to side
Uncommon
Platypelloid
Male pelvis shape
Labor progress is poor
Higher among Caucasian women
Heart shaped
Android
Higher among non-Caucasian women
Pelvis that has increased OP delivery
Labor progresses good
Up and down oval shape
Anthropoid
Effacement -(Thinning r shortening of the cervix) how thin?
What is
Palpable with 100% effacement?
2cm- paper thin
A thin edge
Nulliparas (a woman who has never given birth) - when does effacement Of cervix begin?
Begins before the onset of labor
Multiparas (a women who has given birth to two or more babies) - when does effacement of cervix begin?
May it begin until the onset of labor
Opening of the external OS
Dilation
Dilation of the cervix is caused by what
Pressure of presenting part
Contraction and retraction of uterine muscles
Diameter of cervix increases to how many cm during labor?
When is it not palpable?
10cm
At 10cm dilated
During labor, the cervix of who remains thicker?
Multipara women remain thicker than women who have never birthed before
What to asses for in the passenger (baby)
Fetal lie - transverse, longitude Fetal altitude , neck flexion Presentation- brow, breech etc Station - out of pelvis - 0, +1 Position- loa
Longitudinal position of baby vs transverse
Longitudinal- baby’s head in down by cervix
Transverse- head and butt are side to side angling head angling down to cervix
Relationship of fetal parts to each other and degree of flexion or extension of the fetal head
Attitude
What is normal attitude?
Moderate flexion with chin flexed
Presentation determines what?
How the baby is presented to come out of the cervix first
Brow, breech , etc
Cephalic presentation
Head first - most common - 95%
Breech presentation
Pelvis first - 3% term deliveries
Shoulder presentation
Shoulder first - 2%
Relationship of presenting part to ischial spines of moms pelvis
How far the baby is out of pelvis
-3 to +4
What number is at ischial spine
Ballotable head moves when gentle pushed against
passenger station-
0
Relationship between the fetal presenting part and four quadrants of the mothers pelvis
Fetal position
Posterior fontanel,Anterior fontanel, sagittal suture, lamboid suture, coronal suture, Parietal
What is the most common and Best birth position for the fetus
LOA
False labor s/s
Regular contractions ?
Decrease in frequency and intensity
Disappear with sleep
No change in cervix
Sedation decreases or stops contractions
Show usually not present
True labor s/s
Regular contractions
Increase in frequency and intensity
Discomfort begins in back and radiates to abdomen
Activities such as walking increases contractions and continues with rest
Cervix dilate and effaces
Sedation does not stop contractions
Show is present
Labor assessment information
Labor symptoms
Pregnancy hx
Allergies
Cultural needs
Support persons
Medications
Smoking drugs alcohol
Last meal and time
Group b strep status
Vitals
Frequency and duration of uterine contractions
Well being
Urinary protein
Cervical dilation
Fetal presentation and station
Status of membranes
Date and time of arrival and notification of provider
Latent stage of labor duration
Multi gravida - 5.3 hours
Primigravida- 8.6 hours
Contraction frequency in latent stage of labor
every 3-30 minutes , may be irregular
Contraction duration in latent Stage of labor
30 to 40 seconds
Contraction intensity and latent stage of labor
Mild to palpation, 25 to 40mmhg
What do you contractions attempt to do to the cervix?
Soften, efface, dialate
What’s involved in psyche: labor support
Emotional support
Physical support
Advocacy
Support of partner
The physical presence of someone during labor as well as offering words of encouragement
Emotional support
Comfort measures in pain relief, hygiene, reassurance touch, application of heat or cold, calm environment, information and advice during labor
Physical support
Ways one can assess the fetus
Leopold’s
Auscultation
Vaginal exam
Ultrasound
FHR are incomplete without what?
The clinician should recognize and respond to both palpated and electronically obtained what?
Uterine activity assessment
Uterine activity data
Requires attention to audible characteristics of fetal heart rate
Auscultation
Methods of auscultation of FHR
Fetoscope and Doppler
Intermittent auscultation IA