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ob/peds: midterm > Process Of Birth > Flashcards

Process Of Birth Flashcards

1
Q

What are the 4 ps

A
  • power
  • passage
  • passenger
  • psyche
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2
Q

What are the 2 powers

A
  • contraction
  • maternal pushing
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3
Q

What is primary force

A

uterine muscular contractions

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4
Q

What is secondary force

A

abdominal muscles to push during the second stage of labor

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5
Q

What is Increment:

A

The rise of contraction, a tightening feeling

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6
Q

What is peak: how is it rated

A

Known as the ACME of contraction
- Mild
- Moderate
- Strong

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7
Q

What is decrement

A

The decrease or release of a contraction

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8
Q

Why is the relaxation/ resting phase important

A

to get oxygenated blood to fetus

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9
Q

What is Duration

A

length of contraction (measured in sec)

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10
Q

What is frequency

A

Beginning of one to beginning of another; how often are they occurring

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11
Q

The pelvis is made up of which 3 parts

A
  • Inlet
  • mid pelvis
  • outlet
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12
Q

The size of the maternal pelvis (true pelvis) is measured how

A

Diameter of the pelvic:
- inlet
- mid pelvis
- outlet

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13
Q

Favorable types of pelvis shape:

A
  • Gynecoid
  • Anthropoid
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14
Q

What is considered as the passenger

A
  • fetus
  • placenta
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15
Q

What is fetal lie?
What are the 2 types

A
  • Relationship of the fetal spine to the maternal spine
    — refers to the relationship of the cephalocaudal axis (spinal column) of the fetus to the cephalocaudal axis of the woman
  • longitudinal
  • Transverse
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16
Q

Which type of fetal lie is favorable

A

Longitudinal
- (the occipital is presenting and the body is flexed

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17
Q

What is fetal attitude

A

The relation of fetal parts to the fetus
- Flexion or extension of the fetal body and extremities

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18
Q

What is the preferred fetal attitude?

A

We prefer the fetus to be flexed
- The head and neck is flexed forward with the chin almost resting on the chest
- the arms and legs are flexed

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19
Q

What is fetal presentation

A

The body part of the fetus entering the pelvis in a single or multiple pregnancy
- this is known as the presenting part

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20
Q

How is fetal presentation determined?

A

Fetal lie & the presenting part

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21
Q

Which presentation is most common and favorable?

A

Vertex presentation/ complete flexion
- (neck is flexed)

  • or Frank breech
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22
Q

What is a breech

A

Anytime the presenting part isn’t the head

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23
Q

Types of breach

A
  • Complete (full)
  • Frank breech
  • footling breech- single/ double
  • shoulder presentation
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24
Q

What is a complete breech (full)

A
  • The fetal knees and hips are both flexed, the thighs are on the abdomen, and the calves are on the posterior aspect of the thighs.
  • It is the reversal of the usual cephalic presentation (head down)
  • The buttocks and feet of the fetus present to the maternal pelvis
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25
Q

What is a frank breech?

A
  • The fetal hips are flexed, and the knees are extended.
  • The fetal legs are extended across the abdomen toward the shoulders.
  • The buttocks of the fetus presents to the maternal pelvis.
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26
Q

What is a footling breech?

A
  • Fetal hips and legs are extended
  • The feet of the fetus present to the maternal pelvis
  • In a single footling, 1 foot presents; and a double footling both feet present
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27
Q

What is a shoulder presentation?

A
  • Shoulder presentation is also called a transverse lie
  • Most frequently, the shoulder is the presenting part, and the acromion process of the scapula
  • Maybe due to relaxed abdominal wall due to grand multiparity
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28
Q

What is fetal position?

A
  • refers to the relationship of the landmark on the presenting fetal part to the front (anterior), back (posterior), or sides, (right or left) of the maternal pelvis.
  • The landmark on the fetal presenting part is related to for imaginary quadrants of the maternal pelvis: left/right x anterior/posterior
    — These designate whether the presenting part is directed toward the front back left or right of the maternal pelvis
  • These positions influence both the labor and the birth of the baby
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29
Q

What are the three notations of fetal position?

A
  • right or left side
  • The landmark of the fetal presenting part
  • Landmark direction (of fetal presenting part) in relationship to maternal pelvis
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30
Q

What are the landmarks of the fetal presenting parts?

A
  • Occiput (O)= back of head
  • Mentum (M) chin (in a pic, it looks like the face)
  • Sacrum (S)= sacrum/ buttocks
  • Acromion process (A)= shoulder (seen in transverse lie)
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31
Q

What are the landmark DIRECTIONS in relation to pelvis?

A
  • Anterior (A) front= you can see it
  • Posterior (P) back= cant see it/ faces away
  • Transverse (T) side of pelvis= side
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32
Q

What are the most common and most preferred fetal positions

A

ROA
LOA

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33
Q

Why is it important to know the fetal position?

A
  • Because it tells us what kind of delivery it will be
  • Documentation
  • Placement of fetal heart monitors
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34
Q

What is Psyche?

A

Psychological response, based on anxiety, culture, experiences, and support
- This is critical because marked anxiety, fear, or fatigue decrease a woman’s ability to cope with pain in labor.
- Maternal Catecholamines secreted in response to anxiety or fear, inhibit, uterine in contractability and placenta blood flow
- Relaxation, however, increases the natural process of labor

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35
Q

What is engagement?

A
  • as the fetal head moves through the birth canal once they get to a certain position in the pelvis the head gets stuck, and the head is engaged. (This position is in the pelvic inlet.)
  • engagement of the presenting part occurs when the largest diameter of the presenting part reaches or passes through the pelvic inlet
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36
Q

Engaged is when:

A

the biparietal diameter (BPD) of the fetal head is in the inlet or the occupit is at the level of the ischial spines.(* or at 0)

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37
Q

When does engagement often occur in nulliparous patients?

A

Before the onset of labor
- labor comes 2 weeks later

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38
Q

What happens when the fetus begins to engage into the pelvic inlet and cause symptoms?
What are those symptoms?
When do they occur?
What is this known as?

A

Lightning:
- Leg cramps/ pains
- Increase pelvic pressure
- Increased venous stasis= causing edema in lower extremities
- Increased urinary frequency- bladder is pushed on/ can’t expand as much
- Increased vaginal secretions
- Mother may begin feeling these symptoms 7-10 days before she is ready to deliver
- This is also known as the baby “dropping”
- Early sign of labor

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39
Q

What is station?

A
  • refers to the relationship of the presenting part to an imaginary line drawn between the ischial spines of the maternal pelvis
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40
Q

In a normal pelvis, what marks the narrowest diameter through which the fetus must pass

A

Ischial spines

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41
Q

If the presenting part is higher than the ischial spines, what kind of number is assigned

A

A negative number
- noting centimeters above 0 station

42
Q

Where is -5 station

A

At the inlet

43
Q

Where is 0 station

A

Ischial spine
- engagement

44
Q

Where is +4 station

A

At the outlet

45
Q

At what station will you see the fetal head
What is this called?

A

Station +5
Crowning

46
Q

During Fetal stations above 0 station, the fetus is described as being what?

A

Ballotable

47
Q

What is Ballottable

A
  • the presenting part is said to be floating when it is freely movable above the inlet. Not yet engaged.
  • Before the head is engaged, you can push the head, and the baby will float up and down
48
Q

What is dipping

A
  • when the presenting part begins to descend into the inlet, before engagement has truly occurred, it is said to be dipping into the pelvis
49
Q

In regards to documentation, how do you read:
+3/9/90%

A
  • +3: station
  • 9: cm dilation
  • 90%: effacement
50
Q

Mom pushes at_____ dialation/effacement/ station

A
  • 10 cm dilation
  • 100% effaced
  • Station: +5
51
Q

How is dilation measured

A

In cm
- 1 cm = 1 finger tip

52
Q

What is effacement?

A

Thinning of the cervix
- The cervix changes progressively from a long, thick structure to a structure that is tissue paper thin

53
Q

What causes cervical dialation

A
  • effacement &
  • the hydrostatic pressure of the fetal membranes
  • at the beginning of labor, there’s no cervical effacement or dilation
  • beginning cervical effacement. As the cervix begins to efface, more amniotic fluid, collects below the fetal head
54
Q

What starts labor?

A
  • We don’t know what starts labor. We think withdrawal of progesterone, build up of prostaglandin, or corticotropin releasing hormone therapy
55
Q

Imminent signs of labor:

A
  • Braxton Hicks contractions
  • Cervical changes
  • Bloody show
  • Rupture of membranes (ROM)
  • Sudden burst of energy
    Others:
  • Weight loss
  • pain
  • N/V/D, indigestion
56
Q

What are Braxton Hicks contractions?

A

Contractions that:
- are random, irregular, & intermittent
- not progressively getting stronger
- may go away if she lays down and rests
- may become regular, only to decrease spontaneously
- may become uncomfortable prior to onset of labor

57
Q

What cervical changes are signs of labor

A

Ripening: The softening of the cervix.
- Happens naturally with progesterone.
- Can give meds directly onto the cervix to help

  • At the beginning of pregnancy, the cervix is rigid and firm, and it must soften so that it can stretch in dilate to allow fetal passage
58
Q

What is a bloody show?
What is a mucus plug/ purpose?

A
  • During the pregnancy, cervical secretions have accumulated in the cervical canal to form a mucus plug
  • Mucous plug: protects the moms uterus from infection
  • About 24-48 hours before birth: Softening of the cervix allows the plug to be expelled, small amounts of blood loss from the exposed cervical capillaries.
  • Pink tinged in color/ spotting amount
59
Q

What is Rupture of membranes (ROM):

A

Rupture of the amniotic membrane
- 24-48 hrs before birth
- spontaneous Labor can occur 24 hrs after rupture
- If membranes rupture and labor does not begin spontaneously within 12 to 24 hours, labor may be induced
- If engagement has not occurred, the danger exist that the umbilical cord may be expelled with the fluid (prolapsed cord)

60
Q

What is the sudden burst of energy?
Why?
What do they do?

A
  • Some women report, a sudden burst of energy approximately 24-48 hours before labor. (Can happen 1-2 weeks long prior)
  • Begin to nest.
  • Due to the increase of epinephrine caused by decreasing in progesterone production by the placenta
61
Q

How much weight loss is a sign of labor

A
  • Weight loss of, 2.2 - 6.6 kg (1-3 lbs) resulting from fluid loss and electrolyte shifts produced by changes in estrogen and progesterone levels
62
Q

What kind of pain is a sign of labor

A

Increased backache, and Sacroiliac pressure from the influence of relaxin hormone on the pelvic joints

63
Q

What is true labor

A
  • shows a consistent pattern of increasing frequency, duration and intensity of labor.

Contractions are:
- regular
- increase in frequency, duration and intensity
- Increase with walking

  • Discomfort begins in the back and radiate around to abdomen
    • cervical dilation and effacement progressive
64
Q

cervical dilation and effacement progressive can only be seen how?

A

with a vaginal exam

65
Q

What is False labor?

A

Contractions are:
- irregular
- Usually no change in frequency, Duration, or intensity

  • Discomfort is usually in abdomen
  • Walking has no effect on or lessens contraction
  • *No change in cervical dilation or effacement
66
Q

What are the stages of labor?

A
  • 1: cervical ripening
  • 2: fetal expulsion
  • 3: placental expulsion
  • 4: maternal homeostatic stabilization
67
Q

When does the 1st stage of labor begin?

A

onset of regular (true labor) contractions

68
Q

When does the 1st stage of labor end?

A

with complete cervix dilation at 10cm and is 100% effaced.

69
Q

How many phases is the 1st stage of labor divided into?
What are they?

A

It has three phases: Latent/ active/ transitional

70
Q

If epidural is used, the total duration of the 1st stage of labor maybe increased by how long?

A

1 hour

71
Q

S/S of 1st stage of labor?

A
  • Hyperventilation; as the woman increases her breathing rate- causes mild respiratory acidosis
  • Restlessness
  • Difficulty understanding directions
  • A sense of bewilderment and anger at the contractions
  • Statements that she “can’t take it anymore”
  • Requests for medication
  • Hiccuping, belching, nausea, or vomiting
  • Increasing rectal pressure
  • Very strong contractions
  • Urge to push down during contractions as the fetal presenting part reaches her pelvic floor?
  • Leg tremors
  • N/V common
  • Women often lose control
    — This may be very confusing to the partner
72
Q

Who has quicker labor/ deliveries?
Nulliparous or multiparous?

A

Multiparous (MP)

73
Q

Latent phase of 1st stage of labor
- Cervical Dilation
- Contraction Frequency/ Duration/ intensity

A
  • Cervical Dilation: 0-3 cm

Contraction:
- Frequency: Q 10-30 min
- Duration: 30-40 secs
- Intensity: mild to moderate

74
Q

Active phase of 1st stage of labor
- Cervical Dilation
- Contraction Frequency/ Duration/ intensity

A
  • Cervical Dilation: 4-7 cm

Contraction:
- Frequency: Q 2-3 min
- Duration: 40-60 seconds
- Intensity: moderate to strong

75
Q

Transition phase of 1st stage of labor
- Cervical Dilation
- Contraction Frequency/ Duration/ intensity

A
  • Cervical Dilation: 8-10 cm

Contraction:
- Frequency: Q 1.5 - 2 min
- Duration: 60- 90 secs
- Intensity: strong

76
Q

In what stage of labor do contractions begin to hurt

A

1st stage: Active Phase

77
Q

In which stage of labor does internal rotation begin?

A

1st stage: Active phase

78
Q

When is an epidural no longer an available option

A

After 7 cm dilation

79
Q

When does cervical dilation show

A

As it progresses from 8-10 cm

80
Q

Diet of laboring mother

A

We only give laboring mom’s ice chips and keep them NPO just in case they need a C-section

81
Q

Most intense stage of labor

A

1st stage: transitional phase
(Intense pain)

82
Q

When does the 2nd stage of labor start?

A

complete cervical dilation (10cm)
- crowning occurs in the beginning of the second stage (+5 station)

83
Q

When does the 2nd stage of labor end?

A

Delivery of fetus

84
Q

Use of epidural anesthesia may extend the duration of the 2nd stage by how long?

A

additional 1 hour

85
Q

S/S of second stage of labor?

A
  • taxed cardiovascular, increased BP just before contraction
  • protruding anus
  • stretched perineium
  • sweating, low fluid and Na
  • increasing hyperventilation
  • G.I. motility reduced
  • Increased WBC
  • As the head distends the vulva with each contraction, the perineum becomes extremely thin, and thus the anus stretches and pertrudes
  • Cardiovascular system is taxed by the uterine contractions, pain, and anxiety.
  • Each contraction greatly decreases or completely stops the blood flow in the branches of the uterine artery that supply the placenta
  • About 300-500 ml of blood is re-distributed into the peripheral circulation, increasing systolic and diastolic BP, and decreasing pulse rate.
  • This all leads to elevated cardiac output until about 24 hours after birth
  • BP is also increased during pushing, and just before a contraction. And returns to baseline when contraction ends.
  • BP may drop when in supine position due to aortocaval pressure
  • Fluid and electrolyte imbalance, due to diaphoresis during labor- loss of water and Na
  • Increasing Hyperventilation= too much O2 retention/ too much CO2 expulsion
    — Returns to normal in fourth stage when breathing patterns slow down and is corrected by 24 hours
  • G.I. motility reduced
  • Increased WBC during labor, primarily increase in neutrophils in response to stress
86
Q

When does the 3rd stage of labor start?

A

Immediately after fetus is born

87
Q

When does the 3rd stage of labor end?

A

delivery of placenta

88
Q

When is a placenta considered retained?

A

if 30 minutes have elapsed since the birth of the baby w/o delivery of placenta

  • We surgically remove it, if it hasn’t come out in 30 minutes because it will cause hemorrhage and infection
  • fragments cause release of some hormone that makes the body think its pregnant
  • thus the uterus wont contract/shrink= causing more bleeding
  • body wont start breastfeeding bc it thinks its pregnant still
  • pieces can become ischemic and rot leading to infection
89
Q

When does placental separation usually occur?

A

5 mins after delivery

  • After the infant is born the uterus contracts firmly, diminishing its capacity and the surface area of the placental attachment
90
Q

Placental separation is indicated by what

A
  • lengthening of the umbilical cord
  • a small spurt of blood
  • change in uterine shape
  • a rise of the fundus in the abdomen.
    .
  • When the signs of placental separation appears, the woman may bear down to aid in placental expulsion.
91
Q

pulling on the umbilical cord causes what?

A
  • hemorrhage
  • Inverted uterus
  • may leave placental fragments
92
Q

When does the 4th stage of labor begin?

A

after delivery of placenta and continues for 1-4 hours after delivery

93
Q

What happens during the 4th stage of labor?

A
  • physiologic readjustment of the mother’s body begins
  • Maternal systemic responses to labor involve the cardiovascular, respiratory, renal, gastrointestinal, and immune systems
  • The uterus effectively contracts to control bleeding at the placental site
94
Q

Normal blood loss during vaginal delivery?

A

Up to 500 mL

95
Q

Normal blood loss during C-section delivery?

A

Up to 1L

96
Q

The return of blood back to the maternal venous beds causes what?

A
  • Moderate drop in both systolic and diastolic BP
  • increased pulse pressure
  • moderate tachycardia
97
Q

Why do women feel a chill after birth?

A
  • Mothers usually experience a chill which can last 20 min- major cardiovascular shift due to loss of weight in fluid
  • Offer heated blanket
98
Q

What is involution?

A

The shrinkage of an organ in old age or went in active
E.g the uterus after childbirth

99
Q

Why is pain normal after birth?

A
  • After birth pain is normal- uterus is contracting a lot (involution)
  • Especially with breast feeding, nipple stimulation causes release of oxytocin, causing more contractions
100
Q

What is the Golden hour

A
  • 1st hour after birth): baby is most alert, good for skin to skin, bonding, first breast feeding

ob/peds: midterm (21 decks)

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