T2 - Labor and Birth Process PPT (Josh) Flashcards
With a — woman, Effacement precedes Dilation.
With a — woman, Effacement and Dilation occur together.
Primagravida
Multigravida
What is effacement?
thinning and shortening of cervix
**Measured in % (ex: 100%)
How is fetal position determined?
identify the presenting part (ex: head)
identify the maternal quadrant the presenting part is facing (ex: right anterior)
Which women can experience a slowed or ineffective progress of cervical dilation?
history of STD or PID
What are the four basic pelvic shapes?
Gynecoid (classic and most favorable)
Android (resembles male pelvis)
Anthropoid (oval shaped w/ wider AO diameter)
Platypelloid (flat pelvis)
What are Premonitory Signs of Labor
Braxton Hick (strong)
Lightening
Energy INCREASED
Ripening of cervix
Mucus plug expelled
Bloody Show (as effacement ruptures cervical capillaries)
What do the stretch receptors in cervix do when stretched by fetal head?
release oxytocin which causes mom to have urge to push
How is Descent measured?
station (+5 to -5)
The normal uterus is about — thick and has a neck that is — long.
1 cm thick
2-3 cm long
What do following abbreviations mean? - ROP- LOT- RMA
Right Occipitoposterior
Left Occipitotransverse
Right Mentoanterior
Phases of First Stage of Labor:
1st Phase =
2nd Phase =
3rd Phase =
0-3 cm
4-7 cm
8-10 cm
What happens to mom’s Hematopoietic System during labor?
leukocytosis (WBCs increase)
fibrinogen increase
***More blood loss in vaginal delivery than open heart surgery b/c blood volume increased by 50%
What degrees mean baby is ABOVE spines?
What degrees mean baby is BELOW spines?
-1, -2, -3, -4, -5
+1, +2, +3, +4, +5
What are signs of Placental Separation?
Cord lengthens
Uterus changes shape to GLOBULAR
Gush of blood from vagina
What is Dilation?
widening of cervical canal to accomodate head of baby
**measured in cm (1-10)
The anterior fontanel is at the junction of which bones?
What about the posterior fontanel?
anterior = frontal and parietal
posterior = occipital and parietal
What is Fetal Position?
relationship of fetal presenting parts to a DESIGNATED POINT on maternal pelvis
ex: ROA (Right Occipitoanterior)
Anterior position has the OCCIPITAL bone facing —
Posterior position has the OCCIPITAL bone facing —
symphisis pubis
sacrum
When can the cervix no longer e palpated by examiner’s finger?
when it is fully dilated and completely retracted
When does the First Stage of Labor end?
dilation at 10 cm
What happens to mom’s CV system during labor?
CO increases
Intrathoracic pressure increases from pushing in 2nd stage
Which Cardinal Movement is AKA restitution?
External Rotation
- when head realigns to original position after rotating internally
When does the Ferguson Reflex occur?
maternal urge to push and happens at 7-10 cm through second stage of labor
UC Frequency =
UC Duration =
Frequency is BEGINNING of one UC to the BEGINNING of next
Duration is BEGINNING of one UC to the END of same UC
Which stage of Labor is True Labor?
First Stage
**until cervix is effaced and dilated 10cm
Involuntary UC cause what to take place in the cervix?
effacement and dilation
What are disadvantages of Breech Presentation?
not effective at dilating cervix
head is last part to be born
umbilical cord can become compressed
Where are True Contractions first felt?
lower back and sweep around to abdomen in a wave
***false UC felt in abdomen and groin
***ATI DOESN’T SAY THIS
Which presentation CANNOT be delivered vaginally?
shoulder
What are Leopold’s Maneuvers?
1st Maneuver = palpate fundus (soft is butt, hard is head)
2nd Maneuver = run fingers along sides of pelvis (smooth is back, knobby is knees)
3rd Maneuver = determine presentation
4th Maneuver = determine attitude of head
— is the degree of descent of presenting part above/below ischial spines
— is when presenting part is AT ISCHIAL SPINES
Fetal Station
Engagement
What is an Extended Fetal Attitude?
when baby presents wider part of the skull in the inlet- examiner would palpate the mentum (chin) or brow
How do we know if they’re false contractions?
Irregular
Begin and remain in abdominal and groin region (ATI DOESN’T SAY THIS)
Disappear w/ ambulation and sleep
Do not increase in duration, frequency or intensity
Do not dilate cervix
Which fontanel is DIAMOND shaped?
Which fontanel is TRIANGLE shaped?
Anterior
Posterior
The normal delivery position (feet in stirrups) is called?
Lithotomy
What is BPD?
Bioparietal Diamter
- the largest transverse diameter of fetal head
When would Stadol be given?
at top of contraction to maximize profusion to mom and minimize profusion to baby
What happens to mom’s Respiratory System during labor?
hyperventilation r/t increased O2 needs
***breathe into cupped hands or brown bag
What happens to mom’s GI System during labor?
Gastric motility decreased
Blood shunted to major organs
***NPO except for ice chips
— is known as secondary powers— is known as primary powers.
Voluntary bearing down (secondary)
Involuntary UC (primary)
What is the Fetal Presentation?
body part of fetus that FIRST enters the pelvic inlet
What signals the beginning of labor?
INVOLUNTARY uterine contractions
What is difference b/t a Complete Breech and a Frank Breech?
Frank Breech = baby’s legs are extended up to face
Complete Breech = baby’s legs are crossed Indian Style
Positional Abbreviations:
First letter means =
Second letter means =
Third letter means =
1st = R or L of maternal pelvis
2nd = specific presenting part (occiput, mentum, sacrum, acromium process)
3rd = location of presenting part in relation to maternal pelvis (Anterior, Posterior, Transverse)
In the nulliparous woman, which comes first, effacement or dilation?
Effacement usually precedes Dilation
Which part of pelvis is narrowest?
ischial spines
- less space for baby’s head to get through
Which position is best for delivery?
Occipitoanterial (OA)
Nursing action w/ a Frank Breech Presentation?
don’t attempt to pull legs down post birth or you could break leg or pull muscle
What is the Ferguson Reflex?
maternal urge to bear down “push”
***occurs when cervix is dilated 7-10 cm and continues through second stage of labor
5 P’s of Labor
Passenger (fetus and placenta)
Passageway (birth canal)
Powers (UC)
Position of mother
Psychologic responses
Which stage results in delivery of baby?
Second Stage
**from 10 cm to baby
What is the Third Stage of Labor?
separation and delivery of placenta
What are the 7 Cardinal Movements of Labor?
1) Engagement
2) Descent
3) Flexion (head bends down)
4) Internal Rotation (head rotates to OA)
5) Extension (head extends out of canal)
6) External Rotation (realignment of infant had to back/shoulders)
7) Expulsion
What is the Fetal Lie?
relation of the long axis (spine) of the fetus to the long axis (spine) of the mother
- Longitudinal (Vertical)
- Transverse (Horizontal)
What are the major fetal presentations?
Cephalic (Vertex)
Breech (butt or feet)
Shoulder
What is the Fetal Attitude?
relation of the fetal body parts to one another
- flexion or extension
Where is the BPD when head is Engaged?
pelvic inlet
In an appropriate fetal presentation, which part of the baby’s head would the nurse first be able to palpate?
posterior fontanel
Mother’s will have a longer labor if baby is coming – –
face up (Occipitoposterior)
