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OB > Week 1 Process of Labor > Flashcards

Week 1 Process of Labor Flashcards

1
Q

What are some common s/s of respiratory alkalosis?

A
  • Tingling of hands and feet
  • Numbness
  • Dizziness
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2
Q

What are the characteristics of active labor

A
  • starts around 5-6cm dilation
  • Accelerated rate of cervical change
  • Descent and Internal rotation occur
  • Ctx every 2-5 minutes
  • Mother is anxious, helpless, focused
  • Pain meds are usually given now
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3
Q

How can the psyche be kept healthy during pregnancy?

A

Prenatal education and support groups

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4
Q

What is a cephalic presentation?

A

head-first

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5
Q

What occurs during the first stage of labor?

A
  • Cervical dilation
  • Cervical effacement
  • There are three phases
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6
Q

What are the 5 major aspects of the passenger?

HFAPP

A
  1. Head diameter
  2. Fetal lie
  3. Attitude
  4. Presentation
  5. Position
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7
Q

What is a normal leukocyte count for a woman who is pregnant in labor?

A

20-30k

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8
Q

What are two substances that stimulate contractions?

A
  • Fetal prostaglandins

- Oxytocin

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9
Q

What are some factors that may have a role in starting labor?

A

Changes in the ratio of maternal estrogen to progesterone

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10
Q

What GI considerations should be made to the woman in labor

A
  • Restricting intake during labor is not EBP

- The mother needs calories for the work of labor

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11
Q

Discomfort in false labor is ___

A
  • Is felt in the abdomen and groin

* May be more annoying than truly painful

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12
Q

When is the “Passenger” considered engaged/When is engagement positive?

A

-The fetus is at zero station (head is at ischial spine)

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13
Q

Discomfort in true labor is ___

A
  • May persist as back pain in some women

* Often resembles menstrual cramps during early labor

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14
Q

What are some comfort measures for the mother in her second stage of labor?

A
  • Lighting
  • Temp
  • Cleanliness
  • Oral care (dry mouth and lips)
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15
Q

How do cervical changes differ in a nullipara?

A

Effacement occurs earlier due to a thinner cervix

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16
Q

What role do catecholamines play in the fetal response to labor related to the CV and pulmonary systems?

A
  • Epi and norepi are produced by the fetus during labor
  • This stimulate cardiac contractions and Breathing
  • Quicken the expulsion of lung fluid
  • Help regulate temp.
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17
Q

What are the four common causes of postpartum discomfort?

A
  • Lacerations
  • Episiotomy
  • Edema
  • Hematoma
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18
Q

How can the mothers UI system be affected during labor?

A

-Reduced sensation of a full bladder(especially with an epidural)

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19
Q

What is laboring down?

A
  • Active pushing

- Allowing the uterine contractions to cause most fetal internal rotation and descent after dilation

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20
Q

What is the role of fetal prostaglandin?

A

To prepare the uterus to receive oxytocin

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21
Q

What are the benefits of frequent positioning changes in the second stage of labor?

A
  • Decreased pain
  • Improved circulation
  • Improved strength and effectiveness of contractions
  • Decreased labor time
  • Facilitates fetal descent
  • Decreases perineal trauma and episiotomies
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22
Q

What are the characteristics of the fourth stage of labor?

A

-Firm contracted uterus

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23
Q

What are the four signs that indicate placental separation?

A
  • Uterus is sperical shaped
  • Uterus rises upwards as the placenta descends
  • cord descends further from vagina
  • Gush of blood after release of placenta
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24
Q

What does the increased fibrinogen create a risk for?
This risk is increased with the presence of a ___
How can this be prevented?

A
  • DVT
  • Epidural
  • Change positions during labor
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25
Q

What are the 4 parts of the contraction cycle?

A
  • Increment
  • Acme
  • Decrement
  • Interval
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26
Q

What happens to mothers temperature directly after birth?

A

The become chilled

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27
Q

How do stress and anxiety diminish contractions?

A

elevated adrenaline levels cause uterine relaxation

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28
Q

During what portion of the contraction cycle should you palpate for relaxation?

A

interval period

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29
Q

True Labor is characterized by

A

Contractions
Discomfort
Cervical change

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30
Q

The cervix in true labor ____

A

• Includes progressive effacement and dilation (most important characteristic)

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31
Q

What is a IUPC?

A

Inter uterine pressure catheter

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32
Q

How is contractions frequency measured?

A

Beginning of one contraction to the beginning of the next

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33
Q

What is the ideal AP diameter of the fetal head at birth?

A

9.5 cm

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34
Q

What is the intensity of a contraction? How is it measured?

A

-The strength of the contraction
-The fundus is palpated
Chin = mild
Nose = moderate
Forehead = strong

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35
Q

In most cases, the fetal lie is ___ but can sometimes be ___

A

Longitudinal

Transverse

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36
Q

What is the normal appearance of lochia after birth?

A
  • Rubra for 3-4 days
  • Serosa
  • Alba
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37
Q

What is the position of the passenger?

A

The location of a fixed reference point on the presenting part in relation to the 4 quads of the maternal pelvis.

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38
Q

What are the three phases of labor?

A
  • Latent
  • Active
  • Transition
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39
Q

What falls under “Power” in the birth process?

A
  • Uterine contractions

- Maternal Pushing

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40
Q

What is the acme portion of the contraction cycle?

A

Moment of highest intensity

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41
Q

What are the three possible presentations of the passenger?

A
  • Cephalic
  • Breech
  • Shoulder
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42
Q

How much does blood volume increase during pregnancy?

A

30-60%

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43
Q

The most important difference between true labor and false labor is ____

A

Cervical changes

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44
Q

What are some signs of a PPH that can be felt on palpation?

A

-soft (boggy) and enlarging uterus

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45
Q

How are clotting factors changed during pregnancy?

A

-Fibrinogen increases during and after pregnancy

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46
Q

Describe the fetal head.

A

Comprised of 5 bones separated by sutures. The sutures are not solid and allow for the skull to be flexible when passing through the pelvic opening

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47
Q

What are the three possible presenting positions of the presenting part of the fetus

A
  • Occiput (top of head first)
  • Mentum (chin first)
  • Sacrum (but first)
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48
Q

what is Uterine hypertonus?

A

A contraction lasting more than 2 minutes

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49
Q

What is aortocaval hypotension?

A

Low maternal blood pressure caused by the compression of the major blood vessels under the weight of the gravid uterus.

Happens when the pregnant woman lies on her back

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50
Q

Why is maintaining an empty bladder important during labor?

A

Because if the bladder is full it will act as a stopper and will obstruct the cervix
(inhibits fetal decent)

51
Q

Describe the maternal response to labor as it relates to the CV system?

A
  • During contractions, the maternal spiral arteries are constricted reducing blood flow to the fetus
  • This increases the mother BP and decreased her pulse via the shunting of maternal blood back into her system
52
Q

Where does the exchange of O2, nutrients, and wastes between the mother and the fetus occur?

A

in the intervillous space of the placenta

53
Q

What is effacement?

A

Cervix becomes shorter and thinner

Fully thinned cervix is 100% effaced / complete

54
Q

What are the characteristics of a 3rd degree laceration?

A

injury to perineum and the anal sphincter complex

55
Q

What is the role of progesterone during pregnancy?

A

Promotes smooth muscle relaxation

56
Q

What are some things that can interfere with the fourth stage uterine contraction?

A

A full bladder or a blood clot

57
Q

What is lightening?

A 
When the fetus begins to drop into its birthing position. The mother is able to breath better, has to pee more, has more edema and leg cramps.
Occurs 2-3 weeks before natural birth
-increased vaginal mucus secretions
-cervical ripening and blood show
-energy spurts
-Weight loss
58
Q

During which portion of the contraction cycle should intensity be measured?

A

Acme

59
Q

Why is it important that the uterus contracts after the release of the placenta?

A

Because it allows the now separated spiral arteries to close. If this does not occur, than PPH is likely

60
Q

What are the characteristics of latent labor?

A
  • Up to 5-6cm dilation

- Mother is sociable, excited, cooperative

61
Q

What are the characteristics of the transition phase of the first stage of labor?

A
  • 8 to 10cm dilation
  • Bloody show
  • Ctx every 1.5 - 2 minutes lasting for 60-90 seconds
  • Urge to push begins
  • Leg tremmors, nausea, vomiting
  • Mother is irritable and may lose control
62
Q

What are some premonitory signs of labor?

A
  • Braxton Hicks contractions

- Lightening

63
Q

levels of the hormone ___ increase, closer to the onset of labor. Once this hormone is more abundant than the other, what occurs?

A

Estrogen

-Once it is more abundant, the sensitivity to substances that cause contractions increases

64
Q

What is the fetal reference point in the position?

A

Left or right of mothers pelvis

65
Q

How is contraction intensity described?

A
  • Palpation

- Mild, Moderate, Strong

66
Q

Normal Labor contractions are what three things?

A
  • Coordinated
  • Involuntary
  • Intermittent
67
Q

What is a normal expected blood loss during a vaginal birth?

A

500mL

68
Q

What are the two main cervical changes?

A
  • Effacement

- Dilatation

69
Q

The cervix in false labor ____

A

• Does not significantly change in effacement or dilation

70
Q

What are the four P’s of the birth process?

A
  • Power
  • Passage
  • Passenger
  • Psyche
71
Q

What are the 6 principles r/t maternal positioning according to AWHONN?

A
  1. Promote spinal flexion
  2. Promote an increase in the uterospinal drive angle (open the pelvis)
  3. Facilitate stronger expulsive forces
  4. promote good fit
  5. increase the pelvic diameter
  6. Facilitate occiput posterior rotation
72
Q

How is frequency of contractions measured?

How is duration expressed?

A

number of contractions in 10 minutes averaged over 30 minutes
-Expressed in seconds

73
Q

Describe normal fetal attitude.

A

One of flexion

  • Head flexed forward
  • arms and legs flexed over the thorax
  • back in a convex C
74
Q

What are the characteristics of a first degree laceration?

A

Injury to the perineal skin only

75
Q

What is the main role of oxytocin?

A

To initiate labor

76
Q

What is the decrement portion of the contraction cycle?

A

Decreasing intensity as the uterus relaxes

77
Q

When does the fourth stage of labor begin and end?

A

-begins with passing of placenta ends 1-4 hours after birth

78
Q

What influences the psyche?

A

Anxiety, Culture, expectations, experiences, support

79
Q

What are some factors that influence the existing contractions?

A
  • Movement/activity can stimulate it

- Stress/anxiety can diminish it

80
Q

How is contraction duration measured?

A

Period from the start of one contraction to the end

81
Q

When should maternal vital signs be taken?

A

Between contractions

82
Q

When does the third stage of labor begin and end?

A

Begins with birth and ends with expulsion of plecenta

83
Q

What does the Friedman curve plot?

A

Dilation vs Descent. Used as an average to measure the likely time of delivery/active labor

84
Q

How can respiratory alkalosis be reversed?

A
  • Slow the mothers breathing

- Cup hands/Paper bag

85
Q

What are Braxton Hicks contractions?

A

irregular, mild, uterine contractions that occur throughout pregnancy

86
Q

What is the attitude of the passenger?

A

The relation of the fetal body parts to one another

87
Q

How do cervical changes differ in a Parous?

A

Cervix is thicker may not efface as fast

88
Q

True labor contractions ___

A
  • Usually have a consistent pattern of increasing frequency, duration, and intensity
  • Tend to increase with walking
  • Begin in lower back and gradually sweep around to lower abdomen
89
Q

What are the 7 cardinal movement/mechanisms

A
  • Engagement
  • Descent
  • Flexation
  • Internal rotation
  • Extension
  • External rotation
  • Expulsion
90
Q

What is cervical ripening?

A
  • Relaxin softens the cervix

- The fetal head caused some capillaries to burst to cause some blood show

91
Q

What is Dilatation?

A

As cervix is pulled upward and the fetus is pushed downward, the cervix dilates

92
Q

How can anxiety/fear affect labor and birth?

A

Catecholamines from the mom can inhibit uterine contractility and placental blood flow

93
Q

What are the characteristics of a 2nd degree laceration?

A

Injury to the perineum involving perineal muscles but not the anal sphincter

94
Q

When does the second stage of labor begin?

A

at 10cm dilation and full effacement

95
Q

How does fetal size influence labor?

A

as the fetus grows, it stretches the uterus and that stretching eventually causes the release of oxytocin

96
Q

Contractions start in the ___ and move towards the ___

A

Fundus to the cervix

97
Q

If contraction frequency is more than ___ in 10 minutes it is referred to as___

A

Tachysystole

98
Q

Describe the maternal response to labor as it relates to the Pulm system?

A
  • Depth and rate of breathing increases

- May lead to Resp. Alkalosis

99
Q

What is a fetal lie?

A

The fetuses orientation to the long axis of the mother

100
Q

If a mother is in a lot of pain it can ____ labor r/t ___

A

prolong

-Diminished contractions

101
Q

Why is weight loss common before labor?

A

The shifting of hormones causes the loss of water weight

102
Q

What does it mean for a contraction to be involuntary?

A

-Mother cant control it’s occurence

103
Q

When contractions are coordinated, what three things are measured?

A
  • Frequency
  • Duration
  • Intensity
104
Q

What is the increment portion of the contraction cycle?

A

Period of increasing strength

105
Q

What is estrogens role in contractions?

A

It allows for coordinated contractions

106
Q

If blood loss is over 500mL during vaginal birth it is considered a ___

A

Postpartum Hemmorage

107
Q

How does the fetus react to CV changes during labor?

A

Quickly

108
Q

How can an infection in the mother induce preterm labor?

A

The release of prostaglandins in response to inflammation

109
Q

How can aortocaval hypotension be relieved?

A

Laying the mother on her side.

left is best

110
Q

What is “Psyche”?

A

The psychological response to labor and childbirth

111
Q

What are the complications of Uterine hypertonus

A

Increased length of contraction will restrict fetal blood flow for an extended period and will lead to the child losing tissue perfusion.
This can cause permanent damage or death

112
Q

False labor contractions are ____

A
  • Inconsistent in frequency, duration, and intensity

* Do not change or may decrease with activity (such as walking)

113
Q

Describe the fetal response to labor as it relates to the pulmonary system?

A
  • During gestation, the fetus breaths in AF and produces fluids in the lungs themselves to aid in development
  • These fluids need to be eliminated to allow normal breathing after birth
  • The fluid is absorbed into the interstitial space of the lungs
  • Absorption is increased during labor
  • 35% of the fluid remains after birth
  • Remaining fluid is expelled with compression of labor
  • This does not occur in C-sections
114
Q

What are the characteristics of 4th degree laceration?

A

injury to perineum and the anal sphincter complex and the anal epithelium.

115
Q

If there is no fetal descent in 2 hours of laboring down, what should be done?

A

an evaluation

116
Q

What are the characteristics of the second stage of labor?

A
  • Duration varies based on para status and if the mother has a epidural
  • Ctx are strong, every 2-3 minutes lasting 40-60 seconds
  • Involuntary pushing
  • possible BM
117
Q

Describe the usual “Passage” in the birth process.

A
  • The maternal pelvis and soft tissue
  • The boney pelvis needs to relax to allow passage
  • Relaxin softens the cartilage at the pubic symphysis. This begins near term
118
Q

What are the 3 possible facing positions of the passenger?

A
  • Anterior
  • Posterior
  • Transverse
119
Q

What are two interventions for a woman in the second stage of labor?

A
  • Ensure an empty bladder

- Frequent position changes

120
Q

What can reduce power during the birth process?

A
  • Epidurals
  • Malnutrition
  • Illness in the mother
121
Q

How is fetal head diameter measured?

A

By measuring the major transverse diameter at the biparietal diameter.

122
Q

If fetal membranes are stripped ___ is released and can induce labor

A

Prostaglandin

123
Q

How does the fetal head usually enter the birth canal?

A

In cephalic presentation

124
Q

What makes up the “Passenger”

A

The fetus, membranes, and placenta

OB (14 decks)

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