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NURS 372 > Week 3: Labour and Birth Process > Flashcards

Week 3: Labour and Birth Process Flashcards

1
Q

def of labour

A

process of moving the fetus, placenta, and membranes out of the uterus and thru the birth canal

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2
Q

describe the preceding labour

A
  • lightening or dropping
  • urinary frequency
  • backache
  • stronger braxton hicks contractions
  • wt loss of 0.5-1.5kg
  • surge of energy
  • increased vaginal discharge or bloody show
  • cervical ripening
  • possible rupture of membranes
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3
Q

on the onset of labour which hormones increase, and which decrease

A

increase:
estrogen, oxytocin, prostaglandins

decrease:
progesterone

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4
Q

lisa calls L&D unit indicating she is having irregular contractions in her abdomen, she indicates that the contractions get less painful when she moves around.
Prelabour or true labour?

A

She is in prelabour - probably Braxton hicks
- Want to know the frequency, duration
- Vaginal discharge, bleeding, fluid loss
- How far they are into their pregnancy are they
6 fetal movement?

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5
Q

signs of prelabour

A

contractions:
- irreg or temp reg
- often stop w walking
- felt in back or abdomen
cervix:
- may be soft but no significant dilation or effacement
- often posterior

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6
Q

signs of true labour

A

contractions:
- reg, stronger, lasting longer, and closer together
- more intense w walking
- felt in lower back, radiating to lower portion of abdomen
cervix:
- changes to softening, effacement, dilation
- anterior position
- bloody show

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7
Q

things to consider w a vaginal assessment

A

Never do a vaginal assessment if there is blood
Do not do one more than every 4 hrs to reduce infection
Ask her to urinate before the exam
Wash hands w soap and water
Use sterile gloves
Drape the pt
Wash front to back with clean water
Note for any infections or cuts that could affect delivery
Wait until she has finished a contraction
Take slow deep breaths to relax
Now separate the labia then insert two fingers
Even before labour the cervix can change, for example getting softer
Check position of cervix - early the cervix may be at the back, but it will move towards the front as they get closer to labour - is it firm like your nose, it will become very soft
You determine the dilation by spreading ur fingers and gently taking them out then measure
Presentation: part of fetus that is entering through the pelvis first - butt first, head first

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8
Q

in a vaginal exam 4cm is approx…

A

2 loose fingers

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9
Q

def of effacement

A

shortening and thinning of the cervix during 1st stage of labour. expressed from 0-100%

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10
Q

def of presentation

A

part of fetus that enters the pelvic inlet first and leads thru the birth canal

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11
Q

def of dilation

A

enlarging and widening of cervical canal
1cm to full 10cm

10cm marks the end of 1st stage of labour

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12
Q

def of engagement

A

largest transverse diameter of presenting part (biparietal diameter) has passed thru the pelvic inlet into pelvic cavity

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13
Q

def of crowning

A

head or the presenting part appears at the vaginal opening

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14
Q

describe station

A

relationship of presenting part to imaginary lines drawn btwn maternal ischial spines and measures the degree of decent

1cm above the spines = minus 1
at the level of the spine = 0
birth imminent presenting part is +4 to +5

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15
Q

5 P’s affecting labour

A

Passenger (fetus and placenta)
Passageway (birth canal)
Powers (contractions)
Position (of mother)
Psychological response

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16
Q

describe why passenger is important in determining if vaginal birth can occur

A

important in birthing vaginally - head is the largest part of baby’s body, bones in head are not fused together to allow some molding as baby goes thru birth canal
Want to be able to feel the (anterior or posterior) Fontenelle to determine which way the baby is facing

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17
Q

what is important to consider with “passenger”

A

size of fetal head
fetal presentation
fetal lie
fetal attitude
fetal position

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18
Q

what does lie mean and what are the 2 subcategories

A

longitudinal: cephalic or breech
transverse: long axis of fetus (spine) directly across maternal spine

transverse: long axis of fetus (spine) directly across maternal spine

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19
Q

describe attitude

A

relationship of fetal body parts to one another
flexion or extension

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20
Q

describe presentation

A

part of the fetus that enters the pelvic inlet first

cephalic (96%), breech (3%), or shoulder (less than 1%)

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21
Q

with a cephalic presentation what is the usual presenting part?

A

Occiput (back at the babies head)

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22
Q

can a pt deliver vaginally w a fetus in a transverse lie?

A

NO

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23
Q

describe fetal position

A

relationship of reference point part to the 4 quadrants of mothers pelvis

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24
Q

3 letter abbreviation for fetal positions

A
  1. right or left side of pelvis
  2. O for occiput, S for sacrum, M for mentum/chin, and Sc for scapula
  3. anterior (A), posterior (P), or transverse (T)
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25
Q

how are LOA and ROA positions

A

LOA and ROA are OKAY (they are best)
-OP’s are sunnyside up - less than ideal position for vaginal birth (OP-owie)
-OT’s occiputs are at transverse section

can reference the chart in slides

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26
Q

describe a frank breech

A

lie: longitudinal or vertical
presentation: breech (incomplete)
presenting part: sacrum
attitude: flexion, except for legs at knees

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27
Q

single footling breech

A

lie: longitudinal or vertical
presentation: breech (incomplete)
presenting part: sacrum
attitude: flexion, except for one leg extended at hip and knee

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28
Q

complete breech

A

lie: longitudinal or vertical
presentation: breech (sacrum and feet presenting)
presenting part: sacrum w feet
attitude: general flexion

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29
Q

shoulder presentation

A

lie: transverse or horizontal
presentation: shoulder
presenting part: scapula
attitude: flexion

30
Q

vertex presentation

A

vertical: 9.25cm
horizontal: 9.5cm

31
Q

sinciput presentation

A

horizontal: 12 cm
vertical: 9.25 cm

32
Q

brow presentation

A

horizontal: 13cm
vertical: 9.25cm

33
Q

describe whats included in the passageway

A

bony pelvis
lower uterine segment
cervix
pelvic floor muscles
vagina
introitus (external opening to the vagina)

34
Q

describe powers; primary and secondary

A

primary:
- effacement
- dilation
- ferguson reflex - oxytocin is released -> uterine contractions occur - feedback loop

secondary powers:
- bearing-down efforts

35
Q

describe position

A
  • position affects anatomic and physiologic adaptations to labour
  • frequent changes in position: relieve fatigue, increases comfort, improves circulation
  • encourage to find positions most comfortable
36
Q

describe psyche

A

-psychological state
- supports
- preparation

37
Q

stage 1 of labour

A

begins w onset of regular contractions and lasts until full dilation and effacement of cervix

38
Q

stage 1: latent phase/early phase

A
  • 0-3cm dilation in primiparous
  • cervical length less than 1cm or 75% effaced
  • typically lasts 6-8 hrs
  • contractions mild to moderate and irregular, q5-30 mins for 30-45 sec
  • brownish discharge, mucous plug or pale pink
39
Q

describe stage 1: active phase

A

beginning at 4 cm in a nulliparous or 4-5cm in a multiparous
- typically 3-6 hrs
- contractions are moderate to very strong, more regular, 12-5 min lasting 40-90 seconds
- pink to bloody mucous

40
Q

GBS

A

culture @ 36-37 weeks
considered normal flora in pt not pregnant
concern about vertical transition from birth canal of mom to babe
IV antibiotics (most often penicillin G)

41
Q

what are the risk factors for GBS

A

preterm birth, PROM >18hrs, intrapartum maternal fever, positive history of early onset neonatal GBS

42
Q

HSV

A

if visible lesions not present, vag birth is acceptable
infants born thru infected vaginal are at risk of neonatal HSV

43
Q

what 2 things can be used to help HSV

A

acyclovir and valacyclovir to reduce sympt of HSV and suppress them at time of birth

44
Q

Evie is a G2P1 that presents to L&D at 38 weeks and 4 days. they believe that their “water has broke”

How do u confirm rupture of membranes?

A

FERN test: look at amniotic fluid under microscope and it looks like a fern that’s how you know its amniotic fluid** This is the gold standard
Sterile speculum exam will show any pooling of fluid
Nitrozene swab assess pH of fluid - if the individual is bleeding at all or had intercourse at all in the last 24 hours it can give false positives
If change in pH of fluid it will turn to a blue-ish green

Frequency of vaginal exams can increase the risk of infection.

44
Q

during labour does cardiac output increase or decrease

A

increase

44
Q

how to assess for rupture of membranes

A

pt may report sudden gush or slow leak

COAT
1. colour
2. odour
3. amount
4. time

  • sterile speculum examination
  • nitrazine or fern test to confirm ROM
45
Q

during labour what happens to HR and RR

A

increases slightly

46
Q

what happens to bp during labour

A

increase during contractions and return to baseline between contractions

47
Q

what happens to WBC during labour

A

increase

48
Q

what happens to temp in labour

A

slightly increased

49
Q

what happens to proteinuria during labour

A

up to 1+ may occur

50
Q

what happens to gastric mobility in labour

A

decreased, N&V in active pahase

51
Q

what happens to blood glucose levels in labour

A

decrease

52
Q

what happens to endorphins in labour

A

raise pain threshold and produce sedation

53
Q

how does fetal o2 do at labour

A

pressure decreases

54
Q

what happens to fetal arterial carbon dioxide pressure at labour

A

increases

55
Q

what happens to arterial fetal pH at labour

A

decreases

56
Q

what happens to bicarbonate levels to fetus during labour

A

decrease

57
Q

what happens to fetal respiratory movements during labour

A

decrease

58
Q

stage 2 labour

A
  • begins w full dilation (10cm) and complete effacement and ends w birth of baby
  • 2 phases: passive and active
  • duration is influenced by parity, maternal size, fetal wt, position and descent
  • median duration is 50-60 mins nulliparous and 20-30 mins multiparous clients
  • use of epidural lengthens the 2nd stage as it blocks or reduces the urge to bear down
59
Q

s/s suggesting stage 2 labour

A

urge to push or feeling need to have a bowel movement
episode of vomiting
increased bloody show
shaking extremities

60
Q

whats the Dx of FTP

A

should not be made w/o pushing for at least 3 hrs in nulliparous and 2 hrs in multiparous, if maternal and fetal conditions permit

61
Q

positions for 2nd stage labour for mom

A

side-lying, squatting, or sitting

62
Q

7 cardinal movements of mechanism of labour that occur in vertex presentation

A
  • engagement
  • descent
  • flexion
  • internal rotation
  • extension
  • restitution and external rotation
  • expulsion
63
Q

nursing care in 2nd stage of labour

A

vitals q5-30 mins
assess FHR q5mins if IA or continuous electronic monitoring in high-risk
assess contraction pattern and bearing down efforts

passive: help rest in comfortable position, conserve energy, promote progress of fetal descent by position changes
active: bearing down efforts, cleanse perineum if BM, coach to pant and breath

administer oxytocin after birth of the anterior shoulder

64
Q

stage 3 of labour

A

follows birth of baby and delivery of placenta
goal: prompt separation and expulsion of placenta
most placentas are expelled within 15 min after the birth
if longer than 30 min considered retained placenta
active management, placenta separation and expulsion are facilitated by oxytocin

65
Q

nursing care in 3rd stage labour

A
  • skin to skin and delayed cord clamping: maternal vital q15mins, assess bleeding and signs of placental separation
  • instruct the client to push when signs of placental separation: sudden gush of dark blood, lengthening of the cord, shape of uterus becomes globular
66
Q

stage 4 labour

A

1-2 hours after birth
after delivery of placenta in which the uterus effectively contacts
mother’s body functions begin to stabilize

67
Q

nursing care in 4th stage of labour

A
  • vitals q15 min for 1st hour
  • fundal assessment
  • fundal massage if fundus is boggy
  • encourage voiding and follow BMP
  • observe lochia
  • assess perineum
  • assess lacerations repair or episiotomy for REEDA: redness, edema, ecchymosis, drainage, approximation
  • encourage breastfeeding in the 1st “golden hour”
68
Q

vaginal exam are contraindicating during which of the following

  1. preterm labour
  2. placenta previa
  3. bulging membranes
  4. signs of fetal distress
A

2

69
Q

a multiparous client arrives to the birth unit 3 cm dilated, contracting approx every 6 min lasting 30 sec w moderate intensity. client is in which stage of labour.

A

stage 1: latent

NURS 372 (6 decks)

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