Mod 2 Maternity and Peds Chapter 13

  1. What factors influence labor?
    • uterine stretch
    • progesterone withdrawal
    • increased oxytocin sensitivity
    • increased release of protaglandins
  2. Estrogen-to-progesterone ratio theory of labor is the belief that labor is initiated how?
    in last trimester, estrogen levels increase and progesterone levels decrease; this leads to increase in myometrium gap junctions; gap junctions are proteins that connect cell membranes and facilitate the coordiantion of uterine contractions and myometrial stretching
  3. Oxytocin, estrogen, and prostaglandins increase and lead to contractions, cervical softening, gap junction induction, and myometrial sensitization, which leads to progressive cervical dilation.
  4. Prostaglandins increase secondary to what in the last trimester?
    increase in estrogen
  5. Prostaglandins are produced where?
    in the decidua and fetal membranes
  6. Premonitory signs of labor
    • Cervical changes
    • Lightening
    • Increased Energy Level
    • Bloody show
    • Braxtion Hicks contractions
    • Spontaneous Rupture of Membranes
  7. When do cervical changes begin to occur in preparation for labor?
    1 month to 1 hour before labor begins
  8. What shape changes does the cervix make as labor approaches?
    from an elongated structure to a shortened, thinned segment
  9. What is lightening?
    when the fetal presenting part begins to descend into the maternal pelvis
  10. When does lightening occur in primiparas? multiparas?
    • primiparas- 2 weeks or more before labor begins
    • multiparas- may not occur until labor
  11. How soon before labor is there an increased energy level and what is thought to be the cause?
    increase energy level 24 to 48 hours before onset of labor and is a result of an increase in epinephrine release caused by a decrease in progesterone
  12. What is bloody show?
    the mucous plug that fills the cervical canal dureing pregnancy that is expelled as a result of cervical softening and increased pressure of the presenting part
  13. What is the difference in braxtion hicks contractions and real labor contractions?
    • braxton hicks occur primarily in the abdomen and groin and gradually spread downward before relaxing; they are irregular and can be decreased by walking, voiding, eating, increasing fluid intake or changing position; they usualy last about 30 seconds and can last up to 2 mins
    • Real contractions occur in the lower back and are regular and are not decreased by any activity.
  14. Infants born between 34-36 completed weeks of gestation are identified as what?
    late preterm
  15. What are the risks or dangers following the rupture of the amniotic sac?
    • barrier to infection is gone and an ascending infection possible
    • danger of cord prolapse if engagement has not occured with sudden release of fluid and pressure with rupture.
    • notify healthcare provider immediately
  16. True labor contractions bring about what?
    cervical dilation and effacement
  17. Names of contractions that do not contribute to birth?
    • braxton hicks
    • false labor
    • prodromal labor
  18. Factors affecting the labor
    The five P's

    • Passageway (birth canal)
    • Passenger (fetus and placenta)
    • Powers (contractions)
    • Postion (maternal)
    • Psychological Responses

    The 5 additional P's

    • Philosopy (low tech , high touch)
    • Partners (support caregivers)
    • Patience ( natural timing)
    • Patient preparation (childbirth knowledge base)
    • Pain Control ( comfort measures)
  19. What happens the pelvis as the pregnancy progresses?
    Hormones relaxin and estrogen cause the connective tissue to become more relaxed and elastic and cause the joints to become more flexible
  20. Which part of the bony pelvis does the fetus travel through during the birthing process?
    the true pelvis
  21. What three planes make up the true pelvis?
    the inlet, the mid-pelvis, and the outlet
  22. What happens to the fetus as it passes through the mid-pelvis?
    the fetus' chest is compressed causing lung fluid and mucus to be expelled and removes the space occupying fluid so that air can enter the lungs wth the newborn's first breath
  23. What part of the pelvis must be measured to ensure adequate space for the fetus to pass through.
    Pelvic oulet
  24. List the four main pelvic shapes.
    • gynecoid
    • anthropoid
    • android
    • platypelloid
  25. Which pelvic shape is considered the true female pelvis and occurs in about 50% of all women?
    Gynecoid pelvis
  26. This pelvic shap is the second most favorable and is common in men and occurs in 20 to 30% of women; is oval and the sacrum is long producing a deep pelvis?
    anthropoid pelvis
  27. This pelvic shape is considered the male-shaped pelvis and is characterized by a funnel shape and occurs in about 20% of women; is heart shaped and posterior segments are reduced in all pelvic planes; failure of fetus to rotate is common; prognosis for labor is poor?
    android pelvic
  28. Least common pelvic shape occuring in 5% of people and women usually require a cesarean birth?
    Platypelloid or flat pelvis
  29. What are the soft tissues of the passageway?
    • cervix
    • pelvic floor muscles
    • vagina
  30. What is effacement?
    the cervix effaces (thins) and dilates (opens) to allow the presenting fetal part to descend into the vagina.
  31. What is fetal attitude?
    degree of body flexion
  32. What is fetal lie?
    relationship of body parts
  33. What is fetal presentation?
    first body part
  34. What is molding of the fetal skull and how does it happen?
    the elongated shape as a result of overlapping cranial bones; happens as the fetus passes through the pelvis
  35. What is caput succedaneum?
    when fluid collects under the scalp
  36. What is cephalohematoma?
    when blood collects beneath the scalp
  37. Caput succedaneum swelling crosses suture lines and disappears within 3 to 4 days. Also called edema of the scalp.
  38. With cephalhematoma the collection of blood is between the periosteum and the bone; it does not cross suture lines and is generally reabsorbed over the next 4 to 6 weeks.
  39. Which fontanelle is the famous soft spot?
    anterior fontanelle
  40. Which fontanelle is diamond-shaped and is 2-3 cm and closes at about 12 to 18 months of age?
    anterior fontanelle
  41. Which fontanelle is triangular closes within 8 to 12 weeks after birth and measures 0.5 to 1 cm at its widest?
    Posterior fontanelle
  42. What are the two most important diameters of the fetal skull that affects the birthing process?
    • suboccipitobregmatic (approximately 9.5 cm at term)
    • biparietal (approximately 9.25 cm at term )
  43. What is the best position of the fetus for the smallest skull dimensions for optimal vaginal birth?
    flexed position in which the chin is resting on the chest
  44. The most common and most favorable fetal attutide is what?
    all joints flexed ---back rounded, chin on chest, thighs flexed on abdomen, legs flexed at knees
  45. Fetal lie refers to the relationship of the long axis (spine) of the fetus to the long axis (spine) of the mother.There are two primary lies; what are they?
    • longitudinal (which is the most common)
    • transverse
  46. What is longitudinal lie?
    when the spine of fetus is parallet to that of mother
  47. What is a tranverse lie?
    • when spine of fetus is perpendicular to the spine of mother
    • fetus cannot be delivered vaginally
  48. What are the three main fetal presentations?
    • cephalic (head first)
    • breech (pelvis first)
    • shoulder (scapular first)
  49. Variations of the cephalic presentations are called?
    • vertex presentation
    • military presentation
    • brow presentations
    • face presentation
  50. Dangers of breech presentation include:
    • fetus skull becoming hung up as it passes through last
    • the umbilical cord can become compressed between the fetal skull and the maternal pelvis after the fetal chest is born
    • possible trauma to head as a result of the lack of opportunity for molding
  51. Types of breech presentations include:
    • frank breech (buttocks present first with both legs extended up toward the face) (50-70%)
    • full or complete breech (the fetus sits crossed-legged above the cervix) (5-10%)
    • footling or incomplete breech (one or both legs are presenting) (10-30 %)
  52. Breech presentations are associated with?
    • prematurity
    • placenta previa
    • multiparity
    • uterine abnormalities (fibroids)
    • congenital anomalies such as hydocephaly
  53. What does fetal postion describe?
    the relationship of a given point on the presenting part of the fetus to a designated point on the maternal pelvis
  54. The landmark fetal presenting parts include:
    • occipital bone (O) (vertex presetation)
    • chin (mentum {M}) (face presentation)
    • buttocks (sacrum{S}) (breech presentation)
    • scapula (acromion process {A}) (shoulder presentation)
  55. Four quandrants of maternal pelvis:
    Used to designate which way the presenting part of fetus is directed toward.
    • Right and left anterior
    • right and left posterior
  56. Postion is indicated by a three letter abbreviation. What due those letter signify?
    • first letter - R or L for whether tilted to right or left
    • second letter- particular presenting part of fetus (O, S, M, A, or D)
    • third letter- defines the location of the presenting part in relation to anterior (A) or posterior (P) or transverse(T)
  57. Fetal position LOA is most common and most favorable. Followed by ROA. What is LOA? ROA?
    • Left occipitoanterior
    • Right occipitoanterior
  58. What is the fetal station?
    station refers to relationship of the presenting part to level of the maternal pelvic ischial spines; it is measured in centimeters and is referred to as a minus or plus, depending on it location above or below the the ischial spine; minus is above and plus is below; plus being closer to birth
  59. What is fetal engagement?
    signifies the entrance of the largest diameter of the fetal presenting part ( usually the fetal head) into the smallest diamter of the maternal pelvis; fetus is said to be engaged when the presenting part reaches 0 station.
  60. What is meant by the term floating?
    when engagement has not occurred because the presenting part is freely movable above the pelvic inlet
  61. Cardinal movements of labor
    • Engagement ( presenting part passes through the pelvic inlet)
    • descent (downward movement of the fetal head until it is within the pelvic inlet)
    • flexion ( vertex meets resistance from the cervix, the walls of the pelvis, or the pelvic floor.)
    • internal rotation ( resistance from one side of the pelvic floor causes head to rotate 45 degrees anteriorly to midline under the symphysis)
    • extension (the nucha (the base of the occiput) becomes impinged under the symphysis and causes head to extend to pass under pubic arch)
    • external rotation ( after head is born , it goes back to original position)
    • expulsion ( passage of the rest of the body is easier)
  62. Three phases of contractions are:
    • increment (build up of the contraction)
    • acme (peak or highest intensity)
    • decrement (descent or relaxation of the uterine muscle fibers)
  63. Monitor and assess what three parameters of contractions?
    • frequency ( how often occur and measured from the increment of one contraction to the increment of the next)
    • duration ( how long it lasts and is measured from beginning of the increment to the end of decrement for same contraction)
    • intensity (strength of contraction dtermined by manual palpation or measured by an internal intrauterine catheter (IUPC); measures pressure of amniotic fluid inside the iterus in millimeters of mercury)
    • intensity
  64. What is a duola?
    trained female support person for a woman during the birthing process
  65. Healthy people 2010 goals related to cesarean births
    • reduce rate of cesarean births among low risk women having their fist child to 15% of live births, from a baseline of 18 %
    • reduce rate of cesarean births among women who have had a prior cesarean birth to 63% of live births from a baseline of 72%
  66. Cesarean birth is associated with increased morbidity and mortality fo both mother and infant, as well as increased inpatient length of stay and health care costs.
  67. What is an amniotomy? and at what point can it be performed?
    artificial rupture of the fetal membranes and can be done when the fetal head is at -2 station or lower with cervix dilated to at least 3 cm
  68. What is used to induce or augment labor by stimulating uterine contractions?
    oxytocin (Pitocin)
  69. What are medical indications for inducing labor?
    • spontaneous rupture of membranes and labor does not start
    • pregnancy more than 42 weeks' gestation
    • maternal hypertension
    • diabetes
    • lung disease
    • uterine infection
  70. Maternal physiologic responses during labor?
    • Heart rate increases by 10 to 20 bpm
    • cardiac output increases by 10-15% in first stage and 30-50% in second stage of labor
    • blood pressure increases by 10-30 mm Hg during contractions
    • white blood cell count increases to 25,000 to 30,000 cells/mm3
    • resp rate increases; more O2 consumed; increase in metabolism
    • gastric motility and food absorption decrease ; increase risk of nausea and vomiting with aspiration
    • temp rises slightly
    • muscular aches/cramps
    • basal metabolic rate increases and blood glucose levels decrease because of stress of labor
  71. Fetal responses to labor include:
    • periodic fetal heart rate accelerations and slight decellerations related to fetal movement, fundal pressure, and uterine contraction
    • decrease in circulation and perfusion to fetus secondary to uterine contractions
    • increase in arterial babon dioxide pressure (PCO2)
    • decrease in fetal breathing movements throughout labor
    • decrease in fetal O2 pressure with a decrease in the partial presure of O2
  72. What are the four stages of labor?
    • dilation
    • expulsive
    • placental
    • restorative
  73. First stage of labor is divided into three phases. What are they called?
    • latent or early phase
    • active phase
    • transition phase
  74. Latent or early phase of stage 1 of labor
    • cervix dilates from 0 to 3 cm
    • contractions occur every 5 to 10 min and last 30 to 45 seconds; described as mild by palpation
    • effacement of cervix is from 0 to 40%
    • for mulliparous women this phase lasts about 9 hours and for multiparous women it lasts about 6 hours
  75. Active phase of the first stage of labor:
    • cervix usually dilated from 4 to 7 cm
    • 40-80% effacement takes place
    • this phase can last up to 6 hours for nulliparous and 4.5 hours for multiparous women
    • contractions every 2-5 minutes and last 45 to 60 seconds
    • moderate to strong contractions by palpation
    • dilation rate for nulliparous is 1.2 cm/hour and multiparous women is 1.5 cm/hour
  76. Transition phase of the first stage of labor
    • dilation slows moving from 8 to 10 cm
    • effacement from 80 to 100%
    • shortest and most difficult phase
    • lasts about 1 hour in first birth and about 15 to 30 min in successive births
    • contraction stronger, more painful, more frequent ( 1 to 2 min) lasting 60 to 90 seconds
    • ave rate of fetal descent is 1 cm/hour in nulliparous and 2 cm/hour in multiparous women
    • strong desire to push
    • should not last longer than 3 hours for nulliparas and 1 hour for multiparas
  77. Second stage of labor
    • begins with cervical dialtion of 10 cm
    • and effacement and ends with the birth of newborn
    • contractions every 2-3 min lasting 60-90 seconds
    • approx 1 hour for nullipara and half that for multipara
  78. The two phases of the second stage of labor are:
    • pelvic phase - fetal head is negotiating the pelvis, rotating and advancing in descent
    • perineal phase - fetal head is lower in the pelvis and is distending the perineum (this is when there is a strong urge to push)
  79. Third stage of labor
    begins with the birth of the newborn and ends with separation and birth of the placenta

    Two phases

    • placental separation
    • placental expulsion
  80. Signs of placenta separation from uterine wall indicating that the placenta is ready to deliver:
    • the uterus rises upward
    • the umbilibal cord lengthens
    • sudden trickle of blood is released from the vaginal opening
    • the uterus changes its shape to globular
  81. Spontaneous birth of the placenta occurs in one of two ways:
    • the fetal side first ( shiny gray side) (called Schult's mechanism or "shiny schultz's")
    • maternal side (red raw side) (called Duncan's mechanism or "dirty Duncan")
  82. What is the purpose of massaging the uterus after the placenta is expelled?
    to facilitate the firming of uterus so that uterine blood vessels constrict, which minimizes the possibility of hemorrhage.
  83. What is considered normal blood loss for a vaginal birth?
    for a cesarean birth?
    • vaginal- 500 ml
    • Cerarean - 1000 ml
  84. The fourth stage of labor
    • begins with completion of the expulsion of the placenta and membranes and ends with the initial physiologic adjustment and stabilization of the mother (1-4 hours after birth)
    • initiates postpartum period
  85. During the fourth stage the mother's fundus should firm and well contracted and is located at the midline between the umbilicus and symphysis and slowly rises to the level of the umbilicus during the first hour after birth.
  86. Describe what lochia is and what is should look like.
    vaginal discharge that is red, mixed with small clots, and moderate flow
  87. Focus during this stage is to monitor the mother for?
    • to prevent hemorrhage
    • bladder distention
    • venous thrombosis
  88. During the fourth stage the bladder is hypotonic and has limited sensation to acknowledge a full bladder or to void.
  89. Monitor vital signs, vaginal discharge, and uterine fundus how often during the fourth stage.
    every 15 min for at least 1 hour
Card Set
Mod 2 Maternity and Peds Chapter 13
Labor and Birth Process