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85 Cards in this Set
- Front
- Back
birthing choices. three primary options available: |
hospital birthing center home |
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the combination unit is referred to as a ________ unit.
some facilities offer single-room services which the woman labors, delivers, and receives postpartum care in one area. this arrangement is referred to as ___________________. |
mother-baby unit
labor, delivery, recovery, postpartum (LDRP) unit |
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a ________ offers childbirth outside of a hospital, but typically nearby to allow for easy access in the event of complications.
it is cost effective and is provided by nurse-midwives and physicians. eligibility for childbirth is limited to those women considered to be low risk for development of complications |
freestanding birthing center |
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women interested in a more relaxed, family centered, and relatively low cost delivery experience may consider a _______. the risk of infection also is lower. only an option for a woman in good health with a reasonable expectation of a positive outcome for both mother and baby.
must be carefully considered by all parties and must be approved by the attending physician and nurse-midwife. |
home birth |
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some of the more common (but sill unproven) onset labor theories relating to hormones are |
oxytocin stimulation progesterone withdrawal estrogen stimulation fetal cortisol |
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as early as 2 weeks before the onset of labor the woman may notice that the fetus seems to have settled, or "dropped" into the pelvis. this is called _______ and is seen most often in nulliparas.
once is has occurred, the woman often notices that urinary frequency returns. she may be able to breathe more normally because the abdominal cavity has more space. |
lightening |
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sign of impending labor, occasionally a woman may have a seepage or sudden outflow of fluid from the vagina. this may be urine, or it may be amniotic fluid, indicating a rupture of the amniotic sac. a simple test with _______ can distinguish between these. |
nitrazine paper |
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if the nitrazine paper reacts (turns blue), the discharge is probably ________. if the test is nonreactive, the membranes are probably ________. |
amniotic fluid intact |
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delivery should occur _______ hours after membranes rupture. |
18 to 24 |
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the amount of vaginal draining typically increases as term approaches, and blood-tinged mucus called _______ may be observed. this is the mucus that occluded the opening of the cervix during pregnancy. |
bloody shaw |
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irregular tightening of the pregnant uterus that begins in the first trimester and increases in frequency, duration, and intensity as pregnancy progresses.
backache and contractions of the uterus
they remain irregular and do not dilate the cervix |
braxton hicks contractions |
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true labor is marked by the onset of regular, rhythmic contractions that cause progressive cervcial dilation and ____________.
thinning and shortening or obliteration of the cervix that occurs during late pregnancy, labor, or both. |
effacement |
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contractions follow a regular pattern
contractions come closer, stronger, and tend to last longer
contractions get stronger with ambulation
contractions seem to start in the lower back and then travel to the lower abdomen
contractions are usually not stopped by controlled breathing, sedation, or other relaxation interventions
the cervix softens, effaces, and dilates
the fetus continues descent into the pelvis |
true labor |
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contractions rarely follow a pattern
contractions vary in length and intensity
contractions frequently stop with ambulation or position change
contractions maybe felt in the back, but are most often noticed in the fundus
contractions eventually stop with relaxation interventions
the cervix may soften, but there is little or no change in effacement or dilation
there is not significant change in the fetal position |
false labor |
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standard precautions during childbrith |
wash hands
don gloves when performing procedures in contact with woman's genitalia or body fluids
when assisting with birth, wear cover gown and mask with eye shield. weak cap and shoe covers for c-section births.
primary health care provider should wear sterile gown.
drape woman with sterile towels and sheets
help woman's partner put on coverings (mask, cap, gown, shoe covers)
wear gloves and gown when handling newborn
use an appropriate method to suction the newborn's airway |
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process of labor and delivery the five Ps |
passageway: pelvis and soft tissue
passengers: the fetus and placenta
powers: contractions
position of mother: standing, walking, side lying
psyche: psychological response |
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the superior position of the ______ supports the uterus and fetus during the late months of pregnancy. |
pelvis |
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these bones aid in directing the fetus into the inferior (lower) portion of the pelvis, which is called the ________. the two sections are divided by an imaginary line called the _______, or pelvic inlet. |
true pelvis
linea terminalis |
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the true pelvis is further divided into three segments: |
the inlet, the cavity or midpelvis, and the outlet. |
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the primary care practitioner can use several methods for evaluating the size of the true pelvis: |
palpation, pelvimetry, ultrasonography |
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during labor the ____, _____, ______, and _______ change is consistency and shape to allow passage of the fetus. |
uterus cervix vagina muscles of the perineum |
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at term the fetus often weighs |
7 pounds or more and is 20 to 21 inches long |
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the ______ is usually the largest part of the body, so delivery of the head is of greatest concern. the bones are not rigidly joined. this allows the bony plates to move and overlap as they progress through the maternal pelvis. |
fetal skull |
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reshaping of the skull bones in response to pressure against maternal pelvis is called |
molding |
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the major bones of the skull are two frontal bones, the two parietal bones, the two temporal bones, and the occiput. They are joined by membranous spaces called ________. |
sutures |
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where sutures meet, there are larger membranous areas called |
fontanelles |
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the _______ is formed by four bones and thus tends to be larger and diamond shaped. the _______ is formed by three bones and is smaller and triangular. |
anterior fontanelle posterior fontanelle |
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the largest transverse diameter of the skull is the __________. if this is too large, the skill may not be able to enter the mother's pelvis |
biparietal measurement |
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the relationship of the fetal body parts to one another is called |
attitude |
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at term, the ideal attitude for the fetal body is |
flexion |
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the back is bowed outward, the chin is touching the sternum, the arms are crossed on the chest, and the thighs are flexed on the abdomen. this is called the |
fetal position |
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if the fetus does not have enough room because of too little fluid (oligohydramnios), multiple pregnancies, or anatomical variations in the mother, the attitude may be altered, leading to |
complications of labor or delivery |
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the relationship of the cephalocaudal (head to buttocks) axis of the mother. |
fetal lie |
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if the spine of the fetus is parallel to the spine of the mother, the lie is called |
longitudinal |
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if the spine of the fetus is perpendicular to that of the mother, it is called ________
most common in women who have had many pregnancies, maternal pelvic contracture, or placenta previa |
transverse lie |
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that part of the fetus that first enters the pelvis and lies over the inlet
describes the part that will be in contact with the cervix.
this is determined by both attitude and lie.
in about 96% of deliveries the presentation is cephalic |
fetal presentation |
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cephalic presentation is divided into four types: |
vertex (region between the fontanelles), brow, face, and mentum (chin). |
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three types of breech presentation are possible: _______, in which the buttocks present and the thighs are well flexed on the abdomen; _______, in which the buttocks present and the thighs are extended across the abdomen and chest; and ________, in which there is no flexion and one foot or two feet present. |
complete breech
frank breech
footling breech |
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to decrease risks to the fetus, the majority of breech births are delivered |
surgically |
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the relationship of the presenting fetal part to a quadrant of the maternal pelvis. can be determined by abdominal inspection and palpation, vaginal or rectal examination, auscultation of fetal heart tones, or ultrasound or x-ray exam. once determined, it is expressed in abbreviated form. |
fetal position |
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the most common position for delivery is ______, in which the occiput of the fetus points toward the left anterior segment of the maternal pelvis. the _______ position is the next most common. |
left occiput anterior (LOA) right occiput anterior (LOA) |
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______ is dangerous because pressure on the vessels in the cord can restrict blood flow to the fetus |
cord prolapse |
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the ______ is also referred to as a passenger. after the fetus is delivered by strong uterine contractions, it's attachment site is significantly smaller. this reduced size causes it to separate from its attachment. |
placenta |
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positions to relieve pressure on cord |
modified sims, trendelenburg's, or knee-chest |
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a placenta will not easily be freed from ______ uterus because the placental attachment site is not reduced in size. |
flaccid (relaxed) |
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placental separation is indicated by the following signs |
firmly contracting fundus
change is uterus shapes
a sudden gush of dark blood
apparent lengthening of cord
a vaginal fullness noted |
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The delivery of the placenta completes the ________ stage of labor. this stage lasts 15 to 30 minutes or longer if the health care practitioner waits for the mother to express the placenta herself. |
third stage |
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after the placenta emerges, it is examined for _______ to be certain that no portion of it remains in the uterine cavity. |
intactness |
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if the _____ is not firm, stimulate the uterine muscles to regain tone and to expel any clots before measuring the distance from the umbilicus. palpate the uterus gently only until it is _____; overstimulation causes uterine muscle fatigue and results in ________. |
fundus
firm
atonia (relaxation) |
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the uterus can contract only if it is free of |
intrauterine clots |
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________ combine to expel the fetus and the placenta from the uterus. |
involuntary and voluntary contractions |
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signal the beginning of labor
originate at certain pacemaker points in the thickened muscle layers of the upper uterine segment. from the pacemaker points, contractions move downward over the uterus in waves, seperated by short rest periods.
called primary powers
responsible for the effacement and dilation |
involuntary uterine contractions |
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_______ is the enlargement of the cervical opening and the cervical canal that occur once labor has begun. the diameter of the cervix increases from less than 1 cm to full dilation (approximately 10 cm) to allow birth of a term fetus.
occurs by drawing upward of the musculofibrous components of the cervix as a result of strong uterine contractions. |
dilation of the cervix |
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full cervical dilation marks the end of the ____ stage of labor. |
first |
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in the first and second stages of labor, increased intrauterine pressure caused by contractions places pressure on the ___________. |
descending fetus and the cervix |
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stretch receptors in the posterior vagina cause release of exogenous oxytocin that triggers the maternal urge to bear down, or ________. |
ferguson's reflex |
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uterine contractions may temporarily become less frequent and intense when the woman recieves |
narcotic analgesics or epidural analgesia early in labor |
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as soon as the presenting part reaches the pelvic floor, the woman experiences an involuntary urge to push. she uses ________ (bearing down efforts) as she contracts her diaphragm and abdominal muscles, and pushes. result in increased intraabdominal pressure that compresses the uterus on all sides and increases the expulsive forces. have no effect on cervical dilation, but they are important in expelling the infant from the uterus and vagina after the cervix is fully dilated. |
secondary powers |
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spontaneous bearing down efforts
closed glottis and prolonged bearing down |
valsalva's maneuver |
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as the fetus moves through the maternal pelvis, several maneuvers are required. these turns and adjustments are called the |
mechanisms of labor |
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occurs when the biparietal diameter of the fetal head crosses the pelvic inlet; the head is said to be fixed or engaged in the pelvis. in nulliparous women, this tends to occur early, often several days or weeks before labor begins. multiparous women may not experience this until labor has started. |
engagement |
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_______ is the downward progress of the presenting part. the amount of progress is measured by comparing the lowest point of the present part to the ischial spines. this is referred to as the station and is measured in centimeters above or below the level of the spines. |
descent |
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enables the fetal head to progress through the maternal pelvis. the largest diameter of the fetal head aligns with the largest diameter of the pelvis. |
internal rotation |
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occurs when the occiput passes under the symphysis pubis. this bony structure acts as a stable point and provides leverage, enabling the head to leave the pelvis. |
extension |
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as soon as the head is delivered, it moves to realign with the body and shoulders. this is referred toas |
restitution |
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occurs as the shoulders and body move through the birth canal, using the same maneuvers as the head. the shoulders are delivered similarly to the head, with the anterior shoulder pressing under the symphysis pubis, which acts as a leverage point and assists in delivering the posterior shoulder. |
external rotation |
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begins with the onset of regular contractions and ends with complete dilation of the cervix. generally the longest stage of labor, averaging 10 to 12 hours in nulliparas and 6 to 8 hours in multiparas. this stage is often divided into three phases: early latent stage, middle or active phase, and transitional phase. |
first stage: dilation |
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begins with complete dilation at 10 cm and ends with the birth of the baby. lasts an average 30 minutes to 2 hours in nuliparas and 20 minutes to 90 minutes in multiparas. contractions continue to lasts 80 to 90 seconds or slightly less. the woman usually feels the urge to push and is anxious to do so. restin between contractions, if possible, is important to conserve energy. primary care provider may provide anesthesia and perform episiotomy. |
second stage: delivery of the fetus |
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the _______ is a surgical incision of the perineum at the end of the second stage of labor to allow easier delivery and to avoid laceration of the perineum. the most common type is midline, or median, incision that seperates the tissues of the perineum at an anatomical junction. |
episiotomy |
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after the shoulders are delivered, the delivery ends with ________, in which the body of the infant leaves the pelvis. delivery of the body occurs rapidly once the shoulders have been delivered. |
expulsion |
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immediately after delivery the baby's ______ is established and the _______ is clamped with two clams and then severed between the clamps. if everything is normal, show baby to parents. |
airway umbilical cord |
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begins with the delivery of the infant and ends with the delivery of the placenta. the average for both primiparas and multiparas is 5 to 20 minutes. mother is less interested in the third stage; she is focused on the newborn. when placenta detaches from the uterine wall, blood suddenly pours out of the vagina. the cord protruding from the vagina lengthens, and the uterus becomes more rounded and firm. woman may again experience contractions. during this time, practitioner repairs the episiotomy if one was performed. |
third stage: delivery of the placenta |
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total blood loss during labor is normally 200 to 300 ml; it is considered excessive if more than ______ of blood is lost during delivery. |
500 ml |
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common drugs given during third stage of labor & delivery |
oxytocin (pitocin) maleate (methergine) |
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mother's body attempts to recover from the efforts of labor. the mother is monitored closely for 2 to 4 hours after delivery in the birthing room or in a recovery room. monitor physiologic changes closely. monitor vitals, uterine tone, vaginal drainage, and perineal tissue. during first hour perform 15 minute assessments. if observations are within normal limits, assessments are done every 30 minutes. |
fourth stage: stabilization |
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_______ is a good indicator of the fetus condition. |
Fetal heart rate (FHR) |
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the normal FHR range is ____ to _____ bpm. an increase or decrease of ______ bpm may indicate fetal distress and should be reported immediatley. |
120 to 160 bpm 30 bpm |
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auscultate the FHR, using a ______ , every 15 to 30 minutes the first stage of labor and every 5 minutes during the second stage. |
fetoscope or doppler |
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can detect subtle changes of condition before they can be recognized by auscultation. |
electronic fetal monitoring |
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an ______ uses high frequency sound waves to reflect movement of the fetal heart ventricles. |
ultrasound transducer |
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FHR is monitored in relation to the contractions. A decrease in FHR occurs in response to the contractions and is called a _________.
can be early, late, or variable. |
decelerations |
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if the amniotic membranes have not ruptured, the primary care practitioner may use a sterile hook-shaped instrument to open the sac and allow the fluid to drain; this procedure is called an _________.
artificial rupture of the fetal membrane. |
amniotomy |
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_____ are spoonlike device that fits around the fetal head to aid in expulsion. closely monitor the FHR. |
forceps |
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is defined as labor that lasts less than 3 hours from the onset of contractions to the time of birth. may result from hypertonic uterine contractions that are tetanic-like in intensity. maternal and fetal complications can result. |
precipitous labor |
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monitors uterine activity and records frequency and duration of contractions. |
tocotransducer |