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69 Cards in this Set
- Front
- Back
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What is a major factor in de terming the course of birth?
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the fetal head because of its size and rigidity
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5 P's
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passenger (fetus and placenta)
passageway postion powers pschye |
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The way a passenger moves through the birth canal is determined by what?
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size of the fetal head, fetal attitude, fetal presentation, fetal lie, fetal position.
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Bones in the fetal skull
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2 temporal, 2 parietal, 1 frontal, 1 occipital
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Anterior fontanel
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larger, 3cm by 2 cm, diamond shaped. closes 16-18 months
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Posterior fontanel
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1cm by 2 cm. closes 6-8 weeks after birth
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Sutures and fontanels make the skull...
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flexible to accommodate the infant brain, which continues to grow after birth
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When does the molding shape go back to normal?
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usually within 3 days.
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Presentation
Types of presentation |
the part of the fetus that enters the pelvic inlet first and leads through the birth canal during labor.
Types: Cephalic 96%, breech3% (buttocks, feet or both), shoulder 1% |
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Presenting part definition
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part of the fetus that is closest to the internal os of the cervix. The part the examiner feels first.
Cephalic- occiput breech- sacrum shoulder- scapula |
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Fetal lie
Types |
relation of the long axis (spine) of the fetus to the mother's
Longitudinal/vertical: parallel to the mother's Transverse, horizontal or oblique: right angle to the mothers |
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a longitudinal lie is always ___ or _____
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breech or cephalic
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An oblique lie usually converts to a longitudinal OR transverse lie during labor.
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true
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Vaginal birth cannot occur when the fetus stays in a ____ lie
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transverse
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Fetal attitude
Most common |
the relation of the fetal body parts to each other.
general flexion |
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Biparietal diameter
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9.5cm is the largest transverse diameter and an important indicator of fetal head size
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Suboccipitobregmatic diameter (vertex presentation)
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9.5 cm at term, the smallest and most critical. head in flexion. This diameter allows the fetal head to pass through the true pelvis easily
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Fetal position
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the relationship of a reference point on the presenting part to the four quadrants of the mother's pelvis. 3 letter abbreviation.
1. location (L or R ) 2. Specific Presenting part (O occiput, S sacrum, M mentum/chin, Sc scapula) 3. P posterior, Anterior, Transverse |
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Station. Birth is imminent when the presenting part is at
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+4 or +5
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Engagement
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a term to indicate that the largest diameter of the presenting part has passed through the maternal pelvic brim and usually corresponds to zero.
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Engagement occurs when?
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weeks before in nullparas, and right before of during labor in multiparas.
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physiologic retraction ring
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separates the thick and upper muscular from the thin walled, passive
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Terms used to describe involuntary contractions
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intensity (strength) duration (length) frequency (from beginning of one contraction to beginning of another)
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Effacement is generally ____ in first time pregnancy before dilation. In following pregnancies they progress together
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advanced
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Full dilation
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less than 1cm to 10 cm
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How does dilation occur?
What slows dilation? |
1. by the drawing upward of the musculofibrous components of the cervix, caused by contractions.
(2) pressure exerted by the amniotic fluid Slows- scarring of cervix |
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Ferguson reflex
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the maternal urge to bear down caused when the p.p reaches the perineal floor
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secondary powers
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as soon as the presenting part reaches the pelvic floor, the contractions change in character and become more explosive. Involuntary urge to push
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Frequent changes in position relieve fatigue, increase comfort, and improve circulation
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true
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upright position
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good for contractions (effacing and dilation resulting in a shorter labor) , cardiac output
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all fours
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relieves back pressure
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lightening
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"dropping" the woman can breathe easily, less congested, but more bladder pressure
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when does lightening occur?
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nullparas- 2 weeks before term
multiparas- after contractions and true labor in progress. |
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signs preceding labor
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lightening
Braxton hicks surge of energy weight loss 0.5-1.5kg back pain membrane rupture cervical ripening bloody show urinary frequency |
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Latent
active transiton |
* Latent: more progress in effacement of the cervix and little increase in descent (0-3/4cm)
* Active: rapid dilation of the cervix and increased rate of descent (contractions about 3 minutes apart, lasing about 1 minute, dilating about 1cm/hour) dilation 4-7cm * Transition: rapid dilation of the cervix and increased rate of descent |
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the first stage of labor is longer than the second and third combined
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20 hours ir more
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mechanism of birth
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the turns and other adjustments necessary in human birth.
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7 cardinal movements of the mechanism of labor
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engagement, descent, flexion, internal rotation, extension, external rotation, expulsion
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when does engagement occur?
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when the biparietal diameter of the head passes the pelvic inlet.
In nullparous pregnancies, this occurs before onset of active labor bc strong abdominal muscles push. In later pregnancies the muscles are more relaxed so the head remains freely movable. |
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four forces of descent
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1. pressure exerted by amniotic fluid
2. pressure of fetus 3. force of contraction of the maternal diaphragm and abdominal muscles in second stage. 4. extension and straightening of fetal body |
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in first time pregnancies, descent is...
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slow but steady
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internal rotation to occiponterior position
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true
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When does extension occur?
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when the fetal head reaches the perineum for birth . occiput, face, chin
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restitution and external rotation 382
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restitution- after the head is born it returns to how it was occupied in the pelvic inlet.
The 45 degree turn realigns the infant's head with her or his back and shoulders. |
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expulsion
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after birth of the shoulders, the head and shoulders are lifted up toward the mother's pubic bone. the trunk of the baby is born by flexing it laterally in the direction of the symphysis pubis.
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Fetal heart rate
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term 140 average, range 110-160.
earlier in gestation higher, average 160 at 20 weeks |
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Fetal respirations
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Fetal lung fluid is cleared from the air passages during labor and vaginal birth
Everything decreases except carbon dioxide pressure PCO2 increases |
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Maternal changes during labor
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Cardiac Output increases 10-15 in first stage, 30-50 in second.
Temp, WBC, RR, HR BP increases (systolic in 1st, s and d in second) Glucose decreases Protenuria +1 may occur, spontaneous voiding may be difficult gastric motility and absorption of solid food is decreased, NV may occur during transition from 1st to second stage. |
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When does supine hypotension occur
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when the ascending vena cava and descending aorta are compressed.
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During labor decreased ____ and increased (hormones)
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decreased progesterone
increased estrogen, prostagladins and oxytocin |
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Involuntary first stage- expels fetus and placenta down
Voluntary- "bearing down" second stage. |
true
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the onset of true labor. maybe..
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changes in cervix, uterus and pituitary gland.
Hormones produced by the fetal hypothamlus, pituitary and adrenal cortex probably contribute. |
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visceral pain. location?
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the pain from distention of the lower uterine segment, stretching of cervical tissue as it effaces and dilates, pressure and traction on adjacent structures and nerves, and uterine ischemia during the FIRST stage of labor.
lower abdomen |
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somatic pain
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SECOND stage. intense sharp burning well localized. stretching and distention of perineal tissues and the pelvic floor, pressure against the bladder and rectum, lacerations, distention and traction on the peritoneum and uterocervical supports during contraction.
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______ is stimulated in response to pain and ____ are released
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SNS: catecholamine levels.
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Results of pain
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hyperventilation
respiratory alkalosis pallor, diaphoresis gastric acidity placental perfusion decreases Prolongs labor |
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Women with a history of _____ can experience increased pain during childbirth as a result of higher ______ levels.
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dysmenorrhea; prostaglandin
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endorphins
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endogenous opiods secreted by the pituitary glands that act on CNS and PNS to reduce pain.
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gate control theory of pain
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blocking pain, blocks the capacity of nerve paths to transmit pain. ex. hypnosis, music etc
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dick-read method
lamaze bradley |
take away pain
natural husband coached |
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When is hydrotherapy usually initiated
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In active labor 5cm to prevent prolonged labor
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intradermal water block
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injection of 0.05 to .1 of sterile water. stings for 30 seconds then back pain gone for 2hrs
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When and why are sedatives given. Examples of sedatives
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decrease anxiety induce sleep. PROLONGED latent period.
Ex. barbiturates |
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Discontinue barbiturates if birth in 12-24 hors bc of neonatal CNS depression
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true
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sedatives given with opioid analgesics
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bc of pain and depressant effects
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systemic analgesia
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cross maternal blood brain barrier and the placenta. one reaches the fetus, it crosses the fetal bbb more readily than the motherly bbb
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Naloxone (Narcan) is an
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opioid antagonist...
that blocks kappa and mu from opioid agonists |
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pudendal nerve block
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2nd stage. if episiotomy, forcep or vaccum needed
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local perineal infiltration anesthesia
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episiotomy or suture of lacerations if woman does not have regional anesthesia
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