maternity/OB nursing questions – Flashcards
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What factors effect labor?
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Passenger Passageway Powers Position of mom Psychologic responses
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What is the passenger in labor and what factors effect the passenger?
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baby and placenta, both travel through the passageway= birth canal SLAPP effects the passenger
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what is SLAPP?
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Size of baby's head Lie of fetus Attitude of fetus Position of fetus Presentation of fetus All of these effect the passenger passing through birth canal
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How does the fetus lie effect birth?
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it's spine's relation to the mom's spine. Is the spine of the baby parallel to the spine in either a cephalic presentation of breech presentation or is the spine of the baby transverse to the mom's spine.
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What does it mean if the fetus is in transverse lie?
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There can be no vaginal birth if the fetus does not move out of transverse lie. Ideally we want the baby to move into vertex presentation
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How does the fetus attitude effect birth?
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the relation of the baby's body parts to each other. Normal attitude is general flexion, this is the position of all the baby's body parts in ideal relation to eachother. if not in general flexion birth may be harder.
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what is general flexion?
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The ideal fetal attitude. It is when: -the head of the baby is flexed with chin to chest - thighs flexed to abdomen - legs are flexed at the knees - arms are crossed over thorax - umbilical cord is inbetween legs If there is a deviation from this ideal, for example if head is presenting part and it is extended rather then flexed to chin then the diameter of the head may exceed the limits of the mom's pelvis.
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What critical diameters are the baby's head are usually measured?
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- biparietal diameter which is the LARGEST transverse diameter and will help tell the size of the fetus' head. - suboccipitobregmatic diameter which is the SMALLEST anteroposterior diameter
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normal biparietal diameter at term
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9.25 cm is the transverse diameter of the fetus' head.
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normal suboccipitobregmatic diameter at term
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9.5 cm pg 541
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how does presentation effect labor
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refers to the part of the baby that enters pelvic inlet first. Ideal is cephalic presentation, specifically with occiput presenting
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what does vertex mean?
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a type of presentation when the occiput of the head is presenting
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How does fetal position effect labor?
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Tells us how the presenting part of the baby relates to 4 quadrants of the mom. 3 letters are used to indicate the position
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what is the most common position?
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LOA and ROA
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How to indicate position
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1) The first letter means that the presenting part (think target) is facing the R or L 2) The second letter for the specific presenting part - O= occiput - S= sacrum - M= mentum (chin) -Sc= scapula (shoulder) 3) The third letter is for the relation of the anterior, posterior, or transverse portion of the maternal pelvic
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What does station mean?
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Tells us how far the presenting part of the fetus has descended through the pelvis. Station 0 corresponds to the level of the ischial spines, everything above 0 is - and everything below 0 is +
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Fetal position vs fetal station?
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One is the relation of the presenting part to the mom's 4 quadrant pelvis. Uses 3 letters to describe. One is the way to describe the level of decent of the presenting part of the fetus. Uses - and + numbers to denote.
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What are the 3 types of breech?
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1) complete breech- butt down in the fetal position 2) frank breech- butt down with lefts extended up instead of flexed 3) footling- butt down with one leg extended and one leg flexed
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What is suboccipitobregmatic diameter
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smallest anterior-posterior cephalic diameter
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What characteristics of the moms body must be assess early in pregnancy?
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The shape of her pelvis
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What is the most common and best for child birth pelvic shape?
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Gynecoid
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What soft tissue changes occur during labor and birth?
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Cervix (neck): Ripens, thins, shortens (effaces) and dilates to allow the presenting portion to descend down. Uterine body: separates into a thick muscular supportive upper segment and a thin passive muscular lower segment and a retraction ring that separates the 2 segments. The upper segment allows for uterine contractions to push strongly from above the baby. The lower segment accomodates and distends.
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What type of powers are there?
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1) primary = involuntary 2) secondary= voluntrary
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What are primary powers, when do they occur?
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Involuntary contractions- can't help it! Body is prepping for birth. Occur at the beginning of labor, by the pacemaker in the uterine wall. Responsible for effacement and dialation to prepare for the birth.
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What are secondary powers, when do they occur?
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These are voluntary contractions or pushing powers aka "bearing down efforts" by the mom. These are expulsive contractions. They begin when the presenting part of baby reaches the pelvic floor.
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Which power is associated with dilation?
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PRIMARY, secondary powers have no effect on dilation!!
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What is Ferguson Reflex?
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At one point in labor, stretch receptors in the posterior vagina cause oxytocin to be released from post pit. Oxytocin triggers the urge of the mom to bear down.
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Which stage of labor is the longest?
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Stage 1 which has 3 phases
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How long is the latent of stage 1?
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up to 16 hrs
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how long and frequent are contractions in latent phase?
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30-90 sec long and 10-30 min apart
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what is a bloody show and when does it occur?
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brown tinged mucous discharge in the latent phase (only?)
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how dilated is the cervix in latent phase?
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0-3 cm
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How much decent in latent phase?
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None
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how much effacement in latent phase?
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<50%
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characteristics of contractions in the latent phase?
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mild regular tolerable contractions. can talk through them
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Mom's mood in latent phase?
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excited, talkative, ADL's, energized, eager/anxious
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How long is the active stage?
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3-6 hours
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how long and frequent are contractions in active phase?
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q 3-5 min for 40-70 sec
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3 things contributing to the passage of the baby
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1) mom's pelvis 2) soft tissues 3) hormones
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what is a miscarriage?
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An abortion. Birth before 20 weeks gestation
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when is a baby full term?
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38-42 weeks
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what is a still birth?
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born dead after 20 weeks.
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when does true labor start?
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cervical changes (softening and dialating) and REGULAR contractions. changes in the pituitary gland are involved.
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are braxton hicks contractions a sign of true labor?
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No. They are strong but irregular contractions that PRECEDE true labor.
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what is the mom's mood in active phase?
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restless, anxious, stronger more intense contractions, and can't talk through contractions
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when does stage 1 end?
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when fully dilated!
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what are characteristics of contractions in transitional phase?
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q 2-3 minutes for 45-90 seconds
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what is the mom's mood int he transitional phase?
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fearful of being left alone, hopeless, sweating, tired, inner directed, may have urge to push. Needs a lot of encouragement!
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How to time frequency of contractions?
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from the start of one to the start of the next
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how dilated is cervix in transitional phase?
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8-10 cm
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how active should mom be after ROM?
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activity good before water breaks, after ROM best to stay in bed but TURN frequently
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why should mom be turned frequenty?
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because laying flat can cause fetal distress even if doesn't cause mom distress. moms blood pressure may drop if flat bc pressure on vena cava which can cause slowing of FHR.
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what position is best for FHR for mom to lay in?
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left lateral
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What precautions should nurse take after ROM?
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keep mom DRY and clean. A lot of infection prevention! high risk for infection after ROM bc now chance for bacteria to enter the sterile ennvironement
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when is best to give epidural?
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Latent of active phase. NOT in transitional phase- too late at that point.
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what marks end of stage 1 and beginning of stage 2?
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fully dilated to 10 cm
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what makes end of stage 2?
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birth of baby
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what is best position to be in stage 2?
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squatting position, NOT lithiotomy which is most common
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how long is stage 2?
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few minutes to few hours
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what is open glottis pushing?
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NOT holding your breath while pushing. it's good for oxygenation of fetus.
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what is stage 3?
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birth of placenta. usually happens very quickly after birth
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what happens to mom's body during stage 3
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cramping will happen as the uterus pushes out placenta. placenta usually easily slides out
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stage 4 of labor
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hemostasis. mom's body is stabalizing and hemodynamic changes: blood vessels in uterus are contricting to avoid postpardum hemmorhage from placenta detaching from uterus wall.
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Effacement in phases of stage 1
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latent phase- 0% effaced active phase- 50% effaced transitional phase- 50-100% effaced
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averge delivery time for nullpara
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1 hr (??)
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longest pushing time allowed?
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3 hrs
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how long does the placenta have to be delivered?
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30 min
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what are the positional changes the fetus goes throughf in 2nd stage?
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decent flexion internal roataion (baby turns from side to back of mom, face down when born) extension (head up and out) restitution and external roataion (to push shoulders out) expulsion
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what is a nuchal cord?
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when its wrapped around babys neck
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what are the 2 sides of the placenta that can be delivered during stage 3?
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Either the shiny schultze side will be delivered first or the dirty duncan side.
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what happens to the uterus in the 3rd stage?
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it contracts to expell placenta and shrink back to normal size it becomes spherically shaped and rises up in the abdomen
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how long does the 4th stage of labor last?
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about 4 hrs after placental birth
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what does mom experience in the 4th stage?
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chills, shivering, cramping lochia rubra
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what is going on with the uterus in the 4th stage?
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should become firm and shrink to 10-15 min in diameter
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where can the uterus expected to be located in the 4th stage?
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at the level of the umbillicus
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what is a prolapsed cord?
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cord compression in the cervix, the cord is the presenting part
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why is a prolapsed cord a problem?
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causes compressing of the cord which is the source of blood flow to the fetus
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what will the FHR monitor show if there is a prolapsed cord
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fetal bradycardia with variable dcellerations during UC
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what should be done after ROM to determine if possible prolapsed cord?
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check FHR monitor for signs of distress do vag exam and palpate for pulsations of the cord
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if a prolapsed cord is felt during vaginal exam what should the examiner do? (review pg 552)
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DONT TAKE HAND OUT. keep hand in and try to push the cord back have patient put on call light put mom on hands and knees and put head down
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risk factors for a prolapsed cord
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-presenting part not well engaged -breeched position - ROM - presenting part is balottable (free floating)
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what is the only certain objective sign that the second stage of labor has begun?
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Inability to palpate the cervix duinrg a vag exam because there is totaly effacement and dilation
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premonitory signs of labor
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-low dull backache -bloody show -GI changes - weight loss - nesting - ROM -lightening happens 14 days before labor -braxton hicks contractions
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What is infant mortality rate?
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How many babies have died within 12 months of life per 1000 births
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What is neonatal mortality rate?
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How many babies less than 28 days old (aprox 1 mo) have died per 1000 births
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What is fetal mortality rate?
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How many stillborn deaths per 1000 live births. Stillborn = after 20 wks gestation Miscarriage= before 20 wks gestation
