Essential Factors And Processes Of Labor

Front 1

What are the "four P's" that affect the progress of labor?

Back 1

1. Passage: size, shape of pelvis, abilities of the cervix
2. Passenger: fetal head size, attitude, lie, presentation and position
3. Powers: frequency, duration and intensity of contractions, force of pushing
4. Psyche: mother's preparation (physical, emotional), experiences, support, etc.

Front 2

What factors of the baby affect labor?

Back 2

Fetal head size and rigidity, molding

Front 3

What are fontanels?

Back 3

membrane filled spaces where the fetal skull sutures intersect
1. Anterior: diamond shaped, closes at 18 months
2. Posterior: triangular, closes at 12 weeks

Front 4

What is molding?

Back 4

the adaptation in the size and shape of the fetal head as it passes through the maternal pelvis during labor

Front 5

What does fetal presentation mean?

Back 5

part of the fetus that enters into the maternal pelvis

Front 6

In what position are 95% of all fetuses?

Back 6

cephalic/ vertex

Front 7

Breech presentation account for ___% and include what?

Back 7

4%
frank breech, complete breech, footling (single and double) and incomplete

Front 8

What is fetal lie?

Back 8

Relationship of the long axis (spine) of the fetus to the long axis (spine) of the mother

Front 9

What types of fetal lie are there?

Back 9

1. Longitudinal/vertical: fetal and maternal spines parallel (vertex or breech)
2. Oblique: slight angle
3. Transverse: horizontal
NOTE: oblique and transverse lies prevent vaginal delivery; can convert during labor

Front 10

What is fetal attitude?

Back 10

Relationship of the fetal parts to each other, usually flexion or extension, determines the part of the head and diameter of the skull that presents

Front 11

What fetal attitude does the fetus normally assume?

Back 11

flexed position

Front 12

If the head is flexed what presents first?

Back 12

Occiput

Front 13

If the head is extended what presents first?

Back 13

brow presents

Front 14

If the head is hyperextended what presents first?

Back 14

chin/ mentum

Front 15

What is fetal position?

Back 15

relationship of the presenting part to the 4 quadrants of the mother's abdomen

Front 16

What do the letters in the 3 letter fetal position abbreviation stand for?

Back 16

1. Location of the presenting part in the R or L side of maternal pelvis
2. Presenting part of the fetus (O, S, M, Sc)
3. Location of presenting part in relation to the anterior (A), posterior (P) or transverse (T) portion of the maternal pelvis

Front 17

When a baby is in the cephalic presentation, what are the options for position (3 letter abbreviations)?

Back 17

ROP: right occiput posterior
LOP: left occiput posterior
ROA: right occiput anterior
LOA: left occiput anterior
NOTE: OP's are more difficult to deliver

Front 18

Fetal descent consists of engagement and station. What are these?

Back 18

Engagement: when the widest transverse diameter of the presenting part passes through the pelvic inlet
Station: level of the presenting part of fetus in relation to the ischial spines in the mid-pelvis. Presenting part level with ischial spine= 0 station, -1 to -3 above ischial spine, +1 to +3 below ischial spines

Front 19

How do you determine fetal descent, position, etc?

Back 19

Abdominal inspection and palpation, vaginal exam, fontanels, sonography

Front 20

What are the 4 basic types of pelvis?

Back 20

1. Gynecoid: 50%, round, typically female
2. Android: 23%, heart shaped, typically male (vaginal delivery difficult due to narrow dimensions
3. Anthropoid: 24%, oval
4. Platypelloid: 3%, flat
NOTE: gynecoid and anthropoid are good for delivery, some women have pelvises with a combination of characteristics

Front 21

What are the 4 pelvic planes?

Back 21

1. Pelvic inlet
2. Pelvic canal/ cavity
3. Pelvic outlet
4. Suprapubic angle
NOTE: the plane of least dimensions is the narrowest section of the pelvis

Front 22

What is cephalopelvic disproportion (CPD)?

Back 22

fetal size, fetal position, and pelvic architecture are not favorable for vaginal delivery, the head is too big! Sometimes don't know this until well into labor

Front 23

What is the primary power of labor?

Back 23

Uterine contractions: periodic, rhythmic shortening or tightening of the uterine muscle in response to a stimulus

Front 24

What are the components of uterine contractions?

Back 24

the timing, frequency, duration (length 30-90 seconds), and intensity (strength, mild, moderate or strong to palpation)

Front 25

Frequency of uterine contractions

Back 25

time between beginning of one UC to the beginning of another, need 2-3 minutes for delivery. NOTE that during contraction baby is not getting blood flow

Front 26

What is resting tone?

Back 26

Resting between contractions (uterus does not completely relax)

Front 27

During pregnancy what is the rate of blood flow to baby?

Back 27

600cc/ minute

Front 28

How do you tell the intensity of contractions?

Back 28

Palpate the fundus. Mild will feel like your cheek, moderate feels like chin and strong feels like forehead. The lower portion of the uterus will be more relaxed to facilitate cervical change

Front 29

How does the uterus change with contractions?

Back 29

1. Upper portion becomes thicker and more powerful (shortened myometrial fibers)
2. Lower portion becomes thinner, softer, and more relaxed (lengthened myometrial fibers)

Front 30

What are the purposes of uterine contractions?

Back 30

1. Efface and dilate the cervix
2. Facilitate descent and rotation of fetus
3. Cause the separation and expulsion of the placenta
4. Maintain homeostasis of the uterus by compressing blood vessels post-partum

Front 31

What is effacement?

Back 31

The shortening and thinning of the cervix, expressed in percent.
In primip effacement begins before dilation, in multip dilitation and effacement happen together
1 inch thick is not effaced (0%)
Paper thin is 100%

Front 32

What is a normal cervical length mid-pregnancy?

Back 32

4 cm

Front 33

What is a marker for pre-term labor?

Back 33

short cervix

Front 34

What is dilation?

Back 34

opening and enlargement of the external cervix caused by the retraction of the cervix into lower uterine segment due to uterine contractions and pressure of amniotic fluid
Measured in cm from 0-10

Front 35

What maternal position during labor decreases cord compression?

Back 35

Lateral

Front 36

Why is it good to ambulate during labor?

Back 36

Shorter labor, less anesthesia, and have greater satisfaction with the experience. Gravity, increased intensity of UCs, decreased cord compression and maternal cardiac output

Front 37

What two components must be present to be in labor?

Back 37

1. Regular uterine contractions
2. Cervical change (this could start a few weeks before labor)

Front 38

What signs precede labor?

Back 38

1. Lightening/ dropping: fetal presenting part descends into pelvis
2. Bloody show: mucus plug, cervical change
3. Braxton-hicks contractions: practice
4. Weight loss: 1-3 lbs
5. Surge of energy, nesting
6. Cervical ripening: softens and effacement
7. SROM

Front 39

Parturition cascade theory of labor

Back 39

Latest theory, instead of an active process involving stimulants, labor may be promoted as a result of the removal of inhibitory effects of pregnancy on the uterus, involves FETAL, MATERNAL, and PLACENTAL factors

Front 40

What are the four stages of labor?

Back 40

1. First stage: labor. latent (0-3 cm), active (4-7 cm), transition (8-10 cm)
2. 2nd stage: complete to delivery
3. 3rd: delivery of placenta
4. 4th immediate pp period

Front 41

What are the 7 cardinal movements of labor?

Back 41

1. Engagement
2. Descent
3. Flexion
4. Internal rotation
5. Extension
6. Restitution
7. External rotation
8. Expulsion
yup, that is 8...?

Front 42

Engagement

Back 42

biparietal diameter of the fetal head passes the pelvic inlet

Front 43

Descent

Back 43

progressive downward movement, pressure of the amniotic fluid, pressure of uterine contractions, bearing down of the woman during 2nd stage, extension and straightening of the fetal body

Front 44

Flexion

Back 44

natural attitude of the fetus, causes the smallest portion of the fetal head to present to the maternal pelvis

Front 45

Internal rotation

Back 45

Fetal head usually enters the pelvis in a transverse of oblique position, 45-90 degree rotation of fetal head into a OA or OP

Front 46

Extension

Back 46

flexion of the head continues crowning, caused by downward pressure, base of occiput passes under symphysis pubis and causes the head to extend, brow, face and chin move past the sacrum and coccyx, fetal head into OA position

Front 47

Restitution

Back 47

head delivered OA position, shoulders remain oblique or transverse, head rotates to R or L, rotation direction depends upon original position of head

Front 48

External rotation

Back 48

fetal body rotates so that shoulders are in a anteroposterior position

Front 49

Expulsion

Back 49

delivery of anterior shoulder under sympnysis pubis, delivery of posterior shoulder and body

Front 50

What is the max weight we want a woman to gain during pregnancy?

Back 50

25 lbs

Front 51

What are some signs of true labor?

Back 51

Walking increases UC intensity
UCs at regular intervals
Show is often present
Cervical change
Does not stop with sedation

Front 52

What are some signs of false labor?

Back 52

No change in UC intensity with walking
Irregular UCs
No show
No cervical change or very small change/ thinning
Stops with sedation

Front 53

What prenatal data do you need to gain during admission?

Back 53

Weight gain during pregnancy
Past and present OB history
EDD/EGA
Blood type and Rh factor

Front 54

What information do you need to get during admission interview?

Back 54

SROM (color, amount, time)
Fetal movement (tells us if baby is getting enough O2)
Uterine contractions
Bloody show
Birth plan

Front 55

What information do you need to get upon admission from exam and labs?

Back 55

Cervical exam, fetal presentation (leopold's, US, cervical exam), urine (protein, ketones, glucose), Hgb, Hct, blood type

Front 56

Where on the mother do you place the monitor's?

Back 56

Over fundus for contractions, over lower half of abdomen for fetal heart rate. If heartrate is not in that location think about breech or transverse position.

Front 57

How do you assess for SROM?

Back 57

Use Nitrazine and Ferning
Vaginal secretions are slightly acidic (<5.0) and amniotic fluid (AF) is alkaline (>6-6.5) so if AF the nitrazine paper will turn blue. False positives may be due to blood, semen, vaginitis. Alternatively, spread fluid on slide, dry, amniotic fluid crystallizes into a fern leaf pattern under microspcope

Front 58

What admission data do you need to collect about the fetus?

Back 58

20 minute EFM tracing, fetal heart rate (external or internal)

Front 59

What ongoing assessment need to be performed on a laboring woman?

Back 59

Cervical exam (limit with ROM)
I &O
Pain
Membrane status
Check for cord prolapse, FHR, infection

Front 60

When should pushing begin?

Back 60

With the urge to push after cervix is completely dilated

Front 61

What type of pushing is best?

Back 61

Open glottis pushing is better for the baby, 6-7 seconds in response to urge

Front 62

What is laboring down?

Back 62

When the cervix is dilated but the baby is high, let the contractions push the baby down and then start maternal pushing

Front 63

What is crowning?

Back 63

portion of presenting part is visible at introitus, intense rectal pressure, sensation of stretching, tearing, burning. Ready to deliver when rocking stops.

Front 64

What is fundal pressure?

Back 64

Pushing on the fundus to facilitate delivery, VERY BAD!! Can cause uterine rupture or injury to the baby

Front 65

Nuchal cord

Back 65

cord around the neck

Front 66

Shoulder dystocia

Back 66

Anterior shoulder lodged under symphysis pubis