Maternal Ch 15 - 16

Front 1

Five P's affecting labor

Back 1

Passenger (fetus and placenta)
Passageway
Powers (contractions)
Position of mother
Psychologic response

Front 2

Factors affecting the Passenger

Back 2

Fetal head size, presentation,lie,attitude,position

Front 3

A. Two most important fontanels

B. when do they close?

Back 3

A. Anterior and posterior

B. Ant: 18 mos
Post: 6-8 wks

Front 4

A.What does fetal presentation refer to

B.The fetal lie is established by what criteria?

Back 4

A. part of the fetus that enters the birth canal first

B. relation of the long axis of the fetus to the long axis of the mother

Front 5

A. What is Fetal attitude

B. What determines the presentation

Back 5

A. Relation of the fetal body parts to one another

B. The presenting part of the fetus that overlies the pelvic inlet. (occiput, sacrum, mentum (chin) or sinciput (deflexed vertex)

Front 6

What is the preferred baby presentation?

Back 6

ROA or LOA

Front 7

A. Engagement


B. What is this station termed?

Back 7

A. Term used to indicate that the largest transverse diameter of the presenting part has passed through the pelvic brim into the true pelvis.

B. Zero

Front 8

What is the passageway or birth canal composed of

Back 8

Bony pelvis, lower uterine segment, cervix, pelvic floor muscles, vagina, and introitus

Front 9

A. What do primary powers consist of?

B What do secondary powers consist of?

Back 9

A. Effacement- thinning, Dilation, Ferguson reflex

B. Bearing - down efforts ( which is more effective if the woman waits until she feels the urge to push)

Front 10

What is the Ferguson Reflex?

Back 10

Uterine contractions stimulated by cervical pressure

Front 11

What is Labor?

Back 11

Process of moving fetus, placenta,and membranes out of the uterus and through the birth canal.

Front 12

What are signs proceding labor

Back 12

Lightening or "dropping" , low back ache, increased braxton hicks, possible bloody show, burst of energy (hormone shifting)

Front 13

How many stages of labor are there

Back 13

Four

Front 14

What does the first stage consist of

Back 14

First stage - onset of regular contractions, latent phase (before 4 cm) Active phase (4-8cm) Transition phase (8-10 cm) pressure intensifies descent increases, is painful and difficult for women to control

***lasts fro beginning of dilation to full dilation of cervix***

Front 15

Second Stage of labor consists of three phases:

Back 15

1st - complete dilation w/out the urge to push

2nd - stronger contractions, fetal station advances

3rd - lasts from crowning to birth

***lasts from full dilation to birth of infant***

Front 16

Third Stage of labor consists of what

Back 16

Lasts from birth of fetus until expulsion of the placenta

Front 17

What is the fourth stage of labor

Why is this stage important

Back 17

The period of immediate recovery when homeostasis is reestablished.
***This usually lasts approx 2 hours***

Mother must be monitored closely to prevent un-noticed hemorrhage

Front 18

What are the 7 cardinal movements

Back 18

Engagement, descent (4 forces), flexion,(chin right to chest) internal rotation, extension,( after head comes under the symphysis pubis) restitution and external rotation (ant shoulder descends first), expulsion (birth)

Front 19

Fetal adaptation changes occur in which three functions

Back 19

Fetal Heart rate - normal is 110-160

Fetal circulation - umbilical cord flow is undisturbed

Fetal respiration - fetal respiratory mvmnts decrease during labor.

Front 20

Fetal Respiration changes immediately after birth are:

Back 20

1.Lung fluid is cleared from the air passages as the infant passes through the birth canal
2. Oxygen pressure (Po2) decreases
3. Arterial carbon dioxide pressure (Pco2) increases
4. Arterial pH decreases
5 Bicarbonate level decreases.

Front 21

What causes these respiration changes?

Back 21

Chemoreceptors in the aorta and carotid bodies

Front 22

What are Maternal physiological changes during Labor

BOX 15-2

Back 22

Cardiac output increases 10-15% in 1st stage, 30-50% in second stage
Heart rate increases slightly in 1st and 2nd stages
Systolic BP increases during contractions in 1st stage
Systolic AND Diastolic pressures increase during contractions in 2nd stage.
WBC count increases
Resp rate increases
Temp may be slightly elevated
Proteinuria +1 may occur
Gastric motility and absorption of solid food is decreased, n/v may occur during transition to second-stage labor
blood glucose level decreases

Front 23

When pushing women should be encouraged to use what

Back 23

The Open Glottis Method

Front 24

Pain and discomfort during labor originate from which two neurologic origins

Back 24

1. Viseral

2. Somatic

Front 25

Pain results in a._______________ effects and

b.____________and c._____________ responses,

Back 25

a.Physiologic

b.sensory

c. emotional

Front 26

Factors that influence pain response are:

Back 26

Physiologic factors
Culture
Anxiety & fear
Previous experience
Gate - control theory of pain
Comfort and support
Environment

Front 27

Nonpharmacologic management of discomfort include :

Back 27

Childbirth preparation methods,:
i.e. dick-read method,
Lamaze, bradley method.

Relaxation and breathing techniques:
imagery and visualization, music,touch and massage,accupuncture, etc.

Front 28

Pharmacological management of pain includes Sedatives,

What are some of the adverse effects?

Back 28

respiratory and vasomotor depression of mother and newborn.

And increased sedation

Front 29

Demorol or Dilaudid are agonists, this means what?

Back 29

Agonist an agent that activates or stimulates a receptor to act

Front 30

Fentanyl, hydromorphone, or meperidine are

Antagonists

What does this mean?

Back 30

An agent that blocks a receptor or medication designed

to activate a receptor

Front 31

Stadol and Nuvain are Agonist-antagonist compounds

What does this mean?

Back 31

Provide analgesia without causing respiratory

depression in the mother or neonate.

Front 32

Systemic analgesics cross the blood-brain barrier to provide central analgesic effects. They also cross the placenta which effects the newborn more profoundly and the effects last longer.

What are the effects on the fetus?

Back 32

Respiratory Depression, decreased alertness, delayed sucking

Front 33

Nerve block analgesia and anesthesia types

Back 33

Local perineal infiltration anesthesia

pudenal nerve block

spinal anesthesia (block)