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232 Cards in this Set

  • Front
  • Back
descent of presenting part as it becomes engaged. It may be gradual or sudden.
lightening is much more likely to be noticeable with primigravidas ___-___wks before labor.
lightening will generally occur about ___-___ days prior to labor
________ occur throughout pregnancy, no cervical change
braxton hicks
Cervical changes: prior to labor the cervix is ___, relatively ____ and _____. As labor approaches, it becomes ____, _____ and may slightly ______. These biochemical changes are referred to as :
long, firm, closed.

softer, shorter, dilate

ripening of the cervix
with effacement and dilation, it is loosened and expelled causing a small amt of breakage of capillaries in the cervix.
mucous plug
why is there an increase in mucous secretions?
pressure of fetal head
what color should the bloody show discharge be?
light pink
what is abnormal for the bloody show to be?
frank bleeding with d/c of the plug
what are the 4 p's affecting pregnancy?
what is the largest part of the passenger?
fetal head
sutures allow for overlapping which permits the head to decrease in size when the head passes through the pelvis
when is molding of the head usually returned to normal shape?
within 3days
_______ diameter is the largest of the transverse diameters (9.25cm)
fontanels form where?
suture intersections
this is the relationship between the maternal long axis and fetal long axis
fetal lie
99% of the time, what type of fetal lie is the baby in?
longitudinal (mom and baby's spine are parallel)
______ lie: baby's spine is sideways to moms spine
transverse lie
________lie: fetal spine diagonal to mom's spine
relationship of various parts of the fetus to itself.
fetal attitude
3 types of fetal attitude:
flexed (normal)
Deflexed: head extended
military (head straight on)
presenting part of portion of fetus that enters pelvis first
fetal presentation
96% of the time, the fetal presentation is:
vertex/cephalic: head, occiput
This is the most common type of breech. the legs are completly extended across abd.
upside down normal: all parts flexed to abd but buttocks are coming first
full/complete breech
this type of breech is when one or both feet present first
footling breech
this is the relationship between the fetal part and pelvis
fetal position
what abbreviation is used for occiput?
what abbreviation is used for brow?
what abbreviation is used for face/chin?
M (mentum)
what abbreviation is used for shoulder/scapula?
what abbreviation is used for sacrum/breech?
The fetal position is described how?
in 3 letters
What does the first letter refer to? (fetal position)
which side of maternal pelvis: R or L
what does the second letter refer to? (fetal position)
fetal part presenting
what does the third letter refer to (with fetal position)
quadrant of maternal pelvis: anterior/posterior/transverse
Posterior positions such as LOP/ROP cause:
back labor
ineffectual UC's
prolonged labor
you should not do leopold's maneuver until
the 1st leopold's step:
what's in the fundus?
Feel the fundus to locate th buttocks. (they should feel:
smooth, firm, nonballotable
step 2 of leopolds maneuvers:
where's the back?
step 3 of leopold's maneuvers:
what is the presenting part, what is at the symphysis?
with step 3 of leopold's maneuvers, grasp above the pubic symphysis. The head should be
hard and independently mobile
step 4 of leopolds determines :
the attitude
if the baby is presenting vertex, the FHTs (fetal heart tones) will be where?
lower quadrants
if the baby is in a breech position, the FHT will be where?
above umbilicus
when the presenting part is at the level of the ischial spines
relationship between the maternal ischial spines and presenting part
4 types of pelvis's
this is the typical female pelvis (ideal for childbirth).
the ___________ pelvis is well rounded, forward and back
this is a typical male pelvis. It is heart shaped. (shallow posterior portion/pointed anterior)
this type of pelvis is fairly common. It is narrow transverse/longer ap (anterior posterior)
this type of pelvis is oval and smooth/shallow ap (anterior posterior)
the pelvic joints are:
symphysis pubis
r and l sacroiliac jts
sacrococcygeal jt
what increases the mobility of jts?
hormones (progesterone)
the bony pelvis is assessed by clinical pelvimetry:
vag exam. bones palpated with fingers
when should the bony pelvis be assessed?
early pregnancy and in labor
(AP diameter) This is the distance between the lower border of the symphysis pubis and the sacrum (vag exam)
diagonal conjugate
**how do you calculate the obstetrical conjugate?
diagonal conjugate-2cm
-distance b/n inner surgace of symphysis pubis and sacrum
-shortest diameter b/n inner aspect of pubis and the sacrum
obstetrical conjugate
the _______ diameter is the greatest diameter of the pelvic inlet
biischial diameter
this is an old way of plotting the progress of labor. Should not be used as no two women labor alike.
freidman's curve
a first time mom- once at 5cm, they'll dialate :
1cm q2h
repeat mother: once at 5 cm, dialate:
1 cm q hour
thinning and shortening of the cervix
primips will efface completely
before dilation
multips dilate and efface:_______________. when does it begin?
at the same time

wks before
opening of cervical os from mm to 10cm or size of fetal head
what three things cause the cervix to dilate?
pressure of BOW
fetal head
In the uterus, the line b/n cells that contract and cells that retract
retraction ring
Upper uterine muscle cells _____ and______-uterus gets thicker
the lower uterine segment (cells) ____, ____ and ______ allowing baby to be expelled downward
differentiation b/ upper and lower segments is separated by the
retraction ring
the contraction cycle has ___ phases or parts of the muscular contraction of the uterus
_____________: longest, building of the muscular contraction, begins in fundus and spreads throughout uterus
where does the woman feel the increment part of the contraction?
anywhere, back, low cramps etc.
this is the height of the contraction, most painful
this is when the UC subsides
the length of time contraction lasts in seconds is called:
the duration of contractions in active labor:
60-90 sec
the strength of contraction by palpation
the intensity of a contraction can be :
____________:time between beginning of one contraction to the beginning of the next
(in active labor) we want the freq of contractions to be:
2-5 mins apart and regular
_______________: utilizes a tokodynamometer (pressure transducer) that picks up changes in pressure. (placed over fundus and records pressure changes)
external monitoring
what is a more accuracte way of electronic monitoring?
internal monitoring
what are the disadvantages of internal monitoring?
maternal/neonate infection
uterine perforation
internal monitoring can only be done if:
BOW is ruptured
set of maneuvers by the fetus to move through the birth canal
mechanisms of labor
what first 3 maneuvers occur virtually simultaneously?
flexion of fetal head
this mechanism of labor is when the largest diameter of presenting part is at level is ischial spines
this starts slowly and picks up through labor. it is when the presenting part moves down through the pelvis
occurs as descending head meets resistance from pelvic floor, cervix or pelvic wall so the smallest diameter passes through the pelvis.
flexion of the fetal head
when the fetal head reaches the perineum the neck acts as a pivot and the fetal head extends upwards as it passes under the symphysis pubis and the head is born
after extension, ____ ___ occurs (now shoulders and body change position into AP)
external rotation (really happens internally)
______ shoulder is delivered, followed by _____ shoulder
after the head is birthed, it rotates to either the right or left position (the position it was in when it was engaged)
Once shoulders are delivered rest of body is easily born. birth occurs when the entire body has been born
head rotates to fit AP diameter of pelvic outlet so that head passes through the pelvic cavity.
internal rotation of the HEAD ONLY
____% of bags break before labor begins
contractions become stronger with ____ and therefore the labor speeds up
rupture of membranes
role of the nurse with rupture of membranes: History:
-time of break?
-color of fluid?
-baby moving?
-cord come out?
-how much water?
role of the nurse with rupture of membranes: check fetal heart rate
make sure there is no variation in FHR
role of nurse with rupture of membranes: Check _______
role of nurse with rupture of membranes: assess color and consistency
shouldn't have consistency; no foul odor
role of nurse with rupture of membranes: Minimal vaginal exams
advocate for pt.
what test uses pH paper to confirm membranes have ruptured?
nitrazine test
nitrazine test will turn from yellow to ____ in presence of amniotic fluid
if a swab of the cervix is taken, and put on a microscope slide, it will look like _____. This is called ______ and is 100% accurate in determining ROM>
a fern
Meconium precautions: if meconium is in fluid, they have to:
wall suction the baby to prevent pneumonia
10-15% women demonstrate vena cava syndrome (hypotension, tachycardia). Place them:
in left lateral position
_____ rises with contractions and returns to pre labor level between UCs
___ decreases with UC's due to increase blood volume
strong contractions will diminish or stop flow to
uterine artery
advantage of external monitoring:
non invasive
doesn't req. ROM and fetal descent
woman's vulva is washed with antiseptic and electrode is screwed into fetal presenting part=break in continuity of the fetal skin
internal monitoring
disadvantage of external monitoring:
-not accurate
-woman must lie on back
-req. decreased maternal mvmt
transducer strapped onto maternal abd and placed over fetal back.
external monitor
this is the most reliable way of obtaining FHT
internal monitoring
risks of internal monitoring incl:
uterine infection
neonate infection
what is internal monitoring used for?
high risk labor
rate of the fetal heart b/n contractions
baseline rate
normal baseline rate of fetus is:
increase in FHR in RELATIONSHIP to contractions:
this is a sign of fetal strengh when occuring with movement
decrease in FHR in RELATIONSHIP to contractions
if early decelerations are occuring due to head compression, what should the rn do?
notify practicioner, set up for delivery
early decelerations are common:
late in labor
early decels are generally
These types of decels are due to utero-placental insufficiency and fetal hypoxia
late decels
if women is experiencing late decels, the rn should:
administer Oxygen
these types of decels are due to the compression of the umbilical cord
variable decels
if the woman is experiencing variable decels, the rn should
change her position
______ signifies fetal well being. NORMAL irregularity of the cardiac rhythm
_________>160bpm lasting for more than 10 minutes
fetal tachycardia
______ is often the first sign of fetal distress as the fetus is trying to compensate for problems
fetal tachycardia
_______tachycardia is common with movement and and isn't pathological
_________<120bpm lasting for more than 10 minutes
fetal bradycardia
Nsg care for FHR irregularities:
1. examine_______
2. shut off ______
3. administer________
4. place on _____
6. monitor ___ and for ______
7. notify _____/_____
8. record all _____
1.FHR pattern
2. pitocin
3. oxygen 7-12L/m without H2O
4. left side
5. rate of IV
6. VS/prolapsed cord
7. physician/midwife
8. procedures
the fetal blood pH should be
pH of 7.25-
acceptable (but will watch and repeat)
pH of 7.24-7.2 is
pre acidotic; repeat in 15 min (may do C/S, Vacuum)
pH below 7.2=
fetal distress; stat C/S, Vacuum
enc. to empty bladder freq. to
give more room
a full bladder will result in :
diminished/ineffective contractions
enc voiding q
what is woman is unable to void?
cath b/n contractions
hard stools in rectum will
impede descent
3 types of narcotics given to take edge off, but doesn't take pain away
when is the lumbar epidural administered?
3-4cm dilated
nursing role with epidural: position client:
knees elevated on stool
head flexed
back arched

(can lie on side with knees pulled up and back "cat arched")
how much IV fluid is given before an epidural?
500-1000mL (lactated ringers)
6-8 mins after epidural, there will be:
a long decel or variables
__________ births views birth as a trauma, and sets goal of minimizing trauma, dim lights, soft noises, warm environment
how many stages of labor are there?
Onset of labor to full dilation and effacement
first stage
full dilation to birth
second stage
birth of infant to birth of placenta
third stage
first 2 hours post partum
fourth stage (unofficial stage)
the latent phase in the first stage of labor: woman is dilated:
the latent phase may last:
nulliparas' effacement is often :
complete before dilation begins
multipara: effacement and dilitation:
occur simultaneously
in the active phase of the first stage of labor, the woman is dilated ___-__cm
how long does the active phase of labor last?
what is effleurage?
transition phase of first stage of labor: woman is dilated ____-___ cm
how long does the transition stage last?
20mins to 2hrs
full dilation to birth of infant
2nd stage of labor
how long does the second stage of labor last in the primip?
how long does the second stage of labor last in the multip?
as the head buldges on the perineum, MD/CNM places towel over the rectum, push down on the baby's occupt and chin for greater control of delivery and prevents lacerations
ritgen's maneuver
MD/CNM may perform ___________ (cutting of perineum from vagina to just before rectum to enlaarge the vaginal outlet)
2 types of episiotomies:
on right or left slant (prevents damage to anal sphincter but much more painful)
cut straight from vagina--> just before rectum
when is the repair of the episiotomy done?
after birth of placenta
episiotomies are more common where in the world?
US and Canada
3rd stage of labor (placental stage)
from birth to expulsion of placenta
how long does the 3rd stage of labor last?
2-20 mins
the 3rd stage is most dangerous for the mother due to risk of:
when is the apgar done?
1 and 5 minutes after birth
fourth stage of labor: the immediate pp period
unofficial stage of labor but generally considered the first 2 hrs pp
all decisions are based on the needs and risks of
both mom and fetus
what are the two shapes of the fontanels?
anterior diamond shaped
posterior triangular
if the fetal part is neither in anterior or posterior position it is
this is a signal for breech- you may miss the breech in Leopolds but the location of the ___ is a flag
+5 station means head is where?
on perineum
if the head is above the ischial spines, it is
negative station
if the head is below the ischial spines:
positive station
Upper margins of pubic bones
the pelvic inlet (brim)
narrowest transverse plane
pelvic cavity (midpelvis)
Lower margins of pubic bones
pelvic outlet
how common is the anthropoid pelvis?
with this type of pelvis, transverse is narrow, AP is longer
can you still have a child with an android, or typical male pelvis?
yes, if fetus is small enough
one side of pelvic rim to the other side
biischial diameter
how is effacement described?
graph developed to asses progress of labor based on cervical dilitation and station, hopefully not used independently to manage labor, not an accurate tool. Labors are different and still "normal"
friedmans curve
Power with contractions comes in 2 ways
primary and secondary
The Primary power is involuntary:
the secondary power is :
maternal pushing
Uterine contractions-bld flow is cut off to fetus (fetus is stressed) @
the women should have what b/n contractions?
period of relaxation
the freq of contractions is expressed in:
to determine regularity of contractions:
count freq and pattern
what are some advantages of external electronic monitoring
-non invasive
-doesn't req. ROM
-can monitor freq & length of contractions
what are some disadvantages or external electronic monitoring?
-not very accurate
-no info on intensity
-req. decreased maternal movement
catheter is passed through the vagina into uterus; catheter is filled with sterile water and attached to a pressure recorder. c each contraction, pressure in catheter changes
internal monitoring
once bag is ruptured, there is
an increased risk of infection
_______ during pushing straightens birth canal and aids in fetal descent
when is BOW usually ruptured?
may break at any time prior to onset of labor
if woman doesn't give birth in 24 hrs after bag is ruptured, this is considered:
PROM premature rupture of membranes
what is amniotic fluid is green or yellow?
baby passed meconium b/c it was stressed
there is no such thing as "dry labor" since:
amniotic fluid is produced until delivery
ROM may occur spontaneously (SROM) or artificially (AROM) with:
EFM utilizes doppler
external monitoring:
where is external monitoring often charted?
on permanent graph record
when fetal head is engaged and cervix is slightly dilated an electrode is placed on fetal head and able to monitor a fetal EKG
internal monitoring
When should we look at HR?
b/n contractions
these provide a reassuring pattern and are common with breech presentations
pressure on fetal ____ causes accelerations
early decel's generally occur between ___-___cm and in ______stage of labor
uteroplacental insufficiency causes fetal hypoxia and results in acidosis and tachycardia b/n contractions
late decels
these are caused by: cord b/n fetus and maternal pelvis, cord around fetal part, short cord, knot in cord, prolapsed cord
variable decel's
these are characterized by a sudden sharp drop in FHR, creating "V", "U" or "W" shape.
variable decel's
what 2 positions help the woman experiencing variable decel's?
butt in air, hands on knees
sign of intact ANS and fetal well being. The more the better (sec to sec, min to min)
change in FHR from one beat to the next: interval between one heartbeat and the next.
short term variability
if they don't have ___________, we cant get short term variability
internal monitoring
rhythmic waves of fluctuation which occur 3-5times/minute, detectable with external fetal monitoring
long term variability