Ob Midterm.2

Front 1

the series of events by which the uterine Contraptions expel the fetus and placenta from the uterus:

Back 1

Labor

Front 2

What is necessary to consider about the birth passage prior to/during labor?

Back 2

Size and type of the maternal pelvis and the
Ability of the cervix to **dilate and efface**

Front 3

There are different types of maternal pelvis- which is the most favorable?

Back 3

gynecoid (round inlet best) and it is found in about ½ of women. The inlet is rounded and it has a wide pubic arch
Anthropoid is also favorable

Front 4

What does dilation and effacement of the cervix mean?

Back 4

Dilate- to open
Efface- membrane thins
ex. 50%effaced is membrane 1/2 as thick as it was

Front 5

For labor to occur- mom must ___ and _____

Back 5

dilate and efface

Front 6

The pelvis is made of three parts:

Back 6

Ilium
Ischium
Pubis

Front 7

Ilium

Back 7

flaring portion of the hips of the upper and lateral positions

Front 8

Ischium

Back 8

is the inferior port and the base forms of the 2 projections call ed ischial tuberosisties (these mark the midpoint of the pelvis)

Front 9

Pubis

Back 9

front of the pelvis with the anterior projections of the sacrum.. This is the true pelvis. This is called the diagonal conjugate. This is the most useful measurement of the pelvis. It is considered adequate if it is 12.5 cm, the diameter of the fetal head that passes at that point is 9 cm.

Front 10

How does the Fetal head affect labor?

Back 10

The size is a factor (wether it will fit through the maternal pelvis) as well as the presence of molding

Front 11

Fetal Attitude

Back 11

Flexion or extension of the fetal body and extremities- determined by fetal lie and refers to the presenting part of the fetus that enters the maternal pelvis and lead thru the birth canal

Front 12

Fetal Lie

Back 12

the relationship of the cephalocaudal axis (spinal column) of the fetus to the cephalocaudal axis of the woman.

Front 13

Fetal presentation

Back 13

the body part of the fetus entering the pelvis in a single or multiple pregnancy- feet, buttocks, face, etc

Front 14

What is the most common fetal presentation?

Back 14

Cephalic- When this presentation occurs, labor and birth are more likely to proceed normally.

Front 15

______ and ________ presentations are associated with difficulties during labor and do not proceed as normal; therefore they are called malpresentations.

Back 15

Breech and shoulder

Front 16

Vertex presentation

Back 16

basically cephalic presentation

Head flexed (chin to chest)
Arms crossed over chest
Knees tucked into abdomen

Front 17

In vertex presentation, what is the presenting part of the fetal head?

Back 17

The occiput is the presenting part and with the head flexed chin to chest allows the smallest diameter of the head to present to the pelvis

Front 18

Fetal position

Back 18

relationship of the presenting part to one of the four quadrants of the maternal pelvis

Front 19

Placenta

Back 19

Implantation site

Front 20

What are the primary forces of labor

Back 20

Frequency, duration, and intensity of uterine contractions as the fetus moves through the passage
Effectiveness of the maternal pushing effort
And the Duration of labor

Front 21

Military presentation

Back 21

similar to Vertex except head is not flexed causing an increased presentation diameter

Front 22

Brow presentation

Back 22

top of the head and forehead is presented, increasing presentation diameter

Front 23

Face presentation

Back 23

chin is up face is first to be seen, increasing the presentation diameter

Front 24

Breech deliveries

Back 24

deliveries occur in 3% of pregnancies, baby’s sacrum is presented, resulting in C-Section delivery

Front 25

Frank Breech

Back 25

butt first and legs extended, knees to nose “pike position”

Front 26

Footling Breech

Back 26

feet presented first, legs may be in “splits” position resulting in need of C-Section

Can be single or double footing breech

Front 27

Shoulder Presentation

Back 27

shoulder presentation is also called a transverse lie.
Most frequently, the shoulder is the presenting part, and the acromion process of the scapula

Front 28

Transverse lie

Back 28

Instead of the fetus being head up or head down, the baby is laying in a transverse position in the uterus.

Front 29

Presentations other than vertex are called...

Back 29

malpresentations

Front 30

_________ of the presenting part occurs when the largest diameter of the presenting part reaches or passes through the pelvic inlet

Back 30

Engagement

Front 31

How can the nurse determine if the fetus is engaged?

Back 31

It can be determined by vaginal examination.

Front 32

Presenting part is said to be ________ (or ________) when it is freely movable above the inlet

Back 32

floating (or ballottable)

Front 33

Engaged is when....

Back 33

the bipartieal diameter of the fetal head is in the inlet or the occupit is at the level of the ischial spines- Or at 0

Front 34

When does engagement occur in primigravidas?

Back 34

2wks before term

Front 35

When does engagement occur in Multiparas?

Back 35

may experience engagement several wks before the onset of labor or during the process of labor

Front 36

Do we want to baby to be engaged before we rupture the membranes?

Back 36

Yes- this leaves less chance for umbilical cord disruption, or it getting in the way

Front 37

What does station refer to?

Back 37

Station refers to the relationship of the presenting part to an imaginary line drawn between the ischial spines of the maternal pelvis.

Front 38

In a normal pelvis the ischial spines mark:

Back 38

the narrowest diameter through which the fetus must pass.

Front 39

Where is station -5?

Back 39

At the inlet to the pelvis

Front 40

Where is station 0?

Back 40

At the ischial spines

Front 41

Where is station +4?

Back 41

Where is station +4?

Front 42

At what station is the baby crowning??

Back 42

Station +3

Front 43

3 Notations for Fetal Position

Back 43

R (right) or L (left)

Landmark of the fetal presenting part
O (occiput), M (mentum), S (sacrum)

A (anterior), P (posterior), T (transverse)

Front 44

Fetal position

Back 44

refers to the relationship of the landmark on the presenting fetal part to the front (anterior), back (posterior), or sides (right or left) of the maternal pelvis

Front 45

The landmark on the fetal presenting part is related to four imaginary quadrants of the maternal pelvis:

Back 45

left anterior, right anterior, left posterior, and right posterior

Front 46

Why is fetal position so important to know?

Back 46

these positions influence both the labor and the birth of the baby

Front 47

What is the monst common fetal position?

Back 47

occiput anterior

Front 48

What is the importance of occiput anterior?

Back 48

This means birth is more likely to proceed with out difficulty. Other positions are call malpostions.

Front 49

What is the primary force of labor?

Back 49

uterine muscular contractions, which cause the changes of the first stage of labor – complete effacement and dilatation of the cervix

Front 50

What is the secondary force of labor?

Back 50

the use of abdominal muscles to push during the second stage of labor

Front 51

Between contractions what does the uterus do?

Back 51

Rests

Front 52

Each contraction has three phases what are they?

Back 52

Increment
Acme
Decrement

Front 53

What is the increment of a contraction?

Back 53

the building up of the contraction and this is the longest phase

Front 54

What is the acme of a contraction?

Back 54

peak of the contraction

Front 55

What is the decrement of a contraction?

Back 55

the coming down

Front 56

What phase of the contraction do we palpate to see the intensity of contraction?

Back 56

At the acme

Front 57

What is the frequency of contractions?

Back 57

the time between the beginning of one contraction and the beginning of the next contraction.

Front 58

What is the duration of contractions?

Back 58

The duration of each contraction is measured from the beginning of the contraction to the completion of the contraction.

Front 59

as the uterine contractions become stronger they become _________ in duration.

Back 59

longer

Front 60

What does the intensity of the contraction refer to?

Back 60

to the strength of the uterine contraction during acme.

Front 61

How is the intensity of contractions measured?

Back 61

intensity is estimated by palpating the contraction, but it may be measured directly with an intrauterine catheter attached to an electronic fetal monitor.

Front 62

How does the nurse guage dilation?

Back 62

nurse places index finger and middle fingers against side of cervix to determine size of opening

Front 63

What starts labor?

Back 63

Really don’t know what starts labor but somewhere in 38th to 42 week the mature fetus is ready for delivery. Think it may be withdrawal of preogesterin, build up of prostoglandin, or corticotrophin releasing hormone theory.

Front 64

Effacement is

Back 64

taking up (or drawing up) of the internal os and the cervical canal into the uterine side walls.

Front 65

During effacement, what happens to the cervix?

Back 65

The cervix changes progressively from a long, thick structure to a structure that is tissue-paper thin

Front 66

What causes cervical dilation?

Back 66

the process of effacement along with The increasing amount of amniotic fluid below the fetal head exerts hydrostatic pressure on the cervix and on the fetal membranes

Front 67

What happens during dilation?

Back 67

The cervical os and cervical canal widen from less than a centimeter to approximately 10 cm, allowing birth of the fetus.

Front 68

Lightening is...

Back 68

when the fetus begins to engage into the pelvic inlet

Front 69

How does mom feel when lightening occurs?

Back 69

mom can breathe better, acid reflux gets better, more confort-

Front 70

When does lightening usually occur?

Back 70

avg 2 weeks before onset of labor

Front 71

What discomfort may mom feel after lightening occurs?

Back 71

Leg cramps or pains due to pressure on the nerves that course through the obturator foramen in the pelvis
Increased pelvic pressure
Increased venous stasis leading to edema in the lower extremities
Increased urinary frequency
Increased vaginal secretions resulting from contestation of the vaginal mucous membranes*

Front 72

Braxton Hicks contractions

Back 72

the irregular, intermittent contractions that have been occurring throughout the pregnancy , they may become regular at times, only to decrease spontaneously
Prior to the onset of labor may become uncomfortable

Front 73

During the pregnancy cervical secretions have accumulated in the cervical canal to form a ____ ____.

Back 73

mucous plug

Front 74

Bloody Show

Back 74

About 24 to 48 hours before birth. Softening of the cervix allows the plug to be expelled small amt of blood loss from the exposed cervical capillaries. It is pink tinged in color

Front 75

After ____ _____, 80% of women will experience spontaneous labor within 24 hours.

Back 75

membranes rupture

Front 76

What happens If membranes rupture and labor does not begin spontaneously within 12 to 24 hours?

Back 76

labor may be induced

Front 77

What is the danger of membranes rupturing before engagement has occurred?

Back 77

If engagement has not occurred, the danger exists that the umbilical cord may be expelled with the fluid (prolapsed cord)

Front 78

Sudden Burst of Energy (often called nesting)

Back 78

Some women report a sudden burst of energy approximately 24 to 48 hours before labor. Due to increase of epinephrine caused by decrease in progesterone production by the placenta.

Front 79

What GI problems might mom feel before the onset of labor?

Back 79

Diarrhea, indigestion, or nausea and vomiting just prior to the onset of labor.

Front 80

Why might mom feel Increased backache and sacroiliac- pelvic and hip pain pressure right before the onset of labor?

Back 80

from the influence of relaxin hormone on the pelvic joints.

Front 81

True labor show a consistent pattern of increasing:

Back 81

frequency, duration and intensity of labor

Front 82

First stage of labor begins and ends with...

Back 82

begins with the beginning of true labor contractions and ends when the cervix is completely dilated at 10 cm and is 100% effaced.

Front 83

First stage of labor has three phases...

Back 83

Latent, active , and transitional

Front 84

Second stage of labor begins and ends with...

Back 84

begins with complete dilation and ends with the birth of the infant.

Front 85

Third stage of labor begins and ends with...

Back 85

begins with the expulsion of the infant and ends with the expulsion of the placenta

Front 86

Fourth stage of labor is...

Back 86

1 to 4 hours after expulsion of the placenta, the uterus effectively contracts to control bleeding at the placental site.

Front 87

How much does the cervix dilate in the latent phase?

Back 87

0-3cm

Front 88

Latent phase begins with...

Back 88

Begins with the onset of regular contractions

Front 89

Latent phase contractions frequency

Back 89

Frequency = Q10-30min

Front 90

Latent phase contractions duration

Back 90

Duration = 20-40 seconds

Front 91

Latent phase contractions intensity

Back 91

Intensity = begin as mild and progress to moderate

Front 92

How does mom feel emotionally during latent phase?

Back 92

The woman feels able to cope with the discomfort, may be relieved that labor has finally started
She may be anxious, but she is able to recognize and express those feelings of anxiety
She is often talkative and smiling and eager to talk about herself and answer questions

Front 93

How often to assess v/s during latent phase?

Back 93

Every hour if WNL
Temp Every 4 hr, unless >99.6- then every hour

Front 94

Can mom ambulate during latent phase

Back 94

Yes it should be encouraged unless contraindicated

Front 95

What can mom eat during the latent phase?

Back 95

clear liquids and ice chips

Front 96

How often should mom void during latent phase?

Back 96

Every 1-2 hours

Front 97

What happens to the amniotic fluids during latent phase?

Back 97

At the beginning of labor the amniotic membranes bulge through the cervix in the shape of a cone.
Spontaneous rupture of membranes (SROM) generally occurs at the height of an intense contraction with a gush of the fluid out of the vagina.

Front 98

Who can artificially rupture membranes?

Back 98

certified nurse-midwife/physician.

Front 99

What is artificial rupture of membranes (AROM) actually called?

Back 99

amniotomy

Front 100

How does mom feel emotionally during active phase?

Back 100

o Anxiety begins to increase as she senses the intensification of contractions and pain.
o She begins to fear loss of control and may use a variety of coping methods
o May experience feelings of helplessness
o Exhibits increased fatigue and may begin to feel restless and anxious
o Expresses fear of abandonment
o Becomes more dependent as she is less able to meet her needs.

Front 101

How much does the cervix dilate during active phase?

Back 101

between 4-7cm

Front 102

Active phase contractions frequency

Back 102

Q2-5 min

Front 103

Active phase contractions duration

Back 103

40-60 seconds

Front 104

Active phase contractions intensity

Back 104

begin as moderate and progress to strong

Front 105

What happens with vaginal secretions curing active phase?

Back 105

Vaginal discharge and bloody show increase

Front 106

If mom wants to lie in bed curing active phase what is the best position for her?

Back 106

a side lying position and place support pillows between her knees, under her abdomen and against the small of her back.

Front 107

How can nurse and support person help comfort mom during active phase?

Back 107

Offer a backrub or apply counter pressure to lower sacral area.
Offer cool washcloths for the forehead or back of the neck
Encourage woman to maintain breathing patterns
Provide quiet environment to reduce external stimuli
Provide reassurance, encouragement and support
Offer shower, whirlpool or warm bath if available

Front 108

How much does cervix dilate in transition phase?

Back 108

8-10 cm

Front 109

Transition phase contractions frequency

Back 109

every 1.5-2 min

Front 110

Transition phase contractions duration

Back 110

60-90 sec

Front 111

Transition phase contractions intensity

Back 111

strong by palpation

Front 112

What does mom feel As dilation approaches 10cm?

Back 112

there may be increased rectal pressure and an uncontrollable urge to bear down, an increase in bloody show- plug is lost, and rupture of membranes.

Front 113

How does mom feel emotionally during transition phase?

Back 113

Woman may fear she will be “torn open” or “split apart” by the force of the contractions.
She will most likely withdraw into herself and may doubt her ability to cope with labor.
May become apprehensive and irritable
May not want anyone to talk to her or touch her
May need help regaining focus
Other characteristics of this phase are: hyperventilation, hiccupping, belching, nausea or vomiting, curling of her toes, crying or yelling
She may become amnesic and sleep between her contractions
May not be able to speak in coherent sentences

Front 114

Should nurse encourage mom to push during transition phase?

Back 114

No, mom needs to dilate to 10 before puching

Front 115

What are cardinal movements?

Back 115

For the fetus to pass through the birth canal, the fetal head and body must adjust to the maternal pelvis by certain positional changes

Front 116

What are the cardinal movements?

Back 116

Descent:
Flexion:
Internal Rotation:
Extension:
Restitution:
External Rotation:
Expulsion:

Front 117

Second stage takes how long for nulliparas?

Back 117

completed within 2 hours

Front 118

Second stage takes how long for multiparas?

Back 118

within 15 minutes

Front 119

How does mom feel emotionally during second stage of labor?

Back 119

May continue to fear that she will tear apart
May feel she has lost control and become embarrassed and apologetic, or she may demonstrate irritability towards staff or her own support in attempt to regain control

Front 120

When do cardinal movements occur?

Back 120

during second stage of labor

Front 121

What is nurses role in second stage of labor?

Back 121

Assist mom in pushing
encourage positions of comfort
Give praise and encouragement
Maintain privacy as woman desires

Front 122

How often to assess V/S during second stage of labor?

Back 122

Every 5-15 min
Assess uterine contractions continuously

Front 123

What causes F&E imbalances during labor?

Back 123

diaphoresis during labor- loss of H20 and NA.

Front 124

When is hyperventilation during labor increased?

Back 124

2nd stage

Front 125

Why are WBCs increased during labor?

Back 125

increase in neutrophils in response to stress.

Front 126

What is the priority nursing care in 3rd stage of labor?

Back 126

focuses on providing initial newborn care and assisting with birth of the placenta

Front 127

Where does baby go right after birth?

Back 127

Baby may be placed on mother’s abdomen or chest

Front 128

What is encouraged of the mother during 3rd stage of labor?

Back 128

Breastfeeding can be encouraged

Front 129

When does the placenta begin to separate from uterus?

Back 129

signs of separation usually appear around 5 min after birth, but can take up to 30 min

Front 130

How is placental separation observed?

Back 130

indicated by lengthening of he umbilical cord, a small spurt of blood, change in uterine shape, and a rise of the fundus in the abdomen.

Front 131

When is the placenta considered retained?

Back 131

if more than 30 min have elapsed from completion of 2nd stage of labor

Front 132

How can mom aid in the delivery of the placenta?

Back 132

the woman may bear down to aid in placental expulsion

Front 133

Schultze mechanism (shiny Schultze)

Back 133

when placenta separates from the inside to the outer margins it is expelled with the fetal (shiny) side presenting

Front 134

Duncan mechanism (dirty Duncan)

Back 134

when placenta separates from outer margins inward, it will roll up and present sideways with the maternal surface delivering first

Front 135

When does attachment occur during the stages of labor?

Back 135

4th stage of labor

Front 136

How does mom feel physically during the 4th stage of labor?

Back 136

mom may be thirsty and hungry
May experience a shaking chill

Front 137

How often to perform fundal massage during 4th stage of labor?

Back 137

frequent intervals – Q15min

Front 138

How often to assess V/S during 4th stage of labor?

Back 138

every 5-15 minutes for the first 1-2 hours

Front 139

Why are breathing techniques important during all stages of labor?

Back 139

Breathing techniques increase the woman’s pain threshold, encourage relaxation, provide distraction, enhance ability to cope with uterine contractions, and allow the uterus to function more efficiently.

Front 140

Mom experiences a systemic drop in BP and mild tachycardia after labor, how do we treat this?

Back 140

Give fluids

Front 141

What is the #1 s/e of an epidural?

Back 141

HYPOTENSION- give fluids

Front 142

If mom having a hard time coping with labor what are 4 nursing interventions that are appropriate?

Back 142

assist in breathing techniques
offer massage
involve support persons for emotional support
provide praise and encouragement

Front 143

Mom c/o numbness and tingling in her hands and feet, what is the cause?

Back 143

Hyperventilation can cause Ca levels in the blood to drop causing these symptoms

Front 144

Nursing interventions for hyperventilation?

Back 144

breathing techniques- pursed lip breathing, breathe into paper bag
Offer support and talk calmly to

Front 145

complete dilation is 10 cm- what stage of labor is this?

Back 145

transitional phase stage 1

Front 146

what are signs that birth is imminent

Back 146

dilation of 10 cm and crowning- when the fetal head is encircled by the external opening of the vagina

Front 147

How often to assess BP and FHR in second stage of labor?

Back 147

Every 15 min in low risk women
High risk women- every 5 min

Front 148

What support and comfort measures can support person and nurse provide for mom?

Back 148

repositioning
massage
soothing tough
vocal encouragement
verbalization of progression
breathing techniques

Front 149

What is the indication for an episiotomy?

Back 149

to increase the diameter of the pelvic outlet
prevent perineal lacerations
facilitate delivery
reduce time for expulsion of the infant

Front 150

what measures can be taken to decrease need for an episiotomy?

Back 150

rub olive oil on perineum and massage 2 mos before labor
massage vaginal opening and support babies head during labor, support surrounding skin with hands to decrease sudden pressure

Front 151

What are ways to provide warmth to the newborn?

Back 151

dry immediately with towels and warm blankets
skin to skin contact with mom
radient heated unit

Front 152

what does newborn need to be dried thoroughly as soon after birth as possible?

Back 152

wet babies can lose a lot of heat very quickly. Quickly drying the baby will avoid heat loss. Drying also provides tactile stimulation to cause the baby to gasp and recover