Lowerdermilk & Perry - Labor & Delivery

Front 1

5 P's that affect the process of labor and birth:

Back 1

Passenger
Passageway
Powers
Position of the Mother
Psychologic Response

Front 2

Passenger:

Back 2

Fetus and Placenta

Front 3

Passenger: Movement through the birth canal affected by -

Back 3

Size of Head
Fetal Presentation
Fetal Lie
Fetal Attitude
Fetal Position

Front 4

Passenger: Molding -

Back 4

Overlapping of cranial bones or shaping of the fetal head to accommodate and conform to the bony and soft parts of the mother's birth canal during labor.

Front 5

Passenger: Presentation -

Back 5

The part of the fetus that enters the pelvic inlet 1st and leads through the birth canal during labor.

Front 6

Passenger: 3 Main Presentations -

Back 6

Cephalic (head 1st)
Breech (buttocks or feet 1st)
Shoulder

Front 7

Passenger: Vertex -

Back 7

When the presenting part is the occiput (back part of the head or skull).

Front 8

Passenger: Fetal Lie -

Back 8

The relation of the long axis (spine) of the fetus to the long axis (spine) of the mother.

Front 9

Passenger: Fetal Attitude -

Back 9

The relation of the fetal body parts to each other.

Front 10

Passenger: Fetal Position -

Back 10

The relation of the presenting part to the 4 quadrants of the mother's pelvis.

Front 11

Passenger: Station -

Back 11

The relation of the presenting part of the fetus to an imaginary line draw between the maternal ischial spines and is a measure of the degree of descent of the presenting part of the fetus through the birth canal. -5 to +5.

Front 12

Passenger: Engagement -

Back 12

The term used to indicate that the largest transverse diameter of the presenting part has passed through the maternal pelvic brim or inlet into the true pelvis and usually corresponds to station O.

Front 13

Passageway:

Back 13

Composed of the mother's rigid bony pelvis and the soft tissue of the cervix, pelvic floor, vagina, and the introitus (external opening to the vagina)

Front 14

Passageway: 4 types of Pelvis -

Back 14

Gynecoid
Android
Anthropoid
Platypelloid

Front 15

Passageway: Gynecoid Pelvis -

Back 15

Classic female pelvis

Front 16

Passageway: Android Pelvis -

Back 16

Resembles the male pelvis

Front 17

Passageway: Anthropoid Pelvis -

Back 17

Resembles the pelvis of anthropoid apes

Front 18

Passageway: Platypelloid Pelvis -

Back 18

Flat pelvis

Front 19

Powers:

Back 19

Involuntary and voluntary powers that combine to expel the fetus and the placenta from the uterus.

Front 20

Powers: Primary -

Back 20

Involuntary contractions, described in terms of frequency, duration and intensity, which result in effacement and dilation of the cervix.

Front 21

Primary Powers: Frequency -

Back 21

Time from the beginning of one contraction to the beginning of the next.

Front 22

Primary Powers: Duration -

Back 22

Length of the contraction

Front 23

Primary Powers: Intensity -

Back 23

Strength of the contraction

Front 24

Primary Powers: Effacement -

Back 24

The shortening and thinning of the cervix during the 1st stage of labor.

Front 25

Primary Powers: Dilation -

Back 25

The enlargement and widening of the cervical opening and cervical canal that occurs once labor has begun.

Front 26

Ferguson Reflex:

Back 26

Occurs when the presenting part of the fetus reaches the perineal floor resulting in the release of endogenous oxytocin and the urge to bear down.

Front 27

Powers: Secondary -

Back 27

Voluntary efforts (bearing down) that aid in the expulsion of the fetus.

Front 28

Stages of Labor: 1st Stage -

Back 28

Last from the onset of regular uterine contractions to full dilation of the cervix.

Front 29

Stages of Labor: 2nd Stage -

Back 29

Last from the time the cervix is fully dilated to the birth of the fetus.

Front 30

Stages of Labor: 3rd Stage -

Back 30

Last from the birth of the fetus until the placenta is delivered.

Front 31

Stages of Labor: 4th Stage -

Back 31

Lasts about 2 hours after the delivery of the placenta.

Front 32

Mechanism of Labor:

Back 32

Turns and other adjustments made in the birth process.

Front 33

Mechanism of Labor: 7 Cardinal Movements -

Back 33

Engagement
Descent
Flexion
Internal Rotation
Extension
External Rotation
Birth by Expulsion

Front 34

Mechanism of Labor: Engagement -

Back 34

When the bipartal diameter of the head passes the pelvic inlet.

Front 35

Mechanism of Labor: Descent -

Back 35

Refers to the progress of the presenting part through the pelvis.

Front 36

Mechanism of Labor: 4 forces of Descent -

Back 36

Pressure exerted by amniotic fluid
Direct pressure exerted by the contracting fundus on the fetus
Force of the contraction of the maternal diaphragm and abdominal muscles in the 2nd stage of labor
Extension of the straightening of the fetal body

Front 37

Mechanism of Labor: Flexion -

Back 37

As soon as the head meets resistance from the cervix, pelvic wall, or pelvic floor it normally flexes so the chin is brought into closer contact w/ the fetal chest.

Front 38

Mechanism of Labor: Internal Rotation -

Back 38

The fetal head rotation that occurs between the maternal inlet and the true pelvis.

Front 39

Mechanism of Labor: Extension -

Back 39

The occiput appears 1st, then the face and finally the chin.

Front 40

Mechanism of Labor: External Rotation -

Back 40

After the birth of the head it briefly rotates to the position it occupied when it was engaged in the inlet.

Front 41

Mechanism of Labor: Expulsion -

Back 41

After the birth of the shoulders the head and shoulders are lifted towards the mother's pubic bone and the trunk of the baby is born by flexing it latterly in the direction of the symphysis pubis.

Front 42

Fetal Decelerations: Early -

Back 42

Begins early in contraction
Returns to baseline before completion of contraction
Caused by fetal head compression

Front 43

Fetal Decelerations: Early, Treatment -

Back 43

Observe for any signs of fetal intolerance

Front 44

Fetal Decelerations: Late -

Back 44

Begins 30 seconds or more after onset of contraction
Returns to baseline after contraction is over
Caused by Uteroplacental Insufficiency (inadequate uterine/placental oxygen exchange that is aggravated by uterine contraction resulting in fetal hypoxia)

Front 45

Fetal Decelerations: Late, Treatment -

Back 45

Left side
O2 (6-7 l/min)
D/C Oxytocin
^ IV fluids
Notify MD of pattern
Continue observation

Front 46

Fetal Decelerations: Variable -

Back 46

Begins anytime
Returns to baseline anytime
Caused by cord compression resulting in fetal hypoxemia

Front 47

Fetal Decelerations: Variable, Treatment -

Back 47

Position change
O2 (6-7 l/min)
D/C Oxytocin
^ IV fluids
Vaginal exam to detect cord prolapse
Notify MD of pattern
Close observation

Front 48

1st Stage of Labor: Phases -

Back 48

Latent
Active
Transitional

Front 49

1st Stage of Labor: Latent -

Back 49

Nullipara - 8.5hrs
Multipara - 5hrs
Dilation - 0-3 or 4cm
Contraction:
Freq. - Every 10-20 mins. increasing to every 5-7 mins.
Duration - 15-30 secs. progressing to 30-40 secs.
Intensity - mild and progress to mod.
Misc.:
Little to no fetal decent
Talking/Smiling

Front 50

1st Stage of Labor: Active -

Back 50

Nullipara - 6hrs
Multipara - 4.5hrs
Dilation - 4-8cm
Contraction:
Freq. - Every 2-3 mins.
Durations - 60 secs.
Intensity - Begin mod. progress to strong
Misc.:
Fetal descent
Epidural given
Uncomfortable
^ fear/anxiety

Front 51

1st Stage of Labor: Transitional -

Back 51

Nullipara - 3hrs
Multipara - 1hr
Dilation - 8-10cm
Contraction:
Freq. - Every 1.5-2 mins.
Duration - 60-90 secs.
Intensity - Strong
Misc.:
^ Fetal descent
^ 2hrs if epidural
Inner directed
Tired
Helpless

Front 52

2nd Stage of Labor:

Back 52

Nullipara - 1 hr
Multipara - 15 mins.
Contractions:
Freq. - Every 1.5-2 mins.
Durations - 60-90 secs.
Intensity - Strong
Misc.:
Episiotomy
Pushing
Crowing
Control
Birth