Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
232 Cards in this Set
- Front
- Back
descent of presenting part as it becomes engaged. It may be gradual or sudden.
|
lightening
|
|
lightening is much more likely to be noticeable with primigravidas ___-___wks before labor.
|
2-3
|
|
lightening will generally occur about ___-___ days prior to labor
|
10-14
|
|
________ 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?
|
passenger
passage/pelvis power psyche |
|
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
|
molding
|
|
when is molding of the head usually returned to normal shape?
|
within 3days
|
|
_______ diameter is the largest of the transverse diameters (9.25cm)
|
biparietal
|
|
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
|
oblique
|
|
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.
|
frank
|
|
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?
|
O
|
|
what abbreviation is used for brow?
|
Br
|
|
what abbreviation is used for face/chin?
|
M (mentum)
|
|
what abbreviation is used for shoulder/scapula?
|
Sc
|
|
what abbreviation is used for sacrum/breech?
|
S
|
|
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
|
32+wks
|
|
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
|
engagement
|
|
relationship between the maternal ischial spines and presenting part
|
station
|
|
4 types of pelvis's
|
gynecoid
anthropoid android platypelloid |
|
this is the typical female pelvis (ideal for childbirth).
|
gynecoid
|
|
the ___________ pelvis is well rounded, forward and back
|
gynecoid
|
|
this is a typical male pelvis. It is heart shaped. (shallow posterior portion/pointed anterior)
|
android
|
|
this type of pelvis is fairly common. It is narrow transverse/longer ap (anterior posterior)
|
anthropoid
|
|
this type of pelvis is oval and smooth/shallow ap (anterior posterior)
|
platypelloid
|
|
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
|
effacement
|
|
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
|
dilitation
|
|
what three things cause the cervix to dilate?
|
UC's
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
|
contract
shorten |
|
the lower uterine segment (cells) ____, ____ and ______ allowing baby to be expelled downward
|
retract
elongate thins |
|
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
|
3
|
|
_____________: longest, building of the muscular contraction, begins in fundus and spreads throughout uterus
|
increment
|
|
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
|
acme
|
|
this is when the UC subsides
|
decrement
|
|
the length of time contraction lasts in seconds is called:
|
duration
|
|
the duration of contractions in active labor:
|
60-90 sec
|
|
the strength of contraction by palpation
|
intensity
|
|
the intensity of a contraction can be :
|
mild-moderate
strong |
|
____________:time between beginning of one contraction to the beginning of the next
|
frequency
|
|
(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?
|
invasive
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?
|
engagement
descent flexion of fetal head |
|
this mechanism of labor is when the largest diameter of presenting part is at level is ischial spines
|
engagement
|
|
this starts slowly and picks up through labor. it is when the presenting part moves down through the pelvis
|
descent
|
|
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
|
extension
|
|
after extension, ____ ___ occurs (now shoulders and body change position into AP)
|
external rotation (really happens internally)
|
|
______ shoulder is delivered, followed by _____ shoulder
|
anterior
posterior |
|
after the head is birthed, it rotates to either the right or left position (the position it was in when it was engaged)
|
restitution
|
|
Once shoulders are delivered rest of body is easily born. birth occurs when the entire body has been born
|
expulsion
|
|
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
|
12
|
|
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 _______
|
perineum
|
|
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
|
blue
|
|
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
ferning |
|
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
|
BP
|
|
___ decreases with UC's due to increase blood volume
|
pulse
|
|
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
-artifact -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:
|
110/120-160bpm
|
|
increase in FHR in RELATIONSHIP to contractions:
|
accelerations
|
|
this is a sign of fetal strengh when occuring with movement
|
accelerations
|
|
decrease in FHR in RELATIONSHIP to contractions
|
decelerations
|
|
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
|
benign
|
|
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
|
variability
|
|
_________>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
|
transient
|
|
_________<120bpm lasting for more than 10 minutes
|
fetal bradycardia
|
|
Nsg care for FHR irregularities:
1. examine_______ 2. shut off ______ 3. administer________ 4. place on _____ 5.increase 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
|
7.3-7.35
|
|
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
|
2-3hr
|
|
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
|
stadol
demerol nubain |
|
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
|
leboyer
|
|
how many stages of labor are there?
|
4
|
|
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:
|
0-3cm
|
|
the latent phase may last:
|
8-10hrs
|
|
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
|
4-7
|
|
how long does the active phase of labor last?
|
2-5hrs
|
|
what is effleurage?
|
massage
|
|
transition phase of first stage of labor: woman is dilated ____-___ cm
|
8-10
|
|
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?
|
60mins
|
|
how long does the second stage of labor last in the multip?
|
20mins
|
|
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)
|
episiotomy
|
|
2 types of episiotomies:
|
midline
mediolateral |
|
on right or left slant (prevents damage to anal sphincter but much more painful)
|
mediolateral
|
|
cut straight from vagina--> just before rectum
|
midline
|
|
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:
|
hemorrhage
|
|
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
|
transverse
|
|
this is a signal for breech- you may miss the breech in Leopolds but the location of the ___ is a flag
|
FH
|
|
+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?
|
fairly
|
|
with this type of pelvis, transverse is narrow, AP is longer
|
anthropoid
|
|
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:
|
UC's
|
|
the secondary power is :
|
maternal pushing
|
|
Uterine contractions-bld flow is cut off to fetus (fetus is stressed) @
|
peak
|
|
the women should have what b/n contractions?
|
period of relaxation
|
|
the freq of contractions is expressed in:
|
minutes
|
|
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
|
squatting
|
|
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:
|
amnihook
|
|
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
|
accelerations
|
|
pressure on fetal ____ causes accelerations
|
buttocks
|
|
early decel's generally occur between ___-___cm and in ______stage of labor
|
4-7
2nd |
|
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)
|
variability
|
|
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
|