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OB test 3 chapter 16

Labor and Birth Process

Five P's Passenger, Passageway, Powers, Position, Psychologic response
The fetal skull is composed of: two temporal bones, the frontal bone, two parietal bones,and the occipital bone.
Names of the four sutures of the fetal head sagital, lambdoidal, coronal, and the frontal
What are fontanels? Membrane filled spaces where the sutures intersect.
The palpation of the fontanels during a VE reveals: fetal presentation, position and attitude
Anterior fontanel is __________ shaped and lies at the junction of the _______, _________, _________ diamond sagittal, coronal, and frontal sutures
The anterior fontanel closes by: 12-18 month
The Posterior fontanel is_______ shaped and lies at the junction of _______, and _______. Triangle, The two parietal bones and the occiptal bone.
The posterior fontanel closes by: 6-8 weeks after birth
Molding can be extensive but the newborns head returns to normal shape within: 3 days
Cephalic Head down
Breech feet/butt down
These make the skull flexible to accomodate the infants brain, which continues to grow for some time after birth Sutures and fontanels
________ refers to the part of the fetus that enters the pelvic inlet first and leads through the birth canal during labor. Presentation
Three main types of presentations Shoulder, cephalic, breech
______ is that part of the fetus that lies closet to the internal os of the cervix and the first part felt by the examiner during a VE presenting part
In a cephalic presentation what is the presenting part? occiput
In the breech presentation what is the presenting part? sacrum
In the shoulder presentation what is the presenting part? scapula
When the presenting part is the occiput, the presentation is noted as _________ Vertex
Factors that determine the presenting part include: Fetal lie, fetal attitude, and extension or flexion of the fetal head.
The relation of the spine of the fetus to the spine of the mother. Fetal lie
The two primary lies are: longitudal (vertical) Transverse (horizontal or oblique)
Which fetal lie is this? The spine of the fetus is parallel with the long axis of the mothers spine. This fetal lie is associated with cephalic or breech presentation Longitudal (vertical)
Whice fetal lie is this? the spine of the fetus is at a right angle diagonal to the mothers spine. Transverse (horizontal)
A vaginal birth cannot occur with this fetal lie Transverse
What type of fetal lie is this? The spine of the fetus lies at an angle to the spine of the mother Oblique
The relation of the fetal body parts to each other. (posture) Fetal attitude
General flexion The back of the fetus is rounded, the chin in flexed on the chest, the thighs are are flexed on the abdomen, and the legs are flexed at the knees. The arms are crossed over the thorax and the umbilical cord lies between the arms and the legs.
the relationship of a reference point on the presenting part to the four quadrants of the mothers pelvis fetal position
Presentation: How to abbreviate. 1st letter: presenting part in the R or L of pelvis 2nd Letter: presenting part (O=occiput, S=sacrum, M=mentum(chin),Sc=scapula) 3rd Letter: locaton of presenting part in relation to the anterior(A),Posterior(P),or transverse(T) portion of the pelvis
The relationship of the presenting fetal part to an imaginary line drawn between the ischial spines and is a measure of the degree of descent of the presenting part in the birth canal. Station
Birth is imminent when the station of the presenting part is _____ to _______ +4 to +5
The term used to indicate that the largest transverse diameter of the presenting part has passed through the maternal pelvic inlet into the true pelvis and usually corresponds to a station 0. Engagement
When does engagement occur? Nulliparas- weeks just before labor multiparas- before labor or during labor
How can the engagement be determined? by VE or abd exam
false pelvis part above the brim and plays no part in childbearing
True pelvis The part involved in birth, divided into three planes. inlet, mid-pelvis/cavity, outlet
The four basic types of pelvis' Gynecoid (female) Android (resembles male pelvis) Anthropoid (resembles anthropoid ape) Platypelloid (flat pelvis)
The most commong pelvic type Gynecoid
What are the involuntar uterine contractions that signal the beginning of labor called? Primary powers
What are the voluntary bearing down efforts performed by the woman called? Secondary powers (they help augment the force of the involuntary contractions)
The time from the beginning of one contraction to the begninning of the next frequency
Length of the contraction duration
strength of contraction at its peak intensity
These are responsible for the effacement and dilation of the cervix and descent of the fetus. Primary powers
shortening and thinning of the cervix during the first stage of labor. effacement
________ is generally advanced in first-time term pregnancy before more than slight dilation occurs. In subsequent pregnancies this and dilation progress together. effacement
degree of effacement is expressed in ______ percentages from 0-100
the enlargement or widening of the cervial opening and the cervical canal that occurs once laborhas begun. dilation
_______ marks the end of the first stage of labor. Full dilation of the cervix
________ and _______ can help promote cervical dilation Pressure exerted by the amniotic fluid (in unruptured membranes) and the force applied by the presenting part of the fetus
_______ of the cervix can slow dilation scarring
__________ in the posterior vagina cause the release of endogenous oxytocin that triggers the maternal urge to bear down. stretch receptors
The maternal urge to bear down ferguson reflex
This can cause a decreased frequency and intensity of contractions if given in early labor narcotic analgesics
as soon as the presenting part reaches the pelive floor the contractions change and become ________ expulsive
secondary powers have no effect on _________ but they are important in the explusion of the fetus. cervial dilation
closed glottis and prolonged bearing down Valsalva maneuver
Adverse effects associated with prolonged breath holding and forceful pushing efforts include: fetal hypoxia and subsequent acidosis
__________ in position relieve fatigue, increase comfort, and improve circulation in the laboring woman. frequent changes
In this position, gravity can promote the descent of the fetus, uterine contractions are stronger and more efficient in effacing and dialating the cervix, resulting in a shorter labor. Also good for cardiac output Upright (walking, standing, kneeling, squatting
_________ is compromised if the descending aorta and ascending vena cava are compressed during labor cardiac output
Compression of the major vessels can result in __________ which decreased placental perfusion supine hypotension
If a laboring woman wishes to lay down, this position is suggested. Lateral
This position may be used to relieve back pain if the is in a occipitoposterior position and may assist in anterior rotation of the fetus in cases of shoulder dystocia all fours
The process of moving the fetus, placenta, and membranes out of the uterus and through the birth canal. labor
the uterus sinks downward and forward about 2 weeks before term when the fetus's presenting part descends into the true pelvis lightening, or "dropping"
strong, frequent but irregular contractions braxton hicks
The onset of ________ cannot be ascribed to a single cause true labor
this lasts from the onset of regular contractions to full effacement and dilation of the cervix first stage of labor
the ______ stage is the longest stage of labor first
the three phases of the first stage of labor latent, active, and transition
during this phase of the first stage of labor there is more progress in effacement of the cervix and little increase in descent latent phase
during these phases of the first stage of labor there is more rapid dilation of the cervix and increased rate of descent of the presenting part. active and transition phases
This stage of labor lasts from the time that the cervix is totally effaced and dilated to the birth of the fetus second stage
the two phases of the second stage of labor latent and active pushing phase (descent)
during this phase of the second stage of labor the fetus continues to descend through the birth canal and rotate to an anterior position latent
during this phase of the second stage of labor the woman has strong urges to bear down active pushing phase (descent)
this stage of labor lasts from the birth of the fetus until the placenta is delivered third stage of labor
the placenta normally seperates with the ___ or ____ strong uterine contraction after the infant has been born 3rd/4th
the placenta is usually expelled within ___ to ___ minutes after the birth of the baby 10-15
The risk for ______ increases as the length of the thrid stage increases hemorrhage
The third stage of labor is normally completed within ______ minutes 30
this stage of labor lasts 1-2 hours after the delivery of the placenta. fourth stage of labor
this is the period of immediate recovery, when homeostasis is reestablished. this is an important period of observation for complications such as abnormal bleeding fourth stage labor
The turns and other adjustments necessary in the human birth process mechanisms of labor
Seven cardinal movements of the mechanism of labor that occur in a vertex presentation are: descent, flexion, internal rotation, extension, external rotation (restitution), and birth by explusion.
This term refers to a deflected head (anteriorly or posteriorly) asynclitism
This refers to the progress of the presenting part through the pelvis descent
descent depends on at least four forces. These forces include: 1. pressure exerted by amniotic fluid 2. direct pressure exerted by the contracting fundus on the fetus 3. force of the contraction of the diaphragm and abd muscles in the second stage of labor. 4. extension & straightening of the fetal body.
Descent accelerates in the _________ phase when the cervix has dilated to _____ to ____ cm. it is especially apparent when the membranes have ruptured. active; 4-7 cm
as soon as the descending head meets resistance from the cervix, pelvic wall or pelvic floor, it normally _______ so that the _______ is brought in closer to the ______ flexes, chin, chest
_________ permits the smaller suboccipitobregmatic diameter to present to the outlet. Flexion
The fetal head passes into the true pelvis in what position? occipitotransverse
the outlet is widest in the ________ diameter anteroposterior
for the fetus to exit the pelvic outlet, the _____ must ______ head, rotate
Internal rotation begins at the level of the ________ but is not completed until the presenting part reaches the lower pelvis. ischial spines
During internal rotation, as the occiput rotates _________, the face rotates __________ anteriorly, posteriorly
The head is almost always rotated by the time it reaches the _____________ Pelvic floor
When the fetal head reaches the perineum for birth, it is deflected ______ by the perineum. anteriorly
The ________ passes under the lower border of the symphysis pubis first, then the ______ emerges by _________. First the _______, then the ______ and finally the _______ occiput, head, extension. occiput, face, chin
after the head is born it briefly rotates to the postion it occupied when it was engaged in the inlet. restitution or external rotation
The _______ shoulder descends first anterior
When the baby has completely emerged, birth is complete and the _______ stage of labor ends second
The average FHR at term is 140
The normal FHR range is 110-160
The FHR provides information about the condition of the fetus related to _________ oxygenation
Fetal circulation can be affected by: maternal position, contractions, BP, and umbilibal cord blood flow.
Changes that occur during labor and delivery that prepare the fetus for initiating respirations FETAL lung fluid is cleared oxygen pressure decreases (Po2) arterial Co2 pressure increases (Pco2) arterial pH decreases Hco3 decreases respiratory movements decrease during labor.
During each contraction an average of ______ ml of blood is emptied from the uterus into the maternal vascular system. 400
cardiac output is increased by _______% during the first stages of labor and by ______% in the second stage. 12-31% & 50%
Blood pressure _______ during labor. increases r/t blood being moved into the vascular space during contractions
assessing bp between ________ provides a more accurate reading contractions
Because of the increase in BP during labor, a patient already at risk for _______ is at ________risk for complications such as cerebral hemorrhage. HTN; increased.
___________ occurs when the ascending vena cava and the descending aorta are sompressed supine hypotension
In the unmedicated woman, in the second stage of labor o2 consumption almost _________ doubles
during labor, spontaneous voiding may be _______ difficult
Why is spontaneous voiding difficult for a woman in labor? tissue edema, discomfort, analgesia, and embarrassment
Proteinuria of _____ is a normal finding because it can occur in response to the breakdown of muscle tissue from the physical work of labor. 1+
In reference to neuro changes in the laboring woman what "phases" occur Initially euphoria, then increased seriousness, then amnesia between contractions during the second stage, finally elation or fatigue after giving birth.
_______________ raise the pain threshold and produce sedation. Endgoenous endorphins
During labor, GI motility and absorption of solid food are ________ and stomach emptying time is ____________. Decreased and slowed
Nausea and belching occur as a reflex response to full dilation
The onset of labor may be triggered by __________ levels of progestrone and ________ levels of estrogen, prostoglandins and oxytocin decreasing;increasing
Metabolism increases during labor, blood glucose levels may __________ with the work of labor. decrease
The ________ is a major factor in determining the course of birth fetal head
Talking will bother patients in the _________ phase transitional
Occipitoposterior (OP) means ________ up face
Created by: 1272858662
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