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N113 L&D

N113 - Labor & Delivery

What are the 4 P's impacting labor & birth? Passage, Passenger, Power & Psyche
How does passage affect labor & birth? Size & type of pelvis, ability of cervix to dilate & efface, ability of vagina to distend.
How does the passenger affect labor & birth? Head size, attitude, lie, presentation, position & implantation site of placenta.
How does power effect labor & birth? Frequency, duration & intensity of contractions, effectiveness of pushing, duration of labor.
How does the mothers psyche effect labor & birth? Physical preparation, sociocultural heritage, previous experience, support system, emotional integrity
What are the pelvic measurements? Diagonal conjugate, true conjugate, obstetric conjugate, inlet & outlet.
What is the diagonal conjugate? The distance between the lower border of the symphysis pubis to sacral promontory. Should be >11.5 cm for pelvic inlet to be adequate. Measured by hand during pelvic exam.
What is the true conjugate? Distance from upper border of symphysis pubis to middle of sacral promontory, determined by subtracting 1 cm from the diagonal - estimated, cannot be measured.
What is the obstetric conjugate? Determined by subtracting 1.5 to 2 cm from diagonal. Smallest diameter through which the fetus must pass. Can be measured by x-ray, should be >10 cm.
What is the inlet? The upper border of the true pelvis, transverse diameter of the true pelvis is the largest.
What is the outlet? The lower border of the true pelvis. Extends from the lower border of the symphysis pubis to the tip of the sacrum. Anterior to posterior measurement should be the largest.
What is the most common type of pelvis? Gynecoid or round, 50% of females have this type
What is the most favorable type of pelvis? Gynecoid or round, anthropoid or oval is usually adequate
What is the least favorable type of pelvis? Android or heart shaped, platypelloid or flat
What is attitude? The relation of fetal parts to one another. Normal is flexion of head, arms to chest, legs to abdomen, classic fetal position.
What is lie? Relation of long axis (spine) of the fetus to that of the mother. Normal is longitudinal, transvers is when baby is laying across the abdomen.
What is presentation? What part is first in the maternal pelvis.
What is cephalic presentation? Head first, 97% of term births.
What are the different types of cephalic presentation? Vertex - neck completely flexed, most common - smallest diameter of head presents, Military - neck neither flexed or extended - head & neck is straight, Brow - neck partially extended - head tipped slightly back, Face - neck hyperextended
What are the risks associated with brow presentation? Trauma to neck, trachea, & larynx, facial edema, detected by palpating fontanelle, anterior fontanelle will be felt instead of posterior.
What are the risks associated with face presentation? Increased risk of CPD - cephalopelvic disproportion - head won't fit through pelvis, facial edema
What is associated with breech presentation? Decreased weight of baby, increased mortality & anomalies, more common with placenta previa, multiple gestation & grand multiparity. Possible head entrapment, increased chance of cord prolpse. Passage of merconium due to compression of intestines.
What are the 3 types of breech presentation? Complete - fetus sitting indian style, Frank - butt first with legs & feet straight up by head, Footling - single or double feet present first.
What is a shoulder presentation? When fetus is across the abdomen. Can lead to uterine rupture due to stress on uterus, increased danger of cord prolapse.
What is engagement? When largest diameter of presenting part reaches or passes through pelvic inlet - upper diameter of pelvis
What is station? Relationship of presenting part to imaginary line drawn between the ischial spines, graded at + or -.
What is fetal position? Relationship of the landmark on the fetal presenting part to the front, sides or back of the maternal pelvis.
What are the fetal positions? O - Vertex or occiput - normal fetal position, M - face, chin or mentum presenting, S - breech, sacrum presenting, A - shoulder, scapula or acromion process presenting.
What are the cardinal movements in labor? Engagement & descent, flexion, internal rotation, extension, external rotation, expulsion.
What is engagement & descent? head enters inlet in occiput transverse position because the inlet is widest from side to side
What is flexion? Occurs as head meets resistance from musculature & soft tissue.
What is internal rotation? Fetus rotates 45 to 90 degrees to fit the widest anterior/posterior diameter of the outlet
What is extension? Head passes under the symphisis pubis; occiput, brow & face emerge; complete when entire head is born.
What is external rotation? As shoulders rotate to anterior posterior position the head is turned further to one side
Which stages can be seen? Extension, external rotation & expulsion
What are the 3 stages of a contraction? Increment - building up - longest, Acme - peak, Decrement - period of decreasing intensity
How is the frequency timed? From the beginning of one contraction to the beginning of the next.
How is the duration calculated? From the beginning of one to the end of same contraction.
How is intensity rated? Mild - fingertips can easily indent fundus - cheek, moderate - can indent sligntly - chin, strong/hard - cannot indent - forehead.
How is the latent phase characterized? Last 2-16 hours, cervical dilation up to 3-4 cm, mild contractions, with short duration and long interval in between. Mother feels excited, happy, some apprehension
How is the active phase characterized? Cervical dilation from 4-8 cm, contraction stronger & longer, more frequent, more painful, Mother needs to use breathing techniques, pain medication is usually administered
How is the transition phase characterized? Cervical dilation 8-10 cm, contraction longer & stronger, may experience nausea & possible vomiting, mother becoming tired, frustrated & unable to cope, need to focus mom and have her concentrate
What is the second stage of delivery? This is when the mom feels the need to push, doctor may do episiotomy at this time, contractions are less painful since cervix is completely dilated
What is the third stage of delivery? Birth of baby and delivery of placenta, mother is exhausted and eager to see baby, very hungry & thirsty.
What is the fourth stage of delivery? This is the first hour post partum
What is the main difference between true & false labor? There is no change in the cervical consistency in false labor.
Created by: jrb265