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OB exm
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| Question | Answer |
|---|---|
| The 5 P’s affecting labor & birth | Passenger Passageway Powers Position Psychologic response |
| 1. Passenger: | Size of fetal head Fetal presentation Fetal lie Fetal attitude Fetal position |
| Fetal skull composed of: | 2 parietal bones 2 temporal bones Frontal bone Occipital bone. |
| Bones united by sutures: | sagittal, lambdoidal, coronal, & frontal. |
| After membranes rupture, fontanels & sutures | are palpated to assess fetal presentation, position & attitude. |
| Anterior fontanel – | diamond-shaped, ~ 3 cm x 2 cm, at junction of sagital, coronal, & frontal sutures; closes by 18 months of age |
| Posterior fontanel – | triangular, ~1 cm x 1 cm, at junction of parietal & occipital sutures; closes ~ 6 - 8 weeks after birth. |
| Fetal skull is flexible | skull bones not firmly united |
| Molding | (overlapping of skull bones): - occurs to permit adaptation to various diameters of maternal pelvis - usually resolves in 3 days after birth. |
| Presentation | refers to the fetal part that enters the pelvic inlet first. |
| 3 main presentations: | cephalic presentation (head first, 96% of births) breech presentation (buttocks or feet first, 3% of births) shoulder presentation (about 1% of births) |
| Presenting part | = the part of the fetal body felt by examiner during vaginal exam |
| Cephalic presentation | – occiput |
| Breech presentation – | sacrum |
| Shoulder presentation | – scapula |
| “vertex” | If occiput is the presenting part |
| Lie = | the relation of long axis of fetus to long axis of mother. |
| Longitudinal lie | – fetus’ spine is parallel to mother’s spine |
| Transverse lie – | fetus’ spine at right angles to mother’s spine. |
| Attitude = | relation of fetal body parts to each other. |
| Normally, fetal back is rounded, chin flexed on chest, thighs flexed on abdomen, legs flexed at knees, & arms crossed over thorax. | Normal fetal attitude |
| Biparietal diameters | = largest diameters, ~ 9.25 cm. = the widest part of head entering the pelvic inlet in a well flexed cephalic presentation. |
| Suboccipitobregmatic diameter | = the smallest & most critical AP diameter, ~ 9.5 cm. When fetal head is in complete flexion, this small diameter allows the fetal head to pass through the true pelvis |
| Position = | the relation of presenting part to the 4 quadrants of mother’s pelvis |
| Position is denoted by 3 letter abbreviation. | 1st R or L side of pelvis 2nd O, S, M or Sc 3rd A P and T |
| Station = | the relation of presenting part of fetus to an imaginary line drawn between the maternal ischial spines. |
| Placement of presenting part is measured in | cms ↓ or ↑ ischial spines. |
| Station at level of ischial spines | = station 0. |
| Birth imminent when presenting part is | + 5cm. |
| Engagement | = term used to indicate that the largest transverse diameter of presenting part has passed through the maternal pelvic inlet into the true pelvis. |
| Primipara | Occurs in weeks just before labor |
| Multipara- | Often occurs when labor begins or during |
| Passageway composed of | Rigid bony pelvis Soft tissues of cervix, pelvic floor, & vagina |
| The Bony Pelvis | Formed by fusion of ilium, ischium, pubis, & sacrum |
| 4 pelvis joints: | symphysis pubis, R & L sacroiliac joints, & sacrococcygeal joint. |
| Pelvis is Divided into 2 parts: | False pelvis above True pelvis below – involved in birth |
| True pelvis divided into: | Pelvic inlet = upper border of the true pelvis. Pelvic cavity = curved passage with a short anterior wall & longer concave posterior wall. Pelvic outlet = lower border of the true pelvis; coccyx is moveable in late pregnancy |
| Pelvic inlet | = upper border of the true pelvis. |
| Pelvic cavity = | curved passage with a short anterior wall & longer concave posterior wall. |
| Pelvic outlet = | lower border of the true pelvis; coccyx is moveable in late pregnancy |
| Bony Pelvis - 4 Basic Types | Gynecoid Android Anthropoid Platypelloid |
| Gynecoid – | classic female type, 50% of all women, supports spontaneous vaginal birth |
| Android – | classic male pelvis, 23%, heart shaped, may need assistance with forceps or suction; may require C/S |
| Anthropoid- | oval shaped, 24%, usually can deliver vaginally, may need assistance |
| Platypelloid - | 3%, flattened from front to back, widest side to side, supports vaginal birth |
| Primary powers | involuntary uterine contractions that signal the beginning of labor. |
| Secondary powers | = voluntary bearing-down efforts by the woman ↑ force of involuntary contractions |
| Involuntary contraction | Originate in muscle layers of upper uterus Contraction moves ↓ over uterus in waves, separated by short rest periods. |
| Frequency = | time from beginning of 1 contraction to beginning of next. |
| Duration = | length of contraction |
| Intensity = | strength of contraction |
| Effacement | shortening & thinning of cervix during 1st stage of labor. |
| Cervix normally 2 - 3 cm | long & ~1 cm thick. |
| Only a thin edge of cervix is palpated | when effacement is complete. |
| Degree of effacement is expressed in percentages | from 0% to 100%. |
| Cervical Dilation | enlargement or widening of cervical opening & cervical canal; occurs when labor begins. |
| When completely dilated & effaced, | cervix is no longer palpable. |
| Full cervical dilation | = end of 1st stage of labor. |
| During labor, ↑ intrauterine pressure puts pressure on | cervix. |
| Cervix stretches when presenting part of fetus reaches the | perineal floor. |
| Stretch receptors in vagina cause release of | oxytocin that triggers the maternal urge to bear down |
| UCs may ↓ in frequency & intensity if | narcotic analgesic or epidural analgesic is given early in labor |
| UCs change when presenting part reaches pelvic floor | > urge to push. |
| Client uses diaphragm & abdominal muscles | to push. |
| “Bearing down” causes | ↑ intra-abdominal pressure that compresses the uterus & adds to powers of expulsion |
| Prolonged breath holding & forceful pushing efforts are associated | with fetal hypoxia & acidosis. |
| Directed pushing is associated with | perineal tears. |
| 1st stage of labor: | Encourage client to find a position that is the most comfortable Frequent position changes relieve fatigue, ↑ comfort & improve circulation. |
| Upright position | walking, sitting, squatting > gravity aids fetal descent UCs stronger, more effective in causing effacement & dilation ↑ maternal cardiac output improves blood flow |
| Vena Cava Syndrome - | ↓ cardiac output if descending aorta & vena cava are compressed during labor; results in supine hypotension & ↓ placental perfusion. |
| “All fours” | (hands & knees position) used to relieve backache if fetus is in posterior position. May also assist in anterior rotation of fetus in cases of shoulder dystocia |
| 2nd Stage of Labor | Semi-recumbent – can push coccyx forward, ↓ the pelvic outlet. Sitting or squatting – uterus moves forward & aligns the fetus with pelvic inlet, ↑ the pelvic outlet Lateral – helps rotate fetus in posterior position, ↓ force of bearing down |
| Semi-recumbent – | can push coccyx forward, ↓ the pelvic outlet. |
| Sitting or squatting | uterus moves forward & aligns the fetus with pelvic inlet, ↑ the pelvic outlet |
| Lateral – | helps rotate fetus in posterior position, ↓ force of bearing down |
| The course of normal labor consists of: | Regular progression of UCs Effacement & progressive dilation of cervix Progress in descent of presenting part |
| Signs of Impending Labor | Lightening Bloody show Loss of 0.5 - 1.5 kg Return of urinary frequency ↑ Braxton Hicks contractions Surge of energy Backache ROM |
| 1st stage of labor Starts with | onset of regular UCs & ends with full dilation of cervix. Much longer than 2nd & 3rd stage combined |
| Full dilation can occur in | < than 1 h or may last up to 20 h (primips) |
| 2nd stage of labor | Lasts from full dilation of cervix to the birth of fetus. |
| Epidural analgesia often lengthens the | |
| 3rd stage of labor | Lasts from time of birth until birth of the placenta. Placenta usually separates with 3rd or 4th strong UC after birth of infant. |
| 4th stage of labor | Is the 2 h period post delivery of the placenta. Period of recovery when homeostasis is re-established. Important time to monitor for complications, EX. PPH |
| Mechanism of labor | Engagement Descent Flexion Internal rotation Extension External rotation Expulsion |
Created by:
knnmala
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