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OB Exam 1
OB chapter 13
| Question | Answer |
|---|---|
| factors influencing onset of labor | Uterine stretch Progesterone withdrawal Increased oxytocin sensitivity Increased release of prostaglandins |
| Uterine stretch | uterus is a muscle and within the muscle there is a layer called the endometrial lining the gap junctions in the uterus communicate btwn cells and uterus |
| Increased release of prostaglandins | varied forms but one type = relaxation of uterus and the other type is contraction of uterus |
| when palpating the fundus | it will be hard, excitability associated with gap junctions |
| during the third trimester | decrease progesterone and increase estrogen, pituitary is involved and oxytocin helps contractions |
| premonitory signs of labor | Cervical changes (cervical softening, possible cervical dilation) Lightening Increased energy level (nesting) Bloody show Braxton Hicks contractions Spontaneous rupture of membranes |
| when does actual labor start | dilation of cervix and effacement |
| Cervical changes (cervical softening, possible cervical dilation) | with softening, the cervix can dilate (open) |
| lightening | fetus is moving down into birth canal, easier to breathe but impacts bladder |
| increased energy level (nesting) | burst of energy you get before you guy into active labor some don't get this and some have decrease in energy |
| bloody show | plug forms around 2nd trimester, vagina is filled with bacteria so needs a plug to prevent from going into uterus when plug has force, it comes out and has bloody show - smear on TP, not overwhelming - if a lot, come in ASAP |
| braxton hicks contractions | increase in oxytocin, preparatory contractions irregular and no shortening or dilation of cervix |
| spontaneous rupture of membranes | released 38-39 weeks, if happens before the provider then there is increase risk of infected fetus fetus grows in H2O and is covered in it, AF is a cushion "bubble wrap" |
| true vs false labor is based on | Contraction timing Contraction strength Contraction discomfort Change in contraction activity Stay or go? |
| contraction timing | if 7-10 min for 1 hr then false labor |
| contraction strength | discomfort increasing? feeling worse? increase pain tolerance? |
| change in contraction activity | begins in back and extends to abdomen, ask if can move and if so then check to see if pain decreases |
| true labor | Contractions are regular Get stronger, longer, and closer together Continue despite walking or changing position Pain often starts in the back and moves to the abdomen Causes cervical dilation and effacement |
| false labor aka braxton hicks | Contractions are irregular Usually do not increase in strength or frequency May decrease with rest, hydration, or changing position Usually felt mainly in the abdomen No progressive cervical changes |
| real active labor doesn't allow | pt or fetus to survive 2-3 days without delivery |
| Critical Factors Affecting Labor and Birth (“Five Ps”) | Passageway (birth canal: pelvis and soft tissues) Passenger (fetus and placenta) Powers (contractions) Position (maternal) Psychological response |
| passageway | is it big enough? if previous pregnancy, then how big, fam Hx? |
| powers | getting stronger |
| position | where's placenta positioned? |
| best position for placenta | fetus to be in the middle |
| worst position for mom | is on her back but is best for the Dr squatting is best for mom but not for Dr |
| if placenta is on top of os, then | you are going to have bleeding and this will impact fetus bc nutrients going to the baby will be reduced |
| Five Additional Factors Affecting the Labor Process | Philosophy (low tech, high touch) Partners (support caregivers) Patience (natural timing) Patient preparation (childbirth knowledge base) Pain control (comfort measures) |
| stages of labor | latent phase and active phase (first stage), transition phase, second stage, third stage, fourth stage |
| latent phase | pain and contractions are there but the cervix is not at 4-5cm yet so not ready, activation of labor has not started can last a couple days |
| during the latent phase, | cervix is more favorable to begin dilation when gap junctions are communicating and there is oxytocin sensitivity mom can shop, walk, etc |
| active phase | stronger, more frequent contractions, take longer on first pregnancy but shorter active phase for previously pregnant moms |
| amniotic fluid does not | need to rupture before labor |
| transition phase | cervix can dilate to 10 cm (full dilated, takes several hours) and then can move into 2nd stage |
| when do moms typically ask for pain meds | during transition phase |
| when is cervix non palpable | at 10 cm |
| second stage | pushing baby down, toes and feet out is when baby is fully delivered which initiates 3rd stage |
| third stage | placenta expulsion, see fundal area rise up, you can see blood when placenta separates from uterine lining and when mom pushes the placenta will slide out within 30 min |
| if placenta does not come out within 30 min | it is a retained placenta and as long as it remains it is going to bleed |
| fourth stage | post baby and post placenta, now in post partum 1 to 4 hours following delivery |
| Passageway: Bony Pelvis | Linea terminalis True pelvis (below linea terminalis) False pelvis (above linea terminalis) |
| Linea terminalis | division of false and true pelvis |
| True pelvis (below linea terminalis) | inlet: entering, first place baby moves into Mid-pelvis Outlet (pelvic measurements): coccyx/sacrum |
| False pelvis (above linea terminalis) | Upper flared parts of two iliac bones and concavities Wings of base of sacrum |
| ischial spines | great landmark!!!! |
| what causes the pregnancy waddle | symphysis pubis stretches |
| Passageway: Pelvic shape | Gynecoid Android Anthropoid Platypelloid |
| gynecoid | favorable for vaginal delivery not ideal anymore |
| android | male shaped, not favorable narrower |
| Anthropoid | usually adequate big, want U not V shape |
| Platypelloid | not favorable |
| passageway: soft tissues | Cervix Pelvic floor muscles Vagina |
| what happens to cervix during birth | thins through effacement to allow presenting part to descend into vagina |
| passenger | Fetal skull Fetal attitude Fetal lie Fetal presentation Fetal position Fetal station Fetal engagement |
| fetal skull | parietal diameter is 8.5-9 |
| fetal attitude | able to move through if all is flex, head down, arms flex, fleet straight "flexion" |
| fetal lie | we want spine or baby and mom to be parallel transverse means spines are perpendicular so no vaginal delivery |
| fetal presentation | what body part is presenting first double feet out = breech complete = butt and feet frank = butt |
| when feet are showing through | we rarely deliver vaginally because then head gets caught |
| fetal position | based on presenting part, there are 3 components |
| 3 components of fetal position | direction, position and anterior or posterior |
| fetal station | occiput at level of spines, if above then number is negative and if below then number is positive |
| fetal engagement | Presenting part reaching 0 station Floating: no engagement; presenting part freely movable about pelvic inlet |
| fetal skull is the | Largest and least compressible structure |
| fetal skull components | sutures, fontanelles, diameters |
| sutures | allow for overlapping and changes in shape (molding) during delivery; help identify position of fetal head |
| fontanelles | intersections of sutures; help in identifying position of fetal head and in molding, can palpate these and they pulsate when baby cries |
| diameters | occipitofrontal, occipitomental, suboccipitobregmatic, and biparietal |
| diameter of c section baby | more round |
| longitudinal lie is when | mom and baby have parallel spines |
| transverse lie is when | mom and baby have perpendicular spines |
| fetal presentation | cephalic, breech, shoulder |
| go memorize slide 18!!!!!!!!!!! | right now go do it |
| fetal position landmarks | Occipital bone (O): vertex presentation Chin (mentum [M]): face presentation Buttocks (sacrum [S]): breech presentation Scapula (acromion process [A]): shoulder presentation |
| fetal position is identified by | 3 letter abbreviations |
| cardinal movements of labor | engagement, descent, flexion, internal rotation, external rotation, extension, repulsion |
| engagement, descent flexion | fetal head enters the pelvic inlet, fetus moves downward through the pelvis, fetal chin moves toward the chest baby descents into birth canal and is engaged in O station |
| internal rotation | baby rotates as moves lower towards symphysis pubis fetal head rotates to align with the maternal pelvis |
| external rotation | head rotates to realign with the shoulders, extends neck |
| extension | fetal head extends as it passes under the pubic bone |
| Expulsion | shoulders and the rest of the body are delivered |
| powers | Uterine contractions (primary stimulus) Intra-abdominal pressure from laboring patient pushing and bearing down Contractions: involuntary, thin and dilate cervix Three parameters |
| Three parameters | Frequency Duration Intensity |
| frequency | How often contractions occur, measured from the beginning of one contraction to the beginning of the next, measured in minutes |
| duration | How long each contraction lasts, measured from the beginning to the end of the same contraction, measured in seconds |
| Factors influencing a positive birth experience | Clear information on procedures Support, not being alone Sense of mastery, self-confidence Trust in staff caring for the patient Positive reaction to the pregnancy Personal control over breathing Preparation for the childbirth experience |
| Physiologic Responses to Labor pt 1 | Increased heart rate, cardiac output, blood pressure (during contractions) Increased white blood cell count Increased respiratory rate and oxygen consumption Decreased gastric motility and food absorption Decreased gastric emptying and gastric pH |
| Physiologic Responses to Labor pt 2 | Slight temperature elevation Muscle aches/cramps Increased BMR Decreased blood glucose levels |
| Physiologic Responses to Labor: Fetal | Periodic FHR accelerations and slight decelerations Decrease in circulation and perfusion Increase in arterial carbon dioxide pressure Decrease in fetal breathing movements Decrease in fetal oxygen pressure; decrease in partial pressure of oxygen |
| Signs of Placental Separation | The uterus rises upward. The umbilical cord lengthens. A sudden trickle of blood is released from the vaginal opening. |
| Factors Influencing Pain During Labor and Birth | Physiologic Spiritual Psychosocial Cultural Environmental |
Created by:
leh195