Labor and Birth Process
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| Five P's | Passenger, Passageway, Powers, Position, Psychologic response
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| The fetal skull is composed of: | two temporal bones, the frontal bone, two parietal bones,and the occipital bone.
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| Names of the four sutures of the fetal head | sagital, lambdoidal, coronal, and the frontal
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| What are fontanels? | Membrane filled spaces where the sutures intersect.
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| The palpation of the fontanels during a VE reveals: | fetal presentation, position and attitude
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| Anterior fontanel is __________ shaped and lies at the junction of the _______, _________, _________ | diamond
sagittal, coronal, and frontal sutures
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| The anterior fontanel closes by: | 12-18 month
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| The Posterior fontanel is_______ shaped and lies at the junction of _______, and _______. | Triangle, The two parietal bones and the occiptal bone.
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| The posterior fontanel closes by: | 6-8 weeks after birth
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| Molding can be extensive but the newborns head returns to normal shape within: | 3 days
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| Cephalic | Head down
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| Breech | feet/butt down
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| These make the skull flexible to accomodate the infants brain, which continues to grow for some time after birth | Sutures and fontanels
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| ________ refers to the part of the fetus that enters the pelvic inlet first and leads through the birth canal during labor. | Presentation
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| Three main types of presentations | Shoulder, cephalic, breech
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| ______ 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
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| In a cephalic presentation what is the presenting part? | occiput
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| In the breech presentation what is the presenting part? | sacrum
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| In the shoulder presentation what is the presenting part? | scapula
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| When the presenting part is the occiput, the presentation is noted as _________ | Vertex
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| Factors that determine the presenting part include: | Fetal lie, fetal attitude, and extension or flexion of the fetal head.
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| The relation of the spine of the fetus to the spine of the mother. | Fetal lie
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| The two primary lies are: | longitudal (vertical)
Transverse (horizontal or oblique)
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| 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)
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| Whice fetal lie is this? the spine of the fetus is at a right angle diagonal to the mothers spine. | Transverse (horizontal)
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| A vaginal birth cannot occur with this fetal lie | Transverse
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| What type of fetal lie is this? The spine of the fetus lies at an angle to the spine of the mother | Oblique
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| The relation of the fetal body parts to each other. (posture) | Fetal attitude
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| 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.
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| the relationship of a reference point on the presenting part to the four quadrants of the mothers pelvis | fetal position
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| 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
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| 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
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| Birth is imminent when the station of the presenting part is _____ to _______ | +4 to +5
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| 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
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| When does engagement occur? | Nulliparas- weeks just before labor
multiparas- before labor or during labor
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| How can the engagement be determined? | by VE or abd exam
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| false pelvis | part above the brim and plays no part in childbearing
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| True pelvis | The part involved in birth, divided into three planes. inlet, mid-pelvis/cavity, outlet
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| The four basic types of pelvis' | Gynecoid (female)
Android (resembles male pelvis)
Anthropoid (resembles anthropoid ape)
Platypelloid (flat pelvis)
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| The most commong pelvic type | Gynecoid
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| What are the involuntar uterine contractions that signal the beginning of labor called? | Primary powers
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| What are the voluntary bearing down efforts performed by the woman called? | Secondary powers (they help augment the force of the involuntary contractions)
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| The time from the beginning of one contraction to the begninning of the next | frequency
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| Length of the contraction | duration
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| strength of contraction at its peak | intensity
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| These are responsible for the effacement and dilation of the cervix and descent of the fetus. | Primary powers
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| shortening and thinning of the cervix during the first stage of labor. | effacement
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| ________ is generally advanced in first-time term pregnancy before more than slight dilation occurs. In subsequent pregnancies this and dilation progress together. | effacement
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| degree of effacement is expressed in ______ | percentages from 0-100
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| the enlargement or widening of the cervial opening and the cervical canal that occurs once laborhas begun. | dilation
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| _______ marks the end of the first stage of labor. | Full dilation of the cervix
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| ________ 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
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| _______ of the cervix can slow dilation | scarring
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| __________ in the posterior vagina cause the release of endogenous oxytocin that triggers the maternal urge to bear down. | stretch receptors
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| The maternal urge to bear down | ferguson reflex
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| This can cause a decreased frequency and intensity of contractions if given in early labor | narcotic analgesics
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| as soon as the presenting part reaches the pelive floor the contractions change and become ________ | expulsive
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| secondary powers have no effect on _________ but they are important in the explusion of the fetus. | cervial dilation
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| closed glottis and prolonged bearing down | Valsalva maneuver
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| Adverse effects associated with prolonged breath holding and forceful pushing efforts include: | fetal hypoxia and subsequent acidosis
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| __________ in position relieve fatigue, increase comfort, and improve circulation in the laboring woman. | frequent changes
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| 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
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| _________ is compromised if the descending aorta and ascending vena cava are compressed during labor | cardiac output
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| Compression of the major vessels can result in __________ which decreased placental perfusion | supine hypotension
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| If a laboring woman wishes to lay down, this position is suggested. | Lateral
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| 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
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| The process of moving the fetus, placenta, and membranes out of the uterus and through the birth canal. | labor
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| 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"
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| strong, frequent but irregular contractions | braxton hicks
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| The onset of ________ cannot be ascribed to a single cause | true labor
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| this lasts from the onset of regular contractions to full effacement and dilation of the cervix | first stage of labor
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| the ______ stage is the longest stage of labor | first
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| the three phases of the first stage of labor | latent, active, and transition
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| 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
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| 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
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| This stage of labor lasts from the time that the cervix is totally effaced and dilated to the birth of the fetus | second stage
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| the two phases of the second stage of labor | latent and active pushing phase (descent)
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| 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
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| during this phase of the second stage of labor the woman has strong urges to bear down | active pushing phase (descent)
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| this stage of labor lasts from the birth of the fetus until the placenta is delivered | third stage of labor
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| the placenta normally seperates with the ___ or ____ strong uterine contraction after the infant has been born | 3rd/4th
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| the placenta is usually expelled within ___ to ___ minutes after the birth of the baby | 10-15
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| The risk for ______ increases as the length of the thrid stage increases | hemorrhage
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| The third stage of labor is normally completed within ______ minutes | 30
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| this stage of labor lasts 1-2 hours after the delivery of the placenta. | fourth stage of labor
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| 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
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| The turns and other adjustments necessary in the human birth process | mechanisms of labor
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| 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.
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| This term refers to a deflected head (anteriorly or posteriorly) | asynclitism
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| This refers to the progress of the presenting part through the pelvis | descent
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| 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.
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| 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
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| 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
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| _________ permits the smaller suboccipitobregmatic diameter to present to the outlet. | Flexion
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| The fetal head passes into the true pelvis in what position? | occipitotransverse
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| the outlet is widest in the ________ diameter | anteroposterior
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| for the fetus to exit the pelvic outlet, the _____ must ______ | head, rotate
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| Internal rotation begins at the level of the ________ but is not completed until the presenting part reaches the lower pelvis. | ischial spines
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| During internal rotation, as the occiput rotates _________, the face rotates __________ | anteriorly, posteriorly
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| The head is almost always rotated by the time it reaches the _____________ | Pelvic floor
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| When the fetal head reaches the perineum for birth, it is deflected ______ by the perineum. | anteriorly
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| 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
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| after the head is born it briefly rotates to the postion it occupied when it was engaged in the inlet. | restitution or external rotation
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| The _______ shoulder descends first | anterior
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| When the baby has completely emerged, birth is complete and the _______ stage of labor ends | second
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| The average FHR at term is | 140
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| The normal FHR range is | 110-160
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| The FHR provides information about the condition of the fetus related to _________ | oxygenation
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| Fetal circulation can be affected by: | maternal position, contractions, BP, and umbilibal cord blood flow.
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| 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.
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| During each contraction an average of ______ ml of blood is emptied from the uterus into the maternal vascular system. | 400
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| cardiac output is increased by _______% during the first stages of labor and by ______% in the second stage. | 12-31% & 50%
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| Blood pressure _______ during labor. | increases r/t blood being moved into the vascular space during contractions
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| assessing bp between ________ provides a more accurate reading | contractions
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| 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.
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| ___________ occurs when the ascending vena cava and the descending aorta are sompressed | supine hypotension
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| In the unmedicated woman, in the second stage of labor o2 consumption almost _________ | doubles
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| during labor, spontaneous voiding may be _______ | difficult
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| Why is spontaneous voiding difficult for a woman in labor? | tissue edema, discomfort, analgesia, and embarrassment
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| 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+
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| 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.
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| _______________ raise the pain threshold and produce sedation. | Endgoenous endorphins
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| During labor, GI motility and absorption of solid food are ________ and stomach emptying time is ____________. | Decreased and slowed
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| Nausea and belching occur as a reflex response to | full dilation
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| The onset of labor may be triggered by __________ levels of progestrone and ________ levels of estrogen, prostoglandins and oxytocin | decreasing;increasing
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| Metabolism increases during labor, blood glucose levels may __________ with the work of labor. | decrease
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| The ________ is a major factor in determining the course of birth | fetal head
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| Talking will bother patients in the _________ phase | transitional
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| Occipitoposterior (OP) means ________ up | face
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