OB test 2
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| Labor & Birth | end of pregnancy & intrauterine life, beginning of extrauterine life, change in relationships
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| Theories of Labor | Progesterone w/drawl hypothesis, Prostraglandin hypothesis-^sensitivity to oxytocin/Pitocin
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| 5 Critical Factors in Labor | passage, passengers, relationship btw passage/passengers, physiological forces of labor, psychological factors
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| Passage | birth canal, cervix, vaginal canal, pelvic/perineal muscles
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| Passage-factors affecting | type & size of pelvis, ability of cervix to dilate(need 10cm to push), ability of vagina to distend, ability of perineum to distend
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| Pelvis most conducive to delivery | Gynacoid & Anthropoid
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| Passengers | fetus, chorion/amnion membranes, placenta
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| Passengers movement-affected by | fetal head, fetal lie, fetal attitude, fetal presentation, placenta
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| Passenger’s head | largest & least compressible part, face-base of skull-vault of cranium
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| Vault of Cranium | 2 parietal bones, 2 frontal bones, occipital bone—not fused, can overlap
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| Skull bones are united by | Sutures
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| Sutures intersect at | fontanels, anterior & posterior most useful, identifies position
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| Anterior fontanel | junction of sutures, diamond shaped, 2cmx3cm, permits brain growth, remains open for 18 months
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| Posterior fontanel | junction of posterior sutures, above occipital bone, triangular shaped, 1cmx2cm, closes 8-12wks after birth
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| Mentum | fetal chin
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| Sinciput | frontal lobe, anterior, brow
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| Bregma | anterior fontanel, large, diamond shaped
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| Vertex | area btw anterior & posterior fontanels
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| Occiput | area beneath posterior fontanel, occipital bone
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| Passenger-Fetal attitude | posture of body w/ reference to limbs, flexion or extension
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| Normal Attitude of Fetus | flexion; flexion of head, flexion of legs, flexion of arms on chest
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| Passenger-Fetal Movement affected by Placenta | normal placental implantation-uppermost posterior part of uterus, abnormal placental implantation-lower uterine segment(placenta previa), may cover part or all of cervical os->movement impeded
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| Passenger-Fetal Lie | relationship of fetus’ long axis(cephalocaudal)to mother’s long axis(spine)
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| Longitudinal/vertical lie | cephalocaudal axis of fetus is parallel to mom’s axis
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| Transverse lie | cephalocaudal axis of fetus is perpendicular to mom’s axis
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| Oblique lie | cephalocaudal axis of fetus is diagonal to mom’s axis
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| Passenger-Fetal Presentation | determined by fetal lie and body part that enters pelvic passage first-presenting part
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| Presentation types | cephalic, breech, shoulder->further categorized based on fetal attitude
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| Passenger-Fetal Position | relationship of designated landmark on presenting part to specific part on maternal pelvis-four imaginary quadrants
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| Engagement | largest diameter of presenting part reaches or passes through pelvic inlet->determined by vaginal exam, confirms adequacy of pelvic inlet only, in primigravida occurs 2wks before term
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| Floating | fetal head is directed down toward the pelvis but can still easily move away from inlet
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| Dipping | fetal head dips into the inlet but can be moved away by exerting pressure on the fetus
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| Engaged | the biparietal diameter(BPD) of fetal head is in the inlet of the pelvis, most instances the presenting part(occiput) is at level of ischial spines(0 station)
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| Station | relationship of presenting part to the ischial spines->narrowest diameter of normal pelvis, ischial spines marks 0 station, above spines -, below spines +, -5-+5
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| No Progress | CPD? Cephalopelvic disproportion
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| Powers of Labor | primary force-causes complete effacement/thinning of cervix->dilation/widening, secondary force-abdominal muscles->used to push during 2nd stage of labor
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| Preliminary/Premonitory/Prodromal Signs of Labor | lightening, surge of energy, Braxton-hicks, ripening of cervix, rupture of membranes, bloody show
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| True/Actual Signs of Labor | cannot be attrib to a single cause-changes in maternal uterus, changes in cervix/pit gland, aging of placenta, ^intrauterine pressure, uterine contractions change, efface/thinning, dilation-progressive enlarge/widening of cervical opening, dia ^1-10cm
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| First Stage of Labor | Dilation-begins w/ onset of regular contractions(mild), ends w/ full dilation of cervix, longer than other stages, consists of 3phases
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| Early/Latent-1st phase of 1st stage of labor | progressive effacement of cervix, little ^ in descent, excited and anxious
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| Active-2nd phase of 1st stage of labor | contractions resume, dilates 4-7cm, bearing down efforts, fetal station advancing, anxiety ^-employ coping strategies
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| Transition-3rd phase of 1st stage of labor | contractions more frequent-longer-stronger(90sec), more rapid dilation of cervix(8-10cm, ^ rate of descent, rectal pressure-low backache-belching-N/V, perspiration on brow, apprehensive-irritable-angry-withdrawn(breathe)
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| Second Stage of Labor | Pushing-lasts from time cervix is completely dilated to birth of fetus, avg 20-50min, crowning occurs when birth is imminent, head encircled by vaginal introitus, sense of purpose, burning sensation
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| Third Stage of Labor | Placental-from birth of fetus until placenta is delivered, normally separates eith 3rd or 4th contraction after fetus is born, from 3-5min to 1hr->risk of hemorrhage ^ as length of stage ^
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| Fourth Stage of Labor | Recovery-1-4hs after delivery of placenta, avg 2hr after birth, period of immediate recovery-homeostasis, observe for complications-abnormal bleeding
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| SVD | Spontaneous Vaginal Delivery-Cephalic/vertex, most common
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| FAVD | Forceps Assisted Birth-Instrumental/operative vaginal delivery, Outlet forceps-fetal skull reached perineum, Low forceps-presenting part at station +2, Midforceps-fetal head is engaged
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| FAVD-Indications | threat to mother or fetus, Hx of heart disease, pulmonary edema, exhaustion
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| FAVD-Conditions | cervix completely dilated, engagement, ruptured membranes, vertex or face presentation, bladder empty, CPD ruled out
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| FAVD-Risks | Newborn-ecchymosis/edema of face, lacerations, succedus caput or cephalhematoma->hyperbilirubinemia, transient paralysis, cerebral hemorrhage, Maternal-lacerations of birth canal, 3rd or 4th degree extension of episiotomy, bleeding, bruising, edema
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| FAVD-Nursing Care | decrease need for oper vag birth, correct labor dyst PRN, encrage posit changes, amb, empty client bladder freq, correct FHR decel, apply O2 PRN, ^fluid intake, assist ID contracts, reinfrce push w/ tract, assess newborn, assess mom for REEDA/hematoma/inf
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| VVD | Vacuum Assisted Birth-vacuum extractor used to apply suction to fetal head, traction applied during contractions, decent should be seen w/ first two pulls
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| VVD-Risk/Nursing Care | cephalhematoma of newborn, keep family informed, assess FHR, assure that caput will disappear w/in 3 days, assess newborn for intracerebral hemorrhage, jaundice
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| Cesarean Birth/C-section | birth of infant through an abdominal and uterine incision, repeat-elective-preservation of pelvic floor
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| VBAC | Vaginal Birth After Cesarean-rule out CPD, adequate pelvis, low transvers incision
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| Perineal Episiotomy | surgical incision in perineum to enlarge vaginal outlet-1st degree-extend through skin, 2nd degree-skin & muscle, 3rd degree-skin, muscle, & anal sphincter, 4th degree-skin, muscle anal sphincter & rectal wall
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| REEDA | redness, ecchymosis, edema, discharge, approximation
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| Episiotomy-Median/midline | most common in U.S., effective, easy to repair, least painful, extension to or through anal sphincter more likely
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| Episiotomy-Mediolateral | need for posterior extension, 3rd degree laceration may occur, blood loss greater, difficult to repair, more painful
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| Episiotomy-Prevention | prenatal Kegel exercises, perineal massage, natural pushing, side-lying pushing position, warm compresses, counterpressure
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| Episiotomy-Care | assist w/ distraction and discomfort during repair, apply ice 20-30 min, inspect every 15min x4, REEDA
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| Contractions-Frequency | beginning of on contraction to beginning of the next
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| Contractions-Duration | time between beginning of a contraction to the end of same contraction
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| Contractions-Intensity | strength of contraction at peak/acme, fundus palpated for indentibility, measured accurately with Intrauterine Pressure Catheter(IUPC)
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| Resting Tone | tone of muscle between contractions
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| Contractions-Maternal Danger Signs | hyperstimulation of uterus->uterine resting tone >25mmHg, uterine contractions >90sec, uterine resting period <30sec
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| Pelvic Inlet | upper border of true pelvis; sacral prominence around superior aspect of symphysis pubis, widest diameter: transverse 13.5cm
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| Pelvic Outlet | lower border of true pelvis; coccyx to ischial tuberosities to inferior aspect of symphysis pubis, widest diameter: anterior/posterior, 9.5-11.5cm, may be increased by 1.5-2cm w/ squatting/sitting
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| Cephalic Presentation | 96-97% of births, head presented into passageway, classified according to attitude of fetal head: degree of flexion or extension
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| Cephalic Presentation-Vertex | most common, head flexed on chest, smallest diameter-suboccipitobregmatic 9.5cm, presenting part-occiput
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| Cephalic Presentation-Military | head neither flexed nor extended, occipitofrontal 11.75cm, presenting part-top of head
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| Cephalic Presentation-Brow | head is partially extended, largest anterior-posterior diameter, occipitomental, presenting part-sinciput
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| Cephalic Presentation-Facial | head complete extension, submentobregmatic, presenting part-face
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| Breech Presentations | 3% of births, buttocks &/or feet presented to pelvis, sacrum is landmark
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| Breech Presentation-Complete | knees and hips flexed; buttocks and feet present(cannonball)
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| Breech Presentation-Frank | hips flexed, knees extended, buttocks present(pike)
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| Breech Presentation-Footling | hips and legs extended, feet present, single or double footling
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| Shoulder Presentation | transverse/horizontal, presenting part-shoulder, presenting part-acromian process of scapula
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| Cardinal Movements | adaptions that fetus undertakes to maneuver through the pelvis during birth and labor
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| Pain Management | breathing techniques-open mouth/pant & blow, analgesics, anesthetics, touch-effluerage/soft stroking
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| Analgesics | decrease amount of pain perceived-Stadol, Demerol
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| Anesthetics | regional, spinal, local, general
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| Anesthetics-Epidural | med injected into epidural space, catheter/epidural, onset 20-30min, lasts 2 hours then re-injected
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| Anesthetics-Spinal Block | med injected into spinal fluid, quick onset, lasts 18-24 hours
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| Anesthetics-Epidural/Spinal | need baseline for mother and baby, must be in ACTIVE labor, monitor respiratory rate, SE; hot spots, has to wear off, itching, N/V, urinary retention, SE decreased w/ Narcan
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| Rupture of Membranes-Nursing Management | assess fetal heart rate, color, odor, clarity, volume, and time
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| Labor Complications-Dystocia | long, difficult, abnormal labor, often during 1st stage, primary cause for C/S delivery, often caused by dysfunctional labor
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| Hypertonic Uterine Dysfunction | latent stage, cervical dilation <4cm, contractions uncoordinated, frequency ^, intensity decreasing but painful, resting tone ^
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| Hypertonic Uterine Dysfunction-Complications | intrauterine infection, repeated vaginal exams, exhaustion, fetal distress, hypoxia, late decelerations, decreased uteroplacental blood flow, ^prolonged pressure on head, cephalhematoma
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| Hypertonic Uterine Dysfunction-Tx | rest & fluids, narcotics-morphine sulfate/meperidine/tocolytics-inhibits uterine contractions, reduce pain, barbiturate-to allow sleep, usually will awake w/ normal labor pattern
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| Hypotonic Uterine Dysfunction | normal/active labor progress to at least 4cm, then become weak/inefficient-<25mm Hg or stop compleatley, frequency decreasing, intensity decreasing, resting tone unchanged
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| Hypotonic Uterine Dysfunction-Tx | ultrasound/x-ray to rule out CPD, assess FHR/pattern, amniotic fluid, maternal well-being, if those normal may ambulate, hydrotherapy, ROM, Pitocin augmentation
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| Hypotonic Uterine Dysfunction-Complications | fetal distress, risk for infection, tachycardia, intrauterine infection, exhaustion, dehydration, risk for postpartum hemorrhage
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| Pathologic Rings-Soft Tissue Dystocia | constriction rings/hourglass-rare-form and impedes fetal decent, contractions not starting at pacemaker, dangerous, give analgesics/anesthetics to relax rings, C/S
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| Precipitous Labor/delivery | powers work too well, labor <3hrs before birth, 5 contractions in 10min, may be from hypertonic UC, pressure may reach 50-70mmHg, lower uterine segment very soft
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| Precipitous Labor/delivery-Management | NEED dr, stay calm, encourage to push btw contractions, gentle counter pressure to presenting part, if head out check for nuchal cord, suction-mouth 1st then nose, clamp & cut cord, assess & place baby to breast
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| Precipitous Labor/delivery-Risks | lacerations of birth canal, hemorrhage, uterine rupture, hypoxia, trauma to head, intracranial hemorrhage, lack of care/attendance of healthcare personnel, call for help-do not leave!
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| Uterine Rupture-Incomplete | extends into peritoneum but not peritoneal cavity, may be partial separ of old C/S scar, abd tenderness, pain w/ and w/o contractions, small amt vag bleeding/usually internal, dist lower uterine segment, failure of labor to progress->early signs of shock
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| Uterine Rupture-Complete | extends through entire uterus into peritoneal cavity, profuse bright red bleeding, tore away-sharp abd pain, abnormal feel/shape of uterus, rapid onset hypovolemic shock, rapid onset of fetal distress-bradycardia
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| Labor Induction | cervical ripening agent 1st, Pitocin titrated to regular labor pattern
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