What are the four P's that make up the process of labor and birth?
Other than the 4 P's of labor and birth, what are some other "p" words that influence it also?
Forces that cause the cervix to open and that propel the fetus downward through the b irth canal.
powers of labor-uterine contractions and the mother's pushing
What are the primary powers of labor during the first stages of labor, from onset to full dilation?
Uterine contractions are _______ _______ muscle contractions.
What are some things that influence the intensity and effectrivemenss of a woman's contractions?
What are the purpose of uterine contractions?
to cause the cervix to efface (thin) and dilate (open) to allow the fetus to descend into the birth canal.
Contractions push the fetus ________ as the cervix is pulled _________, causing the cervix to become thinner and shorter.
How is effacement determined?
by vaginal exam (touch), using percentage to indicate how much it has effaced from the original cervical length.
How is dilation of the cervix determined?
with vaginal exam (touch), described in centimeters
What is considered full dilation?
What are the 3 phases of contractions?
peak, or acme
The period of time when contractions are increasing in strength
the period of greatest contraction strength
peak or acme
the period of decreaseing strength of contractions
How are contractions described?
The elapsed time from the beginning of one contraction until the beginning of the next contraction
How is frequency noted?
in minutes and fractions of minutes
When should you report frequency of contractions to the HCP?
when they are occurring more often than every 2 minutes
Why should contractions occurs more often than every 2 minutes be reported to the doctor?
they may be reducing fetal oxygen supply
the elapsed time from the beginning of a contraction until the end of the same contraction.
How is durating noted?
When should the duration of contractions be reported to the doctor?
If they are lasting longer than 90 seconds, because it may reduce fetal oxygen supply.
The approximate strength of the contraction
How is intensity noted?
mild, moderate, strong
This intensity of contraction is when the fundus is easily indented with the finger. feels similar to the tip of a nose.
This intensity of contraction is when teh fundus can be indented with figers but with more difficulty, fundus feels similar to the chin
This intensity of contraction is when the fundus cannot readily be indented with the figer, and it feels harder, similar to the forehead.
The amount of time the uterus relaxes between contractions.
With each contractions, blood flow from the mother to placenta decreases, but resumes during the __________.
When should length of interval be reported to the doctor?
persistent contraction intervals shorter than 60 seconds may reduce fetal oxygen supply
What 3 instances during contractions should be reported to the doctor?
contractions more frequent than every 2 minutes
lasting longer than 90 seconds
having intervals shorter than 60 seconds
When does a woman start pushing?
When dilated to 10
When does the mom feel a strong urge to push or bear down?
When the cervix is fully dilated and the fetus starts to descend
What can eliminate the natural urge to push?
If a woman is feeling a premature urge to push (before cervix is fully dilated), what might the problem be?
the fetus is pushing against the rectum
What are some problems that can occur from anxiety and fear during the birth process?
inhibit labor progress
reduce blood flow to the fetus
What is the bag of waters called?
What is more likely to occur if many hours elapse between rupture of the membranes and birth?
infection (because the amniotic sac seal the uterine cavity against organisms from the vagina.
Why should a woman go right to the hospital when her amniotic sac ruptures?
1. infection is more likely
2. the umbilical cord may slip down and become compressed between the mom's pelvis and the fetal presenting part
The level of the presenting part (usually the head) in the pelvis.
How is station estimated?
in cm's from the livel of the schial spines in the mom's pelvis
Where is zero at in the stations?
the ischial spine of the mom's pelvis
Where are minus stations located?
above the ischial spines
Where are plus stations located?
below the ischial spines
the positional changes that allow the fetus to fit through the pelvis with the least resistance.
mechanisms of labor (cardinal movements)
What is the last cardinal movement (or mechanism of labor)?
placenta is expelled and uterus contracts
What do stations tell us?
how the baby is progressing down the birth canal
What does intrapartum care of the fetus include?
assessment of FHR
assessment of amniotic fluid for meconium
What does electric fetal monitoring record continuously?
fetal heart rate
What type of monitoring promotes walking during labor?
How often are FHR and contractions monitored if using intermittent monitoring?
every 30-60 minutes
If internal EFM is done, what is required first?
membranes have ruptured
cervix dilated to 1-2 cm for device insertion
If internal EFM is done, where is the probe attached to the baby?
the presenting part of the fetus
What are the two types of EFM?
fluid filled catheter connected to pressure sensitive device, and solid catheter with a pressure sensor in it's tip.
What is used for external fetal heart monitoring?
doppler transducer (uses sound waves)
How are contractions measured externally?
a tocotransducer wiht a pressure sensitive button over the fundus
What should the baseline fetal heart rate be?
110 bpm-160bpm for at least 2 minutes
This describes fluctuation or constant changes in the baseline fetal heart rate within a 10 minute window
temporary, abrupt rate increases of at least 15 beats per minute above the baseline FHR that last less than 30 seconds.
What kind of pattern do accelerations show?
a reassuring pattern
When is acceleration considered prolonged?
when it lasts 2-10 minutes
If an acceleration lasts longer than 10 minutes, what is it considered to be?
a baseline fetal heart rate change
Temporary, gradual rate decreases during contractions, where the FHR always returns to the baseline reate by the end of the contractions.
When is the peak of deceleration?
at the peak of the contraction
What kind of pattern are early decelerations?
a reassuring pattern
abrupt decreases of 15 beats per minute below the baseline, lasting 15 seconds to 2 miuntes. They begin and end abruptly, and do not exhibit a consistent pattern.
what do variable decelerations suggest?
the umbilical cord is being compressed, often because it is around the fetal neck, or insufficient amniontic fluid to cushin the cord.
This is when the umbilical cord is around the baby's neck in uetero
When should you call the doctor related to variable decel?
fhr decreases to 70 bpm
decrease lasts longer than 60 seconds
What are the nonreassuring patterns?
decreased or absent variability
FHR decelerations that being AFTER the beginning of the contractions and do not return to the baseline until after the contraction ends
What does late decelrations suggest?
placenta not delievering enough o2 to the fetus
What is it called when the placenta is not delivering enough o2 to the fetus?
What is usually the first nursing response to variable decel (a nonreassuring pattern)
respositioning the woman to relieve pressure on the umbilical cord and improve blood flow through it.
What can be done to infuse fluid into the amniotic cavity?
What things can be done about late decels?
giving o2 at 8-10L via face mask
increasing IV fluid to expand blood volume
preparing to give tocolytic drugs to stop contractions
a procedure to artificially rupture amniotic membrane
What is recorded when the bag of waters is broken?
amount of fluid
What is the normal color of amniotic fluid?
clear with possible white flecks of vernix in it
What does green amniotic fluid mean?
fetus has passed meconium
How is amniotic fluid volume estimated?
moderate (500 mL)
Large (1000 mL)
What might cloudy or yellow amniotic fulid with an offensive odor indicate?
What test can be performed if it is unclear if a woman's membranes have ruptured?
nitrazine test, fern test
Amniotic fluid is ________ and turns pH paper dark blue green or dark blue.
This is a test to see if membranes ruptured where amniotic fluid is spread on a microscope slide and viewed under the microscope to see if the cyrstals in the fluid look like tiny fern leaves
What would you suspect if a woman loses control and becomes irritable?
she has progressed to the transition phase of labor
what is a VBAC?
vaginal birth after cesarean
What is the main concern with VBAC?
the uterine scar will rupture and disrupt the placental blood flow and cause hemmorrhage
What are the four stages of labor?
dilation and effacement
expulsion of the fetus
expulsion of placenta
What are the 3 phases of the dilation and effacement stage?
latent phase (1-4)
active phase (4-7)
transition phase (7-10)
In what phase of labor does the woman start pushing?
second stage-expulsion of fetus
What stages of labor fall into the immediate postpartum period?
third and fourth stage
how long does the fourth stage of labor (recovery) last?
1-4 hours after expelling placenta or until the mom is physiolocially stable
What 2 non-medical things can be done to stimulate labor contractions via oxytocin?
when the baby's head is too big to fit thru the birth canal
What does ROM stand for? and SROM and AROM?
rupture of membranes
spontaneous rupture of membranes
artificial rupture of membranes
What is the age of viability?
what is considered a "term" baby?
A pregnancy that did not go on past 20 weeks
The number of pregnancies a woman has had
A woman who has never been pregnant
a woman who is pregnant for the first time
a woman who has been pregnant before
a woman who has given birth to one or more children who reached the age of viability
a woman who has given birth to her first child past the point of viability
a woman who has given birth to 2 or more children past the point of viability
prenatal age of the developing fetus calculated from the first day of a womans LMP
Nageles rule to determine the estimated date of delivery
determine the first day of the LNMP
count backward 3 months
add 7 days
the word ______ indicates the number of pregnancies. The word _____ indicates the outcome of the pregnancies. Para increases ONLY when a woman delivers at at least 20 weeks.
If a fetus is aborted spontaneously before 20 weeks it is considered to be:
Recommended schedule for prenatal visits in an uncomplicated pregnancy
conception-28 weeks: q4weeks
29-36 weeks: q2weeks
37 weeks to birth: every week