Labor and Delivery

review of chapter 26 in Foundations book.
descent of the uterus into the pelvic cavity that occurs late in pregnancy. baby has "dropped"
Nitrizine Test
Test used to differentiate urine and ROM. (Uses pH of discharge)
pH of urine and most vaginal fluids
pH of amniotic fluid
Maximum length of time after ROM for delivery to occur
18-24 hrs
Blood-tinged mucus that occludes the cervical opening, is released before true labor begins.
Bloody Show
Irregular tightening of the pregnant uterus; remains irregular; does not dilate the cervix
Braxton Hicks contractions
shortening of the uterine cervix and thinning of its walls as it is dilated during labor
When assisting a delivery, what PPE should be donned?
Cover gown and mask or protective eyewear.
5 P' of Labor
Passageway, Passengers, Powers, Position of mother, Psyche
Most common type of pelvis in women
Overlapping of cranial bones or shaping of the fetal head to accomodate and conform to the bony and soft parts of the mother's birth canal during labor.
areas where cranial bones join together
The membrane-covered gaps between the bones of an infant's skull. They allow the bones of the skull to push through the birth canal, and subsequently accommodate the rapid increase in brain size during childhood.
Fetal Attitude
Relationship of the fetal parts to one another.
back is bowed outward, chin touching sternum, arms crossed at chest, thighs flexed on abd.
Fetal Position
the relationship of the occiput, sacrum, chin, or scapula of the fetus to the front, back, or sides of the mother's pelvis
too little amniotic fluid
Fetal Lie
Relationship of the long axis (head-to-foot or cephalocaudal axis) of the fetus to the long axis of the mother. Relationship of the fetal spine to the spine of the mother. Longitudinal or Transverse
Fetal Presentation
the part of the fetus (head, face, breech, or shoulders) that first enters the pelvis and lies over the inlet.
Most common fetal presentation
Cephalic, 96%
Four types of cephalic presentation
vertex (between fontanelles), brow, face, and mentum (chin)
Complete Breech
Buttocks present and thighs are well flexed on abd.
Frank breech
buttocks present and thighs are extended across abd and chest
Footling Breech
No flexion, one or both feet present
Most common postion for delivery
left occiput anterior (LOA)
Appropriate positioning for prolapsed cord
modified sims' or trendelenburg
Signs of deatched placenta
firmly contracting uterus, cord lengthening, sudden gush of dark red blood
Primary Powers
involuntary uterine contractions, which signal the beginning of labor
Secondary Powers
Voluntary brearign down by woman in labor
Resposnible for effacement and dilation of cervix, and descent of fetus
Primary Powers
enlargement of the cervical opening and canal
Marks the end of stage 1 in labor
Full dilation (10cm)
Ferguson's Reflex
maternal urge to bear down
Valsalva's maneuver
spontaneous bearing down efforts
Mechanisms of labor
turns and adjustments fetus makes as it moves through the pelvis
bilateral diameter of the fetal head crosses into the pelvic inlet
downward progress of the presenting part
Internal rotation
allows fetal head to progress through the maternal pelvis
the occiput passes under the symphysis pubis
Fetus's head moves to realign with the undelivered body
the body of the infant leaves the pelvis
First stage of labor
starts with onset of regular contractions, ends with complete dilation of the cervix
second stage of labor
begins with 10cm dilation and ends with birth of the baby
Third stage of labor
begins wiuth birth of the baby, ends with delivery of placenta
surgical incision of the perineum to enlarge the vagina and so facilitate delivery during childbirth
When is episiotomy performed?
At the end of stage 2 of labor.
Most common type of episiotomy
Midline, or median
Normal amt of blood lost in vaginal delivery
Excessive amt of blood loss in vag delivery
How often DURING 1ST HR post delivery are VS done?
Q15 mins
How often AFTER 1st hr are VS done?
Q30 mins
Normal FHR
FHR measured how often in 1st stage of labor?
Q15-Q30 mins
FHR measured how often in 2nd stage of labor?
Q5 mins
What are early decelerations caused by?
pressure on fetal skull
What are late decelerations caused by?
decreased oxygen and blood flow to fetus through placenta
what are variable decelerations caused by?
Compression on the umbilical cord
measures frequency and duration of contractions
What does an intrauterine catheter measure?
frequency, duration, intensity, and resting tone of uterine contractions
When can internal monitoring be used?
During intrapartal stage, 2-3cm dilated, membranes ruptured
Tachycardia in fetus
Bradycardia in fetus
< 100bpm
thick dark green mucoid material that is the first feces of a newborn child
When is Apgar scoring used?
1 and 5 mins after birth
What is Apgar criteria
HR, Respiratory effort, muscle tone, reflex irritability, color
What is considered an optimal score for Apgar?
substance produced by the infant that decreases suface tension within alveoli and permits inflation
Loss of heat due to ___ can lead to hypothermia
Which side is the infant turned on to facilitate drainage from mouth and promote emptying of the stomach?
Right Side
How of often should a laboring woman void?
When should ambulation be encouraged in a laboring woman?
before ROM or presenting part is fully engaged
Side in which the woman should be placed due to late decelerations or hypotension
Left Side
Precipitious Labor
labor that last less than 3 hours from onset of contractions to time of birth
Leopold's maneuver
determines fetal lie, presentation, and position
When does the anterior fontanelle close?
18 months
When does the posterior fontanelle close?
2 months
Triangle shaped fontanelle
Diamond shaped fontanelle
Fx of upper part of uterus in labor
provides force during labor
Fx of lower part of uterus in labor
acts as a passive tube
Phases during first stage of labor
Early latent, active, and transitional
Which stage does the mother feel the urge to push?
second stage
Spontaneous rupture of membranes
Common medical complication in labor
Strip chart
upper line is FHR, bottom line is uterine contractions.
Hormones secreted by placenta
estrogen, progesterone, human placental lactogen, HCG
Hegars sign
enlargement of uterus, changes in isthmus in uterus
Chadwicks Sign
violet our purple coloring of vulva, vagina, and or cervix
Goodells Sign
softening/increased pliability of cervix
breasts, uterus, bowl, bladder, lochia, episiotomy, surgical site
Linea Terminals
imaginary line dividing pelvis into two sections
Android pelvis shape
gynecoid pelvis shape
anthropoid pelvis shape
platypelloid pelvis shape