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N113 L&D
N113 - Labor & Delivery
| Question | Answer |
|---|---|
| What are the 4 P's impacting labor & birth? | Passage, Passenger, Power & Psyche |
| How does passage affect labor & birth? | Size & type of pelvis, ability of cervix to dilate & efface, ability of vagina to distend. |
| How does the passenger affect labor & birth? | Head size, attitude, lie, presentation, position & implantation site of placenta. |
| How does power effect labor & birth? | Frequency, duration & intensity of contractions, effectiveness of pushing, duration of labor. |
| How does the mothers psyche effect labor & birth? | Physical preparation, sociocultural heritage, previous experience, support system, emotional integrity |
| What are the pelvic measurements? | Diagonal conjugate, true conjugate, obstetric conjugate, inlet & outlet. |
| What is the diagonal conjugate? | The distance between the lower border of the symphysis pubis to sacral promontory. Should be >11.5 cm for pelvic inlet to be adequate. Measured by hand during pelvic exam. |
| What is the true conjugate? | Distance from upper border of symphysis pubis to middle of sacral promontory, determined by subtracting 1 cm from the diagonal - estimated, cannot be measured. |
| What is the obstetric conjugate? | Determined by subtracting 1.5 to 2 cm from diagonal. Smallest diameter through which the fetus must pass. Can be measured by x-ray, should be >10 cm. |
| What is the inlet? | The upper border of the true pelvis, transverse diameter of the true pelvis is the largest. |
| What is the outlet? | The lower border of the true pelvis. Extends from the lower border of the symphysis pubis to the tip of the sacrum. Anterior to posterior measurement should be the largest. |
| What is the most common type of pelvis? | Gynecoid or round, 50% of females have this type |
| What is the most favorable type of pelvis? | Gynecoid or round, anthropoid or oval is usually adequate |
| What is the least favorable type of pelvis? | Android or heart shaped, platypelloid or flat |
| What is attitude? | The relation of fetal parts to one another. Normal is flexion of head, arms to chest, legs to abdomen, classic fetal position. |
| What is lie? | Relation of long axis (spine) of the fetus to that of the mother. Normal is longitudinal, transvers is when baby is laying across the abdomen. |
| What is presentation? | What part is first in the maternal pelvis. |
| What is cephalic presentation? | Head first, 97% of term births. |
| What are the different types of cephalic presentation? | Vertex - neck completely flexed, most common - smallest diameter of head presents, Military - neck neither flexed or extended - head & neck is straight, Brow - neck partially extended - head tipped slightly back, Face - neck hyperextended |
| What are the risks associated with brow presentation? | Trauma to neck, trachea, & larynx, facial edema, detected by palpating fontanelle, anterior fontanelle will be felt instead of posterior. |
| What are the risks associated with face presentation? | Increased risk of CPD - cephalopelvic disproportion - head won't fit through pelvis, facial edema |
| What is associated with breech presentation? | Decreased weight of baby, increased mortality & anomalies, more common with placenta previa, multiple gestation & grand multiparity. Possible head entrapment, increased chance of cord prolpse. Passage of merconium due to compression of intestines. |
| What are the 3 types of breech presentation? | Complete - fetus sitting indian style, Frank - butt first with legs & feet straight up by head, Footling - single or double feet present first. |
| What is a shoulder presentation? | When fetus is across the abdomen. Can lead to uterine rupture due to stress on uterus, increased danger of cord prolapse. |
| What is engagement? | When largest diameter of presenting part reaches or passes through pelvic inlet - upper diameter of pelvis |
| What is station? | Relationship of presenting part to imaginary line drawn between the ischial spines, graded at + or -. |
| What is fetal position? | Relationship of the landmark on the fetal presenting part to the front, sides or back of the maternal pelvis. |
| What are the fetal positions? | O - Vertex or occiput - normal fetal position, M - face, chin or mentum presenting, S - breech, sacrum presenting, A - shoulder, scapula or acromion process presenting. |
| What are the cardinal movements in labor? | Engagement & descent, flexion, internal rotation, extension, external rotation, expulsion. |
| What is engagement & descent? | head enters inlet in occiput transverse position because the inlet is widest from side to side |
| What is flexion? | Occurs as head meets resistance from musculature & soft tissue. |
| What is internal rotation? | Fetus rotates 45 to 90 degrees to fit the widest anterior/posterior diameter of the outlet |
| What is extension? | Head passes under the symphisis pubis; occiput, brow & face emerge; complete when entire head is born. |
| What is external rotation? | As shoulders rotate to anterior posterior position the head is turned further to one side |
| Which stages can be seen? | Extension, external rotation & expulsion |
| What are the 3 stages of a contraction? | Increment - building up - longest, Acme - peak, Decrement - period of decreasing intensity |
| How is the frequency timed? | From the beginning of one contraction to the beginning of the next. |
| How is the duration calculated? | From the beginning of one to the end of same contraction. |
| How is intensity rated? | Mild - fingertips can easily indent fundus - cheek, moderate - can indent sligntly - chin, strong/hard - cannot indent - forehead. |
| How is the latent phase characterized? | Last 2-16 hours, cervical dilation up to 3-4 cm, mild contractions, with short duration and long interval in between. Mother feels excited, happy, some apprehension |
| How is the active phase characterized? | Cervical dilation from 4-8 cm, contraction stronger & longer, more frequent, more painful, Mother needs to use breathing techniques, pain medication is usually administered |
| How is the transition phase characterized? | Cervical dilation 8-10 cm, contraction longer & stronger, may experience nausea & possible vomiting, mother becoming tired, frustrated & unable to cope, need to focus mom and have her concentrate |
| What is the second stage of delivery? | This is when the mom feels the need to push, doctor may do episiotomy at this time, contractions are less painful since cervix is completely dilated |
| What is the third stage of delivery? | Birth of baby and delivery of placenta, mother is exhausted and eager to see baby, very hungry & thirsty. |
| What is the fourth stage of delivery? | This is the first hour post partum |
| What is the main difference between true & false labor? | There is no change in the cervical consistency in false labor. |
Created by:
jrb265
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