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FAMILY EXAM #2
Labor & Delivery
| Question | Answer |
|---|---|
| True Labor Signs | regular contractions that become stronger and closer together over time, and continue in every position. Pain begisn in the back and radiates towards the front, accompanied by vaginal pressure |
| False Labor Signs | irregular and weak contractions, or an alternation between a weak and then a strong contraction. They do not occur close together, and often stop or slow down when walking or changing positions. The pain is felt in the front of the abdomen |
| The first stage of labor | the progressive dilation of cervix, possible membrane rupture, cervical dilation and affacement. Begins with mild cramping, and ends with intense pain. It includes the latent or active phase |
| the Second Stage of labor | Begins after 10 cm dilation. If the membranes have not ruptured they will during this phase, as the fetus is moved through the birth canal. Considered the pushing phase. Typically lasts 30 minutes, but can last up to 3 hours |
| The third stage of labor | begins with the birth of the newborn, and ends with the delivery of the placenta. If there are no problems with the newborn, they should be placed on the mother now. Postpartum hemorrhage is most common in this phase |
| Fourth stage of labor | begins with the expulsion of the placenta and ends when the mother is stabilized, typically between 1-4 hours. Continue to monitor the patient closely for hemorrhage, bladder distention, and DVT |
| The original 4 ps | Passageway, passenger, powers, position, and psychological response. |
| Passageway | is the birth canal |
| Passenger | is the fetus and placenta |
| powers | is the contractions |
| position | is in relation to the mother |
| psychological response | is the emotional response of the mother during labor |
| Maternal Physiological Responses in Labor | include contractions, effacement, and dilation of cervix, increased heart rate by 10-20 bpm. Cardiac output increased, BP rise up to 35 mm Hg during uterine contractions, increased Wbc to 25,000-30,000, increased respiration rate, gastric motility and food absorption decreased, possible nausea and vomiting, muscular aches and cramps, and basal metabolic rate increase with blood glucose level decreasing from stress |
| Fetal Physiological Responses in Labor | Periodic fetal rate accelerations and slight decelerations related to fetal movement, fundal pressure and uterine contractions. Decrease in circulation and perfusion to fetus due to uterine contractions. Increase in arterial carbon dioxide pressure, and fetal breathing movements throughout labor. decrease in fetal oxygen pressure with a decrease in partial pressure oxygen |
| The usual and preferred fetal position | Longitudinal lie, with a cephalic presentation |
| First Stage of Labor Nursing Interventions | Take administration history, check lab results, ask about birth plan, complete physical assessment to establish baselines |
| Second Stage of Labor Nursing Interventions | Focuses on supporting the woman and partner to make decisions about her care, implementing measures to promote and provide support, assistance, and comfort. Encourage them to use positions that can enhance descent and reduce pain |
| Third Stage of Labor Nursing Interventions | Focuses on immediate newborn care and assessment, delivery of the placenta. Protect the natural hormonal process by ensuring uninterrupted contact between mother and newborn, providng warmed blankets to prevent shivering. Allow skin-to-skin contact with initial breastfeeding |
| Fourth Stage of Labor Nursing Interventions | Involves frequently observing the mother for hemorrhage, providing comfort measures, and promoting family attachment |
| Amniotomy | Artifical means of rupturing membranes |
| Involution | Contraction of the muscle fibers to reduce stretched ones (catabolism), regeneration of uterine epithelium from the lower layer of the decidua after the upper layers have been sloughed off and shed in lochia |
| Peuperpium | Refers to the first six weeks post delivery. During this period the mother experiences many physiological and psychological adaptations to return to her prepregnant state. |
| A longitudinal lie | is a vertical lie where the long axis of the fetus is parallel with the long axis of the mother. Can be cephalic or breach |
| A transverse lie | is a horizontal lie, where the long axis of the fetus is at a right angle, or perpendicular to the long axis of the mother. Vaginal birth cannot occur in this position |
| An oblique lie | is in the middle of a longitudinal and transverse lie. Usually converts to transverse or longitudinal lie during labor |
| Fetal Presentation | refers to the part of the fetus that enters the pelvic inlet first, through the birth canal during labor |
| Fetal lie | refers to the relation of the long axis (spine) of the fetus to the long axis (spine) of the mother |
| Cephalic Presentation | means the fetus is head first, presenting part is the occipital, the back of the head |
| Breech Presentation | means the buttocks or feet, or both first. The presenting part is the sacrum |
| Shoulder Presentation | means the shoulder is first, the presenting part is the scapula |
| Fetal Station | Refers to where the presenting part of the fetus is in the pelvis if it is above the ischial spine the number is negative. If it is below the ischial spine it is positive. The ischial spine is considered zero |
| Fetal Attitude | Refers to the relationship of the fetal head to the spine and can be vertex (flexed) which is normal. Or neutral (sinciput), or military, or extended, which includes the brow or face. |
| Variable Decelerations Causes | They are associated with cord compression. . Possibly demonstrating no consistent relationship to uterine contractions. |
| Early Decelerations Causes | Thought to be a result of fetal head compression that results in a reflex vagal response with a resultant slowing of FHR during uterine contractions. |
| Accelerations Causes | indicates everything is okay |
| Late decelerations Causes | indicates placental insufficiency. which occurs when blood flow within the intervillous space is decreased to the extent that fetal hypoxia or myocardial depression exists. |
| When the baby is posterior | you will hear the heart beat at the mothers sides |
| when the baby is anterior | you will hear the heart beat closer to midline on the abdomen |
| when the baby is breech | you will hear the heart beat above the umbilicus |
| when the baby is cephalic | you will heart the heart beat below the umbilicus |
| a negative fetal station | indicates the fetus has not engaged in the the pelvic inlet, and the higher the number the farther it is from engagement |
| a position fetal station | indicates the fetus is engaged in the pelvic inlet and the higher the number the closer delievery is |
| ischial spine | is used to determine the fetal station, and is considered zero |
| A contraction is termed | Systole |
| A relaxation of a contraction is termed | Decrement |
| A buildup of a contraction is termed | Increment |
| The peak intensity of a contraction is termed | Acme |
| The order of fetal engagement during labor | is descent, engagement, flexion, internal rotation, extension, external rotation, expulsion |
| Extension | the head emerges through extension under the symphysis pubis, along with the shoulders |
| Engagement | occurs when the greatest transverse diameter of the head in a vertex position passes through the pelic inlet |
| Descent | is the downward movement of the fetal head until it is within the pelvic inlet |
| External Rotation | allows the shoulders to rotate internally to fit the maternal pelvic |
| Marked Variability in Fetal Heart Rate | occurs when there are more than 25 beats of fluctuation in the heart rate from baseline |
| Baseline Variability in Fetal Heart Rate | is the irregular fluctuations in the baseline fetal heart rate, which is measures as the amplitude of the peak to trough in beats per minute |
| Baseline Fetal Heart Rate | refers to the average fetal heart that occurs during a 10-minute segment that excludes periodic or episodic rate changes such as tachycardia or bradycardia |
| Moderate Variability in Fetal Heart Rate | indicates the autonomic and central nervous system of the fetus are well developed and oxygenated |
| Variability | is the combined result of the autonomic nervous system branch function. The presence implies both branches are working and receiving oxygen |
| SINUSOIDAL PATTERN | Described as having a visually apparent smooth, sinewave-like undulating pattern in the FHR baseline with a cycle frequency of 3-5 bpm that persists for more than 20 minutes. It is rare. It is attributed to a derangement of CNS control of FHR and occurs when a severe degree of hypoxia secondary to fetal anemia and hypovolemia is present. Always considered a category III pattern, and to correct it. Fetal intrauterine transfusion would be needed. It indicates the fetus is in marked jeopardy. |
| PROLONGED DECELERATIONS | Abrupt FHR declines of at least 15 bpm that last longer than 2 minutes but less than 10 minutes. The rate usually drops less than 90 bpm. Many factors are associated with this pattern, including prolonged cord compression, abruptio placenta, cord prolapse, supine maternal position, vaginal examination, fetal blood sampling, maternal seizures, regional anesthesia, or uterine rupture. |
| VARIABLE DECELERATIONS | Present as visually apparent abrupt decreases in FHR below baseline and have an unpredictable shape on the FHR baseline. Usually in the shape of a U, V, or W, or they may not resemble other patterns. Usually occur abruptly with quick deceleration. Most common pattern found in the laboring woman and are usually transient and correctable. They are classified either as category II or III depending on the accompanying change in baseline. |
| LATE DECCELERATIONS | Visually apparent, usually symmetrical, transitory decreases in FHR that occur after the peak of the contraction. Have a gradual waveform and can be recurrent, occurring with each contraction over a period of time. The FHR does not return to baseline levels until after the contraction has ended. Delayed timing of deceleration occurs with the nadir of uterine contraction. |
| EARLY FETAL DECELERATIONS | Visually apparent, usually symmetrical and characterized by a gradual decrease in FHR in which the nadir (lowest point) occurs at the peak of the contraction. Rarely decrease more than 30-40 bpm. Mostly seen during the active stage of any normal labor, during pushing, crowning, or vacuum extraction. Not a sign of fetal distress, and do not require interventions |
| FETAL HEART RATE INTERVENTIONS | Lateral positioning of the mother, increasing IV fluid rate to improve maternal circulation, administering oxygen at 8-10 L/min by mask, considering internal fetal monitoring, documenting findings, and reporting to the health care provider. Possible preparation of surgical birth may be necessary |
| FETAL BRADYCARDIA | Below 110 bpm, lasting 10 minutes or longer. CAUSES: Fetal hypoxia, prolonged maternal hypoglycemia, fetal acidosis, administration of analgesics to the mother, hypothermia, anesthetic agents (epidural), maternal hypotension, fetal hypothermia, prolonged umbilical cord compression, and fetal congenital heart block. May be benign if it is isolated, but it is considered an ominous sign when accompanied by a decrease in baseline variability and late decelerations. |
| CATEGORY I FETAL HEART RATE | Normal. Strongly predictive of normal fetal acid-base status at the time of observation and needs no intervention. Baseline rate is 110-150 bpm. Baseline variability is moderate. Present or absent accelerations. Present or absent early decelerations. No late variable decelerations. Can be monitored with intermittent auscultation during labor |
| CATEGORY II FETAL HEART RATE | Indeterminate. Not predictive of abnormal fetal acid-base status but does not require evaluation or continued monitoring. Fetal tachycardia (> 160 bpm), bradycardia ( < 110 bpm), not accompanied by absent baseline variability. Minimal or marked variability. Recurrent late decelerations with moderate baseline variability. Recurrent variable decelerations accompanied by minimal or moderate baseline variability, overshoots, or shoulders. Prolonged decelerations > 2 minutes, but not < 10 minutes. |
| CATEGORY III FETAL HEART RATE | Abnormal. Predictive of abnormal fetal acid-base status at the time of observation and requires prompt evaluation and interventions such as oxygen, changing positions, discontinuing labor augmentations, and/or treating maternal hypotension. Fetal bradycardia ( < 110 bpm), recurrent late decelerations. Recurrent variable decelerations, declining or absent. Sinusoidal pattern (Smooth, undulating baseline) |
| LEOPOLD MANEUVERS | Method for determining the presentation, position, and lie of the fetus using four specific steps that involve inspection and palpation of the maternal abdomen. |
| Leopold Manuever #1 | What fetal part (head or buttocks) is located at the fundus (top of uterus) |
| Leopold Manuever #2 | On which maternal side is the fetal back located? |
| Leopold Manuever #3 | What is the presenting part |
| Leopold Manuever #4 | Is the fetal head flexed and engaged in the pelvis |
| The strength of uterine contractions that initiate cervical dilation | 30 mm Hg |
| During active labor contraction intensity reach | 50-80 mm Hg |
| Successful newborn adaptations | adaptations demonstrated by the respiratory, circulatory, thermoregulatory, and musculoskeletal systems indirectly indicate the central nervous system’s successful transition from fetal to extrauterine life, because the central nervous system plays a major role in all these adaptations. |
| Neonatal Period | The neonatal period is the first 28 days of life as the newborn adapts to life after birth |
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