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HCC Intrapartum
Question | Answer |
---|---|
Passageway | The birth canal. |
Passenger | Fetus. |
Fetal Skull Parts | The face, the base of the skull(cranium), and the vault of the cranium(roof). |
Molding | When the cranial bones overlap under the pressure of labor. |
Sutures | The membranous joints that unite the cranial bones. |
Frontal Suture | (Mitotic) Located between the two frontal bones. |
Sagittal Suture | Located between the parietal bones, divides the skull into left and right halves. |
Coronal Sutures | Located between the frontal and parietal bones. |
Lambdoidal Suture | Located between the two parietal bones and the occipital bone. |
Fetal Attitude | The relation of the fetal body parts to one another. |
Flexion | Normal fetal attitude, chin flexed to chest. This position is the smallest diameter of presentation. |
Fetal Lie | The relationship of the spinal column of the fetus to that of the mother. Longitudinal or transverse. |
Fetal Presentation | The body part of the fetus that enters the maternal pelvis. |
Malpresentations | Breech and shoulder presentations. |
Cephalic presentation | The fetal head presents to the birth passage in approx. 97% of term births. |
Vertex Presentations | When the presenting part is the occiput. Most common. The head completely flexed to chest. |
Sinciput Presentation | The fetal head is partially flexed. The TOP of the head is the presenting part. |
Brow Presentation | The fetal head is partially extended. The largest anteroposterior diameter. |
Face Presentation | The fetal head is hyperextended(complete extension). The face is the presenting part. |
Breech Presentation | The presenting part is the lower extremities or the buttocks. |
Complete Breech | The fetal knees and hips are both flexed, and the buttocks and feet are the presenting parts. |
Frank Breech | The fetal hips are flexed and the knees are extended. The buttocks is the presenting part. |
Footling Breech | The fetal hips and legs are extended. The feet are the presenting part(s) |
Shoulder Presentation | The fetal shoulder is the presenting part. |
Engagement | When the presenting part reaches or passes through the pelvic inlet. |
Station | The relationship of the presenting part to an imaginary line drawn between the ischial spines of the maternal pelvis. -1 to -5 above ischial spines, +1 to +5 below spines. 0 is equal to spines. |
Fetal Position | The relationship of the landmark on the presenting fetal part to the anterior, posterior, or sides of the maternal pelvis. |
ROA | Right-occiput-anterior. Vertex presentation. |
ROT | Right-occiput-transverse. Vertex presentation. |
ROP | Right-occiput-posterior. Vertex presentation. |
LOA | Left-occiput-anterior. Vertex presentation. |
LOT | Left-occiput-transvers. Vertex presentation. |
LOP | Left-occiput-posterior. Vertex presentation. |
Fontanelle | In the fetus, an unossified space, or soft spot, consisting of a strong band of connective tissue lying between the cranial bones of the skull. |
Contractions | Rhythmic tightenings and shortenings of the uterine muscles during labor. |
Three Phases of a Contraction | 1. Increment-building up(longest phase). 2. Acme-peak of contraction. 3. Decrement-letting up. |
Frequency | The time between the beginning of one contraction and the beginning of the next contraction. |
Duration | Measured from the beginning of the contraction to the completion of the contraction. |
Intensity | The strength of the uterine contraction during acme. Inesity is estimated by palpating the contraction. |
Bearing Down | Once the cervix is completely dilated the maternal abdominal musculature contracts as the woman pushes. |
Effacement | The taking up of the internal os and the cervical canal into the uterine side walls. The cervix changes from long thick structure to tissue-paper thin. |
Cervical Dilatation | The cervical os and canal widen from less than 1 cm to approx 10 cm, allowing birth of the fetus. |
Lightening | The effects that occur when the fetus begins to settle into the pelvic inlet(engagement). |
Braxton Hicks Contractions | Irregular, intermittent contractions that occur throughout the pregnancy-may become uncomfortable. |
Bloody Show | Pink-tinged secretions after the mucous plug is expelled. |
ROM | Rupture Of Membranes. The rupture of the amniotic membranes. |
SROM | Spontaneous Rupture Of Membranes generally occurs at the height of the intense contraction with a gush of the fluid out of the vagina. |
Latent Phase(First Stage) | 0-3cm. Begins with the onset of regular contractions. As the cervix begins to dilate it also efaces, little or no fetal descent. |
Active Phase(First Stage) | 4-7cm. Anxiety tends to increase with intensification of contractions and pain. |
Transition Phase(First Stage) | 8-10cm. Last phase of first stage. Significant anxiety. |
True Labor | Contractions @ reg intervals, intervals grad shorten, contracts increase duration & intensity, discomfort @ back radiates around abd, intensity increase c walking, dilate & efface progress, contracts don't decrease c rest. |
False Labor | Contractions irregular c no change, discomfort usually in abd, walking does not help, no change in dilate or efface, rest & warm baths decrease contracts. |
Nullipara | 1st Preg. Latent 8.6hrs, Active 4.6hrs, Transition 3.6hrs. 2nd stage up to 3hrs. |
Multipara | Latent 5.3hrs, Active 2.4hrs, Transition varies. 2nd stage 0-30min. |
Latent Phase Contractions | Frequency q3-30min, Duration 20-40sec, Intensity mild progress to mod; 25-40 mmHg |
Active Phase Contractions | Frequency q2-5min, Duration 40-60sec, Intensity mod to strong 50-70 mmHg. |
Transition Phase Contractions | Frequency q1.5-2min, Duration 60-90sec, Intensity strong 70-90 mmHg. |
Second Stage | Begins when the cervix is completely dilated to 10 cm and ends with birth of the infant. |
Crowning | When the fetal head is encircled by the external opening of the vagina(introitus) and means birth is imminent. |
Cardinal Movements | Positional changes by the fetal head and body that promote passage through the birth canal. |
Descent | The head enters the inlet in the occiput transverse or oblique position. |
Flexion | The fetal chin flexes downward onto the chest. |
Extension | Extension of the fetal head as it passes under the symphysis pubis, the occiput, then brow and face emerge from the vagina. |
Restitution | Twisting of the neck, then once the head is free the neck untwists-restitution. |
External Rotation | As the shoulders rotate to the anteroposterior position in the pelvis, the head is turned farther to one side. |
Expulsion | The anterior shoulder meets the undersurface of the symphysis pubis and slips under it. The anterior shoulder is born first, then posterior. The body follows quickly. |
Fourth Stage | The time from 1-4hrs after birth in which physiologic readjustment of the mother's body begins. |
Blood Loss | 250-500 mL. |
EFM | Electronic Fetal Monitoring. |
FHT | Fetal Heart Tones. |
UC | Uterine Contractions. |
Leopold's Maneuvers | A systemic way to evaluate the maternal abdomen. After she has emptied her bladder. |
First Leopold's Maneuver | The nurse palpates the upper abdomen with both hands. To determine shape, size, consistency, and mobility. Head or buttocks occupies the fundus? |
Second Leopold's Maneuver | Determine the location of the fetal back. |
Third Leopold's Maneuver | Determine what fetal part is lying above the inlet by gently grasping the lower portion of the abdomen just above the symphysis pubis c the thumb and fingers of the R hand. |
Fourth Leopold's Maneuver | Face the mom's feet, fingers of both hands are moved gently down the sides of the uterus toward the pubis to find the cephalic prominence(brow). |
FHR | Fetal Heart Rate. Under 110 = bradycardia. Over 160 = tachycardia. |
Decelerations (decels) | Decreases in FHR below the BL. |
Early Decelerations | Occurs at the same time as the peak of the contraction. Result of vagal nerve stim caused by fetal head compression that occurs during UCs. |
Late Decelerations | Due to uteroplacental insufficiency and are a result of decreased blood flow and/or oxygen transfer to fetus during contractions. |
Assessment of Uterine Contraction Pattern | Frequency? Duration? Intensity? |
APGAR Score | Newborn is rated at 1 and 5 minutes after birth. A score 7-10 indicates a newborn in good condition. |
APGAR Heart Rate | Above 100 scores 2. Slow-below 100 scores 1. Absent scores 0. |
APGAR Respiratory Effort | Good crying scores 2. Slow irregular breathing scores 1. Absent breathing scores 0. |
APGAR Muscle Tone | Active motion scores 2. Some flexion of extremities scores 1. Flaccid scores 0. |
APGAR Reflex Irritability | Vigorous cry is a score of 2. A grimace is a score of 1. No response is 0. |
APGAR Skin Color | Completely pink scores 2. Blue extremities and rest of body is ping scores 1(acrocyanosis). Totally cyanotic, pale scores 0. |
Initial Newborn Assessment | Resp. 30-60 irregular. Pulse 110-160 somewhat irregular. Skin Temp above 97.8F(36.5C). Color pink c bluish extrem. |
Umbilical Cord | Two arteries and one vein. |
GTPAL | Gravida, Term, Preterm, Abortions, Living |
Gravida | Number of Pregnancies |
Term | Number of pregnancies to term. 38-42 weeks gestation. |
Preterm | Number of pregnancies 20-37 weeks gestation. |
Abortions | Number of pregnancies ending in either spontaneous or therapeutic abortion. |
Living | Number of currently living children to whom the woman has given birth. |
Precipitous Labor and Birth | Labor lasting less than 3 hours. |
Dystocia | Long, difficult, or abnormal labor. |
Primary Powers | Effacement(the effacement is the cause of dystocia) |
Secondary Powers | Descent (the descent is the cause of dystocia) |
Hypertonic Labor Patterns | Frequent contractions that are painful and ineffective in dilating and effacing the cervix. |
Hypotonic Labor Patterns | Longer frequencies of contractions |