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66 Cards in this Set
- Front
- Back
What are the "four P's" that affect the progress of labor?
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1. Passage: size, shape of pelvis, abilities of the cervix
2. Passenger: fetal head size, attitude, lie, presentation and position 3. Powers: frequency, duration and intensity of contractions, force of pushing 4. Psyche: mother's preparation (physical, emotional), experiences, support, etc. |
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What factors of the baby affect labor?
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Fetal head size and rigidity, molding
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What are fontanels?
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membrane filled spaces where the fetal skull sutures intersect
1. Anterior: diamond shaped, closes at 18 months 2. Posterior: triangular, closes at 12 weeks |
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What is molding?
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the adaptation in the size and shape of the fetal head as it passes through the maternal pelvis during labor
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What does fetal presentation mean?
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part of the fetus that enters into the maternal pelvis
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In what position are 95% of all fetuses?
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cephalic/ vertex
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Breech presentation account for ___% and include what?
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4%
frank breech, complete breech, footling (single and double) and incomplete |
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What is fetal lie?
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Relationship of the long axis (spine) of the fetus to the long axis (spine) of the mother
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What types of fetal lie are there?
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1. Longitudinal/vertical: fetal and maternal spines parallel (vertex or breech)
2. Oblique: slight angle 3. Transverse: horizontal NOTE: oblique and transverse lies prevent vaginal delivery; can convert during labor |
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What is fetal attitude?
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Relationship of the fetal parts to each other, usually flexion or extension, determines the part of the head and diameter of the skull that presents
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What fetal attitude does the fetus normally assume?
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flexed position
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If the head is flexed what presents first?
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Occiput
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If the head is extended what presents first?
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brow presents
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If the head is hyperextended what presents first?
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chin/ mentum
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What is fetal position?
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relationship of the presenting part to the 4 quadrants of the mother's abdomen
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What do the letters in the 3 letter fetal position abbreviation stand for?
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1. Location of the presenting part in the R or L side of maternal pelvis
2. Presenting part of the fetus (O, S, M, Sc) 3. Location of presenting part in relation to the anterior (A), posterior (P) or transverse (T) portion of the maternal pelvis |
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When a baby is in the cephalic presentation, what are the options for position (3 letter abbreviations)?
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ROP: right occiput posterior
LOP: left occiput posterior ROA: right occiput anterior LOA: left occiput anterior NOTE: OP's are more difficult to deliver |
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Fetal descent consists of engagement and station. What are these?
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Engagement: when the widest transverse diameter of the presenting part passes through the pelvic inlet
Station: level of the presenting part of fetus in relation to the ischial spines in the mid-pelvis. Presenting part level with ischial spine= 0 station, -1 to -3 above ischial spine, +1 to +3 below ischial spines |
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How do you determine fetal descent, position, etc?
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Abdominal inspection and palpation, vaginal exam, fontanels, sonography
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What are the 4 basic types of pelvis?
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1. Gynecoid: 50%, round, typically female
2. Android: 23%, heart shaped, typically male (vaginal delivery difficult due to narrow dimensions 3. Anthropoid: 24%, oval 4. Platypelloid: 3%, flat NOTE: gynecoid and anthropoid are good for delivery, some women have pelvises with a combination of characteristics |
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What are the 4 pelvic planes?
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1. Pelvic inlet
2. Pelvic canal/ cavity 3. Pelvic outlet 4. Suprapubic angle NOTE: the plane of least dimensions is the narrowest section of the pelvis |
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What is cephalopelvic disproportion (CPD)?
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fetal size, fetal position, and pelvic architecture are not favorable for vaginal delivery, the head is too big! Sometimes don't know this until well into labor
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What is the primary power of labor?
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Uterine contractions: periodic, rhythmic shortening or tightening of the uterine muscle in response to a stimulus
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What are the components of uterine contractions?
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the timing, frequency, duration (length 30-90 seconds), and intensity (strength, mild, moderate or strong to palpation)
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Frequency of uterine contractions
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time between beginning of one UC to the beginning of another, need 2-3 minutes for delivery. NOTE that during contraction baby is not getting blood flow
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What is resting tone?
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Resting between contractions (uterus does not completely relax)
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During pregnancy what is the rate of blood flow to baby?
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600cc/ minute
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How do you tell the intensity of contractions?
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Palpate the fundus. Mild will feel like your cheek, moderate feels like chin and strong feels like forehead. The lower portion of the uterus will be more relaxed to facilitate cervical change
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How does the uterus change with contractions?
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1. Upper portion becomes thicker and more powerful (shortened myometrial fibers)
2. Lower portion becomes thinner, softer, and more relaxed (lengthened myometrial fibers) |
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What are the purposes of uterine contractions?
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1. Efface and dilate the cervix
2. Facilitate descent and rotation of fetus 3. Cause the separation and expulsion of the placenta 4. Maintain homeostasis of the uterus by compressing blood vessels post-partum |
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What is effacement?
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The shortening and thinning of the cervix, expressed in percent.
In primip effacement begins before dilation, in multip dilitation and effacement happen together 1 inch thick is not effaced (0%) Paper thin is 100% |
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What is a normal cervical length mid-pregnancy?
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4 cm
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What is a marker for pre-term labor?
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short cervix
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What is dilation?
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opening and enlargement of the external cervix caused by the retraction of the cervix into lower uterine segment due to uterine contractions and pressure of amniotic fluid
Measured in cm from 0-10 |
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What maternal position during labor decreases cord compression?
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Lateral
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Why is it good to ambulate during labor?
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Shorter labor, less anesthesia, and have greater satisfaction with the experience. Gravity, increased intensity of UCs, decreased cord compression and maternal cardiac output
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What two components must be present to be in labor?
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1. Regular uterine contractions
2. Cervical change (this could start a few weeks before labor) |
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What signs precede labor?
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1. Lightening/ dropping: fetal presenting part descends into pelvis
2. Bloody show: mucus plug, cervical change 3. Braxton-hicks contractions: practice 4. Weight loss: 1-3 lbs 5. Surge of energy, nesting 6. Cervical ripening: softens and effacement 7. SROM |
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Parturition cascade theory of labor
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Latest theory, instead of an active process involving stimulants, labor may be promoted as a result of the removal of inhibitory effects of pregnancy on the uterus, involves FETAL, MATERNAL, and PLACENTAL factors
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What are the four stages of labor?
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1. First stage: labor. latent (0-3 cm), active (4-7 cm), transition (8-10 cm)
2. 2nd stage: complete to delivery 3. 3rd: delivery of placenta 4. 4th immediate pp period |
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What are the 7 cardinal movements of labor?
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1. Engagement
2. Descent 3. Flexion 4. Internal rotation 5. Extension 6. Restitution 7. External rotation 8. Expulsion yup, that is 8...? |
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Engagement
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biparietal diameter of the fetal head passes the pelvic inlet
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Descent
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progressive downward movement, pressure of the amniotic fluid, pressure of uterine contractions, bearing down of the woman during 2nd stage, extension and straightening of the fetal body
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Flexion
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natural attitude of the fetus, causes the smallest portion of the fetal head to present to the maternal pelvis
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Internal rotation
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Fetal head usually enters the pelvis in a transverse of oblique position, 45-90 degree rotation of fetal head into a OA or OP
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Extension
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flexion of the head continues crowning, caused by downward pressure, base of occiput passes under symphysis pubis and causes the head to extend, brow, face and chin move past the sacrum and coccyx, fetal head into OA position
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Restitution
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head delivered OA position, shoulders remain oblique or transverse, head rotates to R or L, rotation direction depends upon original position of head
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External rotation
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fetal body rotates so that shoulders are in a anteroposterior position
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Expulsion
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delivery of anterior shoulder under sympnysis pubis, delivery of posterior shoulder and body
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What is the max weight we want a woman to gain during pregnancy?
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25 lbs
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What are some signs of true labor?
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Walking increases UC intensity
UCs at regular intervals Show is often present Cervical change Does not stop with sedation |
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What are some signs of false labor?
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No change in UC intensity with walking
Irregular UCs No show No cervical change or very small change/ thinning Stops with sedation |
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What prenatal data do you need to gain during admission?
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Weight gain during pregnancy
Past and present OB history EDD/EGA Blood type and Rh factor |
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What information do you need to get during admission interview?
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SROM (color, amount, time)
Fetal movement (tells us if baby is getting enough O2) Uterine contractions Bloody show Birth plan |
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What information do you need to get upon admission from exam and labs?
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Cervical exam, fetal presentation (leopold's, US, cervical exam), urine (protein, ketones, glucose), Hgb, Hct, blood type
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Where on the mother do you place the monitor's?
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Over fundus for contractions, over lower half of abdomen for fetal heart rate. If heartrate is not in that location think about breech or transverse position.
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How do you assess for SROM?
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Use Nitrazine and Ferning
Vaginal secretions are slightly acidic (<5.0) and amniotic fluid (AF) is alkaline (>6-6.5) so if AF the nitrazine paper will turn blue. False positives may be due to blood, semen, vaginitis. Alternatively, spread fluid on slide, dry, amniotic fluid crystallizes into a fern leaf pattern under microspcope |
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What admission data do you need to collect about the fetus?
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20 minute EFM tracing, fetal heart rate (external or internal)
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What ongoing assessment need to be performed on a laboring woman?
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Cervical exam (limit with ROM)
I &O Pain Membrane status Check for cord prolapse, FHR, infection |
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When should pushing begin?
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With the urge to push after cervix is completely dilated
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What type of pushing is best?
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Open glottis pushing is better for the baby, 6-7 seconds in response to urge
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What is laboring down?
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When the cervix is dilated but the baby is high, let the contractions push the baby down and then start maternal pushing
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What is crowning?
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portion of presenting part is visible at introitus, intense rectal pressure, sensation of stretching, tearing, burning. Ready to deliver when rocking stops.
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What is fundal pressure?
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Pushing on the fundus to facilitate delivery, VERY BAD!! Can cause uterine rupture or injury to the baby
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Nuchal cord
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cord around the neck
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Shoulder dystocia
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Anterior shoulder lodged under symphysis pubis
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