Maternal Chapter 8 study

What do the cardinal movements include?

Engagement, descent, flexion, internal rotation, extension, external rotation and expulsion.

How often do contractions occur during the transition (3rd) phase of the first stage of labor?

Every 2 to 3 minutes.

What is expulsion?

Expulsion (birth) occurs after delivery of the anterior and posterior shoulders.

How would the cervix be described in early pregnancy?

Firm, long and closed.

How is the platypelloid pelvis shaped?

Flat in it's dimensions with a very narrow anterior-posterior diameter and a wide transverse diameter. This shape makes it extremely difficult for the fetus to pass through the bony pelvis.

What is the fetus said to be if the station is minus four (-4) or higher?

Floating and unengaged.

How many basic pelvic shapes are there?

Four

What are the 4 different breech presentations?

Frank, complete, single footling, and double footing.

What three descriptors do you use in documenting contractions?

Frequency, duration, and intensity.

What should you observe the woman for during the recovery (4th) stage of labor?

Frequently for signs of hemorrhage or other complications.

What is internal rotation?

Frequently, in early labor, the fetal head presents to the pelvis in a transverse position because the inlet of the pelvis is widest from side to side. During active labor, the fetal head typically rotates 45 degrees from a transverse position to an anterior position so that the head can accommodate the pelvic outlet, which s wider from front to back.

How long does the recovery stage (4th) of labor last?

From 1 to 4 hours.

Which type of pelvis is most favorable for vaginal birth?

Gynecoid pelvis.

Which type of pelvis is considered the typical female pelvis?

Gynecoid, although only about half of all women have a gynecoid pelvis.

What are the four basic pelvic shapes?

Gynecoid, anthropoid, android, and platypelloid.

How does the practitioner estimate the size of the obstetric conjugate?

He measures the diagonal conjugate, which extends from the symphsis pubis to the sacral promontory. The practitioner then subtracts 1.5 to 2 cm from the measurement of the diagonal conjugate to approximate the dimensions of the dimensions of the obstetric conjugate.

What are the 3 main ways the fetus can present to the pelvis?

Head (Cephalic presentation), feet or buttocks (breech presentation), or shoulder (shoulder presentation).

What does frequency refer to?

How often the contractions are occurring and is measured by counting the time interval from the beginning of one contraction to the beginning of the following contraction.

What is molding?

The cartilage between the bones allows the bones to overlap during labor, which elongates the fetal skull, thereby reducing the diameter of the head.

How do uterine contractions affect the cervix?

The cervix begins to get shorter and thinner.

When does the transition (3rd) phase of the first stage of labor begin and end?

The cervix is dilated 8 cm and ends with full cervical dilation.

What is the second way uterine contractions affect the cervix?

The cervix must open to allow the fetus to be born. Dilation is measured in centimeters.

How does the cervix change as time for delivery approaches?

The cervix usually begins to soften.

Can a vaginal birth be accomplished with an anthropoid pelvis?

Yes, in approximately 1/3 of women who have variations of the anthropoid pelvis.

When the widest diameter of the presenting part is at the level of the ischial spines, what is the fetal station?

Zero.

What is flexion?

As the head descends during labor, the fetus encounters resistance from the soft tissues and muscles of the pelvic floor. This resistance normally coaxes the fetus to assume an attitude of flexion. Flexion is the attitude that presents the smallest diameters of the fetal head to the dimensions of the pelvis.

What is external rotation?

As the head is born, external rotation lines the head up with the shoulders.

What should the angle of the pubic arch be?

At least 90 degrees.

What is the most common attitude and the one that is most favorable for vaginal birth?

An attitude of flexion, also called a vertex presentation.

Which pelvis type is the typical male pelvis and resembles a heart in its shape?

Android. Approximately 1/3 of white women and 16% of non-white women have an android pelvis.

Which pelvis is elongated in it's dimensions.

Anthroipoid pelvis. The anterior-posterior diameter is roomy, but the transverse diameter is narrow compared with that of the gynecoid pelvis.

How long does the latent phase of the first stage of labor last?

Approximately 8 to 9 hours for the primiparous woman but generally does not exceed 20 hours in length.

If the presenting part is above the level of the ischial spines, how is the station recorded?

As a negative number and is read as "minus."

How is effacement recorded?

As a percentage.

If the presenting part is below the level of the ischial spines, how is the station recorded?

As a positive number and is read "plus."

What is the third stage of labor called?

Delivery of the placenta.

What is the average length of the second stage of labor (birth)?

1 hour for primipara and 20 minutes for multipara.

How many centimeters is the cervix dilated when dilation is complete?

10 cm.

When the cervix is paper thin, what percent effaced is it?

100%.

What measurement of an obstetric conjugate is considered adequate to accommodate a vaginal delivery?

11 cm

What is the duration of contractions in early labor or the latent phase of the first stage?

30 to 45 seconds.

How long do contractions last during the active phase (2nd) of the first stage of labor?

45 to 60 seconds.

How long does the delivery of the placenta (3rd stage) last?

5 to 20 minutes.

At a length of 1 cm, what percent effaced is the cervix?

50%.

How long do the contractions last during the transition (3rd) phase of the first stage of labor?

60 to 90 seconds.

How often do the contractions occur in the latent phase or early labor of the first stage?

A frequency of 5 to 10 minutes or as infrequently as every 30 minutes.

What is the most common fetal lie position?

A longitudinal lie, in which the long axis of the fetus is parallel to the long axis of the mother.

What does the woman experience in the transition (3rd) phase of the first stage of labor?

A strong urge to push as the fetus descends.

What is the second phase of the first stage of labor called?

Active labor or active phase.

When does the active phase of the first stage of labor begin and end?

Begins at 4 cm of cervical dilation and ends when the cervix is dilated 8 cm.

When does early labor or the latent phase begin and end?

Begins when the contractions of true labor start and ends when the cervix is dilated at 4 cm.

What is an oblique lie?

Between a longitudinal and transverse lie.

What is the second stage of labor called?

Birth.

What is the true pelvis?

Bony passageway through which the fetus must pass during delivery.

What does a mulltiparous woman experience first?

Both processes usually occur at the same time. Often, the multipara's cervix dilates 1 to 2 cm several weeks before labor begins.

How must women with platypelloid pelvises usually deliver their children?

By cesarean section.

How is fetal position determined?

By comparing the relationship of an arbitarily determined reference point on the presenting part of the fetus to the quadrants of the maternal pelvis. To determine position, first establish the presenting part and locate the appropriate reference point. Then determine toward which pelvic quadrant the reference point is facing.

How do you estimate the intensity of a contraction?

By palpating the fundus at the peak of the contraction and record it as mild, moderate or strong. Intensity can be measured directly with an intrauterine pressure transducer.

What is descent?

Descent may begin before labor when the fetus "drops." Descent is measured by station, which is the relationship of the fetal-presenting part to the maternal ischial spines. Descent continues throughout labor to varying degrees.

What does fetal lie describe?

Describes the position of the long axis of the fetus in relation to the long axis of the pregnant woman.

What are the 4 stages of labor?

Dilation, Birth, Delivery of placenta, Recovery.

What is the first stage of labor called?

Dilation.

How is the first stage subdivided?

Early labor (latent phase), Active labor (active phase), and Transition (transition phase).

What is the first phase of the first stage of labor?

Early labor or latent phase.

What are soft tissues that form the passageway known as the birth canal?

Cervix and vagina.

What is the passageway?

Consists of the woman's bony pelvis and soft tissues of the cervix and vagina.

What does each contraction do?

Constricts the blood vessels that supply the placenta, thereby decreasing the amount of oxygen that flows to the fetus.

What are factors that may affect the maternal psyche?

Current pregnancy experience. Previous birth experiences. Expectations for current birth experience. Preparation for birth. Presence and support of a birth companion. Culture.

What does a primiparous woman experience first?

Effacement before dilation.

When the cervix gets shorter and thinner during uterine contractions, what is this called?

Effacement.

What are the three phases each involuntary uterine contraction is composed of?

Increment, acme and decrement followed by a relaxation period.

What is engagement?

Initial descent of the fetal head may result in engagement when the presenting part descends to the level of the ischial spines. Engagement may occur as early as 2 weeks before labor or not until after the onset of labor.

How is the obstetric conjugate measured?

It cannot be measured directly; therefore, the practitioner must estimate the size.

What does the false pelvis consist of?

It is the flared upper portion of the bony pelvis. It is not part of the bony passageway.

What increases the risk for aspiration during active labor?

Labor prolongs the normal gastric emptying time. This change often leads to nausea and vomiting during active labor and increases the risk for aspiration.

What are the three basic ways that the fetus can lie in the uterus?

Longitudinal, transverse, or oblique position..

How are the contractions of early labor (latent phase) described?

Mild intensity.

How are the contractions described in the active phase (2nd) of the first stage of labor?

Moderate to strong intensity.

Is gross proteinuria normal during labor?

Never.

Can you determine the shape and dimension of the pelvic inlet by the size of the woman?

No. A woman might be small in stature but have a roomy gynecoid pelvis. A larger woman may have a small, contracted, platypelloid or android pelvis.

What is the most important measurement of the pelvic inlet?

Obstetric conjugate.

What is the smallest diameter of the inlet through which the fetus must pass?

Obstetric conjugate.

When does the first stage of labor (dilation) begin and end?

Onset of true labor and ends with full dilation of the cervix at 10 cm.

What are the 4 essential components of labor?

Passageway, passenger, powers and psyche.

Where is the true pelvis located?

Portion of the pelvis blow the linea terminals/

What normally occurs during the active phase (2nd) of the first stage of labor?

Progressive cervical dilation and fetal descent.

What are characteristics of true labor?

Progressive dilation and effacement. Membranes may bulge or rupture spontaneously. Bloody show is present. Contraction patterns are regular, increasingly more intense and more frequent. Pain often starts in the small of the back and radiates the lower abdomen and may begin with a cramping sensation. The effects of walking may make the contractions continue and become stronger.

Why is it important for the woman to resist the urge to push until the cervix is completely dilated?

Pushing against a partially dilated cervix can cause swelling, which slows labor, or the cervix can develop lacerations, leading to hemorrhage.

What is the fourth stage of labor called?

Recovery.

What is fetal attitude?

Refers to the relationship of the fetal parts to one another.

What is the bony pelvis?

Rigid passageway through which the fetus must navigate to deliver vaginally.

What are clinical signs that labor is approaching?

Ripening or softening and effacement (thinning) of the cervix. Dilation of the cervix may accompany softening and effacement, particularly in multiparous women.

How are the contractions described in the transition (3rd) phase of the first stage of labor?

Strong intensity.

What part of the involuntary uterine contraction is the peak?

The acme.

What part of the involuntary uterine contraction is the letting up phase?

The decrement.

What is expulsion by Schultze mechanism?

The fetal or shiny side of the placenta delivers first.

What does the passenger refer to?

The fetus.

What does fetal presentation refer to?

The foremost part of the fetus that enters the pelvic inlet.

What are the 4 essential components of labor also known as?

The four Ps of labor. Passageway, passenger, powers and psyche.

What phase of the involuntary uterine contraction is the longest?

The increment or building up of the contractions.

What are important landmarks of the true pelvis?

The inlet (entrance to the true pelvis), midpelvis, and outlet (exit point).

What does duration refer to?

The interval from the beginning of a contraction to its en.

What is transverse lie?

The long axis of the fetus is perpendicular to the long axis of the woman.

What is expulsion by Duncan mechanism?

The maternal or rough side of the placenta presents first.

Which is the least common type of pelvis?

The platypelloid pelvis.

What is meant when the fetus is said to be floating?

The presenting part has not yet entered the true pelvis.

What does fetal station refer to?

The relationship of the presenting part of the fetus to the ischial spines of the pelvis.

Why is the gynecoid pelvis most favorable for a vaginal birth?

The rounded shape of the gynecoid inlet allows the fetus room to pass through the dimensions of the bony passageway.

What determines the pelvic type?

The shape of the inlet.

What is the most important fetal structure in relation to labor and birth?

The skull because it is the largest and least compressible structure.

What does intensity refer to?

The strength of the contraction.

What are the cardinal movements?

The turns and movements of the passenger (fetus) during the journey of birth.

What are the characteristics of false labor?

There are no cervical changes. The membranes remain intact. There is no bloody show. May expel mucus plug. Contraction pattern tends to be irregular, although the contractions may seem to have a regular pattern for a time. Pain may be described as a tightening sensation usually the discomfort is confined to the abdomen. The effects of walking may decrease the frequency or eliminate the contractions altogether.

What is extremely important to the well-being of the mother and the fetus?

There is a period of relaxation between contractions.

What happens to larger babies who try to be delivered to a mother with an android pelvis?

They get stuck in the birth canal and must be delivered by cesarean. Smaller babies may be able to navigate the narrow diameters.

What is the third phase of the first stage of labor called?

Transition phase.

What is shoulder presentation associated with?

Transverse lie.

How often to contractions occur during the active phase (2nd) of the first stage of labor?

Typically, every 2 to 5 minutes.

What is extension?

Typically, the fetal head is well flexed with the chin on the chest as the fetus travels through the birth canal. When the fetus reaches the pubic arch, it must extend under the symphysis pubis.

What is a woman encouraged to do during the second stage of labor (birth)?

Use her abdominal muscles to bear down during contractions while the fetus continues to descend and rotate to the anterior position.

How do you document fetal position in the clinical record?

Using abbreviations. The first letter describes the side of the maternal pelvis toward which the presenting part is facing (R for right). The second letter indicates the reference point (O for occiput). The last part of the designation specifies whether the presentation part is facing the anterior (A) or the posterior (P) portion of the pelvis or whether it is in a transverse (T) position.

What are the 4 different fetal attitudes?

Vertex, military, brow, or face.

When is the fetus said to be engaged?

When the presenting part has settled into the true pelvis at the level of the ischial spines and is reported to be at a station of zero (0).

What factors affect the psychological state or psyche of the laboring woman?

When the woman feels confident in her ability to cope and finds ways to work with the contractions, the labor process is enhanced. However, if the laboring woman becomes fearful or has intense pain, she may become tense and fight contractions. This situation often becomes a cycle of fear, tension and pain that interferes with the progress of labor.

When does the second stage of labor begin and end?

When then cervix is fully dilated to 10 cm and ends with the birth of the infant.

When does delivery of the placenta (3rd stage) begin and end?

With the birth of the baby and ends with delivery of the placenta.