OB- Chapter 13
Presentation types include:
1) Cephallic (head down)= vertex- back of head 2) Breech- frank, complete, single footing, double footing 3) Shoulder
Powers (contractions) include what 3 factors?
1) Duration 2) Intensity 3) Frequency
Passenger includes what 4 things?
1) Fetal lie 2) Presentation 3) Position 4) Station
The 5 P's are what?
1) Passageway (birth canal: pelvis and soft tissue) 2) Passenger (fetus/placenta) 3) Powers (contractions) 4) Position (maternal) 5) Psychological response
What 3 positions are possible for birth?
1) Squatting 2) Lithotomy 3) Walking
What 3 physiologic factors should a nurse evaluate in a woman in regards to labor and birth? SATA A) BP- increased due to pain, stress, anxiety B) GI- decreased gastric motility and food absorption, decreased gastric emptying C) Pain- muscle aches/cramps= inevitable, increases as you get closer to delivery D) HR- decreases closer to delivery
A) BP- increased due to pain, stress, anxiety B) GI- decreased gastric motility and food absorption, decreased gastric emptying C) Pain- muscle aches/cramps= inevitable, increases as you get closer to delivery
A nurse is providing care to a woman in labor. The nurse determines that the client is in the active phase based on which assessment findings? Select all that apply. A) cervical dilation of 6 cm B) contractions every 2 to 3 minutes C) cervical effacement of 90% D) contractions every 90 seconds E) strong desire to push
A) cervical dilation of 6 cm B) contractions every 2 to 3 minutes Rationale: During the active phase, the cervix usually dilates from 6 to 10 cm, with 40% to 100% effacement taking place. Contractions become more frequent, occurring every 2-5 min and increase in duration (45 to 60 seconds). Effacement of 30% reflects the latent phase. Contractions occurring every 90 seconds suggest the second stage of labor. A strong urge to push reflects the later perineal phase of the second stage of labor. Reference: p. 456
In order for a labor to be considered TRUE what change has to be present?
Changes in the cervix
What part of contractions is measured in seconds?
Duration
A woman experiencing what type of labor is directed to drink fluids and walk around to see if there's a change in intensity of contractions- if they diminish in intensity- stay home.
False labor
Contractions usually felt in the front of the abdomen are indicative of what type of labor?
False labor
Frequently weak, not stronger with time or alternating contractions are indicative of which kind of labor?
False labor
Irregular, not close together contractions are indicative of true or false labor?
False labor
These contractions may stop/slow down with walking/changing position in which type of labor?
False labor
The relationship of the presenting part of the level of the maternal pelvis ischial spines (How close the baby is to coming out)
Fetal Station
Describes the relationship of a given point on the presenting part of the fetus to a designated point of the maternal pelvis.
Fetal position
This stage of birth is the longest stage and consists of two phases. - This is the process of progressive dilation of the cervix. -Begins with onset of regular uterine contractions and ends once dilated at 10cm.
First stage
How many stages of labor are there?
Four stages (only 3 are counted during total birth time- 4th is imaginary)
What part of contractions is measured in minutes?
Frequency
What part of contractions are measure either manually by palpation or by an internal intrauterine pressure catheter (charted in mmHg)
Intensity
1st letter landmark is either _____ or ______
L or R- left or right
This is the first phase during the first stage of birth. It is also known as the early stage 0-6cm dilation Contractions are every 5-10 minutes Contractions last 30-45 seconds
Latent phase (early phase)
If doing a vaginal exam, baby is in a cephallic position in the sagittal suture, the occiput is slightly to the left of the sacrum, what position would the baby be in?
Left occiput anterior (LOA) preferred position
This type of fetal lie is when the mom and baby are in a straight line (fetal spine to maternal spine side by side)
Longitudinal
This fetal station is below ischial spines
Plus station
This part of labor influences the length of the labor, and controls/predicts a woman's length/pain level during labor
Psyche
The Fetal Lie can be:
longitudinal, transverse, or oblique
First stage births usually take how many hours?
16 hours
What type of pelvis is considered ideal for vaginal birth? A) Gynecoid B) Anthropoid C) Android D) Platypelloid
A) Gynecoid Rationale: This is considered to be round and roomy- the female pelvis Anthropoid- usually adequate Android- males pelvis Platypelloid- not favorable
Landmarks are charted with how many letters?
3
Second stage of birth usually takes how long? (for first time mom) For second/more time mom?
5-10 hours Within 1 hour
Third stage of birth lasts how long?
5-30 minutes
Length of labor question: Morning- irregular contractions 12 (noon) contractions are 5-7 mins apart (consistent/stronger) 4pm= goes to hospital, contractions are 4 mins apart Wants epidural Water breaks when she's 8cm dilated 7:15 began birthing 7:22 placenta comes out How long is the birth?
7 hours 22 minutes
During a follow-up prenatal visit, a pregnant woman asks the nurse, "How long do you think I will be in labor?" Which response by the nurse would be most appropriate? A) "It's difficult to predict how your labor will progress, but we'll be there for you the entire time." B) "Since this is your first pregnancy, you can estimate it will be about 10 hours." C) "It will depend on how big the baby is when you go into labor." D) "Time isn't important; your health and the baby's health are key."
A) "It's difficult to predict how your labor will progress, but we'll be there for you the entire time." Rationale: It is difficult to predict how a labor will progress and therefore equally difficult to determine how long a woman's labor will last. There is no way to estimate the likely strength and frequency of uterine contractions, the extent to which the cervix will soften and dilate, and how much the fetal head will mold to fit the birth canal. We cannot know beforehand whether the complex fetal rotations needed for an efficient labor will take place properly. All of these factors are unknowns when a woman starts labor. Telling the woman an approximate time would be inappropriate because there is no way to determine the length of labor. It is highly individualized. Although fetal size and maternal and fetal health are important considerations, these responses do not address the woman's concern. Reference: p. 453
A pregnant woman comes to the labor and birth unit in labor. The woman tells the nurse, "Yesterday, I had this burst of energy and cleaned everything in site, but I don't know why," Which response by the nurse would be most appropriate? A) "You had a burst of adrenalin, which is common before labor." B) "You were trying to get everything ready for your baby." C) "You felt your mind telling you that you were about to go into labor." D) "You were looking forward to the birth of your baby."
A) "You had a burst of adrenalin, which is common before labor." Rationale: Some women report a sudden increase in energy before labor. This is sometimes referred to as nesting because many women will focus this energy toward childbirth preparation by cleaning, cooking, preparing the nursery, and spending extra time with other children in the household. The increased energy level usually occurs 24 to 48 hours before the onset of labor. It is thought to be the result of an increase in epinephrine (adrenaline) release caused by a decrease in progesterone. The burst of energy is unrelated to getting everything ready, the mind telling the woman that she will be going into labor, or looking forward to the birth. Reference: p. 438
Which of the following are premonitory signs of labor? SATA A) Cervical changes- softening/dilation B) Lightening (baby dropping) C) Increased energy level (Nesting) D) Bloody Show- mucus plug expelled E) Braxton Hicks Contractions stronger/more frequent F) Spontaneous rupture of membranes (water breaking) G) Heavy vaginal bleeding
A) Cervical changes- softening/dilation B) Lightening (baby dropping) C) Increased energy level (Nesting) D) Bloody Show- mucus plug expelled E) Braxton Hicks Contractions stronger/more frequent F) Spontaneous rupture of membranes (water breaking)
Signs of placental separation include: SATA A) Uterus rises upward B) The fundus is at 12 cm C) The umbilical cord lengthens D) Sudden trickle of blood released from vaginal opening E) Uterus changes its shape to globular
A) Uterus rises upward C) The umbilical cord lengthens D) Sudden trickle of blood released from vaginal opening E) Uterus changes its shape to globular
A woman has been in labor for some time, but her membranes have not yet ruptured. Artificial rupture of membranes is being considered. Which assessment findings would support the decision to perform the procedure? Select all that apply. A) cervical dilation of 4 cm B) uterine contractions every 2 minutes C) cervical effacement 50% D) fetal head at -2 station E) vertex presentation
A) cervical dilation of 4 cm D) fetal head at -2 station
The fetus of a nulliparous woman is in a shoulder presentation. The nurse would most likely prepare the client for which type of birth? A) cesarean B) vaginal C) forceps-assisted D) vacuum extraction
A) cesarean Rationale: The fetus is in a transverse lie with the shoulder as the presenting part, necessitating a cesarean birth. Vaginal birth, forceps-assisted, and vacuum extraction births are not appropriate. Reference: p. 446
A nurse is caring for several women in labor. The nurse determines that which woman is in the transition phase of labor? A) contractions every 5 minutes, cervical dilation 3 cm B) contractions every 3 minutes, cervical dilation 5 cm C) contractions every 21/2 minutes, cervical dilation 7 cm D) contractions every 1 minute, cervical dilation 9 cm
A) contractions every 5 minutes, cervical dilation 3 cm Rationale: Contractions every 5 minutes with cervical dilation of 3 cm is typical of the latent phase. Contractions every 3 minutes with cervical dilation of 6 cm, contractions every 2½ minutes with cervical dilation of 8 cm, and contractions every 1 minute with cervical dilation of 9 cm suggest the active phase of labor. Reference: p. 456
A nurse is providing care to a pregnant client in labor. Assessment of a fetus identifies the buttocks as the presenting part, with the legs extended upward. The nurse identifies this as which type of breech presentation? A) frank B) full C) complete D) footling
A) frank Rationale: In a frank breech, the buttocks present first, with both legs extended up toward the face. In a full or complete breech, the fetus sits cross-legged above the cervix. In a footling breech, one or both legs are presenting. Reference: p. 445
The nurse is reviewing the monitoring strip of a woman in labor who is experiencing a contraction. The nurse notes the time the contraction takes from its onset to reach its highest intensity. The nurse interprets this time as which phase? A) increment B) acme C) peak D) decrement
A) increment Rationale: Each contraction has three phases: increment or the buildup of the contraction; acme or the peak or highest intensity; and the decrement or relaxation of the uterine muscle fibers. The time from the onset to the highest intensity corresponds to the increment. Reference: p. 450, Uterine Contractions, Figure 13-13
A nurse is preparing a class for pregnant women about labor and birth. When describing the typical movements that the fetus goes through as it travels through the passageway, which movement would the nurse most likely include? Select all that apply. A) internal rotation B) abduction C) descent D) pronation E) flexion
A) internal rotation C) descent E) flexion Rationale: The positional changes that occur as the fetus moves through the passageway are called the cardinal movements of labor and include engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion. The fetus does not undergo abduction or pronation. Reference: p. 448
Assessment of a woman in labor reveals cervical dilation of 3 cm, cervical effacement of 30%, and contractions occurring every 7 to 8 minutes, lasting about 40 seconds. The nurse determines that this client is in: A) latent phase of the first stage. B) active phase of the first stage. C) transition phase of the first stage. D) perineal phase of the second stage
A) latent phase of the first stage. Rationale: The latent phase of the first stage of labor involves cervical dilation of 0 to 3 cm, cervical effacement of 0% to 40%, and contractions every 5 to 10 minutes lasting 30 to 45 seconds. The active phase is characterized by cervical dilation of 4 to 7 cm, effacement of 40% to 80%, and contractions occurring every 2 to 5 min test lasting 45 to 60 seconds. The perineal phase of the second stage occurs with complete cervical dilation and effacement, contractions occurring every 2 to 3 minutes and lasting 60 to 90 seconds, and a tremendous urge to push by the mother. The third stage, placental expulsion, starts after the newborn is born and ends with the separation and birth of the placenta. Reference: p. 457
A nurse is conducting an in-service program for a group of nurses working in the labor and birth suite of the facility. After teaching the group about the factors affecting the labor process, the nurse determines that the teaching was successful when the group identifies which component as part of the true pelvis? Select all that apply. A) pelvic inlet B) cervix C) mid pelvis D) pelvic outlet E) vagina F) pelvic floor muscles
A) pelvic inlet C) mid pelvis D) pelvic outlet Rationale: The true pelvis is made up of three planes: the pelvic inlet, mid pelvis, and pelvic outlet. The cervix, vagina, and pelvic floor muscles are the soft tissues of the passageway. Reference: p. 440
A nurse is preparing a presentation for a group of pregnant women about the labor experience. Which factors would the nurse most likely include when discussing measures to promote coping for a positive labor experience? Select all that apply. A) presence of a support partner B) view of birth as a stressor C) low anxiety level D) fear of loss of control E) participation in a pregnancy exercise program
A) presence of a support partner C) low anxiety level E) participation in a pregnancy exercise program Rationale: Numerous factors can affect a woman's coping ability during labor and birth. Having the presence and support of a valued partner during labor, engaging in exercise during pregnancy, viewing the birthing experience as a meaningful rather than stressful event, and a low anxiety level can promote a woman's ability to cope. Excessive anxiety may interfere with the labor progress, and fear of labor and loss of control may enhance pain perception, increasing the fear. Reference: p. 455
A nurse is describing how the fetus moves through the birth canal. Which component would the nurse identify as being most important in allowing the fetal head to move through the pelvis? A) sutures B) fontanelles C) frontal bones D) biparietal diameter
A) sutures Rationale: Sutures are important because they allow the cranial bones to overlap in order for the head to adjust in shape (elongate) when pressure is exerted on it by uterine contractions or the maternal bony pelvis. Fontanelles are the intersections formed by the sutures. The frontal bones, along with the parietal and occipital bones are bones of the cranium that are soft and pliable. The biparietal diameter is an important diameter that can affect the birth process. Reference: p. 443
A client is in the third stage of labor. Which finding would alert the nurse that the placenta is separating? A) uterus becomes globular B) fetal head at vaginal opening C) umbilical cord shortens D) mucous plug is expelled
A) uterus becomes globular Rationale: Placental separation is indicated by the uterus changing shape to globular and upward rising of the uterus. Additional signs include a sudden trickle of blood from the vaginal opening, and lengthening (not shortening) of the umbilical cord. The fetal head at the vaginal opening is termed crowning and occurs before birth of the head. Expulsion of the mucous plug is a premonitory sign of labor. Reference: p. 460
A nurse is providing care to a client in labor. A pelvic exam reveals a vertex presentation with the presenting part tilted toward the left side of the mother's pelvis and directed toward the anterior portion of the pelvis. When developing this client's plan of care, which intervention would the nurse include? A. implementing measures for a vaginal birth B. preparing the client for a cesarean birth C. assisting with artificial rupture of the membranes D. instituting continuous internal fetal monitoring
A. implementing measures for a vaginal birth Rationale: The fetal presentation and position is left occiput anterior position or LOA, which is the most common and most favorable fetal position for birth. LOA along with right occiput anterior position are optimal positions for vaginal birth. Therefore the nurse should implement measures for a vaginal birth. This fetal presentation is not an indication for cesarean birth. Nor is there need for artificially rupturing the membranes. Continuous internal fetal monitoring would be warranted if the woman or fetus was considered to be high risk. Reference: p. 446
This is the second phase during the first stage of birth Most common for water to break during this time 6-10cm dilation Contractions are every 2-5 minutes Contractions last 45-60 seconds
Active phase
A woman telephones her health care provider and reports that her water just broke. Which suggestion by the nurse would be most appropriate? A) "Call us back when you start having contractions." B) "Come to the clinic or emergency department for an evaluation." C) "Drink 3 to 4 glasses of water and lie down." D) "Come in as soon as you feel the urge to push."
B) "Come to the clinic or emergency department for an evaluation." Rationale: When the amniotic sac ruptures, the barrier to infection is gone, and there is the danger of cord prolapse if engagement has not occurred. Therefore, the nurse should suggest that the woman come in for an evaluation. Calling back when contractions start, drinking water, and lying down are inappropriate because of the increased risk for infection and cord prolapse. Telling the client to wait until she feels the urge to push is inappropriate because this occurs during the second stage of labor. Reference: p. 439
A nurse is conducting a continuing education program for a group of nurses working in the perinatal unit. After reviewing information about the maternal bony pelvis with the group, the nurse determines that the teaching was successful based on which statement by the group? A) The bony pelvis plays a lesser role during labor than soft tissue. B) The pelvic outlet is associated with the true pelvis. C) The false pelvis lies below the imaginary linea terminalis. D) The false pelvis is the passageway through which the fetus travels
B) The pelvic outlet is associated with the true pelvis. Rationale: The maternal bony pelvis consists of the true and false portions. The true pelvis is made up of three planes—the inlet, the mid pelvis, and the outlet. The bony pelvis is more important part of the passageway because it is relatively unyielding. The false pelvis lies above the imaginary linea terminalis. The true pelvis is the bony passageway through which the fetus must travel. Reference: p. 440
A nurse is providing care to a pregnant woman in labor. The woman is in the first stage of labor. When describing this stage to the client, which event would the nurse identify as the major change occurring during this stage? A) regular contractions B) cervical dilation C) fetal movement through the birth canal D) placental separation
B) cervical dilation Rationale: The primary change occurring during the first stage of labor is progressive cervical dilation (dilatation). Contractions occur during the first and second stages of labor. Fetal movement through the birth canal is the major change during the second stage of labor. Placental separation occurs during the third stage of labor. Reference: p. 457
When assessing cervical effacement of a client in labor, the nurse assesses which characteristic? A) extent of opening to its widest diameter B) degree of thinning C) passage of the mucous plug D) fetal presenting part
B) degree of thinning Rationale: Effacement refers to the degree of thinning of the cervix. Cervical dilation refers to the extent of opening at the widest diameter. Passage of the mucous plug occurs with bloody show as a premonitory sign of labor. The fetal presenting part is determined by vaginal examination and is commonly the head (cephalic), pelvis (breech), or shoulder. Reference: p. 438
A client is admitted to the labor and birthing suite in early labor. On review of her prenatal history, the nurse determines that the client's pelvic shape as identified in the antepartal progress notes is the most favorable one for a vaginal delivery. Which pelvic shape would the nurse have noted? A) platypelloid B) gynecoid C) android D) anthropoid
B) gynecoid Rationale: The most favorable pelvic shape for vaginal birth is the gynecoid shape. The anthropoid pelvis is favorable for vaginal birth, but it is not the most favorable shape. The android pelvis is not considered favorable for a vaginal birth because descent of the fetal head is slow and failure of the fetus to rotate is common. Women with a platypelloid pelvis usually require cesarean birth. Reference: p. 441
A woman in her third trimester comes to the clinic for a prenatal visit. During assessment the woman reports that her breathing has become much easier in the last week but she has noticed increased pelvic pressure, cramping, and lower back pain. The nurse determines that which event has most likely occurred? A) cervical dilation B) lightening C) bloody show D) Braxton-Hicks contractions
B) lightening Rationale: Lightening occurs when the fetal presenting part begins to descend into the maternal pelvis. The uterus lowers and moves into the maternal pelvis. The shape of the abdomen changes as a result of the change in the uterus. The woman usually notes that her breathing is much easier. However, she may complain of increased pelvic pressure, cramping, and lower back pain. Although cervical dilation also may be occurring, it does not account for the woman's complaints. Bloody show refers to passage of the mucous plug that fills the cervical canal during pregnancy. It occurs with the onset of labor. Braxton Hicks contractions increase in strength and frequency and aid in moving the cervix from a posterior position to an anterior position. They also help in ripening and softening the cervix. Reference: p. 438
A woman calls the health care facility stating that she is in labor. The nurse would urge the client to come to the facility if the client reports which symptom? A) increased energy level with alternating strong and weak contractions B) moderately strong contractions every 4 minutes, lasting about 1 minute C) contractions noted in the front of abdomen that stop when she walks D) pink-tinged vaginal secretions and irregular contractions lasting about 30 seconds
B) moderately strong contractions every 4 minutes, lasting about 1 minute Rationale: Moderately strong regular contractions 60 seconds in duration indicate that the client is probably in the active phase of the first stage of labor. Alternating strong and weak contractions, contractions in the front of the abdomen that change with activity, and pink-tinged secretions with irregular contractions suggest false labor. Reference: p. 457
A woman in her 40th week of pregnancy calls the nurse at the clinic and says she's not sure 1. whether she is in true or false labor. Which statement by the client would lead the nurse to suspect that the woman is experiencing false labor? A) "I'm feeling contractions mostly in my back." B) "My contractions are about 6 minutes apart and regular." C) "The contractions slow down when I walk around." D) "If I try to talk to my partner during a contraction, I can't."
C) "The contractions slow down when I walk around." Rationale: False labor is characterized by contractions that are irregular and weak, often slowing down with walking or a position change. True labor contractions begin in the back and radiate around toward the front of the abdomen. They are regular and become stronger over time; the woman may find it extremely difficult if not impossible to have a conversation during a contraction. Reference: p. 440
Assessment of a woman in labor reveals that the fetus is in a cephalic presentation and engagement has occurred. The nurse interprets this finding to indicate that the presenting part is at which station? A) -2 B) -1 C) 0 D) +1
C) 0 Rationale: Fetal engagement signifies the entrance of the largest diameter of the fetal presenting part (usually the fetal head) into the smallest diameter of the maternal pelvis. The fetus is said to be engaged in the pelvis when the presenting part reaches 0 station. Reference: p. 447
Assessment of a pregnant woman reveals that the presenting part of the fetus is at the level of the maternal ischial spines. The nurse documents this as which station? A) -2 B) -1 C) 0 D) +1
C) 0 Rationale: Station refers to the relationship of the presenting part to the level of the maternal pelvic ischial spines. Fetal station is measured in centimeters and is referred to as a minus or plus, depending on its location above or below the ischial spines. Zero (0) station is designated when the presenting part is at the level of the maternal ischial spines. When the presenting part is above the ischial spines, the distance is recorded as minus stations. When the presenting part is below the ischial spines, the distance is recorded as plus stations. Reference: p. 447
A nurse is conducting a class for a group of nurses new to the labor and birth unit about labor and the passage of the fetus through the birth canal. As part of the class, the nurse explains that specific diameters of the fetal skull can affect the birth process. Which diameter would the nurse identify as being most important? Select all that apply. A) Occipitofrontal B) Occipitomental C) Suboccipitobregmatic D) Biparietal E) Diagonal conjugate
C) Suboccipitobregmatic D) Biparietal Rationale: The diameter of the fetal skull is an important consideration during the labor and birth process. Fetal skull diameters are measured between the various landmarks of the skull. Diameters include occipitofrontal, occipitomental, suboccipitobregmatic, and biparietal. The two most important diameters that can affect the birth process are the suboccipitobregmatic (approximately 9.5 cm at term) and the biparietal (approximately 9.25 cm at term) diameters. Diagonal conjugate is a measure of the pelvic inlet of the mother. Reference: p. 443
The nurse is reviewing the medical record of a woman in labor and notes that the fetal position is documented as LSA. The nurse interprets this information as indicating which part as the presenting part? A) occiput B) face C) buttocks D) shoulder
C) buttocks Rationale: The second letter denotes the presenting part which in this case is "S" or the sacrum or buttocks. The letter "O" would denote the occiput or vertex presentation. The letter "M" would denote the mentum (chin) or face presentation. The letter "A" would denote the acromion or shoulder presentation. Reference: p. 446
A client has not received any medication during her labor. She is having frequent contractions every 1 to 2 minutes and has become irritable with her coach and no longer will allow the nurse to palpate her fundus during contractions. Her cervix is 8 cm dilated and 90% effaced. The nurse interprets these findings as indicating: A) latent phase of the first stage of labor. B) active phase of the first stage of labor. C) late active/transition phase of the first stage of labor. D) pelvic phase of the second stage of labor
C) late active transition phase of the first stage of labor. Rationale: Late in the active phase of labor, contractions become more frequent (every 2 to 5 minutes) and increase in duration (45 to 60 seconds). The woman's discomfort intensifies (moderate to strong by palpation). She becomes more intense and inwardly focused, absorbed in the serious work of her labor. She limits interactions with those in the room. The latent phase is characterized by mild contractions every 5 to 10 minutes, cervical dilation of 0 to 3 cm and effacement of 0% to 40%, and excitement and frequent talking by the mother. The pelvic phase of the second stage of labor is characterized by complete cervical dilation and effacement, with strong contractions every 2 to 3 minutes; the mother focuses on pushing. The perineal phase of the second stage is the period of active pushing. The third stage, placental expulsion, starts after the newborn is born and ends with the separation and birth of the placenta. Reference: p. 456
A nurse is providing care to a woman in labor. After assessment of the fetus, the nurse documents the fetal lie. Which term would the nurse most likely use? A) flexion B) extension C) longitudinal D) cephalic
C) longitudinal Rationale: Fetal lie refers to the relationships of the long axis (spine) of the fetus to the long axis (spine) of the mother. There are three primary lies: longitudinal, oblique, and transverse. Flexion and extension are terms used to describe fetal attitude. Cephalic is a term used to describe fetal presentation. Reference: p. 444
A woman is in the first stage of labor. The nurse would encourage her to assume which position to facilitate the progress of labor? A) supine B) lithotomy C) upright D) knee-chest
C) upright Rationale: The use of any upright position helps to reduce the length of labor. Research shows that women who assumed the upright position during the first stage of labor experienced significant improvement in the progress of labor, faster fetal head descent, significant reduction of pain, and a good Apgar score. Additionally, studies show that recumbent positions result in supine hypotension, diminishing uterine activity and reducing the dimensions of the pelvic outlet. The knee-chest position would assist in rotating the fetus in a posterior position. Reference: p. 452
A nurse is assessing a woman in labor. Which finding would the nurse identify as a cause for concern during a contraction? A) heart rate increase from 76 bpm to 90 bpm B) blood pressure rise from 110/60 mm Hg to 120/74 C) white blood cell count of 12,000 cells/mm3 D) respiratory rate of 10 breaths/minute
D) respiratory rate of 10 breaths/minute Rationale: During labor, the mother experiences various physiologic responses including an increase in heart rate by 10 to 20 bpm, a rise in blood pressure by up to 35 mm Hg during a contraction, an increase in white blood cell count to 25,000 to 30,000 cells/mm3, perhaps as a result of tissue trauma, and an increase in respiratory rate with greater oxygen consumption due to the increase in metabolism. A drop in respiratory rate would be a cause for concern. Reference: p. 455
During this stage of birth, it begins with the completion of expulsion of placenta and membranes and ends with initial physiologic adjustment and stabilization of mother (1-4 hours after- of recovery)
Fourth Stage
This fetal station is above ischial spines
Minus station
2nd letter landmark is usually what letter? But can be S (sacrum) breech presentation or M (mentum or chin) face presentation
O- designates a vertex presentation
This type of fetal lie makes a diagonal (at an angle)
Oblique
3rd letter landmark is either of what 3 letters?
P, A, or T- posterior, anterior, transverse
This stage of birth is when the woman is pushing the baby out of the body. -Begins with complete cervical dilation of 10cm and effacement and ends with the birthing of the baby.
Second stage
It's not only the shape of the pelvis but also the _________ that matters when delivering babies.
Size
During this stage of birth, the placenta comes out. Begins with the birth of newborn and ends with separation and birth of placenta
Third Stage
This type of fetal lie makes a T- baby is sideways inside mother
Transverse
Which two fetal lie positions CAN'T be delivered vaginally?
Transverse and Oblique
What type of labor consists of contractions which are stronger with time, and vaginal pressure is felt?
True labor
What type of labor consists of regular, closer together contractions 4-6 minutes apart, lasting 30-60 seconds each
True labor
Which type of labor consists of contractions that continue no matter what the position?
True labor
Which type of labor consists of contractions that start in the back and radiate to front of abdomen?
True labor
Which type of labor consists of the patient being instructed to stay home until contractions are 5 mins apart, last 45-60 seconds and are strong enough to where conversation during one isn't possible? Directed to go to hospital/birthing center once these occur.
True labor
This fetal station is at the level of maternal ischial spines
Zero station (engaged)
