OB Quiz 2 Learning Tool

What are Leopold's maneuvers and what important questions can it answer?

(1) What fetal part is in the uterine fundus? (2) Where is the fetal back located? (3) What is the presenting fetal part?

What contraindications exist to breastfeeding?

- Newborns with galactosemia - Mothers who are positive for human T cell lymphotropic virus types I or II - Mothers with untreated brucellosis - Mothers with active tuberculosis - Mothers with active herpes simplex lesions on the breasts - Mothers with HIV infection

What does it mean if the neonate is crowning?

Occurs when the widest part of the head (the biparietal diameter) distends the vulva just before birth.

What are the components of assessment of uterine contractions?

? A general characteristic of effective labor is regular uterine activity (i.e., contractions becoming more frequent with increased duration), but uterine activity is not directly related to labor progress. Uterine contractions are the primary powers that act involuntarily to expel the fetus and the placenta from the uterus. Several methods are used to evaluate uterine contractions, including the woman's subjective description, palpation and timing of contractions by a health care provider, and electronic monitoring. Each contraction exhibits a wavelike pattern. It begins with a slow increment (the "building up" of a contraction from its onset), gradually reaches a peak, and then diminishes rapidly (decrement, the "letting down" of the contraction). An interval of rest ends when the next contraction begins. A uterine contraction is described in terms of the following characteristics: • Frequency: How often uterine contractions occur; the time that passes from the beginning of one contraction to the beginning of the next contraction • Intensity: The strength of a contraction at its peak • Duration: The time that passes between the onset and the end of a contraction • Resting tone: The tension in the uterine muscle between contractions; relaxation of the uterus

What is the point of maximal intensity?

? It is the location on the maternal abdomen at which the FHR is heard the loudest. It is usually directly over the fetal back. In a vertex presentation you can usually hear the FHR below the mother's umbilicus in either the right or the left lower quadrant of the abdomen. In a breech presentation you usually hear the FHR above the mother's umbilicus

When doe the first stage of labor begin and end?

Begins with the onset of regular uterine contractions to full effacement and dilation of the cervix.

What is supine hypotension and how can it be prevented?

Compression of the aorta and vena cava due to the enlarged uterus and presence of the fetus when the woman is laying on her back. This decreases the amount of blood returning to the heart and thus decreases cardiac output and causes hypotension in the supine position. Place woman on side or wedge her pelvis with a pillow or blanket to tilt the uterus off of the vessels.

What are the benefits of breastfeeding to the mother?

Decreased postpartum bleeding and more rapid uterine involution, Reduced risk for: Ovarian cancer and breast cancer (primarily premenopausal), Type 2 diabetes, Hypertension, hypercholesterolemia, and cardiovascular disease, Rheumatoid arthritis, Unique bonding experience, Increased maternal role attainment

What does engagement mean?

Engagement is the term used to indicate that the largest transverse diameter of the presenting part (usually the biparietal diameter) has passed through the maternal pelvic brim or inlet into the true pelvis and usually corresponds to station 0 (ie. The ischial spines). Engagement can be determined by abdominal or vaginal examination

Describe an amniotomy and why would it be performed?

When a provider uses an amnihook to artificially rupture the membranes. If the woman's water has not broken on its own the provider may choose to artificially rupture the membranes

What are the stages of labor?

First Stage- is considered to last from the onset of regular uterine contractions to full effacement and dilation of the cervix. The first stage also has three phases: Latent, Active, and Transition Second Stage-lasts from the time the cervix is fully effaced and dilated to the birth of the fetus. Third Stage-lasts from the birth of the fetus until the placenta is delivered. Fourth Stage- begins with the delivery of the placenta and includes at least the first 2 hours after birth.

Describe the degrees of perineal lacerations.

First degree-laceration that extends through the skin and vaginal mucous membrane but not the underlying fascia and muscle Second degree-laceration that extends through the fascia and muscles of the perineal body, but not the anal sphincter Third degree- laceration that involves the external anal sphincter Fourth degree-laceration that extends completely through the rectal mucosa, disrupting both the external and internal anal sphincters

What is an episiotomy and why might it be performed?

Incision to the perineum to enlarge the vaginal outlet

What are the signs of potential complications in labor?

Intrauterine pressure of ≥80 mm Hg or resting tone of ≥20 mm Hg (both determined by internal monitoring with intrauterine pressure catheter [IUPC]), Contractions lasting ≥90 seconds, More than five contractions in a 10-minute period (contractions occur more frequently than every 2 minutes, Relaxation between contractions lasting <30 seconds, Fetal bradycardia or tachycardia; absent or minimal variability not associated with fetal sleep cycle or temporary effects of central nervous system (CNS) depressant drugs given to the woman; late, variable, or prolonged fetal heart rate (FHR) decelerations, Irregular FHR; suspected fetal arrhythmias, Appearance of meconium-stained or bloody fluid from the vagina, Arrest in progress of cervical dilation or effacement, descent of the fetus, or both, Maternal temperature of ≥38° C (100.4° F), Foul-smelling vaginal discharge, Persistent bright or dark red vaginal bleeding

Why is breastmilk the ideal food for the Infants?

It is a dynamic substance with a composition that changes to meet the changing nutritional and immunologic needs of the growing infant. Breast milk is specific to the needs of each infant; for example, the milk produced by mothers of preterm infants differs in composition from that of mothers who give birth at term. Human milk contains immunologically active components that provide some protection against a broad spectrum of bacterial, viral, and protozoal infections. The major immunoglobulin (Ig) in human milk is secretory IgA; IgG, IgM, IgD, and IgE are also present. Human milk also contains T and B lymphocytes, epidermal growth factor, cytokines, interleukins, bifidus factor, complement (C3 and C4), and lactoferrin, all of which have a specific role in preventing localized and systemic bacterial and viral infections.

What are the signs that precede labor

Lightening, Return of urinary frequency, Backache, Stronger Braxton Hicks contractions, Weight loss of 0.5 to 1.5 kg (approximately 1 to 3½ pounds), Surge of energy, Increased vaginal discharge; bloody show, loss of part or all of the mucous plug, Cervical ripening (softening), Possible rupture of membranes

What are the considerations for a woman in labor or during birth with a history of sexual abuse?

Limit the number of providers and procedures that invade her body

How is a Nitrizine test for rupture of membranes interpreted?

Membranes ruptured-blue, blue-green, blue-gray Membranes not ruptured (intact)-yellow, olive-yellow, olive-green

Describe the Valsalva maneuver

Method of bearing down where the woman holds her breath closes her glottis and pushes, which increases intrathoracic and cardiovascular pressure

What is the priority nursing intervention when ROM or SROM occurs on the unit?

Observe the fetal heart rate to see how the fetus responds

What are the five P's of labor and give a description of each?

Passenger-The way the passenger, or fetus, moves through the birth canal is determined by the following interacting factors: the size of the fetal head, fetal presentation, fetal lie, fetal attitude, and fetal position. Because of its size and relative rigidity, the fetal head has a major effect on the birth process. The process of molding occurs when the fetal skull bones slightly overlap creating a palpable ridge on the fetal skull, this process allows the fetal skull to adapt to the maternal pelvis during labor and birth. Presentation refers to the part of the fetus that enters the pelvic inlet first and leads through the birth canal during labor. The three main presentations are cephalic presentation (head first); breech presentation (buttocks, feet, or both first); and shoulder presentation). Factors that determine the presenting part include fetal lie, fetal attitude, and extension or flexion of the fetal head. Lie is the relation of the long axis (spine) of the fetus to the long axis (spine) of the mother. The two primary lies are longitudinal, or vertical, in which the long axis of the fetus is parallel with the long axis of the mother; and transverse, horizontal, or oblique, in which the long axis of the fetus is at a right angle diagonal to the long axis of the mother. Attitude is the relation of the fetal body parts to one another. The fetus assumes a characteristic posture (attitude) in utero partly because of the mode of fetal growth and partly because of the way the fetus conforms to the shape of the uterine cavity. Normally the back of the fetus is rounded so that the chin is flexed on the chest, the thighs are flexed on the abdomen, and the legs are flexed at the knees. The arms are crossed over the thorax, and the umbilical cord lies between the arms and the legs. This attitude is termed general flexion. Deviations from the normal attitude may cause difficulties in childbirth. The presentation, or presenting part, indicates that portion of the fetus that overlies the pelvic inlet. Position is the relationship of a reference point on the presenting part (occiput, sacrum, mentum [chin], or sinciput [deflexed vertex]) to the four quadrants of the mother's pelvis. Position is denoted by a three-part abbreviation. The first letter of the abbreviation denotes the location of the presenting part in the right (R) or left (L) side of the mother's pelvis. The middle letter stands for the specific presenting part of the fetus (O for occiput, S for sacrum, M for mentum [chin], and Sc for scapula [shoulder]). The final letter stands for the location of the presenting part in relation to the anterior (A), posterior (P), or transverse (T) portion of the maternal pelvis. For example, ROA means that the occiput is the presenting part and is located in the right anterior quadrant of the maternal pelvis. LSP means that the sacrum is the presenting part and is located in the left posterior quadrant of the maternal pelvis. Station is the relationship of the presenting fetal part to an imaginary line drawn between the maternal ischial spines and is a measure of the degree of descent of the presenting part of the fetus through the birth canal. The placement of the presenting part is measured in centimeters above or below the ischial spines. For example, when the lowermost portion of the presenting part is 1 cm above the spines, it is noted as being minus (−) 1. At the level of the spines the station is said to be 0 (zero). When the presenting part is 1 cm below the spines, the station is said to be plus (+) 1. Birth is imminent when the presenting part is at +4 to +5 cm. The station of the presenting part should be determined when labor begins so that the rate of descent of the fetus during labor can be determined accurately. Passageway- The passageway, or birth canal, is composed of the mother's rigid bony pelvis and the soft tissues of the cervix, the pelvic floor, the vagina, and the introitus (the external opening to the vagina). Although the soft tissues, particularly the muscular layers of the pelvic floor, contribute to vaginal birth of the fetus, the maternal pelvis plays a far greater role in the labor process because the fetus must successfully accommodate itself to this relatively rigid passageway. The four basic types of pelves are classified as follows: 1. Gynecoid (the classic female type) 2. Android (resembling the male pelvis) 3. Anthropoid (oval shaped, with a wider anteroposterior diameter) 4. Platypelloid (the flat pelvis) The gynecoid pelvis is the most common, and ideal for vaginal birth. Powers- The primary powers (involuntary) are the contractions that originate at certain pacemaker points in the thickened muscle layers of the upper uterine segment. From the pacemaker points, contractions move downward over the uterus in waves, separated by short rest periods. Terms used to describe these involuntary contractions include frequency (the time from the beginning of one contraction to the beginning of the next), duration (length of contraction), and intensity (strength of contraction at its peak). The primary powers are responsible for the effacement and dilation of the cervix and descent of the fetus. Effacement of the cervix means the shortening and thinning of the cervix during the first stage of labor. The cervix, normally 2 to 3 cm long and about 1 cm thick, is obliterated, or "taken up," by a shortening of the uterine muscle bundles during the thinning of the lower uterine segment that occurs in advancing labor. Only a thin edge of the cervix can be palpated when effacement is complete. Effacement generally progresses significantly in first-time term pregnancy before more than slight dilation occurs. In subsequent pregnancies effacement and dilation of the cervix tend to progress together. Degree of effacement is expressed in percentages from 0% to 100% (e.g., a cervix is 50% effaced). Dilation of the cervix is the enlargement or widening of the cervical opening and the cervical canal that occurs once true labor has begun. The diameter of the cervix increases from being closed to full dilation (approximately 10 cm) to allow birth of a term fetus. When the cervix is fully dilated (and completely retracted), it can no longer be palpated. Full cervical dilation and effacement marks the end of the first stage of labor. Secondary powers (voluntary)-As soon as the presenting part reaches the pelvic floor, the contractions change in character and become expulsive. The laboring woman experiences an involuntary urge to push. She uses secondary powers (bearing-down efforts) to aid in expulsion of the fetus as she contracts her diaphragm and abdominal muscles and pushes. These bearing-down efforts result in increased intraabdominal pressure that compresses the uterus on all sides and adds to the power of the expulsive forces. Position- Position affects the woman's anatomic and physiologic adaptations to labor. Frequent changes in position relieve fatigue, increase comfort, and improve circulation. Therefore, a laboring woman should be encouraged to find positions that are most comfortable to her. Positioning for second-stage labor may be determined by the woman's preference, but choices are limited by her condition or that of the fetus, the environment, and the health care provider's confidence in assisting in a birth in a specific position. Positioning that utilizes gravity includes: sitting, standing, squatting and kneeling. The position most often used for pushing and delivery of the infant is lithotomy which does not utilize the aid the gravity. Physiologic adaptations- In addition to the maternal and fetal anatomic adaptations that occur during birth, physiologic adaptations must occur.

What are the benefits of breastfeeding to the infant?

Reduced risk for: Nonspecific gastrointestinal infections, Celiac disease, Childhood inflammatory bowel disease, Necrotizing enterocolitis in preterm infants, Clinical asthma, atopic dermatitis, and eczema, Lower respiratory tract infection, Otitis media, SIDS, Obesity in adolescence and adulthood, Types 1 and 2 diabetes, Acute lymphocytic and myeloid leukemia, Enhanced neurodevelopmental outcomes, especially in preterm infants

How is a vaginal examination interpreted?

The vaginal examination reveals whether the woman is in true labor and enables the examiner to determine whether the membranes have ruptured. The first number ranges from 0-10 and refers to the number of centimeters a woman is dilated. The second number is shown in a percentage and ranges from 0-100% and refers to cervical effacement. The third number describes the fetal position in the maternal pelvis.

Compare and contrast true labor to false labor.

True Labor Contractions- Occur regularly, becoming stronger, lasting longer, and occurring closer together. Become more intense with walking. Are usually felt in the lower back, radiating to the lower portion of the abdomen. Continue despite use of comfort measures Cervix (by Vaginal Examination)-Shows progressive change (softening, effacement, and dilation signaled by the appearance of bloody show). Moves to an increasingly anterior position Fetus- Presenting part usually becomes engaged in the pelvis, which results in increased ease of breathing; at the same time, the presenting part presses downward and compresses the bladder, resulting in urinary frequency. False Labor Contractions- Occur irregularly or become regular only temporarily. Often stop with walking or position change. Can be felt in the back or the abdomen above the umbilicus. Can often be stopped through the use of comfort measures. Cervix (by Vaginal Examination)-May be soft but with no significant change in effacement or dilation or evidence of bloody show. Is often in a posterior position Fetus-Presenting part is usually not engaged in the pelvis