Week 5: Intrapartum

Which fetal lie is most conducive to a spontaneous vaginal birth? A) Transverse B) Longitudinal C) Perpendicular D) Oblique

B) Longitudinal A longitudinal lie places the fetus in a vertical position, which would be the most conducive for a spontaneous vaginal birth.

What is the normal amount of blood loss for a vaginal birth?

About 500mL

The most intense time during labor is during the - A. Active Phase B. Latent Phase C. Membranes breaking D. Placental expulsion phase

B. Latent phase

How often do uterine contractions usually occur & last during the Active Phase or labor?

Contractions become more frequent (2 - 5 minutes) & increase in duration (45 - 60 seconds).

What is the purpose of contractions during the first stage of labor?

Contractions cause complete dilation and effacement of the cervix during the first stage of labor.

What factors make up the first of the four P's (Passenger)?

1) Fetal skull 2) Fetal Lie 3) Fetal attitude 4) Fetal presentation 5) Fetal positon 6) Fetal engagement 7) Fetal station

What is a fetus in a footling position at risk for?

A fetus in a footling position is at risk for cord prolapse.

Describe a fetus in a transverse lie position. Can the fetus be delivered vaginally?

A transverse lie occurs when the long axis of the fetus is perpendicular to the long axis of the mother (fetal spine lies across the maternal abdomen and crosses her spine). A fetus in a transverse or oblique lie position cannot be delivered vaginally.

When determining the frequency of contractions, the nurse would measure which period of time? A) Start of one contraction to the start of the next contraction B) Beginning of one contraction to the end of the same contraction C) Peak of one contraction to the peak of the next contraction D) End of one contraction to the beginning of the next contraction

A) Start of one contraction to the start of the next contraction.

A laboring woman is admitted to the labor and birth suite at 4-cm dilation. She would be in which phase of labor? A. Latent Phase B. Active Phase C. Late D. Early

A. Latent

What happens to the fetus as it travels through the mid-pelvis?

As the fetus passes through this small area, their chest is compressed, causing lung fluid and mucus to be expelled. This expulsion removes the space-occupying fluid so that air can enter the lungs with the newborn's first breath.

Which hormones prepare the passageway or the mother's pelvis for birth?

As the pregnancy progresses, the hormones relaxin and estrogen cause the connective tissues to become more relaxed and elastic and cause the joints to become more flexible to prepare the mother's pelvis for birth.

As the nurse is explaining the difference between true versus false labor to her childbirth class, she states that the major difference between them is... A) Discomfort level is greater with false labor. B) Progressive cervical changes occur in true labor. C) There is a feeling of nausea with false labor. D) There is more fetal movement with true lab.

B) Progressive cervical changes occur in true labor.

Which fetal lie is most conducive to a spontaneous vaginal birth? A. Transverse B. Longitudinal C. Perpendicular D. Oblique

B. Longitudinal

As the nurse is explaining the difference between true versus false labor to her childbirth class, she states that the major difference between them is: A. Discomfort level is greater with false labor. B. Progressive cervical changes occur in true labor. C. There is a feeling of nausea with false labor. D. There is more fetal movement with true labor.

B. Progressive cervical changes occur in true labor

There are four essential components of labor. The first is the passageway. It is composed of the bony pelvis and soft tissues. What is one component of the passageway? A) False Pelvis B) Uterus C) Cervix D) Placenta

Cervix. The cervix and vagina are soft tissues that form the part of the passageway known as the birth canal.

How often do uterine contractions usually occur & last during the Latent Phase or labor?

Contractions usually occur every 5 - 10 minutes, last 30 - 45 seconds, & are described as mild by palpation by the nurse.

The nurse notes that the fetal head is at the vaginal opening and does not regress between contractions. The nurse interprets this finding as which process?

Crowning occurs when the top of the fetal head appears at the vaginal orifice and no longer regresses between contractions.

Which cardinal movement of delivery is the nurse correct to document by station?

Descent is documented by station, which is the relationship of the fetal presenting part to the maternal ischial spines.

Which diameters are used to measure the fetal skull?

Diameters include occipitofrontal, occipitomental, suboccipitobregmatic, and biparietal.

Define & describe duration of uterine contractions

Duration refers to how long a contraction lasts & it is measured from the beginning of one contraction to the end of that same contraction.

What are the 3 phases of a contraction? Describe each.

Each contraction has three phases: increment (buildup of the contraction), acme (peak or highest intensity), and decrement (descent or relaxation of the uterine muscle fibers).

Define fetal attitude

Fetal attitude refers to the posturing (flexion or extension) of the joints and the relationship of fetal parts to one another.

Define fetal engagement

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. Engagement is determined by pelvic examination.

Define fetal lie

Fetal lie refers to the relationship of the long axis (spine) of the fetus to the long axis (spine) of the mother.

Define fetal position

Fetal position describes the relationship of a given point on the presenting part of the fetus to a designated point of the maternal pelvis.

Define fetal presentation

Fetal presentation refers to the body part of the fetus that enters the pelvic inlet first (the "presenting part"). This is the fetal part that lies over the inlet of the pelvis or the cervical os. Knowing which fetal part is coming first at birth is critical for planning and initiating appropriate interventions.

Define fetal station

Fetal 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.

Define & describe frequency of uterine contractions

Frequency refers to how often the contractions occur. It is measured from the beginning of one contraction to the beginning of the next contraction.

Which pelvis shape is considered to be most favorable for vaginal birth?

Gynecoid Pelvis: It is considered the true female pelvis. About 40% of women have this shape of pelvis.

Define the intensity of a uterine contraction. How can they be determined?

Intensity refers to the strength of the contraction. This can be determined by an internal pressure catheter or an external multichannel electromyogram.

What is the most favorable fetal position for birthing?

LOA & ROA are currently the most favorable & optimal positions for vaginal birth. (Left occiput anterior & right occiput anterior)

How many stages of labor are there? What are they called?

Labor is typically divided into four stages: dilation, expulsive, placental, and restorative.

Which diameters are used to measure the fetal skull?

Occipitomental, occipitofrontal, suboccipitobregmatic

When determining the frequency of contractions, the nurse would measure which period of time?

Start of one contraction to the start of the next contraction

When does the Active Phase of labor begin & end?

The Active Phase of labor begins at the end of the Latent Phase (0-6cm) until completion of cervical dilation & complete effacement. (10cm, 100%)

Which pelvis shape is considered the male pelvis shape?

The android pelvis (funnel shaped).

A nurse is admitting a client who presents in active labor at 41 weeks' gestation. The nurse prepares for the possibility of a cesarean delivery after noting the client has which type of pelvis documented?

The android pelvis is considered the male-shaped pelvis and is characterized by a funnel shape, or smaller dimensions in the lower outlet than the upper level. It is very difficult for a large fetus to pass through and it may require a cesarean delivery.

Describe the android pelvis.

The android pelvis is considered the male-shaped pelvis and is characterized by a funnel shape. It occurs in approximately 20% of women. The pelvic inlet is heart shaped & descent of the fetal head into the pelvis is slow.

Describe the anthropoid pelvis.

The anthropoid pelvis occurs in approximately 25% of women. The pelvic inlet is oval & the sacrum is long, producing a deep pelvis.

Passageway

The birth passageway is the route through which the fetus must travel to be born vaginally. The passageway consists of the maternal pelvis & soft tissues.

The nurse is caring for a client who is late in her pregnancy. What assessment finding should the nurse attribute to the role of prostaglandins?

The cervix is softening.

When does the fourth stage of labor begin & end?

The fourth stage of labor begins with the completion of the expulsion & membranes. It ends with the initial physiologic adjustment & stabilization of the mother. (1 - 4 hours )

What are the landmarks of fetal positioning?

The landmark fetal presenting parts include the occipital bone (O), the chin (mentum [M]), the buttocks (sacrum [S]), and the scapula (acromion process [A]).

For which condition associated with shoulder presentation during a vaginal birth should the nurse assess?

The nurse, along with the primary care provider, has to assess for fetal anomalies, which are usually associated with a shoulder presentation during a vaginal birth.

Describe the platypelloid pelvis.

The platypelloid or flat pelvis is the least common type of pelvic structure among men and women with an approximate incidence of 3%. The pelvic cavity is shallow but widens at the pelvic outlet, making it difficult for the fetus to descend through the mid-pelvis.

Which pelvis shape is considered to be the least favorable for vaginal birth?

The platypellpoid (flat) pelvis.

What involuntary stimulus powers labor?

The primary involuntary stimulus powering labor is uterine contractions.

The nurse is monitoring a client who is in active labor. The nurse will carefully monitor which phase of the involuntary uterine contraction to ensure the fetus is progressing adequately? A) Acme B) Decrement C) Increment D) Relaxation

The relaxation phase of uterine contractions is the time in which the fetus has a break. This time needs to be observed, and it is beneficial for the fetus to have a break.

When does the second stage of labor begin & end?

The second stage of labor begins with complete cervical dilation (10cm) & complete effacement (100%). It ends with the birth of the newborn.

When does the third stage of labor begin & end?

The third stage of labor begins with the birth of the newborn & ends with the separation & birth of the placenta.

What part of the pelvis does the fetus travel through during birth?

The true pelvis is the bony passageway through which the fetus must travel.

Which role do Braxton Hicks contractions play in aiding labor?

These contractions help in softening and ripening the cervix.

What are they characteristics of the cervix during the Latent Phase in the first stage of labor?

This phase begins with the start of true contractions until the cervix is 6cm dilated. Effacement of the cervix is from 0% to 40%.

How are uterine contractions monitored & assessed? (3 parameters)

Uterine contractions are monitored and assessed according to three parameters: frequency, duration, and intensity.