Ch. 13 Labor
Fourth stage of labor?
1-4hrs following delivery
False pelvis is above or below linea terminalis?
Above linea terminalis Upper flared parts of two iliac bones and concavities Wings of base of sacrum
What so the fetal skull sutures help with?
Allows for overlapping and changes in shape (molding); helps identify position of fetal head
Which pelvics are not favorable?
Android and platypelloid
True pelvis is below or above linea terminalis?
Below linea terminalis Inlet Mid-pelvis Outlet (pelvic measurements)
Third stage of labor?
Birth of infant to placental seperation Placental seperation Placental expulsion
Buttocks sacrum (S) landmark?
Breech presentation
Premonitary signs if labor? (C, L, I, B, B, S)
Cervical changes (cervical softening, possible cervical dilation) Lightening Increased energy level Bloody show Braxton Hicks contractions Spontaneous rupture
What is within the second stage of labor?
Cervix 10cm dilated to birth of baby
What are the soft tissue passageways?
Cervix: thins through effacement to allow presenting part to descend into vagina Pelvic floor muscles Vagina
Blood glucose is decreased or increased as a physiologic response during labor?
Decreased
Gastric physiological response?
Decreased gastric motility, food absorption, gastric emptying and gastric pH
FHR increases or decreases during circulation and perfusion?
Decreases
FHR increases or decreases during fetal breathing movements?
Decreases
FHR increases or decreases during oxygen pressure or partial pressure of oxygen?
Decreases
Linea terminalis?
Division of false and true pelvis
Chin mentum (MI) landmark?
Face presentation
Passenger?
Fetal skull Fetal attitude Fetal lie Fetal presentation Fetal position Fetal station Fetal engagement
Best pelvis shape for vaginal delivary?
Gynecoid
BMR increase or decrease physiologic response?
Increase
WBC physiological response in labor?
Increased
Cardiac physiological responses in labor?
Increased HR, cardiac output, blood pressure (during contractions)
FHR increases or decreases during arterial carbon dioxide pressure?
Increases
What does fetal fontanelles help with?
Intersections of sutures; helps in identifying position of fetal head and in molding
Passenger of fetal skull?
Largest and least compressible structure
How does the diameters help with the fetal head?
Occipitofrontal, occipitomental, suboccipitobregmatic, and biparietal
5 factors affecting labor? (5 P's)
Passageway (birth canal: pelvis and soft tissues) Passenger (fetus and placenta) Powers (contractions) Position (maternal) Psychological response
5 additional factors affecting labor process?
Philosophy (low tech, high touch) Partners (support caregivers) Patience (natural timing) Patient preparation (childbirth knowledge base) Pain control (comfort measures)
Scapula (acromion process (A) landmark?
Shoulder presentation
During late pregnancy, the nurse teaches a pregnant woman to lay on her left side to avoid what condition? Supine hypotension syndrome Preeclampsia Frequent urination Heartburn
Supine hypotension syndrome Explanation: The left side-lying position prevents the heavy uterus from resting on and compressing her vena cava, a condition known as supine hypotensive syndrome. Compression of the vena cava can cause maternal hypotension and poor gas exchange between the placenta and fetus. Preeclampsia is a condition characterized by elevated blood pressure and proteinuria. Once diagnosed, the treatment includes resting in a left-lateral position, but a side-lying position does not prevent preeclampsia. Urinary frequency in the third trimester is due to the enlarged uterus pressing on the bladder and is not influenced by position. Remaining in an upright position for 1 to 2 hours after meals helps to decrease heartburn. Chapter 11: Maternal Adaptation During Pregnancy - Page 354
What is within the first stage of labor?
True labor to complete dilatation (10cm) Longest of all stages Three phases (Latent, Active, Transition)
Factors influencing onset of labor? (U, P, I, I)
Uterine stretch Progesterone withdrawal Increased oxytocin sensitivity Increased release of prostaglandins
Signs of placental seperation?
Uterus rises upward Umbilical cord lengthens Sudden trickle of blood released from vaginal opening Uterus changes shape to globular
Occipital (O) bone landmark?
Vertex presentation
Are muscle aches or cramps present during labor?
Yes
When measuring the diagonal conjugate of a woman's pelvis, the distance between which anatomic landmarks would be used? anterior surface of the sacral prominence and the anterior surface of the symphysis pubis medial surface of the ischial tuberosities interior surface of the sacral prominence and the posterior surface of the symphysis pubis posterior surface of sacrum and the axis of the ischial tuberosities
anterior surface of the sacral prominence and the anterior surface of the symphysis pubis Explanation: The diagonal conjugate measures the distance between the anterior surface of the sacral prominence and the anterior surface of the inferior margin of the symphysis pubis, or the anterior-posterior diameter of the pelvic inlet. Chapter 12: Nursing Management During Pregnancy - Page 394
Which pelvic shape is usually adequate?
anthropoid
A woman calls the prenatal clinic and says that she thinks she might be in labor. She shares her symptoms over the phone with the nurse and asks what to do. The nurse determines that she is likely in true labor and that she should head to the hospital. Which symptom is an indicator of true labor? contractions beginning in the back and sweeping forward across the abdomen lightening (descent of the fetus into the pelvis) intermittent backache stronger than usual increase in fetal kick count
contractions beginning in the back and sweeping forward across the abdomen Explanation: True labor contractions usually begin in the back and sweep forward across the abdomen similar to tightening of a rubber band. They gradually increase in frequency and intensity over a period of hours. Lightening and intermittent backache are preliminary signs of labor but do not indicate true labor. Increase in fetal kick count does not indicate true labor. Chapter 12: Nursing Management During Pregnancy - Page 397