| factors that negate the woman’s use of a birthing center | complications of pregnancy or necessary cesarean section |
| signs of impending labor: a series of signs may occur as labor is about to begin approximately | 2 weeks before the onset of labor |
| sings of impending labor: the woman may notice that the fetus seems to have settled or “dropped” into the pelvis. this is called | lightening |
| occasionally, a woman may have seepage or sudden outflow of fluid from the vagina. an evaluation performed to determine what the fluid is. a simple test with | nitrazine paper can determine the fluid |
| process of labor and delivery: the five Ps | Passageway
Passenger
Powers
Position of the mother
Psyche |
| process of labor and delivery: the five Ps
Passageway stands for | the pelvis and soft tissues |
| process of labor and delivery: the five Ps
passenger stand for | the fetus |
| process of labor and delivery: the five Ps
Powers stands for | contractions |
| process of labor and delivery: the five Ps
Position of the mother stands for | standing, walking, side lying, squatting, on hands and knees |
| process of labor and delivery: the five Ps
Psyche stands for | psychological response |
| the relationship of fetal body parts to one another is called | attitude |
| the relationship of the cephalocaudal (head-to-buttocks) axis of the fetus to the cephalocaudal axis of the mother | fetal lie |
| the most common position for delivery is | left occiput anterior (LOA) |
| LOA is in which the occiput (back of head or skull) of the fetus points toward the left anterior segment of the | maternal pelvis |
| second most common position for delivery is | right occiput anterior (ROA) |
| placental separation is indicated by signs such as | a firmly contracting fundus
a change in the uterus shape
a sudden gush of dark red blood
apparent lengthening of umbilical cord
a vaginal fullness |
| primary powers are | involuntary contractions |
| primary powers are responsible for | the effacement and dilation of he cervix |
| secondary powers are | the woman experiences an involuntary urge to push (no effect on dilation) |
| cardinal movements of labor:
1 engagement | fetal head crosses the pelvic inlet |
| cardinal movements of labor:
2 descent: (this is referred to) | downward progress of the presenting part, this is referred to station |
| cardinal movements of labor:
3 internal rotation: | the largest diameter of the fetal head aligns with the largest diameter of the pelvis |
| cardinal movements of labor:
4 extension: | when the occiput passes under the symphysis pubis |
| cardinal movements of labor:
5 restitution: | as soon as the head is delivered, it moves to realign with the body and shoulders |
| cardinal movements of labor:
6 external rotation: | occurs as the shoulders and body move through the birth canal |
| cardinal movements of labor:
7 expulsion: | when the body of the infant leaves the pelvis |
| stages of labor and delivery:
first stage: dilation (3 parts) | begins with contractions and ends with complete dilation (10-12 hours)
1. latent phase: 0-3 cm
2. active phase: 4-7cm
3. transitional: 8-10 cm |
| stages of labor and delivery:
second stage: delivery of the fetus | begins with complete dilation at 10cm and ends with the birth of the baby (30mins-2hours) |
| stages of labor and delivery:
third stage: delivery of the placenta | begins with the delivery of the infant and ends with the delivery of the placenta (5-20mins) |
| stages of labor and delivery:
fourth stage: stabilization | when the mothers body attempts to recover from the efforts of labor, monitored closely for 2-4 hours |
| station measured how | even with ischial spines: 0
2cm above spines: -2
2cm below spines: +2 |
| decrease of how many bpm indicates fetal distress | 30bpm |
| magnesium sulfate: need to monitor | check deep tendon reflexes |
| magnesium sulfate: action | seizure prevention in preeclampsia and eclampsia |
| narcan: action | suspected narcotic induced respiratory depression in neonates (given IM vastis lateralis) |
| oxytocin: action | producing uterine contractions; stimulates milk ejection by breasts |
| normal fetal baseline | 120-160 |
| fetal tachycardia | (for 10minutes)
moderate increase: 160-180
marked increase: greater than 180 |
| early decelerations | caused by pressure on fetal skull, correspond to contractions |
| late decelerations | caused by decreased oxygen blood flow too fetus, absence of variability |
| variable decelerations | caused by compression on umbilical cord |
| APGAR: | Appearance
Pulse
Grimace
Activity
Respiration |
| hypoxia | insufficient availability of oxygen to meet metabolic needs |
| meconium | the infants first stool, viscid, sticky, dark greenish brown, almost black; sterile odorless stool |
| meconium staining | meconium released from the fetal rectum in response to hypoxia |
| surfactant | decreased the surface tension within the alveoli and permits inflation |
| regional anesthetics include | paracervical, epidural, spinal, and pudendal blocks |
| to displace the uterus from the vena cava, and promote placenta blood flow | a wedge is placed under right side, or table turned to left side |
| adverse effects of anesthesia | regurgitation with aspiration of acidic gastric contents is fatal complication
aspiration
infection |
| measures to reduce adverse effects of anesthesia | restrict intake to clear fluids
administer drugs to raise gastric pH
administer drugs to reduce secretions |
| avert neonatal respiratory depression by | reducing time from induction of anesthesia until umbilical cord is clamped
keeping use of sedating drugs to minimum until cord is clamped |
| precipitous labor | labor that lasts less than 3 hours demo onset of contractions to time of birth |
| maternal complications | uterine rupture
lacerations of birth canal
amniotic fluid embolism
postpartum hemorrhage |
| fetal complications | hypoxia
intracranial hemorrhage lasted to rapid birth
as a result to rapid descent and related to fetal distress, meconium standing and aspiration may result (lower apgar scores) |
| amniotomy | artificial rupture of fetal membrane |
| oxytocin stimulation | induce labor that is not making adequate progress |
| uterine inertia | absence of weakness of uterine contractions |
| newborn with forceps-assisted delivery may have
& maternal complications include | ecchymosis or edema
lacerations, episiotomy extension, hematomas, and increased bleeding |
| indications for cesarean birth (maternal) | - cephalopelvic disproportion (the head of the fetus if larger than the pelvic outlet)
- previous c section
- breech presentation
- medical conditions that endanger mother (cardiac conditions)
- abnormal conditions of placenta )placenta previa)
- infections of vaginal canal
- pelvic abnormalities |
| indications for cesarean birth (fetal) | - hypoxia
- prolapse of umbilical cord
- breech
- malpresentations
- congenital abnormalities |
| placenta previa | when placenta covers opening of mothers cervix |
