OB test 4
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The shaping of the fetal head to facilitate movement throught he birth canal during labor is:
What is the largest body part of the baby to be delivered?
usually the head
The relationship of the chephalocaudal (head to foot) axis of the fetus to the cephalocaudal axis of the mother is the fetal __________.
The relationship of the presenting fetal part to an imaginary line drawn between the pelvis ischial spines is called the __________.
The relationship of the identified landmark on the presenting part of the four quadrants of the mother's pelvis is the fetal __________.
The position of the fetus can be described as:
- Vertex: O (occiuput)
- Face: M (mentum)
- Breech: S (sacrum)
What position of the baby is most favorable for delivery?
- LOA: left occiput anterior
- ROA: right occiput anterior
The presenting part is determined by:
the fetal lie and the part of the fetus that enters the pelvis first
The relationship of the fetal body parts to one another is called the fetal __________.
The idea fetal attitude is __________ with the head flexed onto the chest, arms flexed over the chest, and the hips and knees flexed on the abd.
If any part of the baby is extended, the fetal attitude is called __________ and is usually a more difficult delivery.
The most common and ideal lie for a fetus to assume before labor is __________.
The most common presentation for a fetus before labor is the __________ position.
The most desirable and most common position of the fetus for birth is __________ or __________.
ROA or LOA
What are the early signs of labor?
- braxton hicks contractions
- cervical changes
- bloody show
- rupture of membranes
- gastrointestinal disturbances
- sudden burst of energy aka "nesting"
__________ is the descent of the fetus into the pelvis, sometimes described as a "drop".
__________ are the irregular, intermittent contractions felt toward the end of the pregnancy.
Braxton Hicks contractions
What cervical changes occur around 34 weeks?
- begins to "mature" or "ripen" and becomes softer and more spongy
- effacement may also begin
__________ is the cervical secretions with blood tinged mucus; labor often begins within __ to __ hrs after this is noticed.
When does the rupture of membranes usually occur?
after labor has begun
Common findings in false labor:
- irregular contractions/ do not increase in freq, duration, intensity
- walking tends to relieve or decrease contractions
- discomfort is felt in the groin/abd (true labor is usually felt in the lower back and abd)
- bloody show is usually not present; there is no change in effacement or dilation of the cervix
A comepletely dilated cervix is __ centimeters.
How is the frequency of contractions determined?
by the time from the beginning of one contraction to the beginning of the next contraction
__________ is the shortening of the cervix.
__________ is the length of one contraction from beginning to the end; 60-90 seconds.
__________ is the strength of the contraction at the acme (peak or highest intensity).
What can be determined about the fetus by abdominal palpation?
Leopold's maneuver to determine fetal lie and presentation
__________ is responsible for stimulation of contractions and the let down of milk.
What are the components of the birth process?
__________ are a component of the birth process that consists of uterine contractions and the mother's pushing efforts.
The __________ phase between contractions allows the mother to rest, also restores __________ circulation. If the mother doesn't get this rest between contractions, the circulation is effected which doesn't allow the baby to get enough oxygen.
- relaxation phase
- uteroplacental circulation
__________ circulation is important to fetal oxygenation and effective circulation in the uterus.
Cephalic presentation in which the occiput (back of head) is the presenting part:
Cephalic presentation in which the sinciput (front of head, baby looking up, with neck extended) is the presenting part:
Cephalic presentation in which the face is the presenting part:
Breech presentation in which the hips and knees are flexed on the abd in an attitude of flexion, with the buttocks as the presenting part:
Breech presentation in which the hips are flexed, but the knees are extended with the buttocks as the presenting part:
Breech presentation in which the hips and knees are extended with the foot as the presenting part (may be single or double footling):
Shoulder presentation occurs in a __________ lie, presenting part is usually the shoulder but may be the arm, back , abd, or side.
What is the purpose of contractions in each stage of labor?
- first: dilation and effacement
- second: expulsion of fetus
- third: expulsion of placenta
- fourth: to contract the uterus back to normal size (immediate post partum period)
What is it important to empty the bladder immediately after birth?
- if it's full and distended, uterus will be higher than expected and often displaced to one side
- full bladder inhibits uterine contractions and can lead to hemorrhage
__________ is when the physician/doctor artificially ruptures the membranes.
Amniotic fluid should be __________ in color (may have white specks of vernix); green may indicate meconium; cloudy/yellow may be infection.
Should there be an odor?
- there should not be an odor
Assessment of amniotic fluid during amniotomy:
Positions to place the pt if there is a prolapsed cord:
- modified Sim's with hips up on pillows
- knee-chest position
- bed in Trendelenburg position
If there is a prolapsed cord, the pt needs to be positioned so that __________ keeps pressure off of the cord.
What is the most common ectopic site?
__________ placenta is the premature separation of the placenta. If the edges begin to separate first, there will be external __________; if the center of the placenta separates first, blood will pool under the __________ and will be hidden. The pt will have sharp, stabbing pain high in the __________.
- uterine fundus
__________ is low implantation of the placenta. There are four degrees:
- placenta previa
- low-lying placenta
__________ placenta is when the implantation is in the lower portion of the uterus.
__________ placenta reaches within 2-3 cm of the cervical opening.
__________ placenta partly covers the cervical opening.
__________ placenta completely covers the cervical opening.
RHOGAM is given to the mother who is ___ and the baby is ___; this should be given within __ hrs of giving birth.
- mother: Rh -
- baby: Rh+
- 72 hrs
__________ is an anticonvulsant given to prevent seizure in pts who have acquired extreme high blood pressure, also known as gestational hypertension.
What reverses the effects of magnesium sulfate?
Monitoring needed when pt is on magnesium sulfate:
- vitals hourly
- temp q4h
- deep tendon reflexes checked every 1-4 hrs
- I&O hourly
- urine protein checked
- lab blood levels ordered q4h
__________ is due to the head being too large to pass through the true pelvis.
Hydraminios is amniotic fluid in excess of __________mL.
What are the 2 tests to determine the rupture of the membranes?
__________ test is when the paper is moistened with discharge and if it is amniotic fluid, it will turn blue.
__________ test is performed by putting a drop of dishcharge/fluid on a slide and looking at it under a microscope; it will look like snowflakes if it's amniotic fluid.
What is the procedue done to enlarge the vaginal opening for delivery?
What are some complications in babies whose mother smoked while pregnant?
- low birth weight
- born addicted to nicotine
- more susceptible to resp complications at birth
__________ is a condition when gestational hypertention includes proteiuria. it progresses to eclampsia when convulsions occur.
____________________ is also called gestational trophoblastic disease; proliferation and degeneration of the trophoblastic villi. As the cells degenerate, they become filled with fluid and appear as fluid filled, grape sized vesicles.
hydatidiform mole-molar pregnancy
__________ is the manipulation of the fetus through the mother's abdomen to a presentation facilitating birth.
__________ is a true emergency. S/s include pathologic retraction ring that appears as an indentation across the abd over the uterus; sudden severe pain during a contraction, may also describe as a tearing sensation.
__________ uterine rupture is when the tear goes through the endometrium, myometrium, and peritoneum. Comntractions will __________; hemorrhage from the torn uterus into the abd cavity and possibly into the vagina.
__________ uterine rupture is when the tear leaves the peritoneum intact. She will experience localized tenderness and persistent aching pain over the area or the lower segment of the uterus.
__________ is excessive nausea and vomiting that can interfere with her food intake and fluid balance; fetal grown may also be restricted.
__________ is the lowering of the BP while in a supine position that occurs as a result of pressure of weight of the pregnant uterus on the __________ vena cava.
- supine hypotension
When the amniotic fluid is forced into an open maternal uterine blood sinus through some defect in the membranes, after the membranes rupture or with partial separation of the placenta this is called:
Risk factors for amniotic embolism are:
- oxytocin administration
- abruptio placenta
If a pt suddenly sits up and grasps her chest due to sharp pain, has the inability to breathe, becomes pale and then sometimes turns bluish-gray it is usually a sign of __________. Death may occur in __________.
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