Labor and Birth Processes Review

Detailed vocabulary flashcards covering labor stages, fetal assessments, pain management, and obstetric emergencies based on lecture notes.

Four factors affecting labor

Passenger, Passageway, Powers, and Position

Passenger

The fetus and placenta

Fetal presentation

The part of the fetus that enters the pelvic inlet first

Three fetal presentations

Cephalic, breech, and shoulder

Cephalic presentation

A head-first fetal presentation

Frank breech

A type of breech presentation

Full breech

A type of breech presentation

Single footling breech

A type of breech presentation

Fetal lie

The relationship of the fetal long axis to the maternal long axis

Longitudinal lie

A primary fetal lie where axes are parallel

Transverse lie

A primary fetal lie where axes are perpendicular

Fetal attitude

The relationship of fetal body parts to one another

General flexion

The normal fetal attitude

Biparietal diameter at term

$$9.25\,cm$$

Biparietal diameter significance

The largest transverse diameter of the fetal head indicating head size

Fetal position

The relationship of a fetal reference point to the maternal pelvis

Station

The descent of the presenting fetal part relative to the ischial spines

Station 0

The point at which the fetal presenting part is at the level of the ischial spines, corresponding with engagement

Engagement

When the largest transverse diameter of the presenting part passes the pelvic inlet

Passageway components

The bony pelvis and soft tissues of the cervix, pelvic floor, vagina, and introitus

Gynecoid pelvis

The classic female pelvis type

Android pelvis

A pelvic type resembling the male pelvis

Anthropoid pelvis

An oval-shaped pelvis with a wider AP diameter

Platypelloid pelvis

A flat-shaped pelvic type

Primary powers

Uterine contractions

Contraction frequency

Time from the beginning of one contraction to the beginning of the next

Contraction duration

The length of a contraction

Contraction intensity

The strength of a contraction at its peak

Effacement

Thinning and shortening of the cervix

Dilation

Enlargement of the cervical opening

Secondary powers

Maternal bearing-down efforts

Lightening

Descent of the fetus into the pelvis

Signs preceding labor

Lightening, urinary frequency, stronger Braxton Hicks, backache, bloody show, weight loss, ROM, and increased energy

First stage of labor

From the onset of regular contractions to complete cervical dilation

Latent phase (First stage)

Characterized by cervical effacement with little descent

Active phase (First stage)

Characterized by rapid cervical dilation and fetal descent

Second stage of labor

From complete dilation to birth of the infant

Third stage of labor

From birth of the infant to placental delivery

Fourth stage of labor

From placental delivery until maternal stabilization

Cardinal movements of labor

Engagement, descent, flexion, internal rotation, extension, restitution, and external rotation

Flexion (Cardinal movement)

Fetal chin moves toward the chest

Internal rotation

Rotation of the fetal head to fit the maternal pelvis

Extension (Cardinal movement)

Fetal head extends under the symphysis pubis during birth

Restitution

The fetal head rotates back to align with the shoulders

Visceral pain (Labor)

Caused by uterine ischemia and stretching during labor

First-stage labor pain segments

$T10-L1$ spinal segments

Somatic pain

Sharp, intense, burning pain during late first and second stages

Factors influencing labor pain

Labor intensity, fetal position, fatigue, culture, anxiety, and support systems

Nonpharmacologic pain management advantages

No side effects and does not slow labor

Nonpharmacologic relief methods

Relaxation, massage, heat/cold, hydrotherapy, music, breathing, and acupressure

Hyperventilation cause

Breathing too rapidly during labor

Epidural anesthesia advantage

Most complete pain relief during labor

Platelet count for epidural

Threshold greater than $100,000$

IV fluid before epidural

$1000\,mL$ LR bolus

Intravascular epidural placement symptoms

Ringing in ears, tachycardia, and metallic taste

Subarachnoid epidural placement symptoms

Sudden pain relief and impaired leg movement

Epidural hypotension priority intervention

Left lateral positioning and IV fluids

Late decelerations (Maternal hypotension)

Fetal heart rate change occurring with maternal hypotension after an epidural

BP monitoring post-epidural

Every $3\,minutes$ for $20\,minutes$

Spinal block primary use

Cesarean delivery

Trendelenburg (Spinal)

A position to avoid after spinal anesthesia to prevent respiratory impairment

Postdural headache cause

CSF leakage after dural puncture

Postdural headache presentation

Severe headache when upright that improves when lying down

Postdural headache treatment

Hydration, caffeine, and blood patch

Nitrous oxide contraindication

Patients with vitamin $B12$ deficiency

Nitrous oxide requirement

The patient must be able to hold her own mask

Normal fetal heart rate baseline

$$110-160\,bpm$$

Factors affecting fetal circulation

Maternal position, contractions, blood pressure, and cord blood flow

Absent variability

Undetectable amplitude in fetal heart rate

Minimal variability

Amplitude less than $5\,bpm$

Moderate variability

Amplitude of $6-25\,bpm$

Marked variability

Amplitude greater than $25\,bpm$

Fetal tachycardia definition

Baseline FHR greater than $160\,bpm$ for greater than or equal to $10\,minutes$

Fetal tachycardia interventions

Assess maternal temperature, reduce fever, and place in left lateral position

Fetal bradycardia definition

Baseline FHR less than $110\,bpm$ for greater than or equal to $10\,minutes$

Fetal bradycardia interventions

Left lateral position, IV fluids, discontinue Pitocin, notify provider, and prepare for delivery

Early decelerations cause

Head compression

Early decelerations intervention

None required

Late decelerations cause

Uteroplacental insufficiency

Late decelerations interventions

Left lateral position, IV bolus, correct hypotension, stop/reduce Pitocin, notify provider

Variable decelerations cause

Cord compression

Variable decelerations interventions

Side-lying or knee-chest position, stop Pitocin, assess for prolapsed cord, amnioinfusion

VEAL CHOP mnemonic

Variable=Cord, Early=Head, Accelerations=Okay, Late=Placental insufficiency

Category I tracing

Baseline $110-160$, moderate variability, accelerations ±, early decelerations ±

Category II tracing findings

Minimal/marked variability, tachycardia, recurrent variable decelerations

Category III tracing definition

Absent variability with recurrent late or variable decelerations, bradycardia, or sinusoidal pattern

True labor vs. false labor

True labor causes progressive cervical dilation and effacement

True labor contractions

Become more frequent and intense

True labor discomfort location

Back and lower abdomen

False labor discomfort location

Above the umbilicus or in the back

Effect of rest on false labor

Rest often decreases contractions

Nulliparous hospital timing

Contractions every $5\,minutes$ for $1\,hour$

Multiparous hospital timing

Contractions every $10\,minutes$ for $1\,hour$

Admission lab values

CBC, blood type and Rh, urine studies, and Group B strep status

Group B strep (GBS) importance

Positive mothers require antibiotics during labor

Effect of anxiety on labor

Increases pain perception and may slow labor progress

Nitrazine paper test

Test used to assess rupture of membranes

Nitrazine blue color

Indication of amniotic fluid

Nitrazine false-positive causes

Blood, urine, semen, and cleansers

Ferning test

Confirmation test for rupture of membranes