Factors Affecting Labor & Delivery
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What does engagement refer to in the context of fetal positioning?

  • The fetal body being fully extended
  • The fetal head touching the uterine wall
  • The fetal head rotating within the pelvis
  • The presenting part of the fetus at the level of the ischial spines (correct)

    • Which of the following best describes the term 'floating' in fetal engagement?

  • The presenting part is fully engaged in the pelvis
  • The presenting part is not engaged (correct)
  • The fetus's limbs are in a breech position
  • The fetal body is positioned vertically in the uterus

    • What type of presentation is considered the most common?

  • Breech Presentation
  • Transverse Presentation
  • Cephalic Presentation (correct)
  • Shoulder Presentation

    • Which of the following is a cause of non-engagement in a primipara?

    <p>Abnormal fetal head positioning</p> Signup and view all the answers

    What is meant by 'acutely flexed head' in fetal presentation?

    <p>Fetal head touches the thorax and sternum</p> Signup and view all the answers

    What does the middle letter in the fetal position abbreviation indicate?

    <p>The fetal landmark</p> Signup and view all the answers

    Which fetal position is considered the most common and ideal?

    <p>LOA</p> Signup and view all the answers

    How are the maternal pelvis quadrants divided?

    <p>According to right and left</p> Signup and view all the answers

    In what position does the baby's bottom come first while legs are flexed at the hip?

    <p>Breech Position</p> Signup and view all the answers

    What percentage of breech babies are in the frank breech position?

    <p>65-60%</p> Signup and view all the answers

    Which of the following fetal landmarks indicates vertex presentation?

    <p>Occiput (O)</p> Signup and view all the answers

    What influences the process and efficiency of labor?

    <p>Fetal positioning</p> Signup and view all the answers

    Which position is characterized by the fetal head pointing toward the mother's right side and anteriorly?

    <p>ROA</p> Signup and view all the answers

    What defines a hypertensive episode in terms of systolic blood pressure?

    <p>Greater than 140 mmHg</p> Signup and view all the answers

    What diastolic blood pressure reading indicates potential hypertension?

    <p>Greater than 90 mmHg</p> Signup and view all the answers

    What indicates a falling blood pressure in relation to shock?

    <p>Increased pulse rate</p> Signup and view all the answers

    What abnormal pulse rate indicates a potential hemorrhage?

    <p>Greater than 100 bpm</p> Signup and view all the answers

    What is a characteristic of hypotonic uterine contractions?

    <p>Less frequent and less intense</p> Signup and view all the answers

    How long do prolonged contractions, indicating hypertonicity, last?

    <p>More than 70 seconds</p> Signup and view all the answers

    Which of the following is NOT associated with falling blood pressure?

    <p>Increased blood volume</p> Signup and view all the answers

    What abnormal pulse rate might suggest a serious concern, such as hemorrhage?

    <p>Greater than 100 bpm</p> Signup and view all the answers

    What is the priority need for a woman during the first stage of labor?

    <p>Pain relief</p> Signup and view all the answers

    Which of the following positions is NOT mentioned as an alternative position for birth?

    <p>Lithotomy position</p> Signup and view all the answers

    What should be done to promote bladder care during labor?

    <p>Promote voiding every 2 to 4 hours</p> Signup and view all the answers

    What is a potential indicator of hyperventilation during labor?

    <p>Tingling or numbness in fingers and toes</p> Signup and view all the answers

    What is the impact of squatting during labor according to the provided content?

    <p>Less tension on the perineum</p> Signup and view all the answers

    What should be assessed immediately after a woman gives birth?

    <p>Lochia amount and characteristics</p> Signup and view all the answers

    Why should contraction times be respected during the first stage of labor?

    <p>To assist with effective breathing exercises</p> Signup and view all the answers

    Which of the following is part of initial assessment during Stage 1 labor?

    <p>Amount and character of show</p> Signup and view all the answers

    What equipment is typically included in the newborn care area of the birthing room?

    <p>Baby island with a radiant heat warmer</p> Signup and view all the answers

    What is a recommended nursing intervention to promote comfort during labor?

    <p>Detailed explanation of labor process</p> Signup and view all the answers

    Which of the following is a consequence of ineffective breathing patterns during labor?

    <p>Lightheadedness</p> Signup and view all the answers

    What is the purpose of Leopold’s Maneuvers during labor assessment?

    <p>To assess the baby's position and presentation</p> Signup and view all the answers

    During postpartum assessment, how often should vital signs be obtained in the first hour?

    <p>Every 15 minutes</p> Signup and view all the answers

    What should be included in a detailed assessment during the first stage of labor?

    <p>Evaluation of family medical history</p> Signup and view all the answers

    What should be done to assess the fundus after childbirth?

    <p>Palpate for size, consistency, and position</p> Signup and view all the answers

    What characteristic of contractions should be explained to the woman in labor?

    <p>The intensity and duration of contractions</p> Signup and view all the answers

    What is one method to assist with managing uterine contractions?

    <p>Pelvic rocking between contractions</p> Signup and view all the answers

    Which of the following is NOT a recognized method for physical and psychological preparation of the client?

    <p>Invasive surgical techniques</p> Signup and view all the answers

    What supportive action can be taken to assist with comfort during labor?

    <p>Offering ice chips or moistening the lips</p> Signup and view all the answers

    What does telemetry monitor in relation to fetal assessment?

    <p>Fetal heart rate and uterine contractions</p> Signup and view all the answers

    Which of the following changes in position is encouraged to support labor progress?

    <p>Sitting, walking, or upright positioning</p> Signup and view all the answers

    What is a potential late complication post-childbirth associated with dural puncture?

    <p>Postdural puncture headache (PDPH)</p> Signup and view all the answers

    What is the role of changing rubber pads during labor?

    <p>To maintain cleanliness and hygiene</p> Signup and view all the answers

    Which pharmacological method is used for pain relief during labor?

    <p>Analgesia</p> Signup and view all the answers

    Study Notes

    Factors Affecting Labor & Delivery

    • Passage:

      • Pelvic measurements are important
        • Diagonal Conjugate (inlet diameter)
        • Transverse Diameter (outlet)
      • Posterior fontanelle (Lambda) is diamond-shaped, at junction of coronal and sagittal sutures.
      • Posterior fontanelle (Lambda) is triangular, at junction of lambdoidal and sagittal sutures.

    • Passenger:

      • Fetal skull: 8 bones (4 superior: frontal, 2 parietal, occipital; + 4 others: sphenoid, ethmoid, 2 temporal)
        • Vertex: space between fontanelles
        • Sinciput: area over frontal bone
        • Occipital: area over occipital bone
      • Fetal skull diameters:
        • Suboccipitobregmatic: 9.5 cm (inferior occiput to anterior fontanelle)
        • Occipitofrontal: 12 cm (from chin to occipital prominence)
        • Occipitomental: 13.5 cm (widest AP diameter from chin to posterior fontanelle)
      • Molding: change in fetal skull shape due to sutures overlapping
        • Can decrease biparietal diameter by 1 cm
        • Recorded as 0-3, with increasing overlapping
      • Fontanelles: membrane-covered spaces at suture junctions
        • Anterior fontanelle (Bregma)

    • Fetal Presentation and Position:

      • Fetal attitude: degree of flexion (full, moderate, partial, poor)
      • Fetal lie: relationship of fetal long axis to maternal long axis (vertical or horizontal)

    Engagement

    • Settling of presenting part into pelvis.
    • Biparietal diameter or intertrochanteric diameter passes the pelvic brim.

    Causes of Non-engagement (Primiparas)

    • Abnormal fetal presentation or position
    • Abnormality of the fetal head

    Types of Fetal Presentation

    • Cephalic (most common, 95%)

      • Vertex: optimal
      • Brow: head moderately extended
      • Face: head hyperextended

    • Breech:

      • Complete: hips and knees flexed.
      • Frank: buttocks and legs extended.
      • Footling: one or both feet present first.

    Fetal Positions

    • Relationship of presenting part to pelvic quadrants (e.g., LOA, ROA)
      • LOA: most common, presenting part towards left side of pelvis

    Mechanisms of Labor (Cardinal Movements)

    • Descent
    • Flexion
    • Internal Rotation
    • Extension
    • External Rotation (Restitution)
    • Expulsion

    Signs of Labor

    • True labor contractions:

      • Regular, becoming stronger over time.
      • Begin in lower back and move forward.
      • Increase in frequency and intensity.
      • Not relieved by rest.
      • Progressive cervical dilation.

    • False labor contractions:

      • Irregular and intermittent.
      • Located primarily in the abdomen.
      • Do not increase in intensity or frequency.
      • May stop with walking or rest.

    • Show (bloody show): mucus plug expelled with blood.

    • Rupture of membranes: expulsion of fluid.

    Importance of Partograph

    • Prevention of prolonged labor
    • Improvement in maternal and neonatal outcomes

    Stages of Labor

    • Stage 1:

      • Latent Phase / Preparatory Phase: regular contractions start, cervix dilates (0-3cm), effacement begins.
      • Active Phase: rapid cervical dilation (4-7 cm); strong contractions.
      • Transition Phase: maximum cervical dilation (8-10 cm)

    • Stage 2: (onset from full cervical dilatation to birth of infant).

    • Stage 3: (from birth of infant to expulsion of placenta).

    • Stage 4: postpartum period

    Danger Signs of Labor & Delivery

    • Fetal:
      • High or low fetal heart rate
      • Meconium staining
      • Fetal acidosis (pH <7.2)
    • Maternal:
      • Rising BP (PIH)
      • Abnormal pulse
      • Inadequate contractions
      • Abnormal lower abdominal contour
      • Prolapse of cord

    Care During Labor & Delivery

    • First Stage: pain relief, void, respect contractions, position changes, bladder care.
    • Second Stage: support client's pushing efforts and position, monitor FHR, support birth positions, perineal care following delivery.
    • Third Stage: delivery of placenta, positioning for uterine contractions, observe for bleeding.

    Placenta Assessment

    • Membranes: complete, ragged.
    • Maternal side: characteristics, cotyledons.
    • Fetal side: umbilical cord (insertion), blood vessels.

    Postpartum Period

    • Retrogressing changes: uterus returns to normal size, hormonal fluctuations, circulation changes.
    • Lactation: primary engagement, breast changes.

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    Related Documents

    Maternal Midterm Reviewer PDF

    Description

    Explore the critical factors that impact labor and delivery, including the dimensions of the pelvic passage and the fetal skull structure. Understand the role of pelvic measurements and the significance of molding in fetal skull shape during delivery. This quiz covers essential concepts for anyone studying obstetrics.

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