Intrapartum Observation in Primigravida

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Questions and Answers

What is the level of pain in relation to a woman's experience?

Level of pain is individual to the woman.

A primigravida at 39 weeks of gestation is observed for 2 hours. What should the nurse expect the woman to be?

Admitted and prepared for a cesarean birth.

Discharged home with a sedative.

Discharged home to await the onset of true labor. (correct)

Admitted for extended observation.

Which nursing assessment indicates that a woman who is in second-stage labor is almost ready to give birth?

The fetal head is felt at 0 station during vaginal examination.

The vulva bulges and encircles the fetal head. (correct)

The membranes rupture during a contraction.

Bloody mucus discharge increases.

Which signs precede labor? (Select all that apply)

Rupture of membranes. Signup and view all the answers

Which factors influence cervical dilation? (Select all that apply)

Scarring of the cervix. Signup and view all the answers

The anterior fontanel closes after birth by how many months?

18 Signup and view all the answers

The relationship of the fetal body parts to one another is called fetal:

Attitude Signup and view all the answers

What is the likely position of the fetus if a round, firm, movable fetal part is felt in the fundal portion of the uterus?

RSA Signup and view all the answers

The woman's last vaginal examination was recorded as 3 cm, 30%, and ?2-2. What does this indicate?

The cervix is 3 cm dilated, effaced 30%, and the presenting part is 2 cm above the ischial spines. Signup and view all the answers

Which stage of labor varies the most in length?

First Signup and view all the answers

What is a common maternal cardiovascular finding during labor?

Increased cardiac output Signup and view all the answers

The five Ps affecting the process of labor and birth include all except:

Pressure Signup and view all the answers

The slight overlapping of cranial bones during labor is known as:

Molding Signup and view all the answers

Which presentation is described accurately in terms of both presenting part and frequency?

Cephalic: occiput; at least 95% Signup and view all the answers

The fetal attitude describes the angle at which the fetus exits the uterus.

False Signup and view all the answers

Engagement is the term used to describe the beginning of labor.

False Signup and view all the answers

Which type of pelvis includes the correct description and occurrence percentage in women?

Platypelloid: flattened, wide, shallow; 3% Signup and view all the answers

What is the conclusive distinction between true and false labor?

Cervical dilation and effacement Signup and view all the answers

Which occurrence is associated with cervical dilation and effacement?

Bloody show Signup and view all the answers

The primary difference between the labor of a nullipara and that of a multipara is the:

Total duration of labor Signup and view all the answers

As the uterus contracts during labor, the maternal-fetal exchange of oxygen and waste products:

Diminishes as the spiral arteries are compressed Signup and view all the answers

What is the best rationale for assessing maternal vital signs between contractions?

Maternal circulating blood volume increases temporarily during contractions Signup and view all the answers

Labor contractions facilitate cervical dilation by:

Pulling the cervix over the fetus and amniotic sac Signup and view all the answers

Study Notes

Key Concepts of Labor and Birth Processes

The anterior fontanel closes by 18 months after birth.
Fetal attitude refers to the relationship of fetal body parts to one another, while lie, presentation, and position relate to the fetal orientation in the mother’s pelvis.
RSA (Right Sacrum Anterior) indicates a specific fetal position during assessment via Leopold maneuvers, where the sacrum is the presenting part.
Cervical examination terminology: 3 cm dilation means the cervix is 3 cm open; 30% effaced indicates the cervix has thinned out, and a position of ?2-2 means the presenting part is 2 cm above the ischial spines.
The first stage of labor varies significantly in duration, lasting from the onset of contractions to full dilation, potentially up to 20 hours in first-time pregnancies.
Maternal cardiovascular changes during labor include increased cardiac output due to blood flow from the uterus into the maternal circulation during contractions.
The five Ps affecting labor are passenger (fetus and placenta), passageway (birth canal), powers (contractions), position of the mother, and psychological response.
Molding refers to the overlapping of cranial bones, aiding the fetal head's adaptation to the birth canal.
The cephalic presentation is the most common, occurring in approximately 96% of births, with the occiput as the presenting part.
The normal fetal attitude is general flexion, important for optimal positioning during delivery.
The station of the presenting part is measured in relation to the mother's ischial spines, with +4 to +5 cm indicating imminent birth.
Pelvic shapes include platypelloid (3% of women), gynecoid (50%), android (23%), and anthropoid (24%).
Primary powers facilitate cervical dilation and effacement, while secondary powers assist in the expulsion of the fetus.
Effective labor positions should be frequently changed for comfort and circulation improvements.
The pressure during contractions reduces blood supply to the placenta, affecting oxygen and waste exchange.
Maternal vital signs should be assessed between contractions for accurate readings, as values can change during contractions.
The distinction between true and false labor is cervical dilation and effacement, which occurs progressively during true labor.
Bloody show indicates cervix changes, signaling true labor onset.
The second stage of labor is indicated by the bulging of the vulva encircling the fetal head during strong urges to push.
A woman in observation with non-progressive contractions and no membrane rupture is likely in false labor, potentially leading to discharge to await actual labor.

Important Definitions and Terminology

Station: Measures the descent of the fetus in relation to the mother’s pelvis.
Engagement: Occurs when the widest part of the fetus enters the pelvic inlet, often before labor.
Asynclitism: A fetal position that involves the head being tilted at an angle to the pelvis.
Restitution: The process of the fetal head rotating back to the original position after birth.
Valsalva Maneuver: A pushing technique that should be avoided during labor to prevent fetal hypoxia.
Lightening: The dropping of the fetus into the pelvic inlet before labor begins, indicating that labor may be near.

Stages of Labor

First Stage: Onset of contractions to full cervical dilation; duration can vary widely.
Second Stage: Cervical dilation to birth; typically lasts 20-50 minutes for first-time mothers.
Third Stage: Birth to delivery of the placenta; usually a short duration.
Fourth Stage: Recovery period post-delivery, lasting about 2 hours.

Nursing Role in Labor

Nurses assess the maternal condition, monitor vital signs, and provide information on the labor process to support patient comfort and well-being.
Understanding physiological changes during labor helps optimize care strategies for both mother and fetus.### Signs That Precede Labor
Lightening indicates the fetus dropping into the pelvis, often leading to increased urinary frequency.
Bloody show refers to the discharge of blood-tinged mucus signaling the cervix is changing.
Rupture of membranes, commonly known as water breaking, often signals the onset of labor.
Many women experience a surge of energy just before labor begins, sometimes referred to as "nesting."
A decrease in fetal movement may indicate distress and does not typically correlate with the onset of labor.

Factors Influencing Cervical Dilation

Strong uterine contractions contribute to the upward drawing of the cervix, facilitating dilation.
The force of the presenting fetal part against the cervix is crucial for the dilation process.
Pressure from the amniotic sac aids in promoting cervical dilation before rupture of membranes.
Scarring from previous infections or surgeries can impede cervical dilation.
The size of the female pelvis does not have an impact on the dilation of the cervix.

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Description

This quiz focuses on the management and observation of a primigravida patient at 39 weeks of gestation during the intrapartum phase. It assesses understanding of fetal heart rate monitoring, contraction patterns, and cervical changes. Ideal for nursing students and professionals looking to enhance their knowledge in maternity care.