Obstetrics Pelvis and Fetal Delivery Quiz

Childbirth - Week 4

• The process of labor and delivery involves four key components: Powers, Passage, Passenger, and Psyche.

Components of the Birth Process

• Four P's
  • #1 Powers:
    • Primary – uterine contractions
      • Effacement/Dilatation
      • Described by: frequency, duration, intensity, and interval.
    • Secondary – maternal pushing.
  • #2 Passage:
    • Bony pelvis composed of 4 bones.
    • Pregnancy hormones (relaxin and estrogen) soften cartilage and increase pelvic ligament elasticity, causing pelvic joints to separate.
    • False pelvis – shallow upper section.
    • True pelvis – lower curved bony canal inlet/cavity outlet.
    • Different types of pelvises exist (Gynecoid, Android, Anthropoid, Platypelloid), with gynecoid being the most favorable for vaginal delivery.
  • #3 Passenger:
    • The fetus
    • Fetal factors such as head size, presentation, lie, attitude, and position determine ease of passage.
    • Fetal head is composed of bony parts (frontal, two parietal, two temporal, and occipital bones).
    • Skull bones are joined by membraneous sutures (fontanels).
    • Fontanels allow for molding (adaptation to size and shape of pelvis).
    • Fetal lie:
      • Longitudinal – parallel to spine.
    • Fetal attitude:
      • Flexion – head, arms, and legs are flexed.
    • Fetal presentations:
      • Head: Vertex, Military, Brow, Face.
      • Breech: Frank, full, footling.
      • Transverse
  • #4 Psyche:
    • Childbirth is more than just a physical process.
    • Relaxation and positive attitude are crucial.
    • Anxiety increases pain perception and stress compound secretion from adrenal glands, inhibiting uterine contractions and diverting blood flow from placenta.

Signs and Symptoms of Impending Labor

• Braxton Hicks contractions
• Cervical changes (increase in discharge)
• Bloody show/mucous plug
• Rupture of membranes
• Energy spurt
• Weight loss

Mechanisms of Labour

• Cardinal movements of labour.

Care and Management of Labour

• Teaching proper breathing techniques to avoid pushing until cervix is fully dilated.
• Providing encouragement to summon inner strength.
• Upright positions
• Electronic Fetal Monitoring (EFM).

Electronic Fetal Monitoring (EFM)

• Placement of uterine activity and Doppler sensors.
• Evaluating patterns (baseline, variability, accelerations, decelerations).
• Keeping everyone informed of progress.
• Determining placement of fetoscope or sensors.
• Recording of data charts.

Stages of Labour

• First Stage: (Longest)

  • Latent Phase:
    • Cervix dilation is 1-4 cm.
    • Amniotic membranes may be intact.
    • Contractions are Q20 min to 5 min.
    • Duration of contractions is 15–40 seconds.
    • Mild to moderate intensity.
    • Patient behaviours are usually comfortable, alert.
  • Active Phase:
    • Cervix dilation is 4–7 cm.
    • Amniotic membrane may rupture.
    • Contractions are 2-5 min apart.
    • Duration is 40-60 seconds.
    • Moderate to firm intensity.
    • Patient behaviours include apprehension, anxiety, introversion, perspiration, and facial flushing.
  • Transition Phase:
    • Cervix dilation is 7–10 cm.
    • Contractions are q2–3 minutes.
    • Duration is 60–90 seconds.
    • Firm intensity.
    • Patient behaviours include irritability, wanting to give up, restlessness, leg tremors, and possible request for pain relief.

• Second Stage: Expulsion of Fetus

  • Cervix is 10 cm dilated.
  • Contractions are q 1 1/2- 3 mins apart.
  • Duration 60 - 80 seconds
  • Firm intensity
  • Episiotomy may be performed.
  • Stage ends with expulsion of fetus.
  • Behaviors may include perineal bulging, possible stool and/or uncontrolled urge to push.

• Third Stage: Expulsion of Placenta

  • Duration is 5–30 minutes
  • Contractions are intermittent
  • Mild to moderate intensity.
  • Umbilical cord is cut.
  • Placenta is delivered.
  • Uterus contracts to the size of a grapefruit.
  • Episiotomy/laceration is sutured if needed.

• Fourth Stage: Recovery

  • Uterus remains midline, firmly contracted below umbilicus, lochia rubra (bloody discharge) saturates perineal pad (no more than one pad per hour).
  • Possible cramping.
  • Patient may experience shaking chills.
  • Behaviors include elation or relief.
  • First period of reactivity.

Nursing Interventions During Labour

• All stages: Establish rapport; Encourage ambulation, rest, review breathing, assess fetal heart, contractions, vaginal discharge, need for health teaching and vital signs q2H. Encourage voiding.

Types of Delivery

• Forceps delivery
• Suction delivery
• Cesarean delivery

Maternal Adaptations to Labor

• Hematologic and cardiovascular system – increased demand for oxygen, increase in cardiac output, high pulse, possible slight change in blood pressure.
• Respiratory system – increased respirations, increased risk for hyperventilation, dry mouth, and dehydration.
• Renal system – pressure on urethra, overfilling of the bladder, decrease in sensation to void, edema, and possible slow in progress of labor.
• Gastrointestinal system – prolonged gastric emptying time, possible nausea or vomiting.

Fetal Adaptations to Labor

• Fetal heart rate – monitoring decelerations, normal rate of 140–160.
• Fetal respiratory system – beneficial to passing through birth canal.
• As fetus descends, maternal tissues compress the body to expel respiratory passage of mucus.

Teaching Points

• When to come to hospital: Regular contractions that are painful, last 30-60 seconds with 5-minute intervals. (or water break).
• Pain management options: Medical options like nitrous oxide, injection of pethidine, etc.
• What is an episiotomy? Surgical cut at the opening of the vagina during childbirth.
• What is an amniotomy? Intentional rupture of the amniotic sac.
• Can I eat or drink during labor? Clear fluids like ice chips.

Test your knowledge on pelvic types, fetal presentations, and delivery factors related to vaginal birth. This quiz explores crucial concepts in obstetrics, focusing on the anatomical and physiological elements that influence delivery outcomes. Ideal for students and practitioners in the field of obstetrics and gynecology.