Obstetrics Pelvis and Fetal Delivery Quiz

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Questions and Answers

Which type of pelvis is considered most favorable for vaginal delivery?

Gynecoid (correct)

Platypelloid

Anthropoid

Android

What characteristic of the platypelloid pelvis makes vaginal delivery extremely difficult?

Narrow anteroposterior diameter (correct)

Wide anteroposterior diameter

Shallow upper section

Narrow transverse diameter

In the context of fetal delivery, what does 'Station' refer to?

The time taken for the fetus to engage in the pelvis

The position of the fetal head in relation to maternal pelvis

The relationship between ischial spines and presenting part of the fetus (correct)

The descent of the fetus through the birth canal

How many pregnant individuals with an anthropoid pelvis can deliver vaginally?

1/3 Signup and view all the answers

Which fetal factors can affect the ease of passage through the pelvis?

Head size, presentation, lie, attitude, and position Signup and view all the answers

What is the most common fetal presentation that is most favorable for a vaginal birth?

Vertex presentation Signup and view all the answers

How long does the anterior fontanel remain open before closing?

18 months Signup and view all the answers

Which fetal lie describes the fetus being parallel to the spine?

Longitudinal lie Signup and view all the answers

What is true regarding the flexion attitude of the fetus?

It is the most common and favorable for vaginal birth. Signup and view all the answers

What type of breech presentation has the fetal legs flexed at the hips and extends towards the shoulders?

Frank breech Signup and view all the answers

Which anatomical part of the fetus typically enters the pelvis first during delivery?

Head Signup and view all the answers

What common fetal presentation involves the chin being hyperextended and not tucked?

Face presentation Signup and view all the answers

When does the posterior fontanel typically close after birth?

6 to 8 weeks Signup and view all the answers

What is a common method to assess fetal heart rate (FHR) during labor?

Placing a Doppler transducer over the lower abdomen Signup and view all the answers

What does fetal bradycardia indicate?

Fetal heart rate below 110 BPM Signup and view all the answers

Which of the following is NOT a common position to facilitate uterine contractions during labor?

Supine position Signup and view all the answers

What should be monitored in the lower grid during electronic fetal monitoring?

Uterine contractions Signup and view all the answers

What is the meaning of variabilities in the FHR tracing?

Constant changes in the heart rate Signup and view all the answers

Where is the strongest fetal heart sound typically located in a cephalic (vertex) presentation?

Lower abdomen Signup and view all the answers

Which aspect is crucial for partners during labor management?

Offering emotional support Signup and view all the answers

What role does a doula typically play during labor?

Providing emotional and physical support Signup and view all the answers

Study Notes

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.

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Description

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.