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Questions and Answers
What is the shape of the parietal bones?
At what age do parietal bones typically ossify?
Which of the following measures the widest transverse diameter of the head?
Which fetal presentation type is described by the vertex?
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What describes the relationship of fetal parts to one another?
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Which landmark is not used for determining fetal position?
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Which of the following is NOT an effect of uterine contractions?
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What is NOT a characteristic of primary uterine contractions?
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What is the primary effect of progesterone deprivation during late pregnancy?
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Which theory suggests that the pressure of the fetal head on the cervix triggers labor?
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What is a consequence of the aging placenta during labor?
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What hormonal change occurs as labor approaches due to the decrease in progesterone levels?
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Which of the following describes the phenomenon of lightening during late pregnancy?
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What triggers the increased frequency of urination associated with lightening?
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Which statement is true about the roles of estrogen, fetal hormone, and prostaglandin in labor onset?
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What happens to uterine muscle function as progesterone levels decrease during pregnancy?
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What is true about Braxton Hicks contractions?
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What does 'lightening' refer to in the context of labor?
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How can true labor be distinguished from false labor?
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Which physiological alteration indicates the onset of labor?
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What is the main reason for ensuring that the station is at least 0 or + during labor?
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What is Bandl's ring associated with during labor?
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Which of the following factors is NOT associated with women's psychological responses to uterine contractions during labor?
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What effect do Braxton Hicks contractions have when a woman is active?
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What should be avoided to ensure maternal comfort during labor?
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In which condition would you expect an increase in vaginal discharge?
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According to the content, which factor is considered a valuable tranquilizer during the childbirth process?
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Which statement about maternal energy levels before labor is true?
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What role does the support system, particularly the husband, play during labor?
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What phase of uterine contractions is characterized by the peak or highest point?
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Which of the following phases of uterine contractions involves the 'letting up' process?
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What does 'frequency' refer to in the context of uterine contractions?
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What indicates a strong uterine contraction?
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In which stage of labor is the supine position discouraged to prevent supine hypotensive syndrome?
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What factor indicates that a mother is ready for pushing during labor?
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What is the main function of intraabdominal pressure during pushing?
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What is the term for the period from the beginning of a contraction to its completion?
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Study Notes
Theories of Labor Onset
- Uterine Myometrial Irritability (Uterine Stretch): As the uterus stretches with fetal growth and increasing amniotic fluid, it leads to irritability, causing contractions to expel the contents.
- Progesterone Deprivation: When progesterone levels decrease and uterine muscle stimulants increase in late pregnancy, labor begins. Progesterone is a uterine muscle relaxant.
- Oxytocin Theory: The pressure of the fetal head on the cervix in late pregnancy stimulates the posterior pituitary gland to secrete oxytocin, triggering uterine contractions.
- Estrogenic, Fetal Hormone, and Prostaglandin Theories: All these hormones have stimulating effects on uterine musculature, increasing uterine contractility.
Premonitory Signs of Labor
- Lightening: Descent of the presenting part into the true pelvis, typically occurring 2 weeks before labor in primigravida and a day before or on the day of labor in multigravida.
- Increased Braxton Hicks Contractions: Irregular contractions 3-4 weeks before labor, often called "false labor."
- Increased Maternal Energy: A burst of energy due to the hormone epinephrine.
- Slight Decrease in Maternal Weight: A decrease of 2-3 pounds 1-2 days before labor.
- Show: A mucus plug that seals the cervix during pregnancy is expelled, producing a pink or bloody discharge.
- Ripening of the Cervix: Softening and thinning of the cervix.
- Rupture of the Bag of Waters: The amniotic sac breaks.
- Progressive Fetal Descent: The presenting part moves further into the pelvis.
True vs. False Labor
- True labor contractions: Regular, progressive, and radiate from the lumbosacral area to the front, increasing in intensity.
- True labor cervix: Dilated.
- True labor walking: Intensifies contractions.
- True labor enema: Intensifies contractions.
- True labor show: Present and increasing.
- False labor contractions: Irregular and non-progressive.
- False labor discomfort: Abdominal.
- False labor cervix: No dilatation.
- False labor walking: No effect on contractions.
- False labor enema: No effect on contractions.
- False labor show: Absent.
Physiologic Alterations in Labor
- Dilatation: Progressive opening/widening of the cervical os.
- Effacement: Thinning and obliteration of the cervical canal.
- Physiologic Retraction Ring: Separation of the active upper uterine segment and passive lower segment.
- Bandl’s Ring: Pathologic retraction ring formed when the upper uterine segment is as active as the lower segment, indicating potential uterine rupture.
Components of Labor Process
- Passageway: The pelvis and the soft tissues of the birth canal.
- Passenger: The fetus, including the fetal head (composed of cranial bones), attitude, and position.
- Powers: The forces of labor: primary (uterine contractions) and secondary (maternal bearing down).
Fetal Head
- Parietal bones: Diamond shaped, measure 2.5 cm x 2.5 cm, ossify (close) in 12 to 18 months.
- Posterior fontanel (lambda): Triangular shaped, formed by the union of 2 parietal and occipital bones, ossify in 6-8 weeks or 2-3 months.
- Suboccipitobregmatic: 9.5 cm from below the occiput to the anterior fontanel, narrowest AP diameter of the head.
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Transverse diameters:
- Biparietal diameter: 9.5 cm, widest transverse.
- Bitemporal diameter: 8 cm.
- Bimastoid diameter: 7 cm.
- Fetal attitude: The relationship of fetal parts to one another.
- Fetal position: Relationship of presenting part to the maternal pelvis, described with 3 letters: L, R, T (maternal pelvis side), O, S, Sc, M (presenting part), A, P (part of maternal pelvis).
Fetal Presentation
- Cephalic: Head first, with various subtypes like vertex, sinciput, brow, and face.
- Breech: Buttocks or feet first, with subtypes like complete, incomplete, footling, and shoulders.
Fetal Position
- Chosen landmarks: Occiput (O), mentum (M), sacrum (S), acromiodorso (AD).
- 4 imaginary quadrants: Left anterior (LA), left posterior (LP), right anterior (RA), right posterior (RP).
- Assessment of fetal position: Leopold's maneuver and vaginal examination.
- Fetal station: Relation of presenting part of the fetus to the ischial spines of the maternal pelvis (0 station is at the level of the ischial spines).
The Power
- Primary power: Uterine contractions, characterized by involuntary, rhythmic, and regular activity of the uterine musculature.
- Purposes of primary power: Propel presenting part downward/forward, efface the cervix, and dilate the cervix.
- Effects of contractions: Increased maternal BP, decreased uteroplacental circulation, fetal hypoxia, cervical dilation, and expulsion of the fetus and placenta.
- Phases of uterine contractions: Increment (building up), Acme (peak), and Decrement (letting up).
- Components of contractions: Duration, frequency, interval, and intensity.
- Secondary power: Maternal bearing down/pushing, involving intraabdominal pressure to expel the fetus.
Position of the Parturient
- 1st stage of labor: LL position is most comfortable and best for fetal well-being, preventing supine hypotensive syndrome. Avoid supine position.
- 2nd stage of labor: Lithotomy position is most commonly used.
- Considerations when choosing positions: Maternal, physical, and psychologic needs, fetal well-being.
Psychologic Response of the Mother
- Factors that make labor meaningful: Cultural influences, expectations and goals, feedback from others participating in the birthing process.
- Women's psychologic responses to uterine contractions: Fear and anxiety.
- Other factors: Childbirth preparation, support system.
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Description
Explore the various theories surrounding labor onset, including uterine myometrial irritability, progesterone deprivation, and the role of hormones like oxytocin and prostaglandins. This quiz will help you understand the physiological processes leading to labor, as well as premonitory signs that signal its approach. Test your knowledge on these crucial aspects of obstetrics!
