OB Assessment #2: Unit 4 with Complete Solutions

Upper or lower uterus ACTIVELY CONTRACTS to push the baby down? - ANSWER-Upper (2/3) Upper or lower remains less or inactive to promote downward passage of the fetus? - ANSWER-Lower (1/3) Effacement - ANSWER-"thinning and shortening of the cervix as it is drawn over the fetus and amniotic sac." In the NULLIPARA woman, this is competed EARLIER than dilation. Estimated as a % of the original cervical length. *A fully thinned cervix is 100% effaced. Dilation - ANSWER-"Opening of the cervix." In the PAROUS women, cervix is thicker than any nullipara during any labor stage. This process occurs BEFORE effacement. Caused by when the cervix is pulled upward and fetus pushed downward. *Expressed in "cm"; a full reading is 10 cm to allow sufficient passage of average-sized-full-term fetus. What is the characteristic of the cervix of a multigravida woman? - ANSWER-Thick (through dilation) How the cardiovascular system is impacted during labor? - ANSWER-Relative increase in blood volume r/t shunting of blood (300-500mL) during uterine muscle contraction. *Resultantly: BP INCREASES & PULSE DECREASES. *Best to assess mother's vital signs within the interval BETWEEN contractions. What form of hypotension may occur during labor? How and what should be encouraged? - ANSWER-Supine hypotension is caused when the mother lies on her back, causing a compression of major blood vessels. *Encourage the mother to lie in other positions other than on her back (left side-lying) to promote venous blood return to heart and thus enhance blood flow to placenta and promote fetal oxygenation. How the respiratory system is impacted during labor? - ANSWER-INCREASE in depth and respiration (anxious or in pain). Breathing deeply and heavily may lead to hyperventilation (respiratory alkalosis) r/t inhaling TOO MUCH CO2. *May feel tingling of hands and feet, numbness, and dizziness. *Encourage mother in breathing exercises: breathe slow and into a paper bag or cupped hands to restore normal blood levels of CO2 and symptom relief. How the hematopoietic (blood) system is impacted during labor? - ANSWER-Accepted VAGINAL birth blood loss: 500 mL Accepted C-SECTION birth blood loss: 800-1,000 mL 1,000= HEMORRHAGE (uterus not clamping down) Hgb: 10.5 g/dL Hct: 33% Leukocytes: 20,000-30,000 mm3 *An anemic mother at the beginning of labor has less reserve for normal blood loss and poor tolerance for excess bleeding. *Elevated clotting factors (fibrinogen) during and after delivery. This provides protection from hemorrhage, BUT increases the risk for venous thrombosis during pregnancy and after birth. *Encourage the wearing of SCDs (c-section) and TEDs to promote venous blood return!!!! How the gastrointestinal system is impacted during labor? - ANSWER-Gastric motility is reduced, leading to N/V. *Most women are THIRSTY and or have a dry mouth (not usually hungry). Thus, provide ice chips and small amounts of other clear liquids and juices, popsicles, and are non-sugar candy. *Withhold solid foods to PREVENT aspiration and vomiting of undigested food in the event of general anesthesia; there is a decreased risk of aspiration with liquids. How the urinary system is impacted during labor? - ANSWER-*Reduced sensation of a full bladder (r/t intense contractions and effects of general anesthesia). A full bladder can INHIBIT fetal descent b/c it occupies the pelvic space. *ENCOURAGE the mom to empty her bladder often. Where does exchange of oxygen, nutrients, and waste products occur between mom and baby (that doesn't interfere with mom and baby blood mixing)? When does this exchange occur? - ANSWER-In the intervillous spaces; this placental exchange occurs during the interval BETWEEN contractions because a strong labor contraction causes a decrease and then cessation in maternal blood supply as the spiral arteries are supplying the IV spaces are compressed by the uterine muscle. *SIDE NOTE: Placental circulation has enough reserve to compared to fetal basal needs to tolerate the periodic interruption of blood flow. Which conditions (with reduced placental function) may alter the fetus' tolerance with labor contractions? - ANSWER-Maternal diabetes & HTN Fetal anemia (reduced fetal O2 carrying capacity) Characteristics of the fetal heart rate during labor? - ANSWER-110-160 bpm *A low BP is OKAY, but a higher BP indicates infection and or fetal stress. *When mom's BP DROPS, the baby's PULSE DROPS. Characteristics of the fetal pulmonary system during labor? - ANSWER-Fetal lungs produce fluid to allow normal development of the airways. *Labor speeds up the absorption of lung fluid, so 35% of fluid remains in the airway at birth: it is important to clear this to facilitate normal air breathing!! *The other remaining fluid is absorbed into the interstitial spaces of the newborn's lungs and into the circulatory system, and a small amount is cleared by the lymphatic system. *Infants born via C-SECTION (not preceded by labor) are more likely to have transient breathing DIFFICULTY. Which catecholamines respond to fetal stress during labor? What do they do? - ANSWER-Norepinephrine and epinephrine Stimulate cardiac contraction and breathing; QUICKEN the clearance of remaining lung fluid and aid in fetal temperature regulation. What are the 4 components of the birth process? - ANSWER-1. Powers (allows more maternal sense of control) 2. Passage 3. Passenger 4. Psyche *They are all interrelated and are NORMAL during childbirth. Powers: first stage of labor (ONSET of full cervical dilation) - ANSWER-uterine CONTRACTIONS are the primary force to move the fetus through the maternal pelvis. *Includes: effacement, dilation, frequency, duration and intensity. Powers: second stage of labor (full cervical DILATION to birth of the baby) - ANSWER-Uterine contractions CONTINUE to propel the baby through the pelvis. *Woman feels the urge to "push and bear down" as the fetus distends her vagina and puts pressure on the rectum. Passage - ANSWER-Consists of maternal pelvis and soft tissues. *BONY PELVIS more important to outcome of labor than soft tissue b/c...bones & joints are not able to readily yield to the forces of labor. Which increased hormone level (near end of term) causes softening of the cartilage that links pelvic bones together? - ANSWER-relaxin Which form of passage is MOST conducive to a vaginal birth? - ANSWER-GYNECOID; if there is no one present, this poses a big problem. Which form of passage is LEAST conducive to a vaginal birth? - ANSWER-PLATYLLPALLOID short and round Which forms of passage are the HARDEST? - ANSWER-Anthropoid (hard and narrow)