RICCI chapter 13 Exam Questions Answered Correctly Rated A+
Initiation of labor - Answers Labor is a physiologic event involving a sequential and integrated set of
changes within the myometrium, decidua, and cervix that occurs gradually over a period of days to
weeks in order to expel the fetus from the uterus. It is difficult to determine exactly why labor begins
and what initiates it. Although several theories have been proposed to explain the onset and
maintenance of labor, none of these has been proved scientifically. It is widely believed that labor is
influenced by a cascade of events, including uterine stretch from the fetus and amniotic fluid volume,
progesterone withdrawal to estrogen dominance, increased oxytocin sensitivity, and increased release
of prostaglandins.
One theory suggests that labor is initiated by a change in the estrogen-to-progesterone ratio. During the
last trimester of pregnancy, estrogen levels increase and progesterone levels decrease. This change
leads to an increase in the number of myometrium gap junctions. Gap junctions are proteins that
connect cell membranes and facilitate coordination of uterine contractions and myometrial stretching
(Norwitz, 2015).
Although physiologic evidence for the role of oxytocin in the initiation of labor is inconclusive, the
number of oxytocin receptors in the uterus increases at the end of pregnancy. This creates an increased
sensitivity to oxytocin. Estrogen, the levels of which are also rising, increases myometrial sensitivity to
oxytocin. With the increasing levels of oxytocin in the maternal blood in conjunction with increasing
fetal cortisol levels that synthesize prostaglandins, uterine contractions are initiated. Oxytocin also aids
in stimulating prostaglandin synthesis through receptors in the decidua. Prostaglandins lead to
additional contractions, cervical softening, gap junction induction, and myometrial sensitization, thereby
lead
Cervical changes - Answers Before labor begins, cervical softening and possible cervical dilation with
descent of the presenting part into the pelvis occur. These changes can occur 1 month to 1 hour before
actual labor begins.
As labor approaches, the cervix changes from an elongated structure to a shortened, thinned segment.
Cervical collagen fibers undergo enzymatic rearrangement into smaller, more flexible fibers that
facilitate water absorption, leading to a softer, more stretchable cervix. These changes occur secondary
to the effects of prostaglandins and pressure from Braxton Hicks contractions. The ripening and
softening of the cervix are essential for effacement and dilation, which reflect the enhanced collagen
breakdown that was previously inhibited by progesterone (Grant, Strevens, & Thornton, 2015). (Ricci
422)
Ricci, Susan. Lippincott CoursePoint for Ricci: Essentials of Maternity, Newborn and Women's Health
Nursing, 4th Edition. CoursePoint, 10/1/2016. VitalBook file.
Lightening - Answers Lightening occurs when the fetal presenting part begins to descend into the true
pelvis. The uterus lowers and moves into a more anterior position. The shape of the abdomen changes
as a result of the change in the uterus. With this descent, the woman usually notes that her breathing is
, much easier and that there is a decrease in gastric reflux. However, she may complain of increased
pelvic pressure, leg cramping, dependent edema in the lower legs, and low back discomfort. She may
notice an increase in vaginal discharge and more frequent urination. In primiparas, lightening can occur
2 weeks or more before labor begins; among multiparas it may not occur until labor starts (Cheng &
Caughey, 2015a). (Ricci 422)
Ricci, Susan. Lippincott CoursePoint for Ricci: Essentials of Maternity, Newborn and Women's Health
Nursing, 4th Edition. CoursePoint, 10/1/2016. VitalBook file.
Increased energy level - Answers Some women report a sudden increase in energy before labor. This is
sometimes referred to as nesting, because many women will focus this energy toward childbirth
preparation by cleaning, cooking, preparing the nursery, and spending extra time with other children in
the household. The increased energy level usually occurs 24 to 48 hours before the onset of labor. It is
thought to be the result of an increase in epinephrine release caused by a decrease in progesterone
(Jordan et al., 2014 (Ricci 422)
Ricci, Susan. Lippincott CoursePoint for Ricci: Essentials of Maternity, Newborn and Women's Health
Nursing, 4th Edition. CoursePoint, 10/1/2016. VitalBook file.
Bloody show - Answers At the onset of labor or before, the mucous plug that fills the cervical canal
during pregnancy is expelled as a result of cervical softening and increased pressure of the presenting
part. These ruptured cervical capillaries release a small amount of blood that mixes with mucus,
resulting in the pink-tinged secretions known as bloody show. (Ricci 423)
Ricci, Susan. Lippincott CoursePoint for Ricci: Essentials of Maternity, Newborn and Women's Health
Nursing, 4th Edition. CoursePoint, 10/1/2016. VitalBook file.
Braxton Hicks contractions - Answers Braxton Hicks contractions, which the woman may have been
experiencing throughout the pregnancy, may become stronger and more frequent. Braxton Hicks
contractions are typically felt as a tightening or pulling sensation of the top of the uterus. They occur
primarily in the abdomen and groin and gradually spread downward before relaxing. In contrast, true
labor contractions are more commonly felt in the lower back. These contractions aid in moving the
cervix from a posterior position to an anterior position. They also help in ripening and softening the
cervix. However, the contractions are irregular and can be decreased by walking, voiding, eating,
increasing fluid intake, or changing position.
Braxton Hicks contractions usually last about 30 seconds but can persist for as long as 2 minutes. As
birth draws near and the uterus becomes more sensitive to oxytocin, the frequency and intensity of
these contractions increase. However, if the contractions last longer than 30 seconds and occur more
often than four to six times an hour, advise the woman to contact her health care provider so that she
can be evaluated for possible preterm labor, especially if she is less than 38 weeks pregnant. (Ricci 423)
Initiation of labor - Answers Labor is a physiologic event involving a sequential and integrated set of
changes within the myometrium, decidua, and cervix that occurs gradually over a period of days to
weeks in order to expel the fetus from the uterus. It is difficult to determine exactly why labor begins
and what initiates it. Although several theories have been proposed to explain the onset and
maintenance of labor, none of these has been proved scientifically. It is widely believed that labor is
influenced by a cascade of events, including uterine stretch from the fetus and amniotic fluid volume,
progesterone withdrawal to estrogen dominance, increased oxytocin sensitivity, and increased release
of prostaglandins.
One theory suggests that labor is initiated by a change in the estrogen-to-progesterone ratio. During the
last trimester of pregnancy, estrogen levels increase and progesterone levels decrease. This change
leads to an increase in the number of myometrium gap junctions. Gap junctions are proteins that
connect cell membranes and facilitate coordination of uterine contractions and myometrial stretching
(Norwitz, 2015).
Although physiologic evidence for the role of oxytocin in the initiation of labor is inconclusive, the
number of oxytocin receptors in the uterus increases at the end of pregnancy. This creates an increased
sensitivity to oxytocin. Estrogen, the levels of which are also rising, increases myometrial sensitivity to
oxytocin. With the increasing levels of oxytocin in the maternal blood in conjunction with increasing
fetal cortisol levels that synthesize prostaglandins, uterine contractions are initiated. Oxytocin also aids
in stimulating prostaglandin synthesis through receptors in the decidua. Prostaglandins lead to
additional contractions, cervical softening, gap junction induction, and myometrial sensitization, thereby
lead
Cervical changes - Answers Before labor begins, cervical softening and possible cervical dilation with
descent of the presenting part into the pelvis occur. These changes can occur 1 month to 1 hour before
actual labor begins.
As labor approaches, the cervix changes from an elongated structure to a shortened, thinned segment.
Cervical collagen fibers undergo enzymatic rearrangement into smaller, more flexible fibers that
facilitate water absorption, leading to a softer, more stretchable cervix. These changes occur secondary
to the effects of prostaglandins and pressure from Braxton Hicks contractions. The ripening and
softening of the cervix are essential for effacement and dilation, which reflect the enhanced collagen
breakdown that was previously inhibited by progesterone (Grant, Strevens, & Thornton, 2015). (Ricci
422)
Ricci, Susan. Lippincott CoursePoint for Ricci: Essentials of Maternity, Newborn and Women's Health
Nursing, 4th Edition. CoursePoint, 10/1/2016. VitalBook file.
Lightening - Answers Lightening occurs when the fetal presenting part begins to descend into the true
pelvis. The uterus lowers and moves into a more anterior position. The shape of the abdomen changes
as a result of the change in the uterus. With this descent, the woman usually notes that her breathing is
, much easier and that there is a decrease in gastric reflux. However, she may complain of increased
pelvic pressure, leg cramping, dependent edema in the lower legs, and low back discomfort. She may
notice an increase in vaginal discharge and more frequent urination. In primiparas, lightening can occur
2 weeks or more before labor begins; among multiparas it may not occur until labor starts (Cheng &
Caughey, 2015a). (Ricci 422)
Ricci, Susan. Lippincott CoursePoint for Ricci: Essentials of Maternity, Newborn and Women's Health
Nursing, 4th Edition. CoursePoint, 10/1/2016. VitalBook file.
Increased energy level - Answers Some women report a sudden increase in energy before labor. This is
sometimes referred to as nesting, because many women will focus this energy toward childbirth
preparation by cleaning, cooking, preparing the nursery, and spending extra time with other children in
the household. The increased energy level usually occurs 24 to 48 hours before the onset of labor. It is
thought to be the result of an increase in epinephrine release caused by a decrease in progesterone
(Jordan et al., 2014 (Ricci 422)
Ricci, Susan. Lippincott CoursePoint for Ricci: Essentials of Maternity, Newborn and Women's Health
Nursing, 4th Edition. CoursePoint, 10/1/2016. VitalBook file.
Bloody show - Answers At the onset of labor or before, the mucous plug that fills the cervical canal
during pregnancy is expelled as a result of cervical softening and increased pressure of the presenting
part. These ruptured cervical capillaries release a small amount of blood that mixes with mucus,
resulting in the pink-tinged secretions known as bloody show. (Ricci 423)
Ricci, Susan. Lippincott CoursePoint for Ricci: Essentials of Maternity, Newborn and Women's Health
Nursing, 4th Edition. CoursePoint, 10/1/2016. VitalBook file.
Braxton Hicks contractions - Answers Braxton Hicks contractions, which the woman may have been
experiencing throughout the pregnancy, may become stronger and more frequent. Braxton Hicks
contractions are typically felt as a tightening or pulling sensation of the top of the uterus. They occur
primarily in the abdomen and groin and gradually spread downward before relaxing. In contrast, true
labor contractions are more commonly felt in the lower back. These contractions aid in moving the
cervix from a posterior position to an anterior position. They also help in ripening and softening the
cervix. However, the contractions are irregular and can be decreased by walking, voiding, eating,
increasing fluid intake, or changing position.
Braxton Hicks contractions usually last about 30 seconds but can persist for as long as 2 minutes. As
birth draws near and the uterus becomes more sensitive to oxytocin, the frequency and intensity of
these contractions increase. However, if the contractions last longer than 30 seconds and occur more
often than four to six times an hour, advise the woman to contact her health care provider so that she
can be evaluated for possible preterm labor, especially if she is less than 38 weeks pregnant. (Ricci 423)
