lOMoARcPSD|69074652
M&J OB Final 1
23 Questions Antepartum and intrapartum
GTPAL
G (Gravida): the number of pregnancies
T (Term): number of infants born at ≥ 37
P (Preterm): born after 20 weeks but before the completion of 37 weeks.
A (Abortion): pregnancies ending in either spontaneous or therapeutic abortion before the end of 20 weeks.
L (Living): number of currently living children.
o Due Date: from the month of their last period add nine months, then add seven days to the first day of their last period.
o Nägele’s Rule: most common method of determining the EDB, which uses 280 days as the mean length of pregnancy. To
use this method, begin with the first day of LMP, subtract 3 months and add 7 days. For
SIGNS OF PREGNANCY
Presumptive Changes
Subjective symptoms experienced by the woman. Doesn’t confirm pregnancy.
o Morning sickness
o Excessive fatigue
o Urinary frequency
o Breast changes
o Quickening
Probable Changes
Objective changes that occur in pregnancy. Doesn’t confirm pregnancy since it could be due to others things
o Goodell’s - Softening of the cervix
o Chadwick’s - Dark violet coloration of cervix
o Hegar’s - Softening of lower part of uterus
o Progressive uterine enlargement
o Enlargement of the abdomen with amenorrhea (no period)
o Braxton-Hicks contractions
o Fetal outline
Ballottement: passive fetal movement elicited when the examiner inserts two fingers into the vagina and pushes against
the cervix. This action pushes the fetal body up and as it falls back down, the examiner feels a rebound
o Pregnancy test
Positive Changes
Diagnostic test that confirm pregnancy
o Fetal heartbeat: detectable by doppler ultrasound
o Fetal movement: detected by echocardiography or transvaginal sonography
o Fetal soufflé: blowing murmur, synchronous with the fetal heartbeat
TRUE VS FALSE LABOR: Many times the only way to tell between true or false is to asses effacement and dilation.
TRUE LABOR:
Contractions of TRUE LABOR produce progressive DILATION and EFFACEMENT of the Cervix, occur regularly with increase in
frequency, duration and intensity.
The discomfort of true labor contractions usually starts in the back and radiates around the abdomen. pain is not relieved by
ambulation (walking may actually intensify pain)
FALSE LABOR:
The contractions of FALSE LABOR DO NOT produce cervical effacement and dilation. They are irregular, and do not increase in
frequency, duration, and intensity, perceived as a hardening or “balling up” without discomfort, or discomfort may occur in the
lower abd. or groin.
Discomfort may be relieved by ambulation, change position.
SIGNS OF ONSET OF LABOR
S/S of impending labor
Lightening (when the fetus begins to settle into the pelvic inlet (engagement).
Braxton Hicks Contractions
Cervical Changes: softening of the cervix is called ripening
Bloody Show: with softening and effacement of the cervix the mucous plug is often expelled.
Rupture of Membranes (ROM)
Sudden Burst of energy (nesting)
Other signs: weight loss of 1-3 lb resulting from fluid loss, diarrhea, indigestion, or N/V just before the onset of labor
, lOMoARcPSD|69074652
M&J OB Final 2
STAGES OF LABOR AND BIRTH
First stage begins with the onset of true labor and ends when the cervix is completely dilated to 10 cm, divided into the latent,
active, and transition phases.
1. Latent (early) Phase:
o beginning of regular contractions, usually mild, woman able to cope with the discomfort, may feel anxious, and able to
recognize and express feelings. Woman is often talkative and is eager to talk about herself and answer questions, her partner
or other support person is often as elated as she is
o They may start as lasting 30 seconds with frequency of 10 to 30 minutes and progress to moderate ones lasting 30-40 seconds
with frequency of 5 to 7 minutes. As the cervix begins to dilate and effaces (little or no fetal descent is evident).
o For a primipara, latent phase of labor averages 8.6 hours but should not exceed 20 hours, in multipara averages 5.3 hours but
should not exceed 14 hours.
o Spontaneous Rupture of membranes (SROM) occurs at the height of an intense contraction with a gush of fluid out of the
vagina. In many instances ruptured by the certified nurse-midwife (CNM) or physician, using an amnihook, procedure is called
an amniotomy, or artificial rupture of membranes (AROM).
2. Active Phase:
o Anxiety increases as the contractions and pain increases. Shows decreased ability to cope and a sense of helplessness. Women
who have support may feel greater satisfaction and less anxiety than those without support.
o Cervix dilates from about 4 cm to 7 cm. Fetal descent is progressive.
o Cervical/dilation averages 1.2cm/her in primiparas and 1.5cm/hr in multiparas
3. Transition Phase
o Last part of the first stage of labor, woman shows significant anxiety. Becomes acutely aware of the increasing force and
intensity of contractions, may become restless, and changes position frequently.
o Often already tired. Fears to be left alone, the nurse should reassure her that she will not be left alone.
o Contractions have a frequency of 1.5 to 2 minutes, a duration of 60-90 seconds, and strong in intensity.
o Cervical dilation slows down and progresses from 8 to 10 cm and the rate of fetal descent dramatically increases.
o This phase does not last > 3 hours for primiparas or > 1 hour for multiparas.
o Other characteristics of this phase may include: Increasing bloody show – Hyperventilation - Generalized discomfort, low
backache, shaking, cramping in legs - Increased need for partners’ or nurse’s support – Restlessness - Increased apprehension
and irritability - A sense of bewilderment, frustration, and anger at the contraction - Request for medication - Hiccupping,
belching, N/V - Beads of perspiration on the upper lip or brow - Increasing rectal pressure and an urge to bear down.
Second stage begins with complete dilation and ends with the birth of the baby, usually completed within 3 hours after fully dilation
for primiparas; the stage averages 15 minutes for multiparas.
o Contractions frequency 11/2 to 2 minutes, duration 60-90 seconds and strong intensity. Descent of fetal presenting part
continues until it reaches the perineal floor.
o During this time, the “first phase”, passive fetal descent occurs in response to uterine contractions. Nursing tasks during this
phase include:
1. Assessing the woman’s perception of the need or urge to push
2. Evaluating the maternal-fetal oxygenation status
3. Assessing fetal status through recommended monitoring protocols.
o Second phase is known as the pushing phase, occur with the urge to push, and the woman starts to push with her contractions.
1. Assessing the effectiveness of the maternal pushing efforts
2. Providing encouragement and direction to obtain a more adequate pushing effort
3. Assessing fetal response that occurs as maternal pushing is performed including continued fetal assessment measures.
o Crowning: fetal head is encircled by the external opening of the vagina (inroitus)
MECHANISM OF LABOR/ CARDINAL MOVEMENTS OF LABOR
1. Descent: four forces: (1) pressure of the amniotic fluid, (2) direct pressure of the uterine fundus on the breech, (3)
contraction of the abdominal muscles, and (4) extension and straightening of the fetal body.
2. Flexion: fetal head descend and meets resistance. As a result of the resistance the fetal chin flexes downward onto
the chest.
3. Internal rotation: fetal head must rotate to fit the diameter of the pelvic cavity.
4. Extension: resistance of the pelvic floor assist with extension of the fetal head as it passes under the symphysis
pubis.
5. Restitution: once the head is out and is free of pelvic resistance, the neck untwists, turning the head to one side
(restitution) and aligns with position of the back in the birth canal.
6. External rotation: as shoulders rotate to the antereoposterior position in the pelvis the head turns farther to one
side
7. Expulsion: as lateral flexion of the shoulder and head occurs the anterior shoulder is born before the posterior
M&J OB Final 1
23 Questions Antepartum and intrapartum
GTPAL
G (Gravida): the number of pregnancies
T (Term): number of infants born at ≥ 37
P (Preterm): born after 20 weeks but before the completion of 37 weeks.
A (Abortion): pregnancies ending in either spontaneous or therapeutic abortion before the end of 20 weeks.
L (Living): number of currently living children.
o Due Date: from the month of their last period add nine months, then add seven days to the first day of their last period.
o Nägele’s Rule: most common method of determining the EDB, which uses 280 days as the mean length of pregnancy. To
use this method, begin with the first day of LMP, subtract 3 months and add 7 days. For
SIGNS OF PREGNANCY
Presumptive Changes
Subjective symptoms experienced by the woman. Doesn’t confirm pregnancy.
o Morning sickness
o Excessive fatigue
o Urinary frequency
o Breast changes
o Quickening
Probable Changes
Objective changes that occur in pregnancy. Doesn’t confirm pregnancy since it could be due to others things
o Goodell’s - Softening of the cervix
o Chadwick’s - Dark violet coloration of cervix
o Hegar’s - Softening of lower part of uterus
o Progressive uterine enlargement
o Enlargement of the abdomen with amenorrhea (no period)
o Braxton-Hicks contractions
o Fetal outline
Ballottement: passive fetal movement elicited when the examiner inserts two fingers into the vagina and pushes against
the cervix. This action pushes the fetal body up and as it falls back down, the examiner feels a rebound
o Pregnancy test
Positive Changes
Diagnostic test that confirm pregnancy
o Fetal heartbeat: detectable by doppler ultrasound
o Fetal movement: detected by echocardiography or transvaginal sonography
o Fetal soufflé: blowing murmur, synchronous with the fetal heartbeat
TRUE VS FALSE LABOR: Many times the only way to tell between true or false is to asses effacement and dilation.
TRUE LABOR:
Contractions of TRUE LABOR produce progressive DILATION and EFFACEMENT of the Cervix, occur regularly with increase in
frequency, duration and intensity.
The discomfort of true labor contractions usually starts in the back and radiates around the abdomen. pain is not relieved by
ambulation (walking may actually intensify pain)
FALSE LABOR:
The contractions of FALSE LABOR DO NOT produce cervical effacement and dilation. They are irregular, and do not increase in
frequency, duration, and intensity, perceived as a hardening or “balling up” without discomfort, or discomfort may occur in the
lower abd. or groin.
Discomfort may be relieved by ambulation, change position.
SIGNS OF ONSET OF LABOR
S/S of impending labor
Lightening (when the fetus begins to settle into the pelvic inlet (engagement).
Braxton Hicks Contractions
Cervical Changes: softening of the cervix is called ripening
Bloody Show: with softening and effacement of the cervix the mucous plug is often expelled.
Rupture of Membranes (ROM)
Sudden Burst of energy (nesting)
Other signs: weight loss of 1-3 lb resulting from fluid loss, diarrhea, indigestion, or N/V just before the onset of labor
, lOMoARcPSD|69074652
M&J OB Final 2
STAGES OF LABOR AND BIRTH
First stage begins with the onset of true labor and ends when the cervix is completely dilated to 10 cm, divided into the latent,
active, and transition phases.
1. Latent (early) Phase:
o beginning of regular contractions, usually mild, woman able to cope with the discomfort, may feel anxious, and able to
recognize and express feelings. Woman is often talkative and is eager to talk about herself and answer questions, her partner
or other support person is often as elated as she is
o They may start as lasting 30 seconds with frequency of 10 to 30 minutes and progress to moderate ones lasting 30-40 seconds
with frequency of 5 to 7 minutes. As the cervix begins to dilate and effaces (little or no fetal descent is evident).
o For a primipara, latent phase of labor averages 8.6 hours but should not exceed 20 hours, in multipara averages 5.3 hours but
should not exceed 14 hours.
o Spontaneous Rupture of membranes (SROM) occurs at the height of an intense contraction with a gush of fluid out of the
vagina. In many instances ruptured by the certified nurse-midwife (CNM) or physician, using an amnihook, procedure is called
an amniotomy, or artificial rupture of membranes (AROM).
2. Active Phase:
o Anxiety increases as the contractions and pain increases. Shows decreased ability to cope and a sense of helplessness. Women
who have support may feel greater satisfaction and less anxiety than those without support.
o Cervix dilates from about 4 cm to 7 cm. Fetal descent is progressive.
o Cervical/dilation averages 1.2cm/her in primiparas and 1.5cm/hr in multiparas
3. Transition Phase
o Last part of the first stage of labor, woman shows significant anxiety. Becomes acutely aware of the increasing force and
intensity of contractions, may become restless, and changes position frequently.
o Often already tired. Fears to be left alone, the nurse should reassure her that she will not be left alone.
o Contractions have a frequency of 1.5 to 2 minutes, a duration of 60-90 seconds, and strong in intensity.
o Cervical dilation slows down and progresses from 8 to 10 cm and the rate of fetal descent dramatically increases.
o This phase does not last > 3 hours for primiparas or > 1 hour for multiparas.
o Other characteristics of this phase may include: Increasing bloody show – Hyperventilation - Generalized discomfort, low
backache, shaking, cramping in legs - Increased need for partners’ or nurse’s support – Restlessness - Increased apprehension
and irritability - A sense of bewilderment, frustration, and anger at the contraction - Request for medication - Hiccupping,
belching, N/V - Beads of perspiration on the upper lip or brow - Increasing rectal pressure and an urge to bear down.
Second stage begins with complete dilation and ends with the birth of the baby, usually completed within 3 hours after fully dilation
for primiparas; the stage averages 15 minutes for multiparas.
o Contractions frequency 11/2 to 2 minutes, duration 60-90 seconds and strong intensity. Descent of fetal presenting part
continues until it reaches the perineal floor.
o During this time, the “first phase”, passive fetal descent occurs in response to uterine contractions. Nursing tasks during this
phase include:
1. Assessing the woman’s perception of the need or urge to push
2. Evaluating the maternal-fetal oxygenation status
3. Assessing fetal status through recommended monitoring protocols.
o Second phase is known as the pushing phase, occur with the urge to push, and the woman starts to push with her contractions.
1. Assessing the effectiveness of the maternal pushing efforts
2. Providing encouragement and direction to obtain a more adequate pushing effort
3. Assessing fetal response that occurs as maternal pushing is performed including continued fetal assessment measures.
o Crowning: fetal head is encircled by the external opening of the vagina (inroitus)
MECHANISM OF LABOR/ CARDINAL MOVEMENTS OF LABOR
1. Descent: four forces: (1) pressure of the amniotic fluid, (2) direct pressure of the uterine fundus on the breech, (3)
contraction of the abdominal muscles, and (4) extension and straightening of the fetal body.
2. Flexion: fetal head descend and meets resistance. As a result of the resistance the fetal chin flexes downward onto
the chest.
3. Internal rotation: fetal head must rotate to fit the diameter of the pelvic cavity.
4. Extension: resistance of the pelvic floor assist with extension of the fetal head as it passes under the symphysis
pubis.
5. Restitution: once the head is out and is free of pelvic resistance, the neck untwists, turning the head to one side
(restitution) and aligns with position of the back in the birth canal.
6. External rotation: as shoulders rotate to the antereoposterior position in the pelvis the head turns farther to one
side
7. Expulsion: as lateral flexion of the shoulder and head occurs the anterior shoulder is born before the posterior
