Modules 9-11

Question 1

5 P’s: Forces of Labor

Answer 1

Powers, passageway, passenger, position, psyche
effect the progress of labor

Question 2

Signs of Impending Labor

Answer 2

1. lightening: descent of the fetus into the true pelvis approximately 2 weeks before term in first-time pregnancies; breathe easier but urinate more
2. Braxton-Hicks: contractions are irregular UCs that do not result in cervical change and are associated with “false labor.”
3. Cervical changes: cervix ripens, becomes soft, and may become partially effaced and begin to dilate, mucus plug may be lost and have different discharge
   4.** Nesting**: a burst of energy or feel the need to put everything in order
4. Weight loss: 1- to 3-pounds
5. N/V/indegestion
6. low backache and sacroiliac discomfort due in part to the relaxation of the pelvic joints
7. brownish or blood-tinged cervical mucus discharge referred to as bloody show

Question 3

Powers

Answer 3

contractions and the voluntary pushing or bearing-down powers that combine to propel and deliver the fetus and placenta from the uterus
in upper segment of uterus, involuntary

Question 4

Powers: Pacemaker Sites

Answer 4

in myometrium (uterine muscles) of the uterus and found near utero tubule junctions
By the third trimester, the myometrial receptors increase by more than 300%, while uterine sensitivity of oxytocin also increases

Question 5

Powers: Contractions

Answer 5

• Become regular as they progress
• 5-30 mins apart, last about 30-45 seconds
• have resting phase / uterine relaxation that allows the woman and uterine muscle a pause for rest

Question 6

Contractions and Relaxation

Answer 6

• Blood flow to the uterus and placenta that was temporarily reduced during the contraction phase
• Much of the fetal exchange of oxygen, nutrients, and waste products occurs in the placenta
• With every contraction, 500 mL of blood leaves the utero–placental unit and moves back into maternal circulation thus ridding the utero-placental unit of waste and bringing in a replenished oxygen supply
• Intermission between contractions diminishes from ten minutes in early labor to as little as two minutes near the end of labor
• Need resting period to re-oxygenate fetus

Question 7

Frequency of Contractions

Answer 7

• How often contractions occur
• Measurement from the beginning of one contraction to the start of the next

Question 8

Duration of Contractions

Answer 8

• How long contractions are
• Time from the beginning of one contraction to the end of the same contraction

Question 9

3 Phases of a Contraction

Answer 9

• Increment: occurs as contraction begins in fundus and spreads throughout the uterus, longest part of contraction
• Peak: or acme, period during the most intense portion, shortest
• Decrement: decrease intensity as the uterus relaxes

Question 10

Intensity of Contraction

Answer 10

• Determined by palpation, patient sensation, or using fetal monitor, the strength
• Fetal monitor: using external tocodynamometer, approximate and change based on placement of the toco
• IUPC: intrauterine pressure cath, must have ruptured mem
• Mild (<40 mmHg), moderate (40-70), strong (>70)
• Mild: uterine wall is easily indented during contraction (nose)
• Moderate: The uterine wall is resistant to indentation during a contraction. (chin)
• Strong: The uterine wall cannot be indented during a contraction. (forehead)