Parturition

Question 1

Parturition

Answer 1

-The process of giving birth

	-Rupure of the membranes

	-Dilation of the cervix

	-Contraction of the uterus

  -Shrinking of the uterus

	-Separation of the placenta

Question 2

Stages of Normal Labor and Delivery

1st Stage

Answer 2

-Onset of contractions to full dilation and effacement of the cervix

Question 3

Stages of Normal Labor and Delivery

2nd stage

Answer 3

-Full dilation and effacement to delivery of fetus

Question 4

Stages of Normal Labor and Delivery 3rd stage

Answer 4

-Delivery of fetus and placenta

Question 5

Abnormal Labor and Delivery

-Tocolysis (tocolytics)

Answer 5

-Tocolysis (tocolytics) - Process of stopping labor by administering medication

`	-B-Mimetic agents

		-Terbutaline sulfate (Breathine) and ritodrine

		-Cause uterine relaxation

	-Magnesium sulfate- muscle paralysis

	-Indomethacin

	-Mifedipine

Question 6

Abnormal Labor and Delivery

-Dystocia

Answer 6

(Prolonged Difficult Labor)

Question 7

Normal Presentation

Answer 7

-Vertex or cephalic presentation = head down, face toward mothers back.

Question 8

Abnormal Presentation

Answer 8

-Anything other than vertex

-Breech

	-Frank - buttocks first

	-Complete- Buttock and lower extremities

	-Footing- lower extremities (first)

	-Transverse- fetus perpendicular to birth canal

Question 9

Abnormal Labor and Delivery

Answer 9

-Problems associated with umbilical cord

	-Prolapse of cord into canal prior to body

		-Common on breech presentation and multiple gestations

		-Occult prolapse- compression of cord in utero

	-Cord Knotted in utero

	-Cord wrapped around the neck of the fetus during delivery

Question 10

Placenta Abnormalities

-Placenta previa

Answer 10

-Diagnosed by ultrasound

	-Partially or completely covering opening into birth canal

Question 11

Placenta Abnormalities

-Abruptio placentae or PLacental Abruption

Answer 11

-Premature separation of the placenta from the uterine wall

	-Preeclampsia most common cause

	-Dangerous to both mother and fetus

Question 12

Cesarean Delivery

Answer 12

-Surgical incision through the abdomen and uterus

-Lack of squeezing lung fluid out of neonate may lead to transient tachypnea of newborn (TTN)

Question 13

Adaption to Extrauterine Life

Answer 13

-establishment of breathing

	-Fetal respiratory movement as early as 18th week, more activity in last 10 weeks

-Surfactant must be present to decrease surface tension

	-Pressure for entail breath as great as -100 cwp

	-Lower pressure needed after FRC established

Question 14

Factors Responsible for 1st Breath

-birth asphyxia

Answer 14

-Chemoreceptors in aorta and carotid arteries

	-Rise in PaCO2 an decrease in PaO2 after cord clamped

Question 15

Factors Responsible for 1st Breath

-Chest expands after being compressed in the birth canal

Answer 15

-Fluid expelled

	-Expanstion pulls air into lungs

Question 16

Factors Responsible for 1st Breath

-Crying reflex

Answer 16

• change from dark, warm, quiet environment to cooler, bright, noisy

Question 17

Change From Fetal to Adult Circulation

-Alteration in circulatory pressure

Answer 17

-Clamping of cord stops blood flow to and from placenta

	-Blood detoured to lower extremities because of increased martial blood pressure

	-Breathing decreases pulmonary artery pressure

		-Establishment of FRC reduces pressure on pulmonary vasculature

		-Increased PaO2 relaxes pulmonary smooth muscles

Question 18

Change From Fetal to Adult Circulation

-Closure of fetal shunt

Answer 18

-Left martial pressure now > right atrial pressure so foremen ovale flap closes’

Question 19

Change From Fetal to Adult Circulation

-As PaO2 increases

Answer 19

-Ductal prostaglandins inhibited

	-Smooth muscle around ductus arteriosus constrict and close


-Umbilical vessels constrict and become ligaments

-Ductus venous constricts and becomes a ligament

Question 20

Other Changes After Birth

Answer 20

-Neonate needs to:

	-Fight off infections

	-Maintain own temperature

	-Provide own nutrition

Question 21

Delivery Room Care- Prepare Equipment

Answer 21

-Drugs: Epinephrine (1:10,00, 3 ml or ml)

-Neonatal bag mask, oxygen

-Suction equipment

-Meconium aspirator

-Intubation

-Airway- clear with bulb syringe- moth then nose

-Dried and kept warm- radiant warmer

-APGAR @ 1 and 5 minutes (treat based on score)

-Continue assessment

	-History, gestational age, weight, appearance, breath sounds.