lOMoARcPSD|13111427
Exam2studyguide - Summary Maternity and Pediatric
Nursing
Concepts Of Maternal-Child Nursing And Families (Nova Southeastern
University)
Downloaded by Evaleen Kamau
, lOMoARcPSD|13111427
OB Exam 2
Labor and Childbirth
Initiation of Labor pg. 456
• It is believed that labor is influenced by: uterine stretch from the fetus and amniotic fluid
volume, progesterone withdrawal to estrogen dominance, increase oxytocin sensitivity,
and
increased release of prostaglandins
• Estrogen to progesterone ratio
o During the last trimester estrogen increases and progesterone decreases
• The number of oxytocin receptors in the uterus increases at the end of pregnancy
• Increased levels of estrogen also lead to increased sensitivity to oxytocin
• With increasing oxytocin levels in the maternal blood along with increasing fetal
cortisol levels that synthesize prostaglandins, uterine concentrations are initiated
• Oxytocin also aids in stimulating prostaglandin synthesis
• Prostaglandins lead to additional contractions, cervical softening, gap junction
induction, and myometrial sensitization leading to progressive cervical dilation
• Uterine contractions have two main functions: dilate the cervix and to push the
fetus through the birth canal
Signs of Approaching Labor pg. 456
• Lightening occurs when the fetal presenting part begins to descend into the true pelvis
o The uterus lowers and moves into a more anterior position
o The woman will usually notice her breathing becomes much easier and there
is decreased gastric reflux
o She may complain of increased pelvic pressure, leg cramping, dependent edema
in the lower legs, low back discomfort, increase in vaginal discharge and urination
o In primiparas, lightening can occur 2 weeks or more before labor beings and
in multiparas, it may not occur until labor
• Braxton Hicks Contractions may be experienced throughout the pregnancy
o Felt as tightening or pulling sensation on top of the uterus
o Occur primarily in abdomen and groin and gradually spread downward
before relaxing
o Irregular contractions that can be decreased by walking, voiding, eating,
increasing fluid intake, or changing position
o Usually last about 30 seconds but can last up to 2 minutes
o As birth gets closer, the uterus becomes more sensitive to oxytocin and
the frequency and intensity of these contractions increases
o If the contractions last longer than 30 secs and occur more than 4-6x/hr, the
woman should contact her HCP so she can be evaluated for preterm labor
• Backache
• Bloody show
o At the onset of labor or before, the mucous plug that fills the cervical canal is
expelled as a result of cervical softening and increased pressure of the presenting
part
Downloaded by Evaleen Kamau
()
, lOMoARcPSD|13111427
o These ruptured capillaries release a small amount of blood that mixes with
mucus resulting in the pink tinged secretions known as the bloody show
• Spontaneous Rupture of Membranes
o Rupture of membranes with loss of amniotic fluid prior to onset of labor
premature rupture of membranes (PROM)
o The majority of women will begin labor within 24 hours
o The rupture can result in either a sudden gush or a steady leakage of amniotic fluid
o A continuous supply of amniotic is produced even though some is lost
o After the amniotic sac has ruptured, the barrier to infection is gone and
ascending infection is possible
o There is also a danger of cord prolapse if engagement has not occurred
• Increased Energy Level
o Some women have a sudden increase in energy before labor
o Sometimes this is referred to as nesting because the mother will use this time
to prepare for the baby and spend time with other children
o Usually occurs 24-48 hours before the onset of labor
o Thought to be the result of an increase in epinephrine released caused by
decreased progesterone
• Weight loss loses 1-3lbs
True vs. False Labor pg. 457
• False labor irregular uterine contractions are felt but the cervix is not affected
o False labor, prodromal labor, Braxton Hicks
• True labor contractions occurring at regular intervals that increase in frequency, duration,
and intensity
o Bring about progressive cervical dilation and effacement
• Example: if a woman comes in and she goes from 2cm to 3 cm then back to 2cm and
stays that way for hours, you would send her home because it’s not progressing
Cervical Dilatations and Effacement
• Dilatation is the opening of the cervix
• Effacement is the thinning of the cervix
Downloaded by Evaleen Kamau
()
, lOMoARcPSD|13111427
Theories of Onset of Labor
• Oxytocin production
• Prostaglandin
• Estrogen stimulation
• Fetal influences
• Others
“P’s” of Labor pg. 458
• Passageway (birth canal)
• Passenger (fetus and placenta)
• Powers (contractions)
• Position (maternal)
• Psychological response
Passageway pg. 458
• Have to make sure the baby can come out
• The birth passageway is the route through which the fetus must travel to be born vaginally
• The passageway way consists of the maternal pelvis and soft tissues
• The pelvis is the most important and it is typically assessed and measured during the
first trimester to identify any abnormalities that might hinder vaginal birth
• Relaxin and estrogen cause the connective tissues to become more relaxed and elastic
and cause the joints to be more flexible to prepare the mother’s pelvis for birth
Bony Pelvis
• The maternal bony pelvis can be divided into the true and false portions
• The false part is the upper part and the true pelvis is the bony passage through which
the fetus must travel
Downloaded by Evaleen Kamau
()
Exam2studyguide - Summary Maternity and Pediatric
Nursing
Concepts Of Maternal-Child Nursing And Families (Nova Southeastern
University)
Downloaded by Evaleen Kamau
, lOMoARcPSD|13111427
OB Exam 2
Labor and Childbirth
Initiation of Labor pg. 456
• It is believed that labor is influenced by: uterine stretch from the fetus and amniotic fluid
volume, progesterone withdrawal to estrogen dominance, increase oxytocin sensitivity,
and
increased release of prostaglandins
• Estrogen to progesterone ratio
o During the last trimester estrogen increases and progesterone decreases
• The number of oxytocin receptors in the uterus increases at the end of pregnancy
• Increased levels of estrogen also lead to increased sensitivity to oxytocin
• With increasing oxytocin levels in the maternal blood along with increasing fetal
cortisol levels that synthesize prostaglandins, uterine concentrations are initiated
• Oxytocin also aids in stimulating prostaglandin synthesis
• Prostaglandins lead to additional contractions, cervical softening, gap junction
induction, and myometrial sensitization leading to progressive cervical dilation
• Uterine contractions have two main functions: dilate the cervix and to push the
fetus through the birth canal
Signs of Approaching Labor pg. 456
• Lightening occurs when the fetal presenting part begins to descend into the true pelvis
o The uterus lowers and moves into a more anterior position
o The woman will usually notice her breathing becomes much easier and there
is decreased gastric reflux
o She may complain of increased pelvic pressure, leg cramping, dependent edema
in the lower legs, low back discomfort, increase in vaginal discharge and urination
o In primiparas, lightening can occur 2 weeks or more before labor beings and
in multiparas, it may not occur until labor
• Braxton Hicks Contractions may be experienced throughout the pregnancy
o Felt as tightening or pulling sensation on top of the uterus
o Occur primarily in abdomen and groin and gradually spread downward
before relaxing
o Irregular contractions that can be decreased by walking, voiding, eating,
increasing fluid intake, or changing position
o Usually last about 30 seconds but can last up to 2 minutes
o As birth gets closer, the uterus becomes more sensitive to oxytocin and
the frequency and intensity of these contractions increases
o If the contractions last longer than 30 secs and occur more than 4-6x/hr, the
woman should contact her HCP so she can be evaluated for preterm labor
• Backache
• Bloody show
o At the onset of labor or before, the mucous plug that fills the cervical canal is
expelled as a result of cervical softening and increased pressure of the presenting
part
Downloaded by Evaleen Kamau
()
, lOMoARcPSD|13111427
o These ruptured capillaries release a small amount of blood that mixes with
mucus resulting in the pink tinged secretions known as the bloody show
• Spontaneous Rupture of Membranes
o Rupture of membranes with loss of amniotic fluid prior to onset of labor
premature rupture of membranes (PROM)
o The majority of women will begin labor within 24 hours
o The rupture can result in either a sudden gush or a steady leakage of amniotic fluid
o A continuous supply of amniotic is produced even though some is lost
o After the amniotic sac has ruptured, the barrier to infection is gone and
ascending infection is possible
o There is also a danger of cord prolapse if engagement has not occurred
• Increased Energy Level
o Some women have a sudden increase in energy before labor
o Sometimes this is referred to as nesting because the mother will use this time
to prepare for the baby and spend time with other children
o Usually occurs 24-48 hours before the onset of labor
o Thought to be the result of an increase in epinephrine released caused by
decreased progesterone
• Weight loss loses 1-3lbs
True vs. False Labor pg. 457
• False labor irregular uterine contractions are felt but the cervix is not affected
o False labor, prodromal labor, Braxton Hicks
• True labor contractions occurring at regular intervals that increase in frequency, duration,
and intensity
o Bring about progressive cervical dilation and effacement
• Example: if a woman comes in and she goes from 2cm to 3 cm then back to 2cm and
stays that way for hours, you would send her home because it’s not progressing
Cervical Dilatations and Effacement
• Dilatation is the opening of the cervix
• Effacement is the thinning of the cervix
Downloaded by Evaleen Kamau
()
, lOMoARcPSD|13111427
Theories of Onset of Labor
• Oxytocin production
• Prostaglandin
• Estrogen stimulation
• Fetal influences
• Others
“P’s” of Labor pg. 458
• Passageway (birth canal)
• Passenger (fetus and placenta)
• Powers (contractions)
• Position (maternal)
• Psychological response
Passageway pg. 458
• Have to make sure the baby can come out
• The birth passageway is the route through which the fetus must travel to be born vaginally
• The passageway way consists of the maternal pelvis and soft tissues
• The pelvis is the most important and it is typically assessed and measured during the
first trimester to identify any abnormalities that might hinder vaginal birth
• Relaxin and estrogen cause the connective tissues to become more relaxed and elastic
and cause the joints to be more flexible to prepare the mother’s pelvis for birth
Bony Pelvis
• The maternal bony pelvis can be divided into the true and false portions
• The false part is the upper part and the true pelvis is the bony passage through which
the fetus must travel
Downloaded by Evaleen Kamau
()
