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46 Cards in this Set
- Front
- Back
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Labor:
Exact cause is unknown, but believed to be influenced by several factors: |
Uterine muscle stretching
Pressure on cervix Stimulated by oxytocin Change in ratio of estrogen and progesterone Decreasing function of placenta Increase in fetal cortisol *fetal membranes production of prostaglandin |
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Preliminary signs of labor:
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lightening, increased energy levels, Braxton Hicks contractions, cervical ripening
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True signs:
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regular contractions, increased show, ROM, cervical change
Differentiate between true and false labor NO cervix change not true labor |
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"Pushing" can increase cardiac output by:
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50%
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Physiological Responses:
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Hemapoetic-25000 WBC
Respiratory-moms use more oxygen consumption espicially during 2nd stage when pushing. Chest compression during delivery clears fluid in lungs and helps spontaneous Temperature regulation-not uncommon to run a fever. (muscle activity) Urinary-baby is pounding on bladder with every single contraction. IV and ice chips. Urine is more concentrated. Before epidural needs to use restroom if bladder fills up then could stop labor. Muscoloskeletal system-relaxin muscles and joints. Peristalysis slows down-no food intake Neurologically-how does patient respond to pain. Integumentary- |
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Components of Labor:
Passage: |
2. Necessary to determine adequacy:
diagonal conjugate- narrowest at inlet (top part of pelvis) transverse diameter- narrowest at pelvic outlet Or a very large baby. Ideal pelvis-gynacoid 3. If fetus presents in unusual position. |
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Components of Labor:
Passenger: |
Depends on fetal head and its alignment
8 bones- 2 frontal bones fused 2 parietal bones 2 occipital bones 2 temporal bones Where these bones meet become the suture lines: Sagittal- separates parietal bones Coronal- separates frontal and parietal lamboid- separates parietal and occipital These suture lines allow for overlapping of bones during delivery Fontanels- anterior (diamond shape) posterior- ( triangle) Smallest diameter is the SUBOCCIPITOBREGMATIC – This area must present to pelvic inlet. (if aligned correctly) Engagement- presenting part that enters the pelvis reaches the level of the ischial spines Molding- change shape of head produced by force of contractions against cervix- TEMPORARY refer to slide 12 |
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Fetal Attitude:
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degree of flexion the fetus assumes or relation of the fetal parts to one another:
complete flexion moderate flexion partial flexion |
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Station:
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relation of presenting part to the level of the ischial spines: -4 to +4
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Crowning-
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Presenting part reaches the perineum.
Station head is in Pelvis anything above a zero is floating. Everything below 0 is + (related to crowning perinium) |
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Fetal lie-
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Relation of fetal spine to spine of the mother:
longitudinal transverse |
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Presentations:
Cephalic- |
4 types Head first:
Vertex-ideal head is on chest flexed Brow-head is not completely extended but straight up Face-full extension Mentum-face |
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Presentations
Breech: |
3 types
Complete-everything crossed Frank-feet and legs are hyper extended Footling-single or double |
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Know page 248
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now!
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3 phases of a contraction :
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Increment
ACME Decrement |
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Mechanisms of labor:
Cardinal Movements: |
descent
flexion internal rotation extension external rotation expulsion |
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Powers of Labor:
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uterine contractions
abdominal muscles 3 phases of a contraction contour changes |
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Contractions:
Frequency: How long? |
beginning to beginning
from beginning to ending |
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“Bandl’s ring”
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If labor becomes difficult this ring becomes a prominent and observable abdominal indention called Bandls ring.
This is a danger sign indicative of impending uterine rupture |
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Cervical changes:
Effacement-subjective: |
Preganant patient cervix is 1-2 cm length prior to labor. Cervix starts thinning out and they start dilating.
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Cervical Changes:
Dilation- |
opening of cervix 0-10cm before she can start pushing.
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Bloody Show:
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mucous plug
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Psyche:
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psychological state or feelings the woman brings into labor with them
those who manage best are: strong self esteem good support |
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Stages of Labor: 1-4
first 4 hours: |
first 4 hours after delivery is called the 4th stage to emphasize the need for close observation.
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Stages of Labor:
Stage 1: |
divided into 3 stages:
Latent-Early part of labor from onset of contractions. Contractions are mild from 5 to 30 minutes apart. Last 35-45 seconds. For first time mom phase can take as long as 6 hours. 4 multigravidas Ask fawn Active-Dilate from 4-7 cm. during this time contractions are 3-5 minutes apart lasting long close to 60 seconds. This is time when bloody schow. Primigravidas-average is 3 hours Multigravidas-2 hours Once they hit active labor you can give pain meds. Transition-Unmedicated unepidurel patients. Dilate 8-10 cm Contractions are every 2-3 minutes lasting 60-90 seconds. ½ minute before next In Transition no one leaves the room. |
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2nd stage of labor:
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Teach mom to push. 4minutes to 5 hours after dilation.
Posterior baby-hands and knees Transverse-put mother on side |
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Third Stage:
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Definition
from delivery of fetus to delivery of placenta signs of placental separation Placental expulsion mechanisms |
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Shiny Shchultz –
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fetal side first thing to come out
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Dirty Dunkin-
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everthing attached to uterus comes out. Make sure lobes and membrane are intact.
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Danger signs- Fetal
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Tachycardia-from hypoxia Normal hr 110-160
Bradycardia-drop in heart if hypoxia not corrected Decelerations- Earlies- Lates- Variable- Meconium-thick black tar like substance that fills gi tract. Danger sign baby has experienced hypoxic episode. Hyperactivity-low oxygen hypoxic. Acidosis-bradycardia or acidosis nick of babies scalp get PH less than 7.2 indicates distress. |
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Danger signs- maternal
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change in BP
abnormal HR abnormal contractions pathological retraction ring abnormal lower abdominal contour increased apprehension |
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Assessments- Stage 1
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initial interview:
EDD frequency, duration of contractions any show ROM? Vital signs last oral intake allergies Dilation stage-interview pull prenatal record look at DD preterm mom? What is going on with patient? Contractions? Water broke? Any kind of shcow? Has water broken? What color? (should be clear color) Latex allergy? |
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History of Mother:
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Review physical and psychological events of this pregnancy
Current pregnancy Past pregnancy Past health History of meth? Para? Any problems at all? Any prenatal care at all? Breast feed bottle feel. Who is pediatrician? Family history |
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???????Physical Exam:
(includes) |
review of systems
abdominal assessment assess for ROM vaginal exam sonogram vital signs lab More focused on baby and pregnancy. Adominal assessmnet-trying to guesstimate any scars on abdomen. Assess rupture of membranes. Vaginal exam-look for fluid. Speculum exam-Amneotic-bright blue no amneotic-green Ferning Ameotic fluid positive crystalized green fern sign of ruptured membrane. Yellow indicative blood incapatability. Always do vaginal exam when not having contractions. If you cant feel head do quick sonogram to check where baby is. Vitals lab work-what is going on with patient. If preemclamptic every 1-2 ruptured etc. v/s-4 Temp-1-2 Most hospitals do CBC If no prenatal complete panel, HIV, HEP B |
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Care during Stage 1:
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respect contraction time
promote position changes promote voiding-Encourage to empty bladder every 2 hours. offer support respect and promote support person’s activities support pain management efforts amniotomy No support person offer your own. Support persons activites must be supported. |
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Care during Stage 2:
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urge to push
argumentative and angry need good support stay with client FHR assessed throughout pushing efforts Urge to push-relieves discomfort. Lots of good support during this time. Monitor babies heart rate entire time pushing. |
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Positioning:
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Various positions available
if use lithotomy position make sure you raise legs at same times to decrease strain back do not put up in stirrups until the last minute |
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Pushing:
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push with contraction to be effective
best position is semi fowler’s not to hold breath but breathe out while pushing to prevent pushing have patient pant |
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Birth:
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fetal head is delivered and nose and mouth are suctioned
check for nuchal cord delivery time is recorded when entire body is delivered cord clamped cord blood obtained Mouth first then nose. Feeling around neck for nucal cord pull it over babies head. O+ or RH- |
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Apgar score:
1952 Physiological adaptations a newborn must perform. Performed within 1 minute of delivery and then 5 minute |
1952
Physiological adaptations a newborn must perform. Performed within 1 minute of delivery and then 5 minute Heart rate Color Reflexes Cry or respiratory effort Muscle tone 0 1 or 2 Good healthy baby will get between 7 & 9 |
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Achrocyanosis:
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hands and feet are blue
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Newborn Assessment:
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Apgar
Cord-2 arteries and a vein Should be 3 vessels-look at cord at placenta side to identify. Brief physical exam –defects, ears, extra digits Identify baby-footprints and ID bands. One on arm and one on leg. One has security sensor. Physical defects Identification attachment |
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Stage 3:
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usually delivers spontaneously
must be inspected for intactness Oxytocin added to IVF’s perineal repair |
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Stage 4:
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immediate postpartum time
1-4 hours after delivery Assessments q 15 minutes for first hour clean perineum offer clean gown shaking- normal response |
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Report immediately:
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decrease in BP
tachycardia uterine atony excessive bleeding temperature above 100.4 |
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Speculum exam-
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Amneotic-bright blue
no amneotic-green |
