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33 Cards in this Set
- Front
- Back
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factors affecting labor progress:
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-The birth passageway (birth canal)
-The passenger (fetus) -The physiologic forces of labor -The position of the mother -The woman’s psychosocial considerations |
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Passenger:
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-Fetal head
-Fetal attitude -Fetal lie -Fetal presentation -Fetal position |
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fetal attitude:
normal |
-The relation of the fetal body parts to one another
-Normal attitude is flexion |
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fetal attitude:
other.. |
-Complete flexion
-Moderate flexion (military) -Poor flexion (brow presentation) Usually c/s -Hyperextension (face presentation) |
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fetal lie:
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The relationship spinal column of the fetus that of the mother
Longitudinal or transverse |
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fetal presentation:
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-Cephalic
-Shoulder -Breech |
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fetal presentation:
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-Engagement
-Station -Ischial spines are zero station -Presenting part moves from – to + |
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fetal position:
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-Right (R) or left (L) side of the maternal pelvis
-Landmark: occiput (O), mentum (M), sacrum (S), or acromion (scapula[Sc]) process (A) -Anterior (A), posterior (P), or transverse (T) |
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external version:
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-Baby externally rotated from breech to cephalic position
-Can lead to c/s if cord becomes entrapped -Induction after successful turn to prevent baby from returning to breech position |
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physiology of labor:
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-Primary force is uterine muscular contractions
-Secondary force is pushing during the second stage of labor |
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uterine contractions
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-Frequency
-Duration -Intensity |
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causes of cervical effacement
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-Estrogen
- Stimulates uterine muscle contractions -Collagen fibers in the cervix are broken down -Increase in the water content of the cervix |
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cervical effacement
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-Physiologic retraction ring
-Upper uterine segment thickens and pulls up -Lower segment expands and thins out -Effacement |
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premonitory signs of labor
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-Lightening
-Braxton Hicks contractions -Bloody show -Rupture of membranes (ROM) -Sudden burst of energy (nesting) -Backache -Nausea and vomiting -Diarrhea |
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true labor
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-Progressive dilatation and effacement
-Regular contractions increasing in frequency, duration, and intensity -Pain usually starts in the back and radiates to the abdomen -Pain is not relieved by ambulation or by resting |
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false labor
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-Lack of cervical effacement and dilatation
-Irregular contractions do not increase in frequency, duration, and intensity -Contractions occur mainly in the lower abdomen and groin -Pain may be relieved by ambulation, changes of position, resting, or a hot bath or shower |
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first stage of labor:
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-Beginning cervical dilatation and effacement
-No evident fetal descent -Uterine contractions increase in frequency, duration, and intensity -Contractions are usually mild |
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psychologic adaptations:
latent phase |
-Feels able to cope with the discomfort
-May be relieved that labor has finally started -Is able to recognize and express feelings of anxiety |
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first stage of labor: active phase
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-Cervical dilatation from 4 to 7 cm
-Progressive fetal descent -Contractions more frequent and intense |
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pschologic adaptations:
active phase |
-Anxiety increases
-Fears loss of control -May have decreased ability to cope |
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3rd stage:
markers |
From birth of infant to delivery of placenta
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systemic responses to labor
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-Changes in cardiac output
-Diaphoresis -Hyperventilation -Changes in ABG levels -Polyuria -Slight proteinuria -Reduced gastric motility -Increased WBCs -Decreased maternal blood glucose -Pain |
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4th stage of labor:
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-4 hours after birth
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fetal adaptations
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-Fetal heart rate decelerations due to intracranial pressure
-Quiet and awake state -Aware of pressure sensations |
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indications for induction
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-GDM
-Pre-eclampsia -Post-dates (>42 weeks) -Non-reactive NST -Low Amniotic fluid index (AFI) -IUGR or SGA -LGA (macrosomia) -PROM |
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social induction
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-FOB work schedule
-Tired of being pregnant -Common complaints of pregnancy -Childcare issues -Prodromal Labor -Family in town to help |
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before beginning induction..
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-Review prenatal record
-Vital Signs -LEOPOLDS!! -Educate patient!! -Start Abx if GBS positive |
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induction meds:
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-Pitocin
-Cervidil -Cytotec (Misoprostil) |
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induction: non-medication
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-Artificial Rupture of Membranes (AROM)
-Nipple stimulation -Sexual intercourse -Stripping membranes |
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Pitocin
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-IV gtt
-Dose in milliunits -Can cause water retention -Dependent upon pitocin receptors -Mimics oxytocin -Can make uterus contract, may not make cervix dilate -Short half life |
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Cytotec (Misoprostil
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-Prostoglandin
-Off label use of med -Tablet placed in posterior fornix of cervix -Can be repeated in 4 hours -Can be difficult to place -DO NOT USE LUBRICANT -May cause tachysystole or hyperstimulation -Cannot be removed once absorbed |
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Cervidil
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-Prostoglandin
-Can be left in for 12-24 hours -Can be removed if tachysystole or hyperstimulation -DO NOT USE LUBRICANT -Placed in posterior fornix of cervix -More expensive than cytotec |
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Consideratons with Induction
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-May require continuous EFM
-May not be effective -May lead to lengthy hospitalization -May lead to tired uterus -May lead to tired baby -Pitocin is named in MANY lawsuits |
