Ch. 8 from notes

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  1. intrapartum
    • begins with onset of contractions
    • lasts until the explusion of the placenta
    • labor
  2. factors that may trigger labor
    • maternal factors:
    • -uterine muscles
    • -increased pressure on the cervix
    • -increased estrogen
    • -decrease progesterone
    • -stimulation of oxytocin (natural hormone)

    • fetal factors:
    • -placenta ages (starts to calcify)
    • -prostaglandin synthesis
    • -increase in fetal cortisol
  3. components of the process of labor
    • -powers (contractions)
    • -passage (passageway)
    • -passenger (fetus)
    • -psyche (womans response)
  4. primary and secondary source of powers
    primary force: uterine muscle contraction for dilation and effacement of cervix

    secondary force: abdominal muscles to push once the cervix is fully dilated
  5. The Powers
    -frequency: beginning of one contraction to the next

    -duration: time from the beginning of the contraction to the end

    • -intensity: strength of the contraction (not pain, just how hard the abdomen is )
    • palpate using fingertips
    • mild
    • moderate
    • strong
  6. Phases of Contractions (The Powers)
    • 1) increment: ascending build up of contraction
    • -begins in fundus
    • -spreads through uterus

    2) acme: peak of intensity

    3) decrement: descending or relaxation of uterus
  7. Types of bony pelvis
    • 1) gynecoid (best)
    • 2) android
    • 3) anthropoid (2nd best)
    • 4) platypelloid
  8. Stations
    relationship with the ischial spines to the presenting part of the fetus and assists in assessing for fetal decent during labor
  9. The Passenger
    fetal head can either hinder childbirth or make it easier. if it can pass through the pelvis, then the rest of the body can too.
  10. front and back fontinal

  11. fetal attitude
    • posture
    • -relationship of the fetal parts to one another
  12. fetal lie
    refers to the long axis (spine) of the fetus in relationship to the long axis of the woman
  13. 2 primary lies:
    longitudinal=long axis of fetus and mom are parallel

    transverse=long axis of fetus is perpendicular to the long axis of the mom
  14. fetal presentation
    • -cephalic-head first
    • ¬† -vertex, brow, face presentation
    • -breech- pelvis first
    • ¬†¬† -complete, frank, footling
    • -shoulder- shoulder
  15. occiput
    head down
  16. relationship of presenting part and maternal pelvis
    engagement occurs when presenting part reaches or passes through the pelvic inlet
  17. fetal positions:relationships
    • refers to the relationship of the presenting part to the front, sides or back of the maternal pelvis. Three notations to describe:
    • 1) R or L
    • 2) landmark of the presenting part: occiput, scrum, etc.
    • 3) anterior, posterior, transverse
  18. The Psyche: labor
    a journey into the unknown that is uncertain, irrevocable, and uncontrollable
  19. The 5th P
    maternal position
  20. lightening
    the descent of the fetus into the true pelvis that occurs about 2 weeks before term in 1st time pregnancies
  21. braxton hicks contractions
    false contractions
  22. effacement
    cervical dilation
  23. bloody show
    • mucous plug is expelled with softening/effacement/dilation
    • -spontaneous rupture of membranes
    • -notify MD
  24. spontaneous rupture of membranes
    may occur before the onset of labor but typically during labor
  25. stages of labor
    1, 2, 3, 4
  26. stage 1
    begins with first true labor contraction and ends with complete dilation of cervix

    • latent phase: contractions last 30-45 sec., frequency 5-10 min, not uncomfortable, mild intensity
    • -cervix dilates 0-3 cm
    • -woman is able to cope

    • active phase: cervix dilates 4-7 cm, contractions reach peak and intensity
    • -best time to have an epidural
    • -every 2-5 mins, 45-60 sec duration, discomfort increases

    • transition phase: (hardest part)
    • -cervix dilates from 8-10 cm
    • -contractions 1-2 mins, 60-90 sec duration, most difficult and painful, becomes restless, tired, changes in positions, fears being alone
  27. 2nd stage
    • -begins when cervix is completely dilated, ends with delivery of infant
    • -contractions 1-2 min, duration 60-90 sec
    • -increase in bloody show
    • -urge to push
    • -perineum flattens, with bulging rectum and vagina
    • -delivery imminent when crowning occurs
  28. 3rd stage
    • -begins after delivery of infant and ends with delivery of placenta
    • -as uterus contracts down after delivery, the placenta is gradually separated from the uterine wall
    • -lasts up to 30 mins.

    schultz mechanism: 80% deliver the fetal surface first (shiny shultz)

    duncan mechanism: 20% the maternal surface first (dirty duncan)
  29. 4th stage
    • -after delivery of placenta
    • -immediate postpartal period
    • -4 hrs
    • -physiologic readjustment from 1-4 hours after birth
    • -blood loss 250-500 ml
    • -Sl decrease in bp, increase in HR
    • -woman thirst, hungry
    • -shaking chills
    • -may have urinary retention
  30. local anesthesia
    • accomplished by injection anesthetic agent into the inracutaneous, subcutaneous and intramuscular¬† area of the perineum
    • -generally used at time of birth
    • -simple and practically free from complications
  31. Pudendal
    • transvaginal injection of anesthetic agent into pudendal nerve
    • -provides perineal anesthesia for end of first stage, second stage, birth and epis/laceration repair
    • -east to administer
    • -doesnt affect maternal or fetal VS
  32. epidural anesthesia
    injection of an anesthetic agent into the epidural space to provide pain relief during labor or C/S

    advantages: provides good pain control intrapartum and postpartum, minimal if any med reaches fetus

    disadvantages: maternal hypotension, fetal hypoxia, labor progress may be slowed, pushing efforts may be less effective, sometimes difficult to locate epidural space
  33. spinal anesthesia (intrathecal)
    injection of an anesthetic agent directly into the spinal fluid in the spinal canal to provide anesthesia for a vaginal birth or c/s

    advantages: immediate onset of anesthesia, provides good pain control for intra and postpartum, minimal if any med reaches fetus, uses smaller drug volumes.

    disadvantages: maternal hypotension, fetal hypoxia, spinal headache, reduces ability to push, temporary paralysis of affected areas, high spinal
  34. general anesthesia
    induced unconsciousness accomplished by intravenous meds and inhalation agents used for cesarean birth and surgical interventions for complications

    advantages: rapid induction may be necessary in cases of severe fetal distress, good uterine relaxation, patient is comfortable and unaware of surroundings during procedure

    disadvantage: fetal depression, risk of aspiration, pos-op nausea/vomitting common, post op pain control not as effective, delays bonding and breastfeeding
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Ch. 8 from notes
2013-02-17 21:53:31


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