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What is the purpose of Leopold's maneuvers
- To determine presentation and position of the
- fetus and aid in location of fetal heart sounds
First step for Leopold’s
- Palpate fundus:
- distinguishes between a cephalic (buttock on fundus) and breech (head on fundus) presentation.
Second step for Leopold's maneuvers
- Palpate the Left and Right
- sides of uterus. Determines which side of the uterus has the fetal back and which side has the fetal arms and legs
Third step for Leopold's maneuvers
Palpate the suprapubic area (pubic hair area). Confirms the presentation and determines whether the presenting part is engaged (0 to -5).
Fourth step for Leopold's maneuvers
- Place hands on uterus with fingers pointing down towards the pelvic inlet. Determines whether the
- head is flexed (vertex) or extended (face). The forehead felt on opposite side of the back if baby in vertex and same side if extended (face).
First cardinal movement (mechanism of labor)
- Descent of presenting part of fetus to true
Second Cardinal Movement
- Presenting part of fetus reaches the ischial spine
- Station of presenting part is 0 or lower (-5 to 0 cm)
Third Cardinal Movement
- Head is flexed to so that smallest diameter of the head is aligned with the smaller
- diameter of the mid pelvis
Fourth Cardinal Movement
- Internal Rotation
- Internal rotation allows the largest head diameter to align with largest pelvis
Fifth Cardinal Movement
- The resistance of the pelvic floor and the pivoting action of the pubic symphysis
- causes the fetal head to extend with each push.
Sixth Cardinal Movement
- External Rotation
- Head rotates and aligns the head with the fetus’ shoulder. When the head externally rotations, the
- shoulders internally rotate to align.
Seventh Cardinal Movement
Expulsion of the body
Three types of Vaginal examination
Dilation, Effacement, Station
- latent 0-3 cm
- active 4-7cm
- transition 7-10cm
- the softening, thinning, and shortening of the cervical canal as it is drawn up into the body of the uterus by labor contractions
- Thinning of the cervix (head descends). 0-100%
- It is 100% during active phase of first stage (begins the cardinal movement during this phase).
- Describes the descent of the fetal presenting part in relation to the level of the ischial spine. Determines whether or not the fetus' head is engaged.
- Scale is +5 to -5.
- Engaged when it's 0 to -5 (coming out).
- Ballotable if +5 to +1 (still inside)
Premonitory signs of labor are
- Braxton Hicks Contractions
- Increased Vaginal Mucous secretion
- Cervical ripening and bloody show
- energy spurt
- weight lost
What is Braxton Hicks contraction?
Irregular, mild uterine contractions that occur throughout pregnancy that make it seem like labor is coming when it isn't. It becomes stronger in the last trimester.
What is Lightening?
- Fetus moves down, so mother can breathe more
- easily but pees more frequently due to increased pressure, causing leg cramps and edema.
- Most noticeable in nulliparas and occurs 2-3 weeks prior to labor
What is Cervical Ripening and bloody show?
- Cervix softens due to relaxin and increased water content.
- Effacement and dilation causes expulsion of mucous
- plug that sealed cervix during pregnancy, rupturing small cervical capillaries (bloody).
What is energy spurt?
- Sudden increase in energy also called "nesting".
- Women should save energy for labor
Why do women lose weight before labor?
Altered estrogen and progesterone ratio causes excretion of extra fluid. Lose about 2.2-6.6 lb (1-3 kg).
Factors affecting labor (5 P's)
Passenger, Passageway, Powers, Positioning, and Psyche/Psychologic response
What are the two components of Power?
- Uterine contraction (occurs during first stage of labor). Primary force
- Maternal pushing effort (occurs during second stage of labor when cerrvix is fully dilated). Secondary force
What is Passageway?
The passage is determined by maternal pelvic anatomy—the bony pelvis and the muscles of the pelvic floor and perineum
- Consists of maternal pelvis and soft tissues. Softening of cartilage linking the pelvic bone occurs near term due to the increase of the hormone relaxin
- Linea terminalis (pelvic brim) divides false and true pelvis
- True pelvis is most important during childbirth
- 3 subdivisions of true pelvis: Inlet (upper opening), Midpelvis (pelvic cavity), Outlet (lower pelvic opening)
Three subdivision of true pelvis
What is the passenger?
Consist of the fetus, membranes and placenta.
Factors that affect the passenger
- The anteroposterior diameter of the head (varies with the degree of flexion) is most favorable in suboccipitobregmatic (9.5cm)
- The fetal lie (orientation of fetus to mother): longitudinal, transverse and oblique)
- Attitude: Flexion (good)
- Presentation: Fetal part that first enters the pelvis
Different Presenting parts
Cephalic (common and most favorable because it can mold, and effective part to dilate cervix), Breech and shoulder.
Four different Cephalic presentation
- Vertex: most common and favorable because smallest diameter of head (suboccipitobregmatic) is presenting. Head is fully flexed, also called occiput presentation.
- Military: neutral head position (not flexed/extended). occipitofrontal diameter.
- Brow: partially extended, can turn into vertex/face. supraoccipitomental diameter
- Face: Head is extended. Submentobregmatic diameter.
What is breech presentation?
Buttock presenting first, more commonly in preterm fetus or fetus with abnormalities and abnormalities of maternal uterus and pelvis and with placental previa (placenta in lower uterus).
Complication of breech presentation
- Umbilical cord can be compressed after fetal chest is born.
- Head must be delivered quickly to allow the infant to breathe.
- It does not permit gradual molding of fetal head
Three different types of breech presentation
- Frank: most common where fetal legs are extended across the abdomen towards the shoulder
- Full (complete): reversal of cephalic presentation.
- Footling: one or both feet presenting.
What is Positioning?
The location of a fixed refrence point on the presenting part in relation to the four quadrants of the maternal pelvis. Right anterior, left anterior, right posterior and left posterior.
Different types of Positioning
- Occiput/Mentum/Sacrum (can be Sc-scapula for shoulder presenting or F-fonto for brow presenting)
- 16 different combination: LOA, ROA, LOT, ROT, LOP, ROP, LMA, RMA, RMP, LMP, LSA, LSP, RSA, RSP, brow and shoulder.
What are Psyche/Psychologic response?
- Cultural values, how birth is seen as (healthy/sick or joyful/sadness-unwanted or accident), Support group, anxious or relaxed.
- Maternal catecholamines, excreted during anxiety and fear, inhibit uterine contractility and placental blood flow. (birthing process is easier when relaxed).