OB

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Author:
amber1026
ID:
7898
Filename:
OB
Updated:
2010-02-28 16:38:56
Tags:
Test 2
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Description:
Stages of Labor
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  1. critical factors in labor (5 p's)
    • passage
    • passenger
    • presenting part
    • physiologic forces of labor
    • psychosocial considerations
  2. three sections of the pelvis
    • inlet
    • mid pelvis
    • outlet
  3. four types of pelvis
    • gynecoid
    • android
    • anthropoid
    • platypelloid
  4. anthropoid pelvis
    oval, long A-P of inlet, shortened transverse, favorable for vaginal birth
  5. android pelvis
    male; heart shaped, all med-pelvic diameters reduced, reduced outlet
  6. platypelloid pelvis
    flat, short A-P and transverse diameters; mid-pelvic transverse diameter only normal one
  7. gynecoid pelvis
    normal female; round; favorable for vaginal birth
  8. factors affection the passenger
    • fetal head
    • fetal attitude
    • fetal lie
    • fetal presentation (presenting part)
    • fetal position
  9. types of fetal head sutures (passenger)
    • frontal
    • sagittal
    • coronal
    • lambdoidal
  10. frontal suture
    between the two frontal bones
  11. sagittal suture
    between the two parietal bones
  12. coronal suture
    between the frontal and parietal bones
  13. lambdoidal suture
    between the two parietal and occipital bones
  14. fetal attitude
    - def
    - normal
    - deviations cause?
    • relationship of fetal parts to each other
    • flexion of the head
    • difficulties to labor and delivery process
  15. fetal lie
    - def
    - normal is?
    - transverse is?
    relationship of the cepalocaudal axis (spine: head to toe) of fetus to that of the mother

    longitudinal

    fetal spine at right angles to mother's (results in a shoulder presentation)
  16. presentation
    - def
    - types
    • cephalic (head, vertex, brow, face)
    • breech (complete, footling or incomplete)
    • shoulder (transverse lie)
  17. relationship of maternal pelvis and presenting part (2)
    • engagement
    • station
  18. egagement
    - def
    - floating
    - dipping
    occurs when the largest diameter of presenting part reaches or passes through pelvic inlet

    balottable: freely moveable above pelvic inlet

    begins descent into pelvis
  19. station
    presenting part in relationship to ischial spines; at spines = zero
  20. position
    - def
    - charting notations used
    refers to the relationship of the landmark on the presenting part to the anterior/posterior (rt. or lft. sides) of maternal pelvis

    right, left, landmark and anterior and posterior (Ex. ROA - right, occiput, anterior)
  21. physiologic forces of labor
    - primary
    - secondary
    involuntary: uterine muscle contractions that cause cervial change during first stage of labor

    voluntary: use of abdominal muscles to push during second stage of labor
  22. normal FHT baseline
    110-160 bpm
  23. FHT variability
    - def.
    - important in?
    fluctuations of 2 cycles per minute or greater in the FHR and it is classified by the visually quantified amplitued of peak-to-trough in beast per minute

    indicator of fetal well-being
  24. when assessing the FHT determine
    • baseline (FHR during a 10 min pd round to 5bpm)
    • variability
    • if there are peridoic changes (associated with uterine ctx's) or episodic changes (not associated with ctx's)
  25. phases of contractions
    • increment - building up
    • acme - peak
    • decrement - letting up
  26. contractions:

    frequency -
    duration -
    intensity -
    • beginning of one ctx to the beginning of the next ctx
    • beginning to end of one ctx
    • mild, moderate, strong
  27. theories of labor
    • uterine overdistension
    • placental aging - declining estrogen/progesterone levels
    • increased production and senstivity to prostaglandins and oxytocin
    • increase in corticotropin - releasing hormone
  28. two portions of uterus in labor
    upper segment - fundus (contracticle portion becomes thicker and shorter)

    lower segment - lower part of uterus and the cervix (non-contractile, passive, expands and thins)
  29. cervial labor changes
    • effacement
    • dilation
    • bloody show
  30. effacement
    thinning, drawing up of internal os and cervial canal into the uterine walls
  31. dilation
    widening of os; caused by fetal axis and hydrostatic pressure as uterine longitudinal fibers are pulled over by the presenting part
  32. S&S of labor (premonitory signs)
    • braxton hicks contractions
    • lightening
    • cervical changes
    • energy burst/nesting behaviors
    • joint/back aches and pain; wt loss; GI upset
  33. signs of true labor
    • reg CTX; increasing frequency, duration and intensity shortening intervals
    • discomfort, usually from back to abdomen; increases with ambulation
    • progressive dilation and effacement
  34. false signs of labor
    • irreg CTX; usually no change in intesity; lower abdominal pain
    • discomfort usually no change with walking
    • no change in dilation and effacement
  35. stages of labor
    - first
    - second
    - third
    - fourth
    • beginning of true labor until full dilation
    • begins with full dilation until delivery of baby
    • after delivery of baby until expulsion of baby
    • 1-4 hrs after expulsion of placenta
  36. first stage of labor
    - work to be accomplished
    - forces
    - phases (3)
    • effacement and dilation of cervix
    • uterine ctx
    • latent - 0-4cm; active - 4-8cm; transition - 8-10cm
  37. latent phase
    - duration
    - ctx
    - show
    - behavior
    • avg is 5.3-8.6 hrs not to exceed 14-20 hrs
    • irreg; mild-mod; 3-30 min apart lasting 20-40 secs and 25-50mm Hg
    • clear plug to brownish/pink
    • excitement signpost; alert, follows directions, talkative, apprehensive
  38. active phase
    - duration
    - ctx
    - show
    - behavior
    • varies; should dilate 1.2-1.5cm/hr (2.4-4.6 hrs)
    • reg; mod-strong; 2-5 min apart; lasting40-60sec and 50-70mmHg
    • pink to bloody mucus
    • serious signpost; inner-focused; experiences pain/fatigue; desires companionship/support
  39. transition phase
    - duration
    - ctx
    - show
    - behavior
    • 1-2 hrs (3hrs if epidural in place
    • strong-very strong; 1.5-2 min apart, lasting 60-90 sec and 70-100mmHg
    • increase in bloody mucus
    • self-doubt signpost; chaotic, difficulty focusing, irritable, N&V
  40. second stage of labor
    - work
    - forces
    - duration
    - ctx
    - station
    - show
    - discomfort
    - behaviors
    • expulsion of fetus
    • CTX + bearing down efforts
    • 15 min-2hrs
    • strong; may be decreased intesity and frequency
    • crowning
    • same or increase in amt
    • strong urge to push if no regional anesthesia; may feel "tearing/ripping apart" sensation
    • intense concentration: may doze between CTX; may express relief that end is near; if prolonged; increase fatige and anxiety; decreased coping
  41. bearing down methods
    - valsalva
    - open-glottis
    • hold breath and push as long and hard as possible during the ctx
    • exhale gently while pushing with ctx
  42. pushing positions

    in order to restrain pushing
    • side
    • squatting
    • lithotomy
    • standing

    • side-lying
    • pant-blow breathing
  43. positional changes of fetus (cardinal movements)
    • descent
    • flexion
    • internal rotation
    • extension
    • restitution
    • external rotation
    • expulsion
  44. descent
    head engages and proceeds down birth canal
  45. flexion
    head flexed to the chest as it meets resistance from soft tissues of pelvis
  46. internal rotation
    - occiput of fetal head
    - occipant
    meets resistance from levator ani muscles

    rotates to bring the back of neck under symphysis
  47. extension
    back of neck pivots under symphysis

    to negotiate pelvic curve; head must change from flexion to extension and ehad is born
  48. restitution
    head returns to normal alignment with the shoulders, presents smallest diameter of shoulders to outlet
  49. external rotation
    shoulders rotate to the anteroposterior position in the pelvis, head is turned farther to one side
  50. expulsion
    after shoulders born; rest of the body delivers quickly

    birth of neonate is complete
  51. third stage of labor
    - work
    - forces
    - duration
    - discomfort
    - behaviors
    • expulsion of placenta (separation and expulsion)
    • uterine CTX and pushing
    • 5-30 min
    • slight cramping
    • excited; relieved; may cry; usually very tired
  52. signs of placental separation
    • globular-shaped uterus
    • rise of fundus in abdomen
    • sudden gush or trickle of blood
    • lengthening of umbilical cord
  53. placental expulsion
    - shiny shultz
    - dirty duncan
    - retained placenta
    fetal side presents; separates from inside to outer margins

    maternal side presents; separates from outer margins inward

    if third stage is >30 min
  54. maternal cardiovascular adaptations
    - cardiac output
    - CV system stressed by many factors:
    increases steadily throughout labor (31% increase in CO)

    • contractions - bearing down (pushing)
    • pain - apprehension, fear
    • position - side-lying, supine
  55. During bearing-down efforts using valsalva maneuver:
    - intrathoracic pressure _________?
    - venous return is ________; venous pressure is _______
    - transient rise in ____ and decrease in _____
    - continued diminished venous return causes decreases in ____ and ____
    • rises
    • reduced; increased
    • CO; pulse
    • BP and CO
  56. what reverses effects of valsava maneuver?
    when breath is taken
  57. repeated valslva may result in?
    inadequate O2 exchange and fetal hypoxia
  58. BP __________ and HR _________ during CTX; HR may _________ by second stage
    increases; decreases; increase
  59. Maternal pulmonary adaptations:
    - first stage
    - second stage
    - significant changes can?
    - changes reversed in ________ stage
    • hyperventilation (res alkalosis)
    • breath-holding (resp acidosis)
    • be harmful to fetus
    • fourth
  60. Maternal Renal adaptations:
    - renin and angiotensinogen _________
    - slight ___________
    - polyuria d/t increased ____ and ____
    - bladder pushed forward and up becomes _________
    • increase
    • protenuria not uncommon
    • CO and GFR
    • edematous
  61. Other Maternal adaptations
    - GI - gastric motility and food absorption _________; prolonged __________
    - Hematologic - WBC's and clotting factors ___________
    - Glucose - levels ________ which lead to _______ in insulin requirements
    • decrease; emptying time
    • increase
    • decrease; decrease
  62. Fetal Oxygenation depends on
    • normal maternal blood flow and O2 sat
    • adequate gas exchange in the placenta
    • open circulatory pathway in umbilical cord
    • normal fetal cirulatory and O2 carrying functions
  63. Fetal oxygenation may be compromised by
    • maternal cardio-pulmonary alterations
    • uterine activity
    • placental alterations
    • interruptions in cord blood flow
    • fetal alterations
  64. psychological factors to stages of labor
    • motivation for pregnancy
    • attitudes and expectations
    • self-esteem
    • response to pain and stress
    • usual coping mechanisms
    • support systems
    • trust in care-providers
    • psychological prep for birth
    • cultural influences
    • negative attitudes

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