MATERNAL AND CHILDSKILLS LAB

FIRST MANEUVER

NORMAL FINDINGS

SECOND MANEUVER

NORMAL FINDINGS

THIRD MANEUVER

NORMAL FINDINGS

FOURTH MANEUVER

NORMAL FINDINGS

MOVIE CLIP OF LEOPOLD’S MANEUVER

CARDINAL SIGNS OFF LABOR / MECHANISMS OF LABAOR

ENGAGEMENT DESCENT FLEXION INTERNAL ROTATION EXTENSION EXTERNAL ROTATION EXPULSION

(ED FIRE ERE)

CARDINAL / MECHANISMS OF LABOR

STAGES OF LABOR

STAGE

PHASE DILATATION

DURATION / INTERVAL

INTENSITY

1S

T STAGE

PHASE I : Latent 0-3 cm 20-40sec, 5-30mins

Mild to Moderate

PHASE II : Active 4-7 cm 40-60sec, 3-5mins Moderate to Strong

PHASE III : Transition

8-10 cm 60-90sec, 2-3mins Strong

PHASE STATION CONTRACTION

2ND STAGE

PHASE I 0 to +2 2 to 3 minutes apart

PHASE II +2 to +4 2 to 2.5 mins apart with urgency to bear down

PHASE III +4 to birth

2 mins apart; fetal head visible increased

3RD STAGE

PLACENTA DELIVERY – Sudden gush of blood, lengthening of the cord, rising of the fundus, globular uetrus.2 PHASES: 1. placental separation 2. placental expulsion

4th STAGE

First 4 hours after delivery of the placenta *vital signs, fundus and lochia monitoring every 15 minutes until stable*

NURSING MANAGEMENT DURING LABOR

Vital signs and FHR Provide comfort measures ( ambulate and if BOW not yet ruptured ,

left side lying is the most comfortable position and provide sacral pressures and back rubs) Note: left side lying position prevents vena cava syndrome

Breathing technique during transition phase: Take a deep breath and exhale slowly and completely. At the

beginning of contraction, take a fairly deep breath. Then engage is shallow breathing. If there is an urge to push, puff out every 3rd, 4th, or 5th breath. Take a deep breath at the end of contraction.

Placental delivery may take 5 – 10 minutes ( maximum 20 minutes). Either by Duncan (dirty presentation of the uterus) or schultze ( shiny glistening). Evaluate placental completeness( up to 30 cotyledons, weighing about 400 to 600 grams (1lb) and is 1/6 of the fetal weight.

Credes maneuver is gentle pressure on the contracted uterine fundus ( never on the non-contracted state or the uterus may evert and lead to hemorrhage). Meanwhile, Brandth-Andrew maneuver is pushing the uterus upward while gently pulling the cord downward to deliver the separated placenta. (preferred method of placental delivery)