Post on 28-Dec-2015
Fetal HeadFetal Head
Because of its size and rigidity, the Fetal Head has a major impact on delivery.
The bones are not firmly united. There are sutures between the bones that allow them to overlap or MOLD to the birth canal.
Head also can rotate, flex, and extend
Fetal Lie
Relationship of the long axis of the fetus to the long axis of the mother.
Longitudinal Lie Transverse Lie
Fetal Presentation
That portion of the fetus that enters the Pelvis first and covers the internal os.
Three Types:Cephalic
Vertex, Face, Brow
BreechShoulder
POSITION
Relationship of the Fetal Presenting Part to the Maternal Pelvis
Steps: 1. Determine the Presenting Part
2. Divide the mothers pelvis into 4 imaginary quadrants
A
P
12
L3
6
9R
Test Yourself !
What is the reference point of a cephalic presentation when the head is fully flexed?A. occiput
B. mentum
C. frontal
d. sagittal
Overlapping of the fetal skull to facilitate its passage through the bony pelvis is ___________.
Relationship of fetal body parts to each other is_____________.
Head first presentation is_________________. Relationship of the fetal spine to the maternal
spine is ________________. Term that refers to the part of the fetus that
enters the pelvic inlet first is _____________.
Test Yourself
THE PELVIS
Determine if the pelvic cavity is of adequate size to allow for the passage of the full term infant
Optimum shaped pelvis is Gynecoid
True Pelvis vs. False Pelvis
False Pelvis Supports the weight of the uterus
Shallow basin above the inlet or brim
True Pelvis Inlet - upper margin of pubic bone to upper
margin of sacrum
Outlet - Lower pubic bone to tip of coccyx
Major Powers Involved
Involuntary Uterine Contractions or Primary Powers Muscular contractions which lead to dilation
and effacement in the First Stage of Labor
Voluntary Uterine Contractions or Secondary Powers Abdominal muscles assist in the Second Stage
with pushing. Increase intra-abdominal pressure to aid in expulsive forces
Techniques for Assessment
Abdominal Palpation / Leopold’s Maneuver Standing on the Right side, face the woman and
palpate with the palms of the hands. Step 1 - Start at upper fundus and palpate for the
head or buttocks Step 2 - Go down each side and locate back Step 3 - Gently grasp lower portion of uterus and
feel for the head Step 4 - Turn and face the woman and repeat the
steps.
True or False ?
If the fetal heart tones (FHT’s) are heard loudest (PMI) in the patient’s upper right quadrant of her abdomen, the fetus would be assessed for a breech presentation.
A. True
B. False
Vaginal Examination
PresentationPositionCondition of Membranes --ruptured or
intactDilation - enlargement and widening of os ( cm.)Effacement- thinning of the cervix (%)
Vaginal Examination
Station- degree that the presenting part has descended into the pelvis. Relationship to ischial spines
Engagement -largest diameter of presenting part has passed through the pelvic inlet
Critical Thinking
If the fetal head did not descend through the pelvis and stayed at the same station for a prolonged period of time, what do you think would be the treatment of choice?
Try this !
When the cervical os widens or opens it is said to________.
The level of the ________ _________ is station zero.
The most common type of pelvis for a woman ___________.
When the cervix shortens and thins is _______________.
For delivery to occur, the fetus must accomodate to this rigid passageway______________.
CAUSES OF LABOR
Increase in EstrogenDecrease in Progesterone
Degeneration of Placenta
Overdistention of Uterus
High levels ofProstagladins
FORCES OF LABOR
Contraction -exhibits a wavelike pattern that begins slowly climbing (increment) to a peak (acme), and decreases (decrement)
Incr
emen
tacme Decrem
entDuration
Frequency
Duration- from beginning of one contraction to the end of the same contractionFrequency- from beginning of one contraction to the beginning of another contraction
Interval
Interval - Resting time between contractions for placental perfusion
Fill in the blank ! Fill in the blank !
Length of a uterine contraction__________.
Strength of a uterine contraction is ___________.
The time from the beginning of one contraction to the beginning of the next contraction is _______.
The time that allows for placental perfusion is __. The peak of a contraction is also known as ____.
When the biparietal diameter of the head passes through the pelvic inlet it is said to be ________.
Assessment of Contraction
1. Subjective symptoms by woman
2. Palpation and timing by the Nurse
3. Use of Electronic Fetal Monitor
Duration of Labor
Resistance of the Cervix Presentation and position of the
fetus, the mother’s pelvis Preparation and relaxation of the
Mother Primigravida - up to 22 hours; ave. 12 1/2 hrs
Multigravida - 8 - 17 hours; ave. 10 hrs.
Premonitory Signs of LaborPremonitory Signs of Labor
The impending signs that take place the last several weeks of pregnancy or even the last several days
Premonitory Signs of Labor
LIGHTENING
FALSE LABOR PAIN
SHOW
ROM
BACKACHE
DIARRHEA
SUDDEN INCREASE IN ENERGY
True vs. False Labor
TRUE LABOR Contractions are: * Regular *Increase in intensity and
duration with walking
*Felt in lower back, radiating to lower portion of abdomen
Bloody show Dilation and effacement Fetus usually engaged
FALSE LABOR Contractions are
irregular Often stop with walking Contractions felt in
abdomen above umbilicus (abdominal pains)
No change in cervix Fetus is ballotable
Phases and Stages of LaborPhases and Stages of Labor
Stage 1 0 - 10 cm. Phase 1 - Latent - dilate 0 - 3 cm. Phase 2 - Active - dilate 4 - 7 cm. Phase 3 - Transition - dilate 8 - 10 cm
Stage 2 - From complete dilation and effacement to delivery of the baby Stage 3 - From delivery of baby to the delivery of the placenta Stage 4 - the first hour after delivery