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Normal Labor and Delivery Physiological Adaptations Presented by Ann Hearn.
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Transcript of Normal Labor and Delivery Physiological Adaptations Presented by Ann Hearn.
Normal Labor and DeliveryPhysiological Adaptations
Presented by Ann Hearn
LABOR
The Process by
which the Products of
Conception are expelled
from the body
Essential Factors in Labor
Passenger
PowersPassageway
Psychological
THEPASSAGEWAY
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
THE PELVIS
False Pelvis Supports the
weight of the uterus
Shallow basin above the inlet or brim
True Pelvis Represents the bony limits of the birth canal
True Pelvis vs. False Pelvis
True Pelvis Inlet - upper margin of pubic bone to
upper margin of sacrum
Outlet - Lower pubic bone to tip of coccyx. This area is the smallest portion that the baby must travel through.
THE
PASSENGER
And
PPRESENTATION
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
True or False?
The optimum lie of the fetus is the longitudinal lie.
A. True B. False
Fetal Presentation
That portion of the fetus that enters the Pelvis first and covers the internal os.
Three Types:Cephalic
Vertex, Face, BrowBreechShoulder
Cephalic = Occiput, posterior fontanel
Breech = Sacrum
Face = Mentum
Reference Points
Attitude
Relationshipof fetal body parts toeach other
Optimumattitude isflexion or ovoid
POSITION
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
ENGAGEMENT
Descent of the fetal presenting part in relation to the ischial spines of the maternal pelvis = 0 station.
Engagement
Engagement -largest diameter of
presenting part has passed through the pelvic inlet
- Assessed during vaginal exam
Ballotable
Engaged
Station
Station- degree that the presenting part has
descended into the pelvisin
Relationship to ischial spines
Goal• Move from – to + stations
Test Yourself !
What is the reference point of a cephalic presentation when the head is fully flexed?A. occiputB. mentumC. frontald. 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
POWERS
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
of Labor with pushing. Increase intra-abdominal pressure to aid in expulsive forces
THE
PSYCHOLOGICAL
FEARFEARTENSIONTENSION
PAINPAIN
BREAK THE CYCLE !
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 or buttock Step 4 - Turn and face the woman feet, using both
hands palpate lower abd. for cephalic prominence or brow.
Ausculation
Assess for the area of greatest intensity of the FHR.Usually best heard at the fetal back
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
Presentation – presenting part (head/buttock)
Position – fetal head (OA, OP etc.)Condition of Membranes – ruptured or
intactDilation - enlargement & 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 (-, 0, +)
Engagement -largest diameter of presenting part has passed through the pelvic inlet
Station
Station- degree that the presenting part has
descended into the pelvisin
Relationship to ischial spines
Goal• Move from – to + stations
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 ________ _________ (bony structure) 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 accommodate to this rigid passageway______________.
CAUSES OF LABOR
Increase in EstrogenDecrease in Progesterone
Degeneration of Placenta
Over-distention of Uterus
High levels ofProstaglandins
Myometrial ActivityMyometrial Activity
Effacement- thinning of the cervix (%)Dilation – enlargement and widening of the os (cm)
FORCES OF LABOR
Contraction -exhibits a wavelike pattern that begins slowly climbing (increment) to a peak (acme), and decreases (decrement)
Incremen
tacme
Decrement
FORCES OF LABOR
Incremen
t acme
DecrementDuration
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
Uterine Contraction - review
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 (EFM)
Duration of Labor
Resistance of the Cervix Presentation and position of the
fetus, The woman’s pelvis Preparation and relaxation of the
mother Primigravida - up to 22 hrs; average 12 1/2 hrs Multigravida - 8 - 17 hrs; average 10 hrs.
Premonitory 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 (Braxton Hicks)
SHOW
Rupture of Membranes (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
* No change or decrease with walking* Contractions felt in abdomen above umbilicus Braxton Hicks
No change in cervix Fetus is ballotable
Phases 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
Signs of Second Stage of Labor
Complete dilatation of cervixUrge to bear downPerineum begins to bulge, flatten and move anteriorlyIncrease in bloody show Rectal pressureLabia begins to part with each contraction
Mechanisms of Labor/ Cardinal Movements
Signs of Stage Three of Labor
The End
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