Clinical 1 Normal Labor and Delivery Flashcards
Def of labor
Progressive Cervical Effacement, Dilatation or both
due to regular uterine contractions
(occur every 5 mins & last 30-60 secs)
Cervical Effacement
“Thinning of the cervix” as it is taken up into the lower uterine segment.
Usually begins prior to labor.
Usually results in the “Bloody Show” where the mucous plug from the cervix mixes with blood.
Caput
Localized, edematous swelling of the fetal scalp. Is caused by pressure of the cervix on the presenting portion of the fetal head.
First stage of labor
From the onset of true labor to complete cervical dilatation.
2nd stage of labor
From complete cervical dilatation to birth of the baby.
Pt is fully dilated. Usually has urge to push.
Duration
Primigravids 30 min to 3 hrs. Median 50 minutes.
Multigravids 5 to 30 minutes. Median 20 minutes.
Completed when baby is born.
3rd stage
From birth of the baby to delivery of the placenta.
4th stage
From delivery of the placenta to stabilization of the patient. (Usually 6 hrs post partum. or 1 hr post partum).
LATENT PHASE-
consists of cervical effacement and early dilatation. Considered completed at 3cm dilatation.
ACTIVE PHASE
- Begins when cervix is 2-4 cm dilated in the presence of regular contractions. Consists of an acceleration, max slope & a theoretical deceleration component.
Know slide 29
KNOW IT
Management of 1st stage
May Ambulate with intermittent monitoring
I.V. Fluids Only (emergencies and pitocin)
Labs (CBC, Type and Rh, Urine for glucose and protein.
Vitals q 1-2 hours.
Analgesia ( Epidural, I.V. Morphine etc..) usually not during latent phase.
FETAL MONITORING (low risk)
every 30 minutes in active phase of Stage 1.
every 15 minutes in 2nd Stage.
With Some Obstetrical risk factors
q 15 minutes in active phase
q 5 minutes in 2nd stage.
HIGH RISK - NECESSITATES CONTINUOUS MONITORING.
If patient is on Pitocin for induction or augmentation, she should be monitored extensively.
Vaginal Exams q 2 hours in active phase or more often as warranted. (Beware the risk of chorioamnionitis if membranes are ruptured.)
Amniotomy -artificially breaking the bag of water. (when labor is advanced) Good for assessing fluid. May speed up labor.
6 cardinal movements
DESCENT FLEXION INTERNAL ROTATION EXTENSION EXTERNAL ROTATION EXPULSION
Descent
Results from the forces of the uterine contractions
is continuous until delivery of the fetus
Flexion
Natural muscle tone of the fetus
resistance from cervix, walls of the pelvis and pelvic floor
Internal rotation
when the fetal head turns anteriorly towards the symphysis pubis from the transverse or oblique diamter.
occurs at the pelvic floor when the head meets the muscular sling of the pelvic floor
Extension
During descent, the fetal head will extend as it meets the vaginal outlet whic his directed upward and forward
“crowning” the bulding of the perineum which indicates that the largest diameter of the fetal head is encircled by the vulvar ring
External rotation
The rotation of the fetal head back to it’s original position at the time of engagement to realign itself with it’s back and shoulders.
expulsion
Usually Anterior shoulder under pubic symphysis
Posterior Shoulder
Rest of fetus in rapid succession.
Management of the second stage
Position- Comfortable as long as fetus can be monitored and mother is able to push.
Monitoring- Continuous is preferred but intermittent may be allowed.( Decelerations may be noted.)
Vaginal Exams- q 30 minutes (more frequent as warranted).
Delivery of the Fetus
Ritgen’s Maneuver- controls delivery of the head. Fingers of one hand press posterior to the rectum extending the fetal head. Counterpressure is applied to the occiput.
Episiotomy- provides greater room to facilitate delivery. 2 types
Midline
Mediolateral
Delivery of the Fetus -continued
After delivery of the head- suction mouth then nares.
Check for Nuchal Cord, Downward traction, Upward traction, traction on shoulders until delivery is completed.
Clamp and Cut Cord.
3rd stage of labor
Delivery of the Placenta - 0 to 30 minutes.
Separation usually occurs at 2 to 10 minutes.
Signs include; Fresh show of blood from vagina, lengthening of umbilical cord, elevation of fundus, uterus becomes firm and globular.
3rd stage management
Inspection of cervix and vagina for lacerations.
Do not pull on cord (Inversion of uterus)
Bleeding Control
Massage
Pitocin, Methergine and Prostaglandin F2 Alpha.
Manual Extraction, D&C
Repair of Episiotomy and or Lacerations.
Laceration Types
1st degree- vaginal epithelium or perineal skin.
2nd degree- extends into subepithelial tissues of vagina or perineum. w/wo perineal body.
3rd degree- anal sphincter
4th degree- rectal mucosa.
Absorbable Sutures
4th stage of labor
1-6 hours after delivery.
1st hour is most important
watch for bleeding, hematoma (pelvic or rectal pain).
increased pulse rate out of proportion to decreased blood pressure.
Indications for induction
Maternal: Preeclampsia, diabetes, heart disease
Indications for augmentation
Abnormal labor (in the presence of inadequate contractions) prolonged latent or active phase
