L&D Flashcards
Powers
Primary- effacement, dilation, freguson reflex
Secondary- bearing-down efforts
Four P’s
Passenger
Passageway
Powers
Psychologic response
Passage
birth canal- bony pelvis, lower uterine segment, cervix, pelvic floor muscle, vagina, introitus
Passenger
size of fetal head fetal presentation fetal lie fetal attitude fetal position
Stage 1 of labor process
onset of regular uterine contractions to complete dilation & effacement
Stage 2 of labor process
complete dilation to birth of infant
Stage 3 of labor process
birth of the infant to delivery of the placenta
Stage 4 of labor process
approx. 2 hrs after placenta delivery
7 cardinal movements of mechanism of labor
engagment descent flexion internal rotation extention external rotation expulsion
latent phase
up to 3 cm
active phase
4-7 cm
transition phase
8-10 cm
BUBBLE HE
Breast Uterus Bowel Bladder Lochia Episitomy Homans- DO NOT DO ANYMORE; look for S&S of clotting Emotions
Rubria
Bright red
day 1
Serosa
pink to brown
day 3
can last 22-27 days
Alba
white to yellow
day 10
can last 4-6 weeks
contractions of muscle fibers
catabolism
regeneration of the uterus epithelium
3 processes of uterine involution
REEDA
Redness Edema Ecchymosis Discharge Approximation
Taking-in phase
mother is focused on her own needs
letting go phase
parents relinquish fantasies about their infants
S&S postpartum hemorrhage
difficult to locate fundus, boggy uterus, fundus above expected level, excessive lochia & clots
bacterial infection after childbirth
puerperal infection
Normal WBC range after birth
14000-16000 mm3
can reach as high as 30000 mm3
fundus descend
after birth midway btwn symphysis pubis & umbilicus
12 hrs later- rise to level of umbilicus
descend 1cm/day
14th day not palpable
return of mensus???
Formula- 40-45% in 6-8 wks; 75% in 12 weeks; all within 6 mths
Boob- as early as 12 wks or as late as 18 mths
anticipatory stage- of role attainment
begins during pregnancy- choosing doc, hospital, classes
formal stage- of role attainment
birth of infant to 4-6 weeks
this is largely guided by others
informal stage- of role attainment
mother learns appropriate responses to their infant’s cues & signals
personal stage- of role attainment
sense of harmony in role, enjoys infant, sees infant as central person in life & has internalized the parental role
drugs used to treat uterine atony
pitocin
methergine
hemabate
dinoprostone (cytotec)
major signs of subinvolution
prolonged discharge of lochia irregular or excessive uterine bleeding profuse hemorrhage pelvic pain or feelings of pelvic heaviness backache fatigue persistent malaise bimanual examination of the uterus feels larger & softer than normal
S&S of superficial venous thrombosis
swelling of the involved extremity & redness
tenderness & warmth
palpate an enlarged, hardened, cordlike vein
may have intermitted caudation or no pain @ all
S&S endometritis
temp of 38*C or higher within 36 hr of birth
chills, malaise, anorexia, ABD pain, cramping, uterine tenderness & purulent, foul smelling lochia, tachycardia & subinvolution
Umbilical Vein
within days
Ductus Venosus
within days
Foramen Ovale
within minutes
Ductus arteriosus
within hours
Umbilical Artery
within hours
changes in the shape of the head that allow it to pass through the birth canal
disappears with a few days
molding
localized edema in the newborns head, as a result of the pressure against the mothers cervix, crosses suture lines, disappears 12-48 hrs
caput succedaneum
bleeding between periosteum & skull, result of pressure during birth, occurs on one or both sides of head, does not cross the suture lines, 2-3 mth to resolve; greater risk of jaundice development
cephalhematoma
first voiding occur
NB- 12-24 hrs, few within 48 hrs
void 1-2 times during first 2 days
@ least 6X/day by the 4th day
prophylactic medications given to NB
Vitamin K & erythromycin
rich in protein, vitamins, minerals, immunoglobulins
protects GI tract from infection, establishes normal flora, speeds passages of meconium
colostrum milk
has less protein & immunoglobulins, but more lactose, fat & calories than colostrums
2-3 days after birth
transitional milk
appears less rich than the colostrums/transitional milk
blue color, still supplies all needed nutrients
mature milk
