labor Flashcards
True labor are:
- Regular, progressive, with increasing duration, intensity and decreasing intervals;
- With discomfort that starts from the back ( lumbosacral) radiating to the front;
- Intensified by walking and enema.
2. Show is present and increasing in true labor.
3. The cervix is open and increasingly dilatws and effaces. The presence of cervical dilatation and effacement is the most important sign of true
labor.
physiologic process during which the products of conception (the fetus, membranes, umbilical cord, and placenta) are expelled outside of the uterus. It is achieved with changes in the biochemical connective tissue and with gradual effacement and dilatation of the uterine cervix as a result of rhythmic uterine contractions of sufficient frequency, intensity, and duration.
Labor
Settling/ dropping of the presenting part into the pelvic inlet or true pelvis. And when the largest diameter of the presenting part passes the pelvic inlet or pelvic brim, the head is said to be engaged.
happens 10-14 days before labor in a primigravida and 1 day before labor or on the day of labor in multipara.
Lightening
Lightening is heralded by the following SIGNS:
- Relief of dyspnea
- Relief of abdominal tightness
- Increased frequency of voiding
- Increased varicosities
- Shooting pains down the legs/leg cramps.
Premonitory signs of labor
- Lightening
- Increased Braxton Hicks’ contractions 3-4 weeks before labor.
Braxton Hicks’contractions are false labor contraction, painless, irregular abdominal and relieved by walking.
3.A sudden burst of maternal energy/activity because of hormone epinephrine. - Slight decrease in maternal weight, about 2-3 lb. This is related to a drop in the water retaining hormone progesterone. If progesterone hormone drops before labor, retained fluid is excreted and thus, slight weight loss.
- Show. This is mucus mixed with small amount of blood from the torn capillaries of the cervix giving it a pink tint.
Show should be differentiated from bleeding. Show is not bleeding. Bleeding, no matter how slight, is still bleeding and is considered a danger sign. - Softening/ ripening of the cervix.
- Rupture of the bag of water is an occasional sign.
- Nesting behavior. This is a psychosocial sign of approaching labor. The woman is busy preparing for the arrival of the baby: sewing diapers, buying a crib, preparing mittens and bonnets, decorating a spare room for the baby.
The expectant mother should be counseled that the moment premonitory signs are noted:
> She should refrain from engaging in long trips,
she should have someone with her always in the home.
expectant mother should contact her doctor or midwife about labor or go to the hospital if:
*show is present
*Contractions are regular, more intense and becoming increasingly frequent occuring every 5 to 8 minutes: or
* The bag of waters ruptures. The rupture
of the bag of waters is always an indication for hospitalization.
True contraction
- Begins irregular but become regular and predictable.
- Felt first in the lower back sweep around to the abdomen in a wave.
*Continue no matter what the woman’s level of activity. - increase in duration, frequency and intensity.
- Achieve cervical dilation and effacement.
False contraction
- Begins and remain irregular.
- Felt first abdominally and remain confined to the abdomen and groin.
*Often disappear with ambulation and sleep.
*Do not achieve cervical dilatation.
components of labor
- passage
- passenger
- Power
4.Psyche - Position
refers to the route the fetus must travel from the uterus through the cervix and vagina to the external perineum, because these organs are contained inside the pelvis the fetus must also pass through the pelvic ring.
Passage
True pelvis 3 subdivisions
- Inlet or upper pelvic opening
- Mid-pelvis or pelvic cavity
- Outlet or lower pelvic opening
2 pelvic measurements are important to determine the adequacy of the pelvic size.
if adequate for fetal head
Diagonal conjugate- anterior posterior diameter of the inlet 11 cm or greater
Transverse diameter- 13 cm
is a condition where the baby’s head or body is too large to fit through the mother’s pelvis.
Cephalopelvic disproportion (CPD)
a technique that measures the size and shape of a woman’s pelvis to predict if she can give birth vaginally. It can be performed before or during labor and can be done using a clinical examination, X-rays, CT scan, or MRI.
Pelvimetry
functions of pelvis
> It provides protection to the organs found within the pelvic cavity.
It provide attachment of muscle, fascia and ligaments
Supports the uterus during pregnancy.
Serves as birth canal
types of pelvis
Gynaecoid pelvis
Justi minor pelvis
Android pelvis
Anthropoid pelvis
Platypelloid pelvis
This is the ideal pelvis for childbearing. it is one that is generally characteristic of a woman in its bone structure and therefore its shape. means like a woman, womanly, female. The female sacrum is wider than the male’s and the iliac bone is flatter.
Gynecoid Pelvis
This pelvis is like a gynaecoid pelvis in miniature. All diameters are reduced but are in proportion. It is normally found in women of small stature, less than 1.5m in height, with small hands and feet, but occasionally found in women of normal stature. The outcome of labor in this situation depends on the fetus. If the fetal size is consistent with the size of the maternal pelvis, normal labor and birth will take place.
Often these women have small babies and the outcome is favorable. However, if the fetus is large, a degree of cephalopelvic disproportion will result. The same is true when a malpresentation or malposition of the fetus exists.
Justo minor pelvis
female pelvis with masculine features, including a wedge or heart shaped inlet caused by a prominent sacrum and a triangular anterior segment.
The reduced pelvis outlet often causes problems during child birth.
male pelvis is more robust, narrower, and taller than the female pelvis. The angle of the male pubic arch and the sacrum are narrower as well. The female pelvis is more delicate, wider and not as high as the male pelvis. The angle of the female pubic arch is wide and round.
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android pelvis
This has a long, oval brim in which the anteposterior diameter is longer than the transverse. The side walls diverge and the sacrum is long and deeply concave. The ischial spines are not prominent and the sciatic notch is very wide, as is the sub-pubic angle. Women with this type of pelivs tend to be tall, with narrow shoulders.
Labor does not usually present any difficulties.
Anthropoid pelvis
kidney-shaped brim in which the anteposterior diameter is reduced and the transverse increased. The side walls diverge, the sacrum is flat and the cavity shallow. The ischial spines are blunt, and the sciatic notch and the sub-pubic angle are both wide
platypelloid pelvis
forms the anterior and lateral aspect of pelvis.
Innominate bones
the upper flaring portion which is the largest bone of the pelvis. Its upper, boarder the iliac crest, forms the hip bone.
Ilium
the portion located below the hip joint. Its ischial tuberosities supports the body in the sitting position.
ischium
the front bones. The pubes are connected by the symphisis pubis.
pubes
is the triangular shaped bone forming the triangular portion of the pelvis. It is composed of 5 sacral vertebra. The first sacral vertebra, the Sacral promontory is an important obstetrical landmark.
Sacrum
It is the posterior portion of the pelvis composed of the five fused vertebra. Its sacrococcygeal joints joins the sacrum to coccyx into the pelvic canal, it moves slightly backward to give more room for the fetal head.
Coccyx
the upper taring portion of the liac, its function is to provide support to the uterus during pregnancy and to direct the fetus to true pelvis during labor.
false pelvis
forms the passage way of the fetus during labor, it consists of the following parts.
true pelvis
12.5.cm diameter between the midpoint of sacral promontory to the lower margin of the symphisis pubis. Measured by internal examination.
diagonal conjugate
11 cm. distance between the midpoint of the of the sacral promontory to the midline of the symphisis pubis which is ascertained by subtracting 1 to 1.5 cm from the diagonal conjugate.
obstetric conjugate
situated between inlet ahd outlet. The pelvic and canal cy neture is confollow the ed i descent thine trated Radesigned
descent can result to rapture of cerebral arteries due to sudden change in pressure. Snugness of pelvic cavity compress the chest, helping to expel lung fluid and mucus.,
pelvic canal
(smallest diameter of pelvic)- 10cm
AP diameter at level of ischial spines-11.5cm
Posterior sagittal diameter- 4.5cm
Interspinous
the most important diameter of the outlet is its transverse diameter or Bi-ischial (distance between two ischial tuberosities) which is about 11.5cm
> Posterior sagittal diameter-7.5cm.
outlet
primary power in labor
uterine contraction
The uterine contraction is the primary power in labor. It is the one that effects the physiologic alterations in labor which are:
1.Cervical dilatation - opening/widening/enlarging of the cervical os from pir point opening to 10 cm (fully dilated cervix)
2. Cervical effacement - shortening/narrowing/thinning of the cervical canal from about 2.5cm to paper-thin or no canal at all.
3.Physiologic retraction ring - the separation or differentiation of the active, shorter but thicker upper uterine segment from the lower, longer but thinner, passive uterine segment.
In obstructed labor, the thinning of the lower segment is extreme that the retraction ring become prominent forming a pathologic retraction ring
Bandl’s ring
Uterine contractions are:
involuntary and
for most part is independent of extra uterine control
rhythmical
intermittent
regular
painful.
The exact cause of pain in labor is not known but several have been
Suggested
- Hypoxia due to circulatory stasis in the myometriun and adjacent tissues which may cause local oxygen deficit.
- Cervical stretching during dilatation
- Iraction on and stretching of the overlying peritoneum and uterocervical supports during contraction and expulsive efforts.
- Compression of nerve ganglia in the cervix and lower uterus by the tightly interlocking bundles.
- Emotional tension caused by fear and anxiety.
- Pressure by the presenting part on the bladder, bowel, or other sensitive pelvic structures
phases of uterine contraction
- Increment - the “ building up” of contraction; period of increasing cont-raction; the longest phase.
- Acme - the peak of a contraction - facial expression |painful
- Decrement - the period of “letting down” or decreasing contraction
characteristics of uterine contraction
duration
frequency
interval of rest
the length of time a contraction lasts; the time from the increment (start/increasing contraction) of one contraction up to the decrement (end /decreasing contraction) of the same contraction.
duration
- the time interval between the beginning of one contraction to the beginning of the next contraction.
frequency
as a characteristic of uterine contraction is the time from the end of one contraction to the start of the next contraction.
interval of rest
It corresponds to the period of rest of the uterus at which time it is to:
a. auscultate FHT
b. check maternal blood pressure
c. deliver the head in extension
refers to the strength of a contraction at acme. It is usually estimated by palpating the contraction. Judging the amount of indentability of the uterine wall during the acme of contraction, the midwife determines whether it is mild, moderate or strong.
If the uterine wall can be indented easily, the intensity is considered mild.
When the uterine wall cannot be indented, it is considered strong intensity.
Moderate intensity falls between these two ranges,
intensity
most important part
largest part of fetal body
head
is the fetus plus the membranes and placenta
Passenger
- a membranous interspace, joins the 2 parietal bones of the skull.
sagittal suture
junction of the frontal bones and 2 parietal bones.
coronal suture
junction of the frontal bones and 2 parietal bones.
coronal suture
the line of junction of the occipital bone and 2 parietal bones.
lambdoid suture
lies at the junction of the coronal and sagittal sutures.
anterior fontanelle (bregma)
covered spaces called the fontanelles are found at the junction of the main suture lines.
significant membrane
lies at the junction of the lambdiodal and sagittal suture, triangular.
posterior fontanelle
posterior fontanelle closes
age 1or 2 months. may already closed at birth
anterior fontanelle closes
between 9 months and 18 months
spaces between the 2 fontanelles
vertex
biparietal diameter average cm in term infants
9.5 cm
The diameter of the fetal head from the lowest posterior point of the occipital bone to the center of the anterior fontanel.
suboccipitobregmatic
suboccipitobregmatic diameters
9.5cm
occipitofrontal
11.5cm
submentobregmatic
9.5 cm
mentovertical
13.5cm
submentovertical
11.5cm
is the change in shape of the fetal skull produced by the force of uterine contractions pressing the vertex against the not yet dilated cervix.
• the bones of the skull are not yet completely ossified and therefore do not form a rigid structure the overlap and cause the head to become narrower but longer, facilitating its passage during birth.
molding
term used to describe the degree of flexion the fetus assumes or the relations of fetal parts to each other.
attitude
the spinal column is bowed forward, the head is flexed forward so much that the chin touches the sternum, the arms are flexed and folded on the chest, the thighs are flexed onto the abdomen, and the calves of the legs are presented against the posterior aspect of the thighs.
• this normal “fetal position” is advantageous for birth because it helps the fetus present the smallest anteroposterior diameter of the skull to the pelvis.
complete flexion
if the chin is not touching the chest but is in an alert or “military pos.”
this position causes the next widest anteroposterior diameter, the occipital frontal diameter, to present to the birth canal.
moderate flexion
presents the “brow” of the head to the birth canal.
poor/partial extension
the back is arched, the neck is extended and the fetus is in complete extension, presenting of the head to the birth canal.
full extension
refers to the settling of the presenting part of the fetus far enough into the pelvis to be at the level of the ischial spines, a midpoint of the pelvis.
• presenting part that is not engaged is said to be “floating.”
• one that is descending but has not yet reached the iliac spines can be said to be “dipping.”
engagement
- refers to the relationship of the presenting part of the fetus to the level of the ischial spine.
• ›when the presenting part is at the level of the ishial spines, it is at a O station (engaged)
station
0 station
engaged
›if the presenting part is above the spines, the distance is measured and
• described as minus station which range from -1 cm to -4 cm.
floating
›If the presenting part is below the ishial spines, the distance is stated as plus station
+1cm to +4cm
+3 +4
at the perineum and can be seen if vulva is separated
the relationship between the long axis of the fetal body, and the long axis of the woman’s body.
lie
either the head or buttocks of the fetus enters the pelvic first.
longitudinal line
exists when the long axis of the fetus is at the right angles t to the womans long axis. - perpendicular
transverse lie
is one that is at same angle between the longitudinal and the transverse lie.
oblique lie
4 types of cephalic
vertex
brow
face
mentum (chin)
3 types of breech presentation
comple
frank
footling
vertex
occipital
face
fetal mentum
breech
fetal sacrum
shoulder
scapula (acromion process)
rubin’s stage of maternal psychological adaptation
1.taking in phase- first 3 days post partum
focuse in self
2. taking hold phase- 3 to 10/ infant
3.letting go- 10 days to 6 weeks
generally show up 3 to 4 days after birth and may last for the few weeks after delivery.
• Signs:- 50% of women experience some feelings of overwhelming sadness.
• Mood swings, sudden crying episodes, irritability, anxiety, loneliness
post partum blues
It is moderate to sever depression in a woman after she has given birth. It may occur soon after delivery or up to a year later.
• Causes:-
• Women commonly have mood changes during pregnancy, especially after delivery.
• These mood changes may be caused by changes in hormone levels.
poat partum depression
is rare. Nevertheless, when it is experienced by anew mother, she might be scared or confused, once out of the psychotic state.
post partum psychosis
phases of 1st Stage of labor
- latent phase
- Active phase
- transition phase
• Begins at the onset of regularly perceived uterine contractions and ends when rapid cervical dilation begins.
• Contractions are mild and shorts, lasting 20 to 40 secs.
• Cervical effacement occur and cervix dilates from 0- 3 cm.
• The phase last approximately 6 hours in a nullipara and 4.5 in multipara.
Latent phase or preparatory phase
best time to teach breathing techniques and to give instruction bec.
The woman is still comfortable, cooperative and can still concentrate on conversation well.
latent phase or preparatory phase
normal duration of labor
primi- 12-24 hrs
multi-10 hrs
• Cervical dilatation occurs more rapidly, increasing from 4-7 cm.
• Contractions grow stronger, lasting 40-60 secs., and occur approximately every 3-5
mins.
• This phase last approximately 3 hours in nullipara and 2 hrs. in multipara.
• Increasing vaginal secretions and spontaneous rupture of membranes my occur.
active phase
Coach woman on breathing and relaxation technique, abdominal breathing is recommended
active phase
Contractions reach their peak intensity, occurring every 2-3 mins. With a duration of 60-90 secs and causing maximum dilatation of 8-10 cm.
ortif5el
• If the membranes have not previously ruptured or been ruptured by amiotomy, they will rupture as a rule at full dilatation.
• End of this phase, both full dilatation and complete cervical effacement have occurred.
• Most difficult period for the woman.
Transition phase
Reinforced breathing and relaxation technique.
Transition phase
epinephrine adrenalin
stress hormone
Catecholamines
excessive amounts of catecholamines may have deleterious effect like:
decreased efficiency of uterine contraction
longer labor
shunting blood away from the uterus and placenta
production of fetal catecholamines causes:
more blood to shunt to vital organs, increased oxygen uptake
helps to prevent fetal hypoglycemia.
CARE OF THE BLADDER
• A woman in labor should be encourage to void frequently, at least every 2 hours to prevent bladder distention because a full bladder:
• Delay fetal descent
• Predispose to urinary tract infection
• Prevent uterus from contracting
• Can be traumatized during labor
True labor to cervical complete dilatation
first stage of labor
Begins with complete dilatation and effacement of the cervix to birth of the infant.
• Contractions change from the characteristics of crescendo- decrescendo pattern to an overwhelming uncontrollable urge to push, blood vessel in the neck may become distended.
• As the fetus touches the internal side of the perineum, the perineum begins to bulge and appears tense.
• The anus may become inverted, and stool may be expelled.
• As the fetal head pushes against the perineum, the vaginal interitous opens and the fetal scalp appears at the opening to the vagina.
second stage of labor
• At first ,the opening is slit like, then becomes oval and then circular.
The circle enlarges from the size of a dime, then quarter, then half dollar this is called
crowning
prolong and difficult child birth
Dystocia
causes of dystocia
distended bladder
Cephalopelvic dispoportion
causes of dystocia
distended bladder
Cephalopelvic dispoportion
when to push
there is uterine contraction
there is cervical dilation 10cm
when not to push
At interval of contraction and in crowning. - to prevent rapid expulsion of head
2. Before complete cervical dilatation as this can result to the following:
a. greater maternal fatigue
b. added fetal strain
c. possible injury to the fetal presenting part.
d. possible injury to the cervix:
* Cervical edema due to chronic passive congestion which can further delay cervical dilatation and predispose to cervical laceration.
* Cervical bruising or trauma as it is forced against the symphysis pubis during pushing.
3. When the woman on labor has a cardiac disease.
pushing can cause more straining of the disease heart and can predispose to cardiac failure. The woman with cardiac disease will have minimal regional anesthesia to eliminate the spontaneous pushing and the pain of labor.
A cardiac mother will also have shorter second stage of labor as the physician is likely to use forcep extraction.
This results to woman’s closing her glottis, thereby increasing intrathoracic and cardiovascular pressure, definitely hazardous for a cardiac mother in labor.
valsalva maneuver
voluntary bearing down effort, a secondary power involved in labor.
pushing
cardinal movements of labor
descent
flexion
internal rotation
extension
external rotation
expulsion
is the downward movement of the biparietal diameter of the fetal head to within the pelvic inlet. Full blank occurs when the fetal head extrudes beyond the dilated cervix and touches the posterior vaginal floor. The pressure of the fetus on the sacral nerves causes the mother to experience a pushing sensation. it occurs because of pressure on the fetus by the uterine fundus. it may be aided by abdominal muscle contraction.
descent
descent occurs pressure from the pelvic floor causes the fetal head to bend forward onto the chest. The smallest AP diameter is the one presented to the birth canal in this flexion position. it is aided by abdominal muscle contraction during pushing.
flexion
during descent the head enters the pelvis with the AP head diameter in a diagonal or transverse position. The head flexes as it touches the pelvic floor, and the occiput rotates until it is superior, or just below the symphysis pubis, bringing the head into the best diameter for the outlet of the pelvis. This movement brings the shoulders coming next, into the optimum position to enter the inlet or puts the widest diameter of the shoulders in line with the wide transverse diameter of the inlet.
internal rotation
as the occiput is born, the back of the neck stops beneath the pubic arch and acts as a pivot for the rest of the head.
The head thus extends, and the foremost part of the head, the face and chin are born.
extension
almost immediately after the head of the infant is born the head rotates back to the diagonal transverse position of the early part of labor. The after coming shoulders is best for entering the outlet. The anterior shoulder is delivered first, assisted perhaps by downward flexion of the infant’s head.
external rotation
once the shoulders are delivered, the next of the baby is delivered easily and smoothly because of its smaller size. This expulsion and is the end of pelvic division of labor.
expulsion
an obstetrical procedure use to
control delivery of the fetal head and to prevent laceration.
ritgen’ manuever
Placental stage, begins with the birth of the infant and ends with delivery of the placenta.
third stage of labor
Placental stage, begins with the birth of the infant and ends with delivery of the placenta.
third stage of labor
2 Separate phases
A. Placental separation
• B. Placental expulsion
2 Separate phases
A. Placental separation
• B. Placental expulsion
Signs of placental separation
•
•
•
Change in shape of the uterus or calkin’s sign- earliest sign
Lengthening of the umbilical cord - Brandt andrews maneuver
Sudden gush of vaginal blood
Firm contraction of the uterus
Appearance of the placenta at the vaginal opening
Signs of placental separation
•
•
•
Change in shape of the uterus or calkin’s sign- earliest sign
Lengthening of the umbilical cord - Brandt andrews maneuver
Sudden gush of vaginal blood
Firm contraction of the uterus
Appearance of the placenta at the vaginal opening
2 types of placental seperation
schultze
duncan
the placenta separate first at its center and lastly at each edges, it tend to fold like an umbrella and presents at the vaginal opening with fetal surface, appearing shiny and glistening from the fetal membrane.
schultze
placenta separate first at its edges, it slides along the uterine surace and present at the vagina with the maternal surface, it looks like raw, red, and irregular, with the ridges or cotyledons that separate blood collection spaces showing.
duncan
placenta separate first at its edges, it slides along the uterine surace and present at the vagina with the maternal surface, it looks like raw, red, and irregular, with the ridges or cotyledons that separate blood collection spaces showing.
duncan
fetal side
amnion
maternal side
chorion
placental expulsion time
3-5minutes
using uterine fundus as a piston the separate placenta is pushed down ward to vagina.
modified crede’s maneuver
- tracking the cord slowly, winding it around the clamp until placenta comes out, rotating it slowly so that no membrane’s are left inside the uterus.
• Once the placenta is delivered, oxytocin(pitocin) is usually ordered to be administered intramuscularly or intravenously, it increases uterine contractions thereby minimizes uterine bleeding.
• Brant Andrew’s maneuver
placenta weighs?
500gs or one-sixth of the weight of the baby, at term.
It is about 20cm in diameter and 1 inch in thickness.
Is a surgical incision of the perineum that made both to prevent tearing of the perineum and to release pressure on the fetal head with birth.
episiotomy
2 episiotomy
midline episiotomy
mediolateral
less danger of complication from rectal mucosal tears.
mediolateral
appear to heal more easily, cause less blood loss, and less postpartal discomfort.
midline episiotomy
meperidine hydrochloride (demerol), morphine sulfate,
nalbuphine (nubain)
butorphanol tartrate (stadol)
narcotic analgesic commonly used
meperidine hydrochloride (demerol), morphine sulfate,
nalbuphine (nubain)
butorphanol tartrate (stadol)
Meperidine
is advantageous as an analgesic in labor bec. It has additional sedative and antispasmodic actions; these make it effective not only for relieving pain but also for helping to relax the cervix and providing a feeling of euphoria an exaggerated or abnormal sense of physical and emotional well being not based on reality or truth) and well being.
• It maybe given either IM or V, the dose is 25-100mg., depending on a woman’s weight and the route of administration, the drugs begins to act about 30 mins. After IM injection and about 5 mins. After IV administration. Its duration of act is 2-3 hours.
demerol
crosses the placenta, it can cause respiratory depression in a fetus, the drug crosses the placenta mins. after administration to the mother, however, bec. the fetal liver
5toto takes 2 to 3 hours to activate the drug into the fetal system, the effect will not be registered to ge in the fetus for 2 to 3 hours after maternal administration, so Demerol is given when the mother is more than 3 hours away more birth.
lumbar epidural
local anesthetic (ropivacaine/ naropin), administered for 1st stage of abor with contineous block, anesthesia will last through birth; injected @ L3-4. Effect on mother rapid onset in mins.; lasting 60-90 min; loss of pain perception for labor contractions and birth; possible maternal hypotension.
Local anesthetic lidocaine (xylocaine). Administered just before birth for perineal anesthesia; injected through vagina. Effects on mother, rapid anesthesia of perineum.
Pudendal block -
Local anesthetic lidocaine (xylocaine). Injected just before episiotomy incision. Effect on mother, anesthesia of perineum almost immediately.
Local infiltration of perineum-
Local anesthetic lidocaine (xylocaine). Injected just before episiotomy incision. Effect on mother, anesthesia of perineum almost immediately.
Local infiltration of perineum-
( Thiopental) administered IV by anesthesiologist or nurse-anesthetist. Effect on mother rapid anesthesia and rapid recovery.
General intravenous anesthetic-
The first 2-3 hours after birth.
4th stage of labor
nursing responsibilities 4th stage of labor
a. Transfer the patient from the delivery table.
b. Provide care of the perineum.
c. Transfer the patient to the recovery room.
• d. Ensure emergency equipment is available in the recovery room for possible complications.
• e. Check the fundus.
f. monitor lochia flow
g. observe mother for chills
h.monitor patient’s vital sign and general condition
j. Evaluate the perineal area for signs of developing edema and/or hematoma.
k. observe for signs of hemorrhage
l. assess for ambulatory stability
Predisposing conditions includes:
prolonged second stage, delivery of a large infant, rapid delivery, forceps delivery, and fourth degree lacerations.
A high, firm fundus usually displaced to one side often indicates
urinary distention- inhibit uterine contraction leads to postpartum bleeding
maternal discharge of blood, mucus, and tissue from the uterus.
lochia
small amount of lochia
less than 4 inch stain on peripad
moderate amount of lochia
less than 6 inch stain on peripad
heavy (large) amount of lochia
heavy amount saturated peripad within 1 hour
is vaginal discharge during the first 3 days. It is bright red in color, similar to menstrual bleeding, may be mixed with decidual fragments,and moderate in amount.
lochia rubra
is vaginal discharge on the days 4-10. it is still blood - tinged but now pale, serosanguinous, pinkish to brownish and light in amount. The added serous fluid and leukocytes give it the paler, watery color.
lochia serosa
vaginal discharge on days 10-14 or as late as day 21, but not uncommon for blank tolast until 6weeks post partum. It is mixture of decidual debris, leucocytes and decreased fluid content giving it characteristics whitish or yellowish-white color scant amount aftr 10th day.
lochia alba
vaginal discharge on days 10-14 or as late as day 21, but not uncommon for lochia alba tolast until 6weeks post partum. It is mixture of decidual debris, leucocytes and decreased fluid content giving it characteristics whitish or yellowish-white color scant amount aftr 10th day.
lochia alba
in 14th day the lochia is bright red it indicates?
laceration
return of uterus to pregnant state
involution
n.c- early ambulation- 24 hrs encourage/assist to ambulate
promote good circulation and promote faster healing of episiotomy
sitz-baths
