maternity Week 2-PPT Flashcards
what is neonatal abstinence syndrome and why does it occur
when the infant is also addicted to the substance the mom is using and must go through withdrawal after brith
most illicit drugs have small molecular weight and can cross the placenta
is it better to have just one person woring with substance use mom or team approach
team
is it a good time to change drug use habits during pregnancy?
Women are more motivated to change their substance use during preg more than any other time
durin labour something very small deviates from normal what do yu do
you MUST consult with the dr
during labour how often are you doing and documenting your H2T on mum and fetus
q15 or even q5
how can you preserve personhood for complex labour/birth/preg
- try to include her birth plan as much as possible
- explain if you have time. if you dont then make sure to go back later and let her talk
- remember its ++special and important for the family
- privacy and modesty
- include their supports
how are the parts of labour divided
2 stages
- latent
- active
active stage has 4 phases 1st –labouring and dilation 2nd –pushing, descent and delivery 3rd -placenta delivers 4th -hemostasis established after delivery of baby and placenta
when a woman is in the latent phase of labour what can she still do
quality of her contractions?
how is her pain?
You can still walk
You can walk and eat light meals
Its tiring
Prevents you from going into deep sleep
The contractions have no pattern. They are all over the place
You have discomfort like menstrual cramps
consideration for those who have long latent phase of labour
they are often very tired and have less energy for active phase
how are contractions in gen during active phase
how long should they last?
Contractions should last 60 seconds
They dont go away. You cant stop them
Theyre uncomfortable to the point you cant talk through them
You need supports to get through them]wont go away with hot bath
what is the max that you want the active phase of labour to be
-what cervical dilation does this start at
8-10hrs
Starts when cervix 2-4cm dilated + thinned
what is the first stage of active labour
1st –labouring and dilation
what is the second stage of active labour and how long should it last
Pushing descent and delivery
Norm is 2hrs. Much longer and alarm bells go off
3rd stage of active labour. what occurs?
timeframe?
major risk?
3rd -placenta delivers
Hemorrhage happens at this stage
Should not take more than half an hour
If placenta hasnt been delivered after 30mins likelihood of hemorrhage is very high
4th stage of active labour and what occurs
4th -hemostasis established after delivery of baby and placenta
(i think this is when the blood vesels are clamping off in her uterus and protecting her from hemmorhage
what are the 4 ps of labor
Power ((uterine contractions))
Passenger (the fetus)
Passage (the birth canal)
Psyche (the woman and family perception of the event)
what is dystocia
a difficult labour which can arise from any of the 4 main components of the labour process
what does dystocia increase the risk of
which of these problems are most emphasized
Infection Hemorrhage Uterine rupture Fistula development Future urinary and fecal incontinence for the mother Infant mortality and morbidity Fetal anoxia
Fetal hypoxia and anoxia standout
hemmorhage and infection too
why infection from dystocia
When labour takes too long we might introduce infection by doing many exams eg vaginal/cervical exam!
when labour takes too long what problems does this pose
- uterine muscle is tired
- mum and babe very tired and inc risk of anoxia and hemmorhage
what is it called when labor is being sluggish
used to be called inertia is now called
Dysfunctional Labour
why is dysfunctional labour a risk
why does it occur
it inc risk of postpartal infect, hemmorhage, infant mortality
prolonged labor appears to result from multiple factors. most likely if lg fetus.
hypotonic and hypertonic and uncoordinated contractions all play aditional roles
risk factors for a problme with the powers
Advanced maternal age Adolescents Women with macrosomic infants Grand multiparas Multiple Gestation Full bladder and bowel Dehydration, Exhaustion, Low Sugars Narcotics used too early in labour
at what age does “advanced maternal age” occur
> 35
what is a grand multipara and why might they encounter a problem with the powers
omeone who has 5 or more children. Might not be able to cope with kids 6,7,8
how long do normal contractions last and what is the normal space betwen them
60 seconds with 4-5mins between
what are the kinds of ineffective uterine force
remember the uterus is a muscle
hypotonic
hypertonic
uncoordinated contractions
how would the contraction timing and between be for hypotonic contractions..other issue with the contraction.
what does this lead to?
risk of?
4-5mins between contractions that last around 20 seconds
the resting tone of the uterus is less than it should be
leads to prolonged labour. also risk of hemmorhage
hypotonic contractions is it painful? what stage does it occur during? what can be done? what intervention might have caused it?
not as painful as hypertonic as the uterine muscle isnt contracting all the way
occurs during the active phase
can give oxytocin to augment it
may have been caused by giving narcotic too early. this can stop or slow labour
why might hypotonic contrctions occur
tend to occur after admin of analgesia espec if cervix is not filated to 3-4 cm or if bowel or bladder distenion is preventing decent
• May also occur if uterus is overstretched by a multiple gestation, larger than usual fetus, hydramnios, or a uterus that is lax from grand multiparity
-may also be after long labour it cant mount effective contractions
what is important in first hr after birth if you had hypotonic contractions
• In first hour after birth, following a labor with hypotonic contractions important to palpate the fundus, get BP and assess amount of lochia q15 min for first hour to ensure contractions are not hypotonic postpartum
hypertonic contractions-
- timeframe of contraction and resting between
- when during labour do they likely occur
- how intense are they in comparison to hypotonic
- pain compared to hypotonic
- 60-90second contraction with 45 seconds between (occuring more frequently than hypotonic)
- likely during latent phase
- may not be any more intense than hypotonic
- likely painful and moreso than hypo
hypertonic why might it occur
ppt: May be from abruption
May be from induction of labour with prostaglandin insert (to soften and make cervix prone). Sometimes it has such a powerful effect
• Hypertonic contractions may occur bc more than one uterine pacemaker is stimulating contractions or bc the muscle fibers of the myometrium do not repolarize or relax after a contraction, thereby wiping it clean to accept a new pacemaker stimulus