Maternity week 3-2 Flashcards
optimal time for pregnancy - age
20-35 years
spontaneous abortion - causes (acres of spontaneity)
20% with increased age (check this), gest. diabetes, c-section, placenta acreta (placenta grows through uterine wall into abdomen and connects to bladder, intestines, etc)
5 Ps
passenger, passage, powers, position, psychological adapations
passageway
Pelvis structure
Birth Canal (Soft Tissues) Laboring Positionf
true pelvis measures from..
symphaiss pubis to top of coccyx
false pelvis
look this up
pelvis structure
biggest reason women can not have a vaginal birth
2nd most common reason woman can’t have vaginal birth - birth canal (2nd most common cervix)
if cervix is still there, can’t have baby.
diagnonal conjucate
this is the symphaiss pubis to top of coccyx. should be 11.5 cm
different shapes of pevlic bone (platepus is short)
gynecoid (this is the good one), android (20% of women) (more like a male pelvis - poor labor progress), anthropoid (25%) (oval), platypelloid (3%) (short and wide, difficult descent)
soft tissues - cervix
can create huge barrier if not dilated all the way
soft tissue - pelvic floor muscles
create some resistience and help rotate the baby
soft tissue - vagina
might have some lacerations due to size
power
contractions
labor is defined
cervical change from regular contr. that increase in strength, cervical change - either effacement and dilation (usually occurs at the same time, but not necessarily. the more babies a women has had, it will go down, maybe 50.***ON TEST
SIGNS PRECEDING LABOR
LIGHTENING (uterus and fetus)
BLOODY SHOW (blood in the mucus)
RUPTURED MEMBRANES (PROM - ruptures before labor)
BRAXTON - HICKS CONTRACTIONS BURST OF ENERGY (nesting syndrome)
FALSE LABOR (not changing cervix w/ contractions makes them false)
INCREASED VAGINAL DISCHARGE PROM
True Labor - where is the pain located? (it’s truly in my back to my abdomen)
UC’s- regular, stronger longer, closer, more intense if walking
Cervix- effaces and dilates (we won’t get into this) , anterior position
Fetus becomes engaged
Felt in low back radiate to abdomen (can be a sign of true labor, baby hasn’t rotated yet and she feels head hitting lower back)
False Labor - where is it felt?
UC’s- irregular or regular temporarily, may stop with position change
Cervix- no change in efface & dilatation
Fetus- not usually engaged
felt in back or abdomen above naval cervix
category 2
slower baseline, good variability. absent
copy page 9
here
category 3
absent baseline variability. recurrent late decelerations. this is critical - call provider and prepare for a c-section immediately.
category 1
baseline - 110 - 160
late decelerations - the number (30 min late)
gradual onset - > 30 seconds from onset to nadir
nadir
lowest point of contraction
late and early are
ok, decelerations
primary powers
uterine contractions, involunarty, signal beginning of labor
secondary powers (abdomen is second)
abdominal muscles, voluntary bearing down
contractions
can you feel when they are notices on a graph (goes up)
presentation
is the part of the body that enteres teh pevlic first.
cephalic (vertex)
breech
shoulder (baby is laying transversely)
presenting part is
the part of the fetal body felt first on the exam
fetal lie is the
relation of the spine of the fetus to the spine of the mother. longitudinal/vertical, transvers, bolique
we don’t want
extension - too hard to get baby out.
attitude is the
realtionship of fetal parts to itself. general flexion and extension
position is the
relationshiop fot he presenting part to the 4 quadrants of the motehr pelvis
position - 3 letters
side of pelvis (R or L)
presenting part (O, M, Sa, A)
relation to anterior or posterior (A or P or T)
we want it to be anterior.
MECHANISMS OF LABOR: 7 CARDINAL MOVEMENTS THAT OCCUR IN A VERTEX PRESENTATION -
just know there are 7.
SIGNS PRECEDING LABOR
LIGHTENING
BLOODY SHOW
RUPTURED MEMBRANES
BRAXTON - HICKS CONTRACTIONS BURST OF ENERGY
FALSE LABOR
INCREASED VAGINAL DISCHARGE PROM
4 stages of labor
1-4 (these will be on exam)
stage 1 - from what to what?
onset of regular contractions to the full dilateion of cervix
stage 2
full cervical dilateion to the birth of the baby
stage 3
birth fo baby to birth of placenta
stage 4
brith of placenta to reestablish homeostasis
PHYSIOLOGIC ADAPTATION TO LABOR
Heart rate 110-160
HR provides information about oxygenation of the fetus and uteroplacental blood
flow
Responds to changes in PCO2, PO2 and other factors
PHYSIOLOGIC ADAPTATION TO LABOR -
MATERNAL
Heartrate increases
WBC increases
Respiratory Rate increases
Renal – paresthesia, difficulty voiding Neuro- endorphins
GI- hypomotility
Endocrine-hormone changes
Cardiac output increases (30-50% 2nd stage) BP increases
PHYSIOLOGIC ADAPTATION TO LABOR
WBC up to 25,000 – normal
Renal-difficulty voiding, loss of sensation,
Neuro- euphoria, amnesia, elation. Raises the pain threshold.
GI- Nausea, vomiting, belching
Endocrine-decreased progesterone, increased estrogen, prostaglandins, oxytocin, increased metabolism, decreased blood glucose
Supine hypotension
PHYSIOLOGIC ADAPTATION TO LABOR
WBC up to 25,000 – normal
Renal-difficulty voiding, loss of sensation,
Neuro- euphoria, amnesia, elation. Raises the pain threshold.
GI- Nausea, vomiting, belching
Endocrine-decreased progesterone, increased estrogen, prostaglandins, oxytocin, increased metabolism, decreased blood glucose
Supine hypotension
POSITION OF LABORING WOMAN - what about squatting?
CHANGE POSITIONS FREQUENTLY *RELIEVES TENSION AND FATIGUE *INCREASE COMFORT
*IMPROVE CIRCULATION
UPRIGHT POSITION:
* GRAVITYASSISTSWITHFETUSDESCENT * STRONGERCONTRACTIONS
* IMPROVES MATERNAL CARDIAC OUTPUT
squatting - increased risk of lacerations
draw lab before epidural to check for - if what is too low?
low platelets - if platelets are too low, they won’t do an epidural.
5 other Ps
Position (Maternal) Psychological Response Philosophy
Partners
Patience
PSYCHOLOGICAL RESPONSE
BACKGROUND
COPING MECHANISMS SUPPORT SYSTEM
PREPARATION FOR LABOR SOCIO-CULTURAL INFLUENCES POSITIVE-NEGATIVE INFLUENCES
ischeal spines
If the presenting part is palpated higher than the maternal ischial spines, a negative number is assigned; if the presenting fetal part is felt below the maternal ischial spines, a positive number is assigned, denoting how many centimeters below zero station
