Normal Labor Flashcards
stage I
onset of contractions until maximum dilation of cervix
two phases
active phase
6-10cm
latent phase
0-5.9cm
nullip - 20hrs
multip - generally around 14hrs
stage II
complete dilation to delivery of baby
no maximum length of time
nullips - push for 3hrs
multips - push for 2hrs
stage III
delivery of baby to delivery of placenta
requires uterine contraction
usually occurs within 30mins of delivery
cervix changes
must change from thick and firm structure that is long to a thin and short structure
how do cervical changes occur
achieved by breaking disulfide bonds between collagen and infusion of water - called cervical ripening
can lead to effacement (shortening of the cervix)
stimulation of cervical changes
fetal head engagement
foley bulb
production of prostaglandin E2 (which is why indomethacin can be a tocolytic)
what is fetal station
how far out baby is and how close baby is to coming out
- 5 to +5
- centimeters from vaginal opening
- 0 is the ischial spine
what is fetal lie
orientation of te baby
how is fetal lie determined
leopold maneuvers or ultrasound
longitudinal fetal lie
axial skeleton parallel to mom’s
transverse fetal lie
axial skeleton perpendicular to mom’s
oblique fetal lie
axial skeleton neither parallel nor perpendicular
what is the ‘right way’
longitudinal cephalic
breech
any position other than longitudinal cephalic
indication for c-section
external version
maneuver that can be attempted at 37wks where you flip the baby around from the outside
frank breech
knees extended
hips flexed
complete breech
knees flexed
hips flexed
footlong breech
knees in any position
hips extended
diameters of delivery
at the pelvic inlet, the largest diameter is transverse, causing the baby’s head to turn transverse to engage. the pelvic inlet is the pubic symphysis to sacral prominence
at mid-pelvis, it’s a 90degree change. largest diameter is at the anterior-posterior, causing a corkscrewing of the baby to get through
fetal movements of delivery
- engagement
- descent
- flexion
- internal rotation
- extension
- external rotation
- expulsion
what is engagement
head (biparietal diameter) passes below the pelvic inlet
what is flexion
flexion of the fetal head occurs passively due to the structure of the pelvis
what is internal rotation
usually from OT position to an antero-posterior position
- also passive
what is extension
extension occurs as baby’s head passes under the pubic symphysis
what is external rotation
aka restitution
the turning of the baby’s head to again align with the rest of its body after its passed under the symphysis
what is expulsion
anterior shoulder is delivered, posterior shoulder is delivered last
