OB T3 Flashcards
True Pelvis
Represents the bony limits of the brith canal; most important in chidlbirth has three sudivisions.
Best pelvis
Gynecoid
Female Bony Pelvis
Four bones-
2 innominate two side bones/hip bones
The ilium,
the ishium the pubis and the Sacrum.
Pelivic diaphram
- Dilation during birth
- Returns to pregnancy condition after birth
- Deep facscia of levater coccygeal muscles form the pelvis.
Premonitory signs of Labor
- Braxton Hicks
- Lightening
- Increased vaginal secretions
- Bloody show/mucous plug
- Energy spurt
True Labor
Progressive dilation and effacement
Regular contractions
- ubcreasubg ub frequency, duration, intensity
- Intensity increases with ambulation
False Labor
Ambulation, changes of position, resting, or hot bath or shower.
A women with Gynecoid pelvis has
LESS COMPLICATIONS
Anthropoid Pelvis
Is also good for labor.
Measuring a womens pelvis
Is just an estimation
Pelvic floor is made of:
Musculature to overcome force of gravity.
Pelvic Diaphragm
- Dilation during birth
- Returns to prepregancy condition after birth
- Deep fascia of levator ani, cocygeal muscles form this part of the pelvis.
Questions to ask patient if she calls and says she is experiencing LABOR
- If she had a contraction and how often
- Did your water break.
- Pain location, stay or does it change or not
- Where is pain located, does it stay the same or does it get worse.
- Is baby moving normally.
WHEN WOMEN HAS FALSE LABOR IT can be RELIEVED by:
- Change in position
- Hot bath or showers.
- Rest
True Labor
- Regular contractions
- Pain usually starts in back, radiates to abdomen
- Pain not relieved by ambulation or by resting.
- Contractions do not decrease
We need to assess
Fetal and maternal status
False Labor
- Lack of cervical effacement and dilation
- Irregular contractions do not increase in frequency, duration, and intensity
- Contractions mainly in lower abdomen and groin
- Pain may be reduced by amubulation, changes of position, resting, or hot bath or shower.
Nursing responsibiities after admission to the Birth Center
- Therapeutic Relationship
- Imminence of Birth
- Fetal and Maternal status
- Admission Assessments
Admissiion Assessment
- Status of Membranes
- Leopolds Manuever
- Pregnancy History
- Cervical dilation
- Pain
- Labs
- Intrapartum high risk screeing
- Heart, Lungs, etc.
- Ultrasound
Ask women to cough….
and FLUID DROPS…Then YES she has ruptured….
Please keep in mind you want to get as much information as possible because women can develop
INFECTION
If a women has GIVEN BIRTH MANY TIMES
She will go faster…than a women that is more dilated but on her first birth.
Physiological changes during the birth process
Cervical changes
- Effacement-thinning and shortening
- Dilation-Opening
Physiologic changes
Cardiovascular system
Check vitals between contractions
-Remember about Positioning- Vena Cava Syndrome.
Physiologic changes
Respiratory system
-Hyperventilation
Physiologic changes
GI system
- Mostly decreased
- Thirst
Urinary System
-Reduced sensation of FULL BLADDER.
Physiologic changes during the birth process
- Hematopietic System
- SVD 500 ml, C/S 1000 ml
- H/H- we want it good in labor
- WBC- UP tp 25,000/mm3
Advantages and disadvantages of incrase clotting factors and decrease in Fibrinolysis.
Adv:ally naturally prevents Post Partum Hemorage
Psychosocial consideration
Readineess
- Fear, anxieties, fantasies, Hx of rape
- molestiation
- Preconceived ideas about birth
- Birth Plan
- Factors associated with postive birth
- Support system
Make sure you include the support person in the
PLAN OF CARE
Nurses can’t delegate anything to the
Doula
BIRTH PLAN
What the patients expectations of the birth.
Compoents of the Birth Process
Powers, Passage Passenger, Psyche.
Powers
Can be mild, moderate and strong
Mild-Nose
Moderate-Chin
Strong Forehead.
Measure of a contractions
Start measuring at the beginning of the contraction.
Duration-From the beginning of one contraction to the end of another contraction.
-Frequency from the beginning of one contraction to the beginning of the next contraction.
Passage
- Size of maternal pelvis
- Type of maternal pelvis
- Ability of cervix to dilate, efface
- Ability of vaginal canal, introitus to distend
Components of the Birth Process
- Gynecoid-Round 50% of women
2. Android-Heart Shaped 30% of women
Passenger
- Fetal Head
- Fetal Lie
- Fetal Attitude
- Fetal Presenation
Fetal Lie
Relationship of fetal spiral column to that of mother’s- Cephalocaudal axis
-Longitudianal-Vertical
Tranverse-Horizontal
-Shoulder Presentation
Fetal Attitude
-Relations of fetal body parts one to another
-Posture of fetus to conform to uterine cavity
Normal attide-General Flexion
+Head flexed, chin on chest
+Arms crossed over chest
+Legs flexed at knee, thights on abdomen
Fetal Presentation
- Vortex
- Sinciput
- Brow C
- Face D
Malpresentation
Breech (Frank, footling, complete)
Malpresentation
Transverse, Lie, Shoulder, Presentation
Fetal Position
Maternal Pelvis
- Right (R) or (L) side
- Occidput (O)
- Mentum (M)
- Sacrum (S)
- Acromion (scapula)
- Anterior (A), posterior (P), Transverse (T)
Station
-Station
-Ischial spines are zero station are zero
station
-Presening part moves from negative to positive.
First Stage
1st Phase
“Cervical Dilation”
Cervical Dilation: 0-10 cm
2 nd
Birth of Baby “pushing”
3 rd
Placental delivery
4th
Recovery
Cervical Dilation-Latent Phase
- Beginning cervical dilation and effacement
- No evident fetal descent
- No evident fetal descent
- Uterine contractions increase in frequency
- duration and intensity
- Contractions usually mild, regular
- Excited talkative smiling.
Cervical Dilation-Active Phase
- Cervical dilation from 4 to 7
- progressive fetal descent
- Contraction more frequent and intense
- Maternal responses-Increase anxiety
Cervical Dilation -Tranverse Phase
-Cervical dilation from 7 to 10 cm Progressive fetal descent -Contractions more frequenct and intense -Maternal responses -Women likely to withhold into self.
Second Pushing
Begins with complete dilations (10 cm)
Ends with birth of a baby
Open Glottis Pushing
-Grunts without holding breath and bears down spontaneously is bad.
Pushing for no more than 6-8 seconds, no more than 3 times per contraction
- Decreased risk of episitomy/laceration
- Decreased risk of operative vaginal birth
- Decreased maternal fatigue
AGOC recommendations for second stage of labor is?
2 hours for a multiparous women with anetheisia and 3 hours for a nulliparous women with anethesia.
After she been pushing for two hours or what ever she has been doing…
Then they are going to consider C section.
We should not do…
Valsalva Maneuver…..Not the norm…
Mechansisms of Labor
- Desent
- Engagement
- Flexion
- Internal Rotation
- Extension
- External Rotation
- Expulsion.
Third Stage “Placental”
Begins with birth of baby, ends with explusion of planenta.
Placental seperation Signs
- GUSH OF BLOOD
- She feels a need to push again.
- Unbilicals lengthens so you see more of it.
- Fondus changes to Globular
- Practionar delivers the plancenta.
Uterine Inversion
Is an emergency of when the placenta does not detach.
-Or provider trying to expadite process and pulls earlier.
If it happens we
Manually have to put it back…..risk for hemorage and infection.
- ALSO possible a piece will stay inside.
Lack of oxygenaises.
Stage 4 Recovery.
- Begins with delivery of placenta, ends when mother is stable
- 1 to 4 hours after birth
- Phsiolgoic readjustment
- Thirsty and hungry
- Shaking
- Bladder is often hyponic
- Uterus remains contracted
Assessments during labor…
Fetal Assessment
Maternal Assessments
Amnionic fluid
Membrain assessment.
Amniotomy and vaginal examination are both
Sterile procedure done by providers or if doctor oks it the nurse can do it.
Why would we want to rupture membraine.
Labor Induction and it is uncomfortable because she is dry now.
RUPTURE OF MEMBRAINE
Make sure it is done at the right time and we want to prevent cord prolapse. If CORD COMES OUT….WE HAVE AN EMERGENCY C SECTION.
WHY WOULD we do this….
IF baby is high or if there is a breach presentation.
TOO MUCH WATER
THE CORD WILL FLUSH OUT TOO
SIGNS we can visualized…
Can be stuck on babies head……and we will see fetal heart rate abnormalities.
What equipment should be available for an amniotomy.
Amnio-hook
- Sterile glove and lubricant
- Clean chux, blankets, washcloths
- Patient positioned in a semireclingin position
- Strict sterile technique.
Cord Compression what is baby experiencing
Hypoxia and deceal heart rate.
Which nrusing assessment are to and after the procedure.
Assure that the presenting part is engaged prior to amniotomy to prevent cord prolapse.
- Monitor FHR prior to and after amniotomy for cord prlapse or compression as evidnce by variable decelerations
- Monitor the color and amount, and smell of fluid.
When a cord come through the crevix before th bayb does
Causes when there is a poor fit betwen the fetal presenting part and the maternal pelvis.
Signs of a prolapse
Cord may or may not be visible, may be felt with VagExam Servere variable decelerations or bradycardia seen in FHR.
Priority is to releive pressure off the cord.
- Birth by stat C/S unless vaginal birth is imminent
- Position hips higher than the head (knee-chest, Trendelenburg.
- With a gloved hand, push the fetal presenting part upward.
- Give O2 FACE MASK.
Nursing Care During Labor
- Promote placental fuciton
2. Provide Comfor measures.
Pain During Labor
Normal physiologic process
- First stage pain, Cervical dilation
- Second stage pain, uterine muscle cell hypoxia.
- Third stage pain, Uterine contractions
Adverse effects of excessive pain
Physiologice-Fear and anxiety release epinephrine whcih causes uterine vasoconstriction and increase uterine musle tone.
Pyscholgoical- Unreolved pain will affect her memory.
Non-pharmacolgoic pain releif.
Relaxation techniques Visualization Thermal stimulation Focal Point Massage Music
Breathing Techniques
Eary Labor- Slow Paced breathing
Middle Labor- Modified paced breathing
Late Labor-Patterned pace breathing
Pharmacolgoic Pain Management
Any drug taken by the women is also taken by the fetus.
- Drusgs can affect the course and length of labor.
- Complication may limit the choic of pain management
- Women who practice substance abuse may have fewer safe choices.
Example of a time that we should induce
- Post term
- Preclampsia
- Trauma or chrnoic condition
- BP on high side
- Gestational diabetes and stress test does not look good.
Labor Induction
We are starting the process of labor with chemical or mechanical initiation of uterine contractions.
Labor Augmentation
Helping the process of labor by improving the quality of uterine contractions once labor has started.
Bishop Score
Used to assess readiness and predict sucess of induction augmenation. Max score is 13.
Cervical Repening
Need to first RIPEN the CERVIX.
Contarindications to Labor Induction or Augementation
- Vasa previa or complete placenta previa
- Transverse fetal lie
- Umbilical cord prolapse
- Previous classical cesarian delivery
- Active genital herpes infection
- Previous myomectomy entering endometrial cavity.
Some Indications for induction
-Nonreassuring fetal testing
-Nonreassuring fetal testing
-Olygohydramnios
-Worsening preclampsia at terms
IUGR at Term
Hx of previous term stillbirths.
Cervical Ripening
- Postglandin E2
- Intravaginal insert
- Left in prsterior vagina
- Easily removed
Advantage of Cervical Ripening Contraindications
- Nonreassuring FHR tracing
- Frequenct moderate uterine contractions
- Prior cesarean section or uterine scar
- Placenta Previa
- Undeagnosed vaginal bleeding.
Disadvanatge of Porostaglandin Administraion
- Uterine hyperstimulation
- Nonreassring fetal status
- Higher incidence of postpartum hemorhage
- Uterine rupture
Stripping amniotic membranes
Use your fingers.
A natural postglandins releaser is
Intercourse
Sythentic form of Oxytocin
Pitocin
Before starting infusion of pictocin the nurse should first.
- Assess Maternal pelvis
- Fetal station, fetal position
Adverse reactions to pitocin
- Hypertonic uterine contractions
- Uterine rupture
- Water intoxation.
