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Labor

RNC-OB Labor information

TermDefinition
Gateway Control Theory theory that massage, heat, and cold stimulate nerve fibers that block painful stimulation
Therapeutic Touch Theory effects are result of energy exchange between client and nurse to reduce pain and anxiety
BIHOP score Duration of labor inversely correlated >8=successful vaginal delivery <6=needs cervical ripening prior to induction 0: closed, 0-30%, -3, firm, posterior 1: 1-2, 40-50%, -2, med, midposition 2: 3-4, 60-70%, -1-0, soft, ant 3: 5-6, 80+%, +1, very sof
Cardinal movements of Delivery series of 8 adaptations the fetus makes as it moves through maternal bony pelvis Influenced by size, position, powers of labor, size and shape of maternal pelvis, and mother's position.
Engagement 1st cardinal movement. Dropping or "lightening"
Descent 2nd cardinal movement assessed by station -3 - +3
Flexion 3rd cardinal movement fetal head nodding forward toward chest
Internal Rotation 4th cardinal movement generally rotates OT to OA
Extension 5th cardinal movement describing the crowning and delivery of the head
Restitution 6th cardinal movement describing the realignment of head and body after delivery of the head
External Rotation 7th cardinal movement shoulders rotate to AP diameter of pelvis
Expulsion 8th cardinal movement describing the birth of the body
Prolonged Latent Phase >20 hours - primips >14 hours - multips caused by unripe cervix and early anethesia
Protracted Active Phase <1.2 cm/hr - primips <1.5 cm/hr - multips caused by CPD, malpresentation, early anesthia, ROM before onset
Secondary Arrest of Active Labor cervical dilatation stops in active phase. No dilatation after 2 hours or when complete for >3 hours (primips) or >1 hour (multips) Caused by anesthesia, malposition, CPD, AROM
Precipitous Labor cervical dilatation >5 cm/hr (primips) or >10 cm/hr (multips)
Protracted Descent rate of descent is <1 cm/hr (primips) or <2 cm/hr (multips) caused by protracted dilatation in active stage, CPD, malpresentation, anesthesia
Arrest of Descent no descent in active phase for >1 hour (primips) or >0.5 hr (multips) caused by advanced gestation, >4000g, CPD, malpresentation, coexisting labor disorder
First Stage of Labor 0-10 cm dilatation 3 phases: Latent, Active, Transition
Latent Phase of Labor 0-3 cm mild contractions distraction most effective in this stage
Active Phase of Labor 4-7 cm moderate contractions
Transition Phase of Labor 8-10 cm strong contractions characterized by panic and fear
Second Stage of Labor 10cm - birth prolonged when >3 hours (primips) or >2 hours (multips) Pelvic phase - period of fetal descent Perineal phase - active pushing
Open Glottis Pushing expel air slowly over 6-8 seconds preferred over holding air methods bc they elad to decreased uterine blood flow, increased fatigue and risk of tears and increased risk of GU problems after delivery
Third Stage of Labor delivery of placenta
Fourth Stage of Labor 1-4 hours after delivery maternal physiologic adjustment
Leopold's Maneuvers 1) palpate lower abdomen (attitude) 2) palpate sides for back and small parts (position) 3) palpate upper abdomen (presentation) 4) palpate facing mom's feet for cephalic prominence (attitude)
Fetal Lie relationship of long axis of baby to mother Longitudinal - cephalic or breech Transverse Oblique
Fetal Presentation part of fetus entering pelvis first Shoulder Breech - complete, frank, footling Cephalic - vertex, brow, face
Fetal Attitude relationship of fetal parts to each other Flexion - chin to chest (easiest delivery) Extension Military - neither flexion or extension
Position relationship of presenting part to specific area, right or left, anterior or posterior, on mom's pelvis
Anterior Fontanelle diamond shape, bigger
Posterior Fontanelle Triangle shape, smaller
Theories of Initiation of Labor CRH (hormone synthesized in increased amounts during pregnancy) stimulates increased estrogen and progesterone which stimulates increased prostaglandins which leads to contractility and softening cervix.
Ferguson Reflex urge to push caused by baby putting pressure on the cervix and Ferguson plexus of nerves
Gynecoid Pelvis Typical female pelvis adequate for labor
Android Pelvis Typical male pelvis narrow dimensions associated with halting labor
Anthropoid Pelvis Apelike pelvis adequate for labor
Platypelloid Pelvis wide-narrow pelvis unfavorable for labor
Category I FHTs baseline 110-160 bpm moderate variability possible early decerations possible accelerations
Category II FHTs not category I or III FHTs
Category III FHTs Absent variability + any of the following recurrent late decelerations recurrent variable decelerations bradycardia sinusoidal pattern
IUPC monitoring uterine baseline 5-15 mmHg, never >30 mmHg
IUPC monitoring 30 mmHg decreased uterine blood flow
IUPC monitoring 40 mmHg complete cessation of blood flow to uterus
MVUs <150 mmHg inadequate labor
MVUs 180-250 mmHg should indicate adequate labor
MVUs >300 mmHg increased uterine activity, tachysystole
Baroreceptors receptors effected by BP changes
Chemoreceptors receptors effected by Oxygenation changes
Created by: kanani8806