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Test 3

Essential components of labor (4) 4P's - passageway, passenger, powers, pshyche
passageway pelvic structures (2) and def false pelvis - upper flare part - not part of bony pelvis; true pelvis - below linea terminalis - bony passage fetus must pass thru during delivery
4 pelvic shapes gynecoid, anthropoid, android, platypelloid
Gynecoid def most favorable vaginal birth - 50% of moms have it and allows fetus to pass thru
Anthropoid def elongated in shape, usually allows vaginal birth. anthropoid diameter is generous but transverse diameter is narrow. 25% of moms have it usually can delivery vaginally
android def heart shaped, looks like male pelvis, not favorable for vaginal delivery - most likely c-section
platypelloid def flat in dimension, narrow anthropoid diameter with generous transverse diameter. usually requires c-section
pelvic measurements calculate the likelihood of delivering vaginally includes the obstetric conjugate and diagonal conjugate
obstetric conjugate measures the smallest diameter of the inlet through which the fetus must pass. determined by subtracting 1.5 from the diagonal conjugate. A measurement of 11 is considered adequate
diagonal conjugate symphisis pubis to sacral promontory
mid pelvis distance between the ischial spines
angle of pubic arch at least 90 degrees
birth canal soft tissues making up the "passageway" includes the cervix and vagina
what are the 2 processes making up the cervix? effacement - cervix gets shorter and thinner in % - 100% is complete thinning of membranes; dilation is from 1cm up to 10cm dilated
fetal adaptations to delivery (2) skull bones have cartilage between them which can overlap to decrease the diameter of the skull and helps adjust to the shape of the pelvis; molding - skull can elongate via pressure from the vaginal walls to decrease the diameter of the skull (cone head)
fetal orientation (3) fetal lie,fetal presentation, fetal attitude
fetal lie relationship to long axis of the mother (longitudinal - up & down, transverse - side to side and oblique - at an angle)
fetal presentation 1st part of the body entering pelvic inlet (cephalic, breech, and shoulder)
fetal attitude position of the head in a cephalic presentation including vertex (chin into chest), military (chin - no flex at all or extension - wider dilation), brow (partially extended back - cone out bruised face), face (head fully extended - extremely bruised face
fetal position position of presenting in relation to quadrants of maternal pelvis.
3 designations 1st designation which side the presenting part is facing (left or right), 2nd designation - reference pt on presenting part, 3rd designation front, back, or side of the maternal pelvis in which the reference is found
what is the most favorable fetal position? LOA - left occipital anterior
fetal station describes the position of the widest part of the presenting part in relation to the level of the ischial spines - "floating" - ballottable - bounce
To what degree is the baby "engaged" or drops 0 also known as lightening - baby is at the level of the ischial spine
Powers - describe contractions frequency - interval of time from beginning of one to the beginning of another, duration - how long they last, strength/intensity - strength of contraction; involuntary - uterus, voluntary - abdominal muscles
Psyche mental state of the laboring woman including current pregnancy experience, previous birth experiences, expectations, preparation, support system, culture
signs that labor may begin soon (4) lightening, braxton-hicks contractions, loss of mucous plug, nesting behavior
lightening def presenting part sets in pelvic cavity at zero station - baby drops - easier for lungs to expand, can eat larger meals and increase urination
braxton-hicks contractions def false/irregular labor pain - practice contractions getting ready for labor - toward end more intense
loss of mucous plug prevents bacteria from entering uterus, some women have huge chunk come out; can come out 1 week before labor
nesting behavior burst of energy before labor - important to conserve for labor and delivery
clinical signs of labor (3) cervical ripening or softening, cervical effacement, dilation
3 components of vaginal exam dilation, effacement, fetal station
how many stages of labor are there? 4
1st stage of labor and components (3) aka dilation stage - begins w/ the onset of true labor and ends when pt is fully dilated - 3 phases - early/latent, active phase & transition stage
early/latent phase contractions mild to moderate, more frequent - early labor.
active phrase contractions are moderate to strong - baby drops to pelvis
transition most intensive usually fastest - contractions very strong - strong urge to push - if not 10 cm DONT push b/c can cause cervical edema and laceration - get very discouraged and want to quit
2nd stage begins when pt is fully dilated and ends with delivery of infant - most common position is dorsal recumbent
dorsal recumbent def most common position for L & D, laying on back with head at 45 degree angle and legs held w/support
3rd stage begins once fetus is expelled and ends when placenta is delivered - placental separation
signs of placental detachment blood discharge from vagina & uterus takes on globular shape - important to inspect placenta to make sure intact and nothing left b/c it could lead to infection
4th stage begins when placenta is delivered and continues for 4 hours
how many hours recovery is for a vaginal delivery? c-section delivery? vaginal - 1 hour; c-section - 4 hours
factors influencing pain mgmt (8) amt of support, age, level of inexperience, other parities/babies, length of labor, fear, amt of anxiety, culture
definitions r/t pain mgmt (3) unique - normal physiologic process, increasing intensity is desirable and positive, predictable; threshold - amt of pain necessary to perceive pain, pain will last 60-90 seconds then rest; tolerance - ability to withstand pain once recognized
paint mgmt techniques - pharmacologic analgesic - reduce sensation of pain - dont give too early because could cause respir distress in baby; anesthesia - block sensation;
paint mgmt techniques - non-pharmacologic (9) labor support, comfort measures, relaxation techniques, breathing, attention focusing, movement & positioning, apply counter pressure, hypnosis, water injections
priorities of fetal monitoring establish a baseline heart rate (110-160), assess variability (fluctation of FHR), variability results from the interplay between the sns and psns - shows goog oxygenation - LPN must know difference between reassure and nonreassuring interplay
periodic FHR changes accelerations - an increase of at least 15 beats above baseline for 15 seconds or more. If acceleration lasts longer than 10 min then it is considered a change of baseline. Accelerations are a reassuring sign which indicate that the fetus is doing well
benign changes early decels - have U shaped appearance and begin at the start of ctx and end at the end of the ctx. Must hit its lowest pt at the peak of a ctx. results from head compression during ctx. continue to monitor as long as baseline and variability are WNL
benign changes closer to delivery - when d-cells are at lowest pt, its at the highest part of contractions
nonreassuring changes variable decels - may occur any time during a monitoring pd. variables have a jagged appearance & be described as U,V, or W shaped. indication of cord compression. if variables resolve quickly & arent severe, NI is minimal - aimed at relieving compression
late decels appear smooth and U shaped but are offset from the ctx. they begin after the onset of ctx and dont resolve until ctx ends. later decels result from a prob w/ BF from uterus to placenta. non-reassuring sign. NI aimed @ improving utero-placental perfusion
NI of late decels uterus relax, ocygen on face, increase IV fluids
reasons for induction post-dats (2wks after due date), premature rupture of membranes (PROM), fetal indication (IUGR, defect), maternal indication (HTN), elective. Usually arent allowed to induce prior to 39 weeks
methods of induction (3) cervical ripening - med which is vaginal suppository for 12hrs which softens the cervix; AROM - artifical rupture of membranes; Pitocin - synthetic form of oxytocin which stimulates uterine ctx
assisted delivery methods (4) episotomy, vacuum, forceps, cesarian section
episotomy surgical cut into the perineum to allow room for delivery of fetus; high risk for infection - not acceptable anymore unless distress; most times allow them to tear on their own
vacuum delivery suction applied to fetal head to assist in delivery
forceps delivery metal tongs applied to either side of baby's head to assist in delivery; high risk for injury; nurse is responsible for pumping up pressure
cesarean section baby is delivered through an incision in the lower abdomen' roughly 25% of births in the USA; high risk
common indications for c-section hx of c-section, labor dystocia (not moving/progressing - cant get passed 4cm), fetal distress, malpresentation - breech/shoulder showing, previa, abruption, cephalopelvic disproportion - pelvis isnt big enough to deliver head, herpes lesion, DM, HTN
Created by: breinard