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M&B test 3

Physiologic primary force of labor is uterine muscular contractions.
Physiologic secondary force of labor is use of abdominal muscles to push during second stage of labor.
When pushing...Dont to soon can risk ripping of cervix (if not complete), more swelling, and exhaustion!
Progesterone causes relaxation of smooth muscle tissue
Estrogen causes stimulation of uterine muscle contradiction.
connective tissue loosens and permits softening, thinning, opening of cervix
Psychosocial considerations for a woman giving birth Understanding and preparing for childbirth experience, Amount of support from others, present emotional status, Beliefs and values.
Physical things to look at from stress of labor (Mom) Respiratory Alkalosis from hyperventillating
Physical things to look at from stress of labor (baby) acidotic less than plt 7.25.
The more times you check mom more risk of infection
Thinning of Cervix is called Effacement
Effacement Muscles of upper uterine segment shorten and cause cervix to thin and flatten. Fetal body straightened as uterus elongates with each contraction.
If cervix is thick, long and hard not going to deliver.
Contraction Pressure of fetal head causes cervical dilation and thin out cervix, rectum and vagina are drawn upward and forward with each contraction, During second stage, anus everts
lightening Fetus descends into pelvic inlet
Braxton hicks contractions Irregular, intermittent contractions that occur during pregnancy, cause more discomfort closer to onset of labor.
cervical changes cervix begins to soften and weaken (ripening)
Bloody show loss of cervical mucous plug, cause blood-tinged discharge (never dismiss it! look at volume and circumstance surrounding)
Check for rupture nitrozene paper - turns blue (amnionic fluid), Best test Speculum test, Fern test, Diffinative slide test shows ferning under microscope
nesting Sudden burst of energy, usually occurs 24-48 hours before onset of labor.
Rupture of membranes If rupture prior to onset of labor, good chance labor will begin within 24 hours. ( risk of infection or preterm labor and or/ delivery)
Premonitory signs of labor loss of 1 to 3 pounds, Diarrhea, indigestion, nausea, vomiting may occur prior to onset of labor.
True labor characterized by Contractions at regular intervals- increase in duration and intensity
Cardinal Movements in Delivery Decent, flexion, Internal Rotation, Extension, Restitution, Expulsion
Decent The head enters the pelvic inlet in the occiput, transverse or oblique position because the inlet is widest from side to side.
In Decent...present in 3 ways Occiput, transverse, oblique
Four forces affecting decent 1, pressure of amniotic fluid, 2, direct pressure of the uterine fundus on the breech, 3, contraction of abdominal muscles, 4, extennsion and strengthening of the fetal body.
Flexion fetal chin flexes downward onto the chest
Internal Rotation Head rotates inside the pelvic cavity from left to right.
Extension The occiput, then brow and face emerge from the vagina
Restitution Shoulders enter pelvic inlet obliquely and remain oblique when the head rotates to the anteroposterior diameter thru internal rotation.
restitution turning the head to one side, and aligns with position of the back in the birth canal.
Expulsion The anterior shoulder quickly born before the posterior and the body quickly follows engagement.
Engagement Presenting part occurs when largest diameter of presenting part reaches or passes thru pelvic inlet.
Engagement can be determined by a sterile vaginal exam (to see if baby is blottable)
Engagement Confirms adequacy of pelvic inlet (does not indicate whether the mid pelvis and outlet are adequate)
Engagement Usually occurs a couple weeks before term.
Once head is engaged there is a less chance of cord prolapse.
station relationship of presenting part to an imaginary line drawn between the ischial spines of the maternal pelvis, the ischial spines are 0 station, if presenting part is higher -, if below + number.
fetal postiion Refers to the relationship of a designated landmark on the presenting fetal part to the front, sides or back of the maternal pelvis.
Lightening moving of the fetus and uterus downward into the pelvic cavity
hyperventalation numbness tingling in fingers or lips give paper bag to breathing. Imbalance o2 and co2...too much 02, shallow breaths, slow breathing, count out loud.. need more co2 in
Pushing Woman uses intra-abdominal pressure, Perineum begins to bulge, flatten and move anteriorally, bloody show may increase, labia begin to part with each contraction.
Crowning fetal head is encircled by the external opening of the vagina, birth is imminent
Frequency (Contraction) The time between the beginning of one contraction to the beginning of the next contraction
Duration (Contraction) The beginning of a contraction to the completion of that same contraction.
if cervix is not completely dilated (10cm), bearing down (pushing) can cause cervical edema, possible tearing and bruising of the cervix and maternal exhaustion
Intensity (contraction) Refers to the strength of the contraction during acme.
Acme Peak of contraction
Intensity can be estimated by palpating the uterine fundus during a contraction.by judging the amount of indentablility of the uterine wall during acme of a contraction.
intensity can be measured by an intrauterine catherter.
Fetal response to labor heart rate may decrease as head pushes against cervix
Fetal response to labor Decrease in pH due to decreased blood flow at peak of each contraction
Fetal response to labor Further decrease of ph occurs during pushing due to woman holding her breathe.
Fetal postition Refers to the relationship of a designed landmark on the presenting fetal part to the front, sides or back of the maternal pelvis.
1st postition right or left of the maternal pelvis
2nd position Fetal presenting part: Occiput (O), mentum(M) which is the face, and sacrum (S), acromion process (A)
3rd position Anterior (A), posterior (P) or transverse (T) (front, back or side of the pelvis)
Most common position.. safe for delivery LOA, ROA
If baby position is posterior really hard to get out (c-section)
Fetal lie Relationship of spine of baby...want longitudinal lie (up & down) or transverse lie (side ways)...move baby or c-section.
effacement thinning of the cervix based on a subjective percentage determined with a sterile vag exam. 100% fully effaced.
First Stage Begins with onset of true labor and ends when the cervix is dialated to 10cm,
Created by: CHARLIA