Term | Definition |
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 |