BC3 - Maternity
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| The 5 P's of successful labor | Passageway, Passenger, Powers, Psyche, Position
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| Passageway refers to | the maternal pelvis
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| The pelvic inlet | the pelvis brim is bordered by the linea terminalis
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| transverse diameter | the largest diameter of the pelvic inlet, its adequacy is determined by the diagonal conjugate
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| diagonal conjugate | distance between the sacral promontory and the lower margin of symphysis pubis
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| Pelvic Outlet | measurement that really counts
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| Pelvic types | Gynecoid, Android, Arthropoid, Platypelloid
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| Gynecoid | Round, female pelvic type; Classic - what you want to have - only 50% have it; outlet wide
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| Android | male - not adequate for childbirth
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| Anthropoid | narrow side to side, long front to back; usually ok for childbirth w/ assist (vacuum or forceps)
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| Platypelloid | Flattened, not adequate; precipatace deliver (fast <3 hrs); Risk for hemorrhage for mom; O2 deprivation for baby
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| Fetal Attitude | *Important role in delivery process; relationship of fetal parts to one another; the problems come with deviation from the normal fetal attitude of flexion
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| Normal fetal attitude | Flexion - back of fetus flexed; chin flexed on chest; thighs flexed up; arms & legs crossed
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| Fetal Lie | The relationship of the long axis of the fetus to that of the mother (want baby to be longitudinal)
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| Fetal Presentation | The portion of the baby's body that lies nearest the external os of the cervix (the presenting part what the examiner is feeling - hopefully its the head 96%)
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| If fetal presentation is the bottom | Breech birth
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| If shoulder or breech presentation | C-Section
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| effacement | thinning of the cervix; described in %; 10% not much; 80-90% is good
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| 4 / 80 / -1 | 4=dilation; 80=effacement; -1 above ischial spine
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| Hardest part to deliver | the fetal skull
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| Sinciput | brow
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| Vertix | **should present - the area between the anterior and posterior fontanelle
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| Occiput | area of fetal skull occupied by the occipital bone, beneath the posterior fontanelle
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| Mentum | fetal chin
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| Presentation can be (3) | cephalic, breech, shoulder
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| Cephalic Presentation | head first (further classified by fetal attitude)
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| Vertex (cephalic presentation) | *most common - head completely flexed on chest, the smallest diameter of head presents
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| Military (cephalic presentation) | top of the head presents
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| Brow (cephalic presentation) | head partly extended - sinciput is presenting part
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| Face (cephalic presentation) | may have risk for CP d/t nerve damage
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| Breech presentation | Bottom first
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| Complete (breech presentation) | thighs & knees completely flexed
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| Frank (breech presentation) | thighs are flexed on hips (feet in air by head)
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| Footling (single & double) | foot is dangling
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| Engagement | occurs when the largest diameter of presenting part (hopefully the head) reaches or passes through the pelvic inlet (confirms adequacy of inlet - not outlet)
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| Station | refers to the relationship of the presenting part to the imaginary line between the ischial spines (narrowest part the fetus must pass through)
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| 0 Station = | ischial spines
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| Negative station | above the ischial spines (0 to -5)
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| Positive station | below the ischial spines (0 to +5)
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| Fetal position | the exact relationship of the presenting part to the maternal pelvis
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| Primary Powers | The uterine contractions
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| Secondary Powers | Maternal abdominal muscles used during the pushing stage
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| Acme | The peak of the contraction
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| Decrement | The letting up of the contraction
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| Duration | The time from the beginning to the end of a contraction
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| Frequency | From the beginning to the beginning of another
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| Increment | The building up of the contraction
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| Intensity | The strength of the contraction
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| Mechanisms of Labor & Birth (Cardinal Movements) | Engagement, Descent, Flexion, Internal Rotation, Extension, External Rotation, Expulsion
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| Why monitor I & O | if mom has an epidural - offer bedpan - may have to straight cath
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| Monitor VS | after epidural - BP for 5-10 minutes; after delivery every 15 minutes
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| Observe ROM for | color, odor, amount and consistency of amniotic fluid
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| After ROM check FHR often for evidence of | prolapsed cord
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| Observe for hypotensive syndrome | If BP falls, position mom on left side, increase IV fluids, Oxygen at a few Liters
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| Supine hypotension | late decelerations
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| Fetal assessment during L & D include | Inspection (fetal lie); Palpation (Leopolds Maneuvers); Auscultation of FHR (monitor)
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| Leopolds Maneuvers | 4 external abdominal palpations
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| Position for Leopolds Maneuvers | Lay on back with shoulders slightly raised on a pillow and knees drawn up a little
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| Sources of pain during labor | dilation/stretching of cervix; emotional tension; hypoxia of uterine muscle cells during contraction; stretching of lower uterine segment; pressure of presenting part on organs/structures; distension of vagina & perineum
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| Factors affecting pain perception | Cultural background, self concept, fatigue, attention and distractions
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| Non-Pharmacologic Measures | Effleurage; Distraction; Controlled breathing; Relaxation techniques
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| Effleurage | Light abdominal stroking in a circular motion - downward
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| Distractions include | reading, TV, cards
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| Analgesia | absence of sensibility to pain, relife of pain, without loss of consciousness
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| Demerol | Alleviates pain during 1st stage of labor; acts in 5-10 min of IV admin; lasts up to 3 hours
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| Maternal S/E of Demerol | respiratory depression, N/V, hypotension, drowsiness
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| Fetal S/E of Demerol | respiratory if given within 2 hours of delivery
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| Stadol and Fentanyl | "takes the edge off"- fairly decent - doesn't eliminate pain - can be given anytime during
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| Anesthesia | Loss of feeling or sensation
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| Lumbar epidural | injection of medication into epidural space in the lumbar regions at levels L2 - L5
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| When is lumbar epidural done | usually after a cervical dilation of 4-5 cm to prevent slowing down of labor
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| Lumbar epidural provides analgesia for what stages of labor without direct adver effects on fetus | 1st and 2nd stages
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| If lumbar epidural is done too late | won't feel the need to push
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| Disadvantages of lumbar epidural | maternal hypotension (monitor BP q 15 min until stable); decreased urge to push; risk of increased need for forceps; risk of dural puncture
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| Spinal | injection of medication into the CSF in the spinal cord - needle penetrates meninges - more chance of s/e
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| S/E of spinal anesthesia | postspinal headache; urinary retention, increased maternal hypotension
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| When can a spinal affect the newborn | if too much time elapses between anesthetic agent and birth
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| Pudendal Block | injection into the pundendal nerves (femoral area) - relief to perineum for episiotomy
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| Local Infiltration | anesthesia is injected into the nerves of teh perineum - main use is for pain caused by the stretching perineum
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| How long could it take to establish a baseline FHR | 5-10 minutes
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| Baseline FHR | the average rate when the woman is not in labor or is between contractions
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| Baseline FHR (#bpm) | between 110-160 bpm (120-160 is normal)
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| Tachycardia (FHR) | above 150 bpm
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| Possible causes of FHR tachycardia | infection, anxiety from mom, medications
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| Bradycardia (FHR) | below 110 bpm
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| Possible causes of FHR bradycardia | heart/cardiac block - not enough O2
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| Variability | the normal irregularity of the cardiac rhythm - internal fetal monitoring measures this best
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| Accelerations | occur in breech presentations
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| Accelerations | are the basis for the nonstress test and occur with fetal movements, indication fetal well being (want to see irregularities)
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| Accelerations | should be seen with every contraction (GOOD)
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| Decelerations | may be benign or ominous - down but comes back up
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| Early deceleration | occur in response to compression of the fetal head (head compression) - OK to have during labor
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| Late deceleration | caused by uteroplacental insufficiency. Deceleration begins after the contraction is well established and persists after contraction ends
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| Late deceleration | Not getting enough O2 - possibly b/c of mom's position, so reposition on Left side, Inc fluids, elevate HOB - if continues > C-section
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| Late deceleration could be a sign of | fetal distress
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| Variables | are caused by compression of the umbilical cord - Do not mirror uterine contraction - No pattern > reposition
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| Reassuring FHR patterns | Baseline FHR in normal range of 110-160 with average variability; accelerations; early decelerations; mild variables
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| Non-Reassuring FHR patterns | Progressive inc or dec in baseline FHR; Tachycardia above 160; progressive dec in baseline variability; severe variable decels; repetitive late decels; total absence of variability; prolonged decels of any kind; severe bradycardia
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