RNC-OB Labor information
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| Gateway Control Theory | theory that massage, heat, and cold stimulate nerve fibers that block painful stimulation
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| Therapeutic Touch Theory | effects are result of energy exchange between client and nurse to reduce pain and anxiety
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| 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
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| 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.
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| Engagement | 1st cardinal movement. Dropping or "lightening"
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| Descent | 2nd cardinal movement assessed by station -3 - +3
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| Flexion | 3rd cardinal movement
fetal head nodding forward toward chest
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| Internal Rotation | 4th cardinal movement
generally rotates OT to OA
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| Extension | 5th cardinal movement describing the crowning and delivery of the head
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| Restitution | 6th cardinal movement describing the realignment of head and body after delivery of the head
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| External Rotation | 7th cardinal movement
shoulders rotate to AP diameter of pelvis
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| Expulsion | 8th cardinal movement describing the birth of the body
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| Prolonged Latent Phase | >20 hours - primips
>14 hours - multips
caused by unripe cervix and early anethesia
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| Protracted Active Phase | <1.2 cm/hr - primips
<1.5 cm/hr - multips
caused by CPD, malpresentation, early anesthia, ROM before onset
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| 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
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| Precipitous Labor | cervical dilatation >5 cm/hr (primips) or >10 cm/hr (multips)
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| 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
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| 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
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| First Stage of Labor | 0-10 cm dilatation
3 phases: Latent, Active, Transition
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| Latent Phase of Labor | 0-3 cm
mild contractions
distraction most effective in this stage
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| Active Phase of Labor | 4-7 cm
moderate contractions
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| Transition Phase of Labor | 8-10 cm
strong contractions
characterized by panic and fear
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| 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
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| 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
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| Third Stage of Labor | delivery of placenta
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| Fourth Stage of Labor | 1-4 hours after delivery
maternal physiologic adjustment
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| 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)
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| Fetal Lie | relationship of long axis of baby to mother
Longitudinal - cephalic or breech
Transverse
Oblique
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| Fetal Presentation | part of fetus entering pelvis first
Shoulder
Breech - complete, frank, footling
Cephalic - vertex, brow, face
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| Fetal Attitude | relationship of fetal parts to each other
Flexion - chin to chest (easiest delivery)
Extension
Military - neither flexion or extension
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| Position | relationship of presenting part to specific area, right or left, anterior or posterior, on mom's pelvis
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| Anterior Fontanelle | diamond shape, bigger
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| Posterior Fontanelle | Triangle shape, smaller
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| 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.
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| Ferguson Reflex | urge to push caused by baby putting pressure on the cervix and Ferguson plexus of nerves
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| Gynecoid Pelvis | Typical female pelvis
adequate for labor
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| Android Pelvis | Typical male pelvis
narrow dimensions associated with halting labor
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| Anthropoid Pelvis | Apelike pelvis
adequate for labor
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| Platypelloid Pelvis | wide-narrow pelvis
unfavorable for labor
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| Category I FHTs | baseline 110-160 bpm
moderate variability
possible early decerations
possible accelerations
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| Category II FHTs | not category I or III FHTs
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| Category III FHTs | Absent variability + any of the following
recurrent late decelerations
recurrent variable decelerations
bradycardia
sinusoidal pattern
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| IUPC monitoring uterine baseline | 5-15 mmHg, never >30 mmHg
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| IUPC monitoring 30 mmHg | decreased uterine blood flow
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| IUPC monitoring 40 mmHg | complete cessation of blood flow to uterus
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| MVUs <150 mmHg | inadequate labor
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| MVUs 180-250 mmHg | should indicate adequate labor
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| MVUs >300 mmHg | increased uterine activity, tachysystole
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| Baroreceptors | receptors effected by BP changes
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| Chemoreceptors | receptors effected by Oxygenation changes
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