Chapter 26 Notes to Review Onset of Labor based on hormonal theory: 1. Oxytocin stimulation 2. Progesterone withdrawal 3. Estrogen stimulation 4.

Fetal cortisol Signs of Labor: Can be seen 2 weeks prior to onset by a drop into the pelvis, called Lightening, which cause urinary frequencies. She breathes better because there is more space in the abdominal cavity. A leakage could be urine or amniotic fluid. Use Nitrazine Paper and place on fluid. If paper turns blue or a shady blue, its amniotic fluid. The paper itself is yellow. How do you get a false test result with nitrazine paper? If theres a bloody show, little amniotic fluid or semen. This could alter results. BOW- Rupture of the Bag of Waters, puts the patient at high risk for infection. Delivery should occur 18 24 hours after BOW. What is a Bloody Show? The mucus that occluded the opening of the cervix during pregnancy(the plug). How does the cervix change in labor? The cervix begins to thin(efface) and open(dilate). Braxton Hicks- irregular contractions that do not open the cervix. Also called false labor. True Labor signs are regular, rhythmic, with progressive dilation. What to look for in patient? An outburst of energy or weight loss of 1-3 pounds. How are perinatal infections transmitted? Through bodily fluids What standard precautions are used ? Wash hands before donning gloves, wear a mask and shield for eye protection and gown, cap and shoes if c-section. Drape the woman in sterile towels and sheets, dress partner with gear and explain to him where to stand, use suctioning for baby such as bulb syringe, Delee oral suction device. When do you use general anesthesia? When the mother refuses or is not a good candidate for epidural or subarachnoidal block or in cases of emergency. What technique is used for general anesthesia? Patient breathes oxygen3 -5 minutes or four deep breaths for storage during anesthesia induction. Tilt her to the left side.

Why place her on her left? To displace the uterus from the aorta and inferior vena cava, promoting placental blood flow. What are the side effects of general anesthesia and how do you minimize them? Maternal aspiration of gastric contents, leading to aspiration pneumonitis. o o Minimize by restricting intake of clear liquids or NPO Administer drugs to raise the ph level and make secretions less acidic with Zantac, pepcid, tagamet, etc. Administer drugs to reduce secretions such as Robinul. Use cricoid pressure (sellicks maneuver)

o o

Uterine relaxation causing postpartum hemorrhage. o o Reduce the time from induction to anesthesia until the umbilical cord is clamped Keep sedation to a minimum until cord is clamped

Respiratory depression- mother or baby, but mostly baby

What are the 5 Ps in Labor and Delivery? Passageway- pelvis and soft tissues Passengers fetus and placenta Powers- the contractions Position of mother- standing, walking, side lying, squatting Psyche- psychological response

What functions as a support for the uterus and fetus during the late months of pregnancy? The superior portion of the pelvis. AKA Iliac segment of the innominate bones. What do these bones do? They help and direct the fetus into the lower portion of the pelvis, AKA true pelvis. What is linea terminalis or pelvic inlet? An imaginary line that divides the two sections of the pelvis. Which section is more important and why? The true pelvis is more important because the fetal head goes through this section and must comply.

Can you use pelvimetry to measure the bony prominences of the pelvis? Yes, but it cannot be used on pregnant women. They must use ultrasonography instead. What are the soft tissues in the passageway? Uterine tissues, cervical tissues, vagina, perineum. How do uterine tissues respond to labor? The upper section of the walls will thicken to provide force and the lower uterine section will be thin and soft acting as a passive tube. There is a band of tissue located between the two sections. What is it called? The physiologic retraction ring. How does the cervical tissues respond to labor? As the pressure is unfolding downward, the cervix will efface and dilate. What changes occur in the vagina? Increase of blood supply, increase thickness of mucosa, loosening of connective tissue, and enlargement of smooth muscle cells. Why do the smooth muscle cells enlarge? In order to make the vagina capable of stretching to allow passage of fetus. What changes occur with the perineum? The anus may appear dilated and bulging due to all the pressure. Which body part of the fetus poses the biggest concern? The fetal skull because its the largest part to pass through. What is molding? The reshaping of the skull bones in response to pressure against the maternal pelvis. What are sutures? They are the membranous spaces that join the skull bones. Where do the sutures meet? They meet in the fontanelles, which are larger membranous areas. The anterior fontanelle is larger and diamond shape, because its formed by four bones. What is fetal attitude? The relationship of fetal body parts to one another. What is flexion? At term, its the ideal attitude for the fetal body. What is oligohydramnios? Its a very small amount or absence of amniotic fluid.