Beruflich Dokumente
Kultur Dokumente
and
DELIVERY
LABOR
Labor (parturition) is a series of events
by which uterine contractions and
abdominal pressure expel a fetus and
placenta from a womans body.
MATERNAL RESPONSE
Cardiovascular
System
Contraction
increase blood flow to placenta
increase blood volume
increase BP slightly and slows pulse
pressure
Respiratory
System
Labor pain
Depth and rate
respiratory alkalosis
tingling
of hands and feet, numbness,
dizziness
Gastrointestinal
Gastric motility
mouth
System
N / V , thirsty, dry
Urinary
System
Placental Response
Placental
Circulation
Cardiovascular
System
Pulmonary
System
Withdrawal
Hypothesis
Prostaglandin Hypothesis
Uterine stretch
Oxytocin theory
Lightening (dropping)
2.
Increase in level of
activity
(energy spurt or
nesting)
- r/t an increase in epinephrine
release initiated by a decrease in
progesterone produced by the
placenta.
5.
Uterine contractions
3. Rupture of membranes
- experienced either as a sudden gush or
scanty, slow seeping of clear fluid from
the vagina.
- AF is continuously produced until
delivery.
2 risk with ROM:
Intrauterine infection
Cord prolapse
PASSENGER
vertex
si
i
c
n
t
u
p
oc
ci
pu
t
Occipitofrontal-12 cm
Suboccipitobregmatic- 9.5 cm
Occipitomental- 13.5 cm
Molding
- is a change in the shape of the
fetal
skull produced by the force of
uterine
contractions pressing the vertex of
the head
against the not yet dilated cervix.
Variations in the
Passenger
A.
1.
2.
3.
Longitudinal
Transverse
Oblique
B.
C.
Types:
1. Cephalic
2. Breech
3. Shoulder
Types of Presentation
1. CEPHALIC = the fetal head presents itself to the
passage, occurs in 97% of births
Classified as:
1. Vertex most common; fetal head is completely
flexed; smallest diameter of the fetal head
(suboccipitobregmatic ) presents to the maternal
pelvis
2. Military fetal head is neither flexed nor
extended; top of the head is the presenting part
3. Brow fetal head is partially extended; sinciput
is the presenting part
4. Face fetal head completely extended; face is
the presenting part
3.
SHOULDER (Acromion)
Station-
2. PASSAGE
Gynecoid
Inlet
Midpelvis
diameters adequate with parallel
side walls.
Outlet
adequate
Favorable for vaginal birth
Android
Inlet
heart-shaped
Midpelvis diameters reduced
Descent into pelvis is slow
Not favorable for vaginal
birth
Anthropoid
Inlet
oval in shape
Outlet adequate
Platypelloid
Inlet
oval in shape
Outlet capacity inadequate
Not favorable for vaginal birth
3. POWER
Major
Uterine contraction
3 phases of labor
contraction
INCREMENT building up of
the contraction (longest
phase)
2. ACME peak of the
contraction
3. DECREMENT letting up of
the contraction
1.
4. POSITION
Maternal
Semi-recumbent position
- woman sits with upper body elevated.
1.
2. Lateral position
- Removes pressure from the vena cava
compression and back to enhance
uteroplacental perfusion and relieves
backache.
3. Upright position
- Effect of gravity enhances the
contraction cycle and fetal
descent.
Squatting
5. PSYCHE
A womans psychological outlook refers to the
psychological state or feelings that a woman brings into
labor.
The woman manage best in labor typically are those
who have a strong sense of self esteem and a
meaningful support person with them.
Women without inadequate support can have an
experience so frightening and stressful they can develop
PTSD.
FALSE LABOR
Contraction
Irregular, no change in
frequency, duration and
intensity
Discomfort
Rest/
Activity
Cervix
Four Stages of
Labor:
Active Phase
Rapid cervical dilatation : 4 cm
to 7 cm
Contractions
Stronger lasting 40 to 60 seconds every 3 to 5
minutes.
lasts approximately
3 hours in a nullipara
2 hours in a multipara
Show : increased vaginal secretions
Perhaps spontaneous rupture of the membranes may
occur.
Emotional status:
Intoverted, less
responsive, decreased
attention span, intense
concentration on
work of labor, some
loss of control may occur
along with a growing
irritability
Transition
Phase
Crowning
As
Mechanism of a spontaneous
vaginal delivery/ Cardinal
movements
Mechanisms of Labor
Descent
Flexion
Internal Rotation
Extension
External Rotation
Expulsion
Placental
Separation
Folding and separation of the
placenta occur.
Active bleeding
maternal surface of the placenta
the bleeding helps to separate the
placenta still further by pushing it
away from its attachment site.
Signs
of placental separation
Lengthening of the umbilical
cord
Sudden gush of vaginal blood
Change in the shape of the
uterus
Firm contraction of the uterus
Appearance of the placenta at
the vaginal opening
Fourth stage
Recovery:
Normal
blood loss
during NSVD 300 to
500 ml.
CS:
Taking In Phase
Mother is dependent, has difficult making
decisions and needs assistance with self-care.
Can last several hours to days.
Taking Hold Phase
After she has rested and recovered from stress
of delivery, the new mother has energy for the
infant. Lasts 2 days to several weeks.
Letting Go Phase
Family relationships are adjusted to
accommodate the infant. Give up the fantasy
child and gets to know the real child.
POSTPARTUM COMPLICATIONS
1.
Causes:
a. Laceration
b. Placental retention
c. Uterine rupture
d. Uterine inversion
e. Uterine atony
2. INFECTIONS
profuse bleeding
b. Episiotomy Infection
Operative Obstetrical
Procedures
Forceps Delivery
Cesarean Section
In the case of severe obstetric emergencies, the time
from decision to delivery is ideally within 30 minutes .
3 types
a. Low Segment CS
method os choice since
lower segment is thinner,
fewer bld vessels,
passive during labor
b. Classical CS
indicated for transverse
lie, placenta previa,
adhesion of tissues
c. Pfannenstiel or bikini