normal labor and delivery

most important hormones involved in labor

-oxytocin

-prostaglandins

oxytocin

-produced in hypothalamus

-released by posterior pituitary

-causes uterine contraction, stimulate the release of milk from the breasts

prostaglandin

-produced by placenta and certix

-help soften and thin cervix

progesterone

-produced by the ovary

-decreases which helps trigger labor

estrogen

-produced by ovaries

-high in pregnancy but opposed by progesterone

dilation

-opening of the cervix during labor

-0-10 cm during labor

effacement

-thinning of the cervix during labor

consistency

-firm non-pregnant, softens or ripens as labor progresses

station

-position of the baby head in the pelvis

0= level of ischial spine

-2= 2cm above ischial spine

+2= 2cm below ischial spine

contraction

-rhythmic tightening of the uterus that help to dilate the cervix and push the baby out of the uterus

progression

-rate at which the cervix dilated and effaces

-normal= 1cm/hr latent and 2cm/hr active

rupture of membranes

-breaking of the amniotic sac

bishop score

-low score ff 1= not going to labor for 3 weeks

-higher score of 10= expected labor in a few days

->8= good chance for vaginal delivery

-<6= lower chance of vaginal delivery

first stage of labor

-longest

Latent phase

-begin when contraction start and become regular and stong

-ends when cervix is dilated to 4 cm

Active phase

-begins when cervix is dilated to 4cm

-ends when cervix is dilated to 10cm

time= 12-19 first time, 10-14 who have children before

second stage of labor

-begins when cervix is fully dilated

-end when delivery of the baby

"push phase"

time= 30-60 min

third stage of labor

-begins after the baby is born

-ends with delivery of placenta

time= 5-15 min

signs and symptoms of normal labor

-contraction should be 4 min apart each contraction lasting 1 min and this pattern lasting 1 hr = come to hospital

-bloody show= cervix is starting to dilate

-water breaking= rupture of amniotic sac

-pelvic pressure= due to descending baby

-diarrhea= cause by hormones

if there is a rupture of membrane during labor

-if the present is not fixed into the pelvis, the umbilical cord can prolapse and become compresses

-labor is likely to begin soon

-delivery is delayed after rupture, intrauterine and neonatal infection is more likely as the time interval lengthens

rupture membrane diagnosis

-amniotic fluid pool in the posterior fornix or clear fluid flows onto the speculum

-check pH >7

-microscope= fern pattern

labs that are checked in labor

-hematocrit and hemoglobin

-type and antibody screen

-some do syphilis, hep B, HIV

-urine sample

non-stress test (NST)

-measures the baby heart rate

-measures strength and frequency of the contraction

biophysical profile (BPP)

-ultrasound

-fetal breath movement

-fetal movement

-fetal tone

-amniotic fluid volume

pain management

-relaxation

-water tub

-ambulation

-epidural IV or IM: blocks pain in particular region of the body, often delivered with opioid

NPO

-hold food during active labor due to delayed gastric emptying and aspiration risk

bladder management

-empty bladder regularly to prevent obstruction of fetal descent and reduce infection risk

at the start of uterine contraction

-patient is instructed to exert downward pressure

-not encouraged to push beyond completion of contraction

-several positions

power

-force of uterine contractions

passenger

-refers to the fetus

-fetal size, estimated fetal weight

-fetal lie

-presentation

-position and station

passage

-refersto the bony pelvic and soft tissue of the birth canal

braxton hicks contractions

-irregular, painless uterine contractions

-before 37 weeks distinguish form preterm labor

fetal lie

-more than 99 percent of of labor at term, the fetal is longitudinal

-ethier head or breech

cephalic presentation

-want right or left occiput anterior

engagement

-head is sitting in pelvic inlet

-happens in last 2 weeks

descent

-present part passing through the pelvis

-continues till the fetus is delivered

flexion

-due to shape of bony pelvis the fetal head passively undergoes flexion to present is smallest diameter

-essential for engagement and descent

internal rotation

-head goes from original position, gradually moving anteriorly toward the symphysis pubis

-descent of the head mid pelvis

extension

-fetus has descended to the introitus and then deflexes

-ring of fire

external rotation

-passive rotation of the fetal head back to anatomical position

-anterior shoulder rotates under the symphysis pubis

expulsion

-delivery of the entire fetus

clamping the cord

-wating 30-60 seconds associated with high hemoglobin levels after delivery and greater iron stores

skin to skin

-results in optimal warmth for the newborn

-earl maternal neonatal bonding and facilitation of early breastfeeding

postpartum care of the mother

-laceration are repaired

-uterine tone and perineum frequently evaluated

-Bp and pulse noted immediately after delivery ever 15 min for 2 hours

-temperature q4 during first 8 hours, then q8 after

preparation for C section

-patient is aware of indication, alternative, risks

-IV 18 gauge needle should be place

-patient given antacid

-foley catheter

-abdomen is preped

abdominal incision

-transverse incision with or without transection of rectal muscles

-15cm

-if emergency midline vertical suprapubic incision is preferred

once baby is delivered C section

-blood loss can be minimized by massaging the uterus

-oxytocin continued in dilute IV solution

-uterine cavity is wiped clean to remove any retained membrane

closure of incision

-entire of the uterine thickness of myometrium should be closed

-should be closed in 2 layers