Pregnancy and Preparation for Labor

Presumptive Signs of pregnancy

Changes felt by woman, these signs and symptoms are not proof of pregnancy but they will make you suspect of pregnancy because it may resemble pregnancy signs and symptoms.

Presumptive signs

amenorrhea, nausea, breast tenderness, deepening pigmentation, urinary frequency, quickening

Probable Signs of pregnancy

signs observed by the examiner (Obstetrician) They are more reliable indicators of pregnancy than the presumptive signs but are not definitive

Uterine changes

these signs in uterus are probable and cannot be consider as true signs of pregnancy.

Probable signs

blood and urine tests, Chadwick's sign, Goodell's sign, Hegar's sign

Positive Signs of pregnancy

Assessment findings present only during pregnancy

Positive signs

audible fetal heartbeat, fetal movement felt by examiner, ultrasound visualization of fetus, x-ray

Preliminary Signs of Labor

-Lightening

-Increase in energy

-Slight loss of weight

-Backache

-Braxton Hicks contractions

-Ripening of the cervix

Lightening

sinking/ descent of the fetal head into the true pelvis. 10-14 days before labor begins. may experience shooting leg pains from the increased pressure on sciatic nerve, increased amounts of vaginal discharge and urinary frequency from pressure on her bladder

Slight loss of weight

as progesterone level falls, more fluid is excreted, slightly lowering body weight.

Backache

labor contractions begin in the back, an intermittent backache stronger than usual may be the first symptom a woman notices

Excess energy

increase in activity is related to a boost in epinephrine release, which is initiated by a decrease in progesterone production by the placenta.

Braxton Hicks Contractions

Sporadic contractions and relaxation of the uterine muscle. Sometimes, they are referred to as prodromal or "false labor" pains.

Ripening of the Cervix

prostaglandins soften the cervix to allow for shortening and dilation

Show

sudden gush of blood (pinkish vaginal discharged.)

Leopold's Maneuvers

common and systematic way to determine the position of a fetus inside the woman's uterus

Christian Gerhard Leopold

gynecologist famous for the maneuver (1884)

1st leopold maneuver

identifies where the head is (up/down). Fundal grip

2nd leopold maneuver

both sides of the uterus are palpated to determine the direction the fetal back is facing. Umbilical grip

3rd leopold maneuver

determines the part of the fetus at the inlet and its mobility. Pawliks grip

4th leopold maneuver

determines the fetal attitude and degree of fetal extension into the pelvis. Pelvic grip

Signs of true labor

Uterine contractions

Show and loss of mucus plug

Rupture of membranes

Dilation and effacement

Fetus engaged

false labor

Contractions are irregular.

Often stop with walking.

Contractions felt in abdomen above umbilicus. (abdominal pains)

No changes in cervix.

Fetus is ballotable.

Labor

coordinated sequence of involuntary, intermittent uterine contractions. It is the series of events that expels the fetus and placenta out of the mother's body. This is made possible by the presence of uterine contractions and abdominal pressure

Uterine Stretching:

any hollow body organ when stretched to its capacity will inevitably contract to expel its contents. The uterus, which is a hollow muscular organ, becomes stretched due to the growing fetal structures.

Oxytocin theory of labor

Pressure on the cervix stimulates the hypophysis to release a hormone from the maternal posterior pituitary gland. Presence of this hormone causes the initiation of contraction of the smooth muscles of the body

Progesterone deprivation

hormone designed to promote pregnancy. It is believed that presence of this hormone inhibits uterine motility. Its reduction initiates labor

Prostaglandin Theory

This hormone is secreted from the lower area of the fetal membrane (forebag). A decrease in progesterone amount also elevates the prostaglandin level. Synthesis of prostaglandin, in return, causes uterine contraction thus, labor is initiated.

Theory of Aging Placenta

Advance placental age decreases blood supply to the uterus. This event triggers uterine contractions, thereby, starting the labor.

4 P's of Labor

Powers (contractions)

passenger (baby)

passage (birth canal)

psyche (psychological factors).

Power

This refers to the strength and effectiveness of the uterine contractions. Strong, regular contractions are necessary to dilate the cervix and push the baby through the birth canal.

Passenger

This is the baby. Factors like the baby's size, position, and the way the baby is facing (e.g., head-first or breech) can affect how easily the baby moves through the birth canal.

9.5cm

Biparietal or transverse diameter

Suboccipitobregmatic measurement (smallest AP diameter)

9.5cm from the inferior aspect of the occiput to the center of the anterior fontanelle

Occipitofrontal diameter

12cm from the occipital prominence to the bridge of the nose

Occipitomental diameter

13.5cm (widest AP diameter) from the posterior fontanelle to the chin.

Passage

This is the mother's pelvis and birth canal. The size and shape of the pelvis, as well as the flexibility of the birth canal, can influence how smoothly the baby can be delivered.

Psyche

refers to the mother's emotional state and mental preparedness. A calm, positive mindset can help the labor process, while anxiety or fear can hinder it. Support from healthcare providers and loved ones is crucial for maintaining a positive psyche.

Fontanelles

spaces compress childbirth to aid in molding of the fetal head. palpating this helps establish the position of the fetal head and whether it is in favorable position for birth

Molding

overlapping of skull bones along the suture lines which causes a change in the shape of the fetal skull to one long and narrow, a shape that facilitates passage through the rigid pelvis. It is caused by the force of uterine contractions as the vertex of the head is pressed against the not yet dilated cervix

Fetal attitude

describes the degree of flexion a fetus assumes during labor or the relation of the fetal parts to each other

Cephalic presentation

the most frequent type of presentation, occurring as often as 96% of the time, the fetal head is the body part that comes first contacts the cervix. The four types of cephalic presentation

Good Fetal attitude

a fetus is in complete flexion: spinal column is bowed forward, the head is flexed forward so much that the chin touches the sternum, the arms are flexed and folded on the chest, the thighs are flexed onto the abdomen and the calves are pressed against the posterior aspect of the thighs

Moderate Flexion

if the chin is not touching the chest but is in an alert or military position

Partial Extension

presents the "brow" of the head to the birth canal

Complete extension

back is arched and the neck is extended, presenting the occipitomental diameter of the head to the birth canal

Breech presentation

means either the buttocks or the feet are the first body parts that will contact the cervix.

Complete breech

the fetus has the thighs tightly flexed on the abdomen; both the buttocks and the tightly flexed feet present to the cervix.

Frank breech

attitude is moderate because the hips are flexed, but the knees are extended to rest on the chest. The buttocks alone present to the cervix.

Footling

neither the thighs nor lower legs are flexed. If one foot presents, it is a single-footling breech, if both present, it is a double-footling breech

Shoulder presentation

A fetus lies horizontally in the pelvis so the longest fetal axis is perpendicular to that of the mother.

The presenting part is usually one of the shoulders (acromion process), an iliac crest, a hand or an elbow.

Fetal Lie

Lie is the relationship between the long (cephalocaudal) axis of the fetal body and the long axis of a woman's body- in other words, whether the fetus is lying in a horizontal lie (transverse) or vertical (longitudinal) position

Fetal Position

the relationship of the presenting part to a specific quadrant and side of a woman's pelvis

right anterior,

left anterior,

right posterior,

left posterior

Maternal pelvis is divided into 4 quadrants:

Engagement

refers to the settling of the presenting part of a fetus far enough into the pelvis that it rests at the level of the ischial spine, the midpoint of the pelvis.

floating

A presenting part that is not engaged

dipping

One that is descending but has not yet reached the ischial spines

Station

Refers to the relationship of the presenting part of the fetus to the level of the ischial spines

Effacement

shortening and thinning of the cervical canal

Dilatation

enlargement or widening of the cervical canal from an opening a few millimeters wide to one large enough to permit passage of a fetus

1st stage of labor

This stage is the longest and is divided into three phases: begins with the initiation of true labor contractions and ends when the cervix is fully dilated). It is 12 hours to complete

Early (Latent) Phase:

Cervical dilation: 0 to 3-4 centimeters.

Contractions: Mild and irregular, becoming more regular and stronger.

Duration: Can last several hours to days, especially in first-time mothers.

Active Phase:

Cervical dilation: 4 to 7 centimeters.

Contractions: Stronger, more regular, and closer together (every 3-5 minutes, lasting 40-60 seconds).

Duration: Typically lasts 4-8 hours.

Transition Phase:

Cervical dilation: 8 to 10 centimeters.

Contractions: Very strong, frequent (every 2-3 minutes), and lasting 60-90 seconds.

Duration: Usually the shortest phase, lasting 30 minutes to 2 hours.

Symptoms: Intense pressure, nausea, shaking, and increased irritability.

2nd stage of labor

This stage involves the actual delivery of the baby. From full dilatation and cervical effacement to birth of the infant:

3rd stage of labor

This stage involves the delivery of the placenta. Two separate phases are involved: placental separation and placental expulsion:

Ritgen's maneuver

extracting the fetal head, using one hand to pull the fetal chin from between the maternal anus and the coccyx, and the other on the fetal occiput to control speed of delivery.

Placental Delivery:

Begins immediately after the birth of the baby and ends with the expulsion of the placenta.

Duration: Typically lasts 5 to 30 minutes.

Contractions: Mild compared to earlier stages, helping detach and expel the placenta.

Signs of Placental separation

Lengthening of the cord

Sudden gush of vaginal blood occurs

Placenta is visible at the vaginal opening

Uterus contracts and feels firm

Schultze presentation

if the placenta separates first at its center and lastly at its edges, it tends to folds on itself like an umbrella and presents at the vaginal opening with the fetal surface evident. Shiny side of the placenta

Duncan presentation

if the placenta separates first at its edges, it slides along the uterine surface and presents at the vagina with the maternal surface evident. Dirty side of the placenta

Brandt-Andrews maneuver

is a method used to aid in the delivery of the placenta, by simultaneously placing pressure on the upper abdomen and tension on the umbilical cord

4th stage of labor

Stage of Early Recovery: Begins immediately after expulsion of the placenta and membrane and last for an hour. During which careful observation for the patient, particularly for signs of post partum hemorrhage is essential. Routine uterine massage is usually done every 15 minutes during this period.

Lochia

body's way of getting rid of the extra blood and tissue in your uterus that helped your baby grow. Should be moderate. Saturating sanitary napkin in 30 mins.

Lochia rubra

Red, distinctly blood-tinged vaginal flow that follows birth and lasts 2 to 4 days

Lochia Serosa

Pinkish/brown, serosanguineous. Lasts day 4-10 postpartum

Lochia Alba

2 to 6 weeks postpartum. Whitish yellow.

paracervical block

an anesthetic used during childbirth that blocks pain sensations in the pelvic area, in which injections are given at positions around the cervix

Pudendal block

an anesthetic administered to block sensation around the lower vagina and perineum. through the sacrospinous ligaments into the posterior areolar tissues.

Low spinal anesthesia (block)

epidural or saddle block

Bonding

Special mutual relationship between mother and infant. Best initiated immediately after birth First 30 minutes or the first period of activity

Apgar Screening

To determine the degree of acidosis and the need for CPR. Done twice at 1 and 5 minutes respectively.

Dr. Virginia Apgar

developed the APGAR Score

Silverman-Anderson Index

A five item system for evaluating breathing of premature infants: 1) chest retraction 2) retraction of lower intercostal muscles 3) xiphoid retraction 4) nasal flaring on inhalation 5) grunt on exhalation. Each one is scored, low is best.