labor and delivery module 2 &3

only some terms, not ALL.

Presumptive Signs of Pregnancy

Presumptive Signs of Pregnancy

Indications like breast tenderness, amenorrhea, and fetal movement that suggest pregnancy but are not definitive.

Probable Signs of Pregnancy

Observable signs such as Braxton Hicks contractions and positive pregnancy tests that strongly indicate pregnancy.

Positive Signs of Pregnancy

Definitive signs like visualizing the baby via ultrasound, hearing fetal heart sounds, and feeling fetal movements that confirm pregnancy.

Prenatal Visits Overview

Components include medical history, sexual health, diet, mental/emotional health, substance use, social support assessment, and guidance on various aspects.

Diabetes in Pregnancy risks

Risks include spontaneous abortion, neonatal hypoglycemia, and preeclampsia; insulin is safe as it doesn't cross the placenta.

Health Behaviors/Education for Moms

Covering aspects like bathing, exercise, nutrition, and recognizing danger signs during pregnancy.

Changes in Body Systems during Pregnancy first trimester

Includes amenorrhea, urinary frequency, nausea, breast changes, and hormonal influences on various body systems.

Chorionic Villus Sampling

A prenatal test done at 10-13 weeks to detect genetic abnormalities like Down syndrome and cystic fibrosis.

Amniocentesis

A test performed at 15-20 weeks to analyze amniotic fluid for genetic conditions and fetal gender.

Second Trimester Surveillance

Involves monthly visits, fetal heart monitoring, ultrasound, diabetic screening, and discomforts like backaches and varicosities.

What happens to the uterus in the third trimester?

it becomes larger and walls get thinner, there are changes in the cervix

What GI changes occur in the third trimester?

Slowed digestion to increase nutrients absorbed

Musculoskeletal Changes

Discomfort in the back and legs, loosening of joints

Respiratory changes in the third trimester?

Shortness of breath from enlarging uterus

Cardiovascular changes in third trimester?

Increased cardiac output

Urinary changes third trimester?

Renewed pressure on the bladder, screening for occult (asymptomatic) and UTI

third trimester discomforts?

return of first trimester discomforts, SOB and dyspnea, heartburn and indigestion, dependent edema, braxton hick’s contractions, backache, leg aches and joint aches, uterine round ligament pain - either sharp or continuous.

what does fetal development look like in the 3rd trimester?

all organs mature further, noticeable increase in size, fat accumulation, skin thicknes, by 32-34 weeks reflexes to suck, swallow, and breathe coordinate if born prematurely, every day and week in utero is critical, high probability of survival if born, fetus should display significant activity, they can hear, taste and respond to external stimuli.

antenatal testing third trimester?

non-stress testing, ultrasound, repeat STI screening,, GBS (group beta strep cultures)

what are some signs of paternal adaptation?

couvade, safety concerns, financial worries, emotional health

what is couvade?

phenomenon when fathers experience pregnancy or labor symptoms

safety concerns that fathers have?

health and safety of the mother and baby

financial worries that fathers may have?

financial stress related to impeding or current child-rearing costs

emotional health that fathers may experience?

fathers may experience baby blues and post partum depression

education (prenatal classes and preparation)

classes offer valuable knowledge about the pregnancy process and a forum to ask questions

attendance to prenatal classes

some mothers may skip if they are planning to use epidural but it is beneficial for their holistic understanding

preconception care

preparing mentally and physically before conceiving

home readiness

ensuring the home enviornment is safe and suitable for the incoming infant

referral services

resources: women, infants and children (WIC), medicaid and others provide support

gestational age

conception to birth - notes how far along the pregnancy is

gravida (gravidity)

a pregnant woman - also refers to the total number of pregnancies experienced in a woman’s lifetime

para (parity)

total number of pregnancies that have progressd past 20 weeks gestational weeks in a woman’s lifetime

uterine contractions

rhythmic, intermittent activity of the uterine muscle

dilation

the gradual opening of the cervical os during labor

effacement

the gradual thinning of the cervix (0%-100%)

fetal station

relationship of presenting fetal part to level of maternal ischial spines of the pelvis

fetal position

relationship between fetal presenting part and specified point of maternal pelvis (O, M, S, A)

vaginal exam

used to assess cervical changes (dilation and effacement) and fetal station/presentation

first stage of labor

latent phase & active phase

latent phase

dilated 0-6cm and effaced 0%-40%

first pregnancy (nullipara) lasts up to 20 hr

consecutive (multipara) up to 14 hours

how consecutive are the contractions in the latent phase?

every 5-10 minutes, and last 30-45 seconds (mild intensity)

active phase

dilated 6-10cm, effaced 40%-100%

nullipara - 6 hours

multipara - 4 hours

how consecutive are the contractions in the active phase?

every 2-5 minutes

lasting 45-60 seconds

intensity is moderate

what are the 4 p’s of labor?

• passenger: fetal head

• power: contractions

• passageway: birth canal

• psyche: psychological response of mother

providing pain management during labor

pain is universal, unique to each client, physical, emotional, social, cultural factors influence pain

pain perception

changes throughout labor progression, depends on behavioral changes of patient

non pharmacologic pain management during labor

• support

• empty bladder

• ambulation (walking), birthing/peanut ball

• maternal position changes

• hydrotherapy

• focused imagery/music

• breathing techniques

• therapeutic touch/massage

• heat/cold application

• counter pressure

pharmacologic pain management during labor

• systemic analgesia (opiods, analgesics and anxiolytics)

• inhaled analgesia (nitrous oxide)

  • regional analgesia/anesthesia (epidural, combined spinal epidural)

VEAL CHOP

• Variable deceleration

• Early deceleration

• Acceleration

• Late deceleration

• Cord

• Head

• Okay! acceleration

• Perfusion

false labor

irregular, contractions stop with walking/position chang, felt in the back or abdomen above the umbilicus, stops with comfort measures.

cervix is soft, no SIGNIFICANT change in effacement & dilation, no bloody show, baby is in posterior position

fetus presenting part is not engaged in the pelvis

true labor

contractions are regular, stronger and longer, and closer together

they are more intense with walking

they are felt in the lower back and radiate to a portion of the abdomen

they continue despite comfort measures

the cervix progressively changes: it softens, effacement, dilation is signaled by the appearance of bloody show, moves to an increasingly anterior position

fetus presenting parts are engaged in the pelvis, increased ease of breathing, presenting part presses down and compresses the bladder = urinary frequencyea

early decelerations?

ARE NORMAL/GOOD ! - THEY mirror mommy’s contractions

late decelerations

they come late, after moms contractions

interventions: oxytocin, position change, oxygen via nonrebrether mask, hydration (IV fluids), elevate legs to correct hypotension

variable decelerations

variable - looks V shaped

interventions: oxytocin, amnioinfusion, position change (side-lying or knee chest will relieve pressure on cord), breathing techniques, oxygen (nonrebreather mask)