Labor

73問 • 1年前

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normally begins between 37-42 weeks of pregnancy when the fetus is sufficiently mature to adapt to extrauterine life, yet not too large to cause mechanical difficulty with births.

Labor

- labor begins before a fetus is mature.

Preterm birth

- labor that is delayed until the fetus and the placentaRostterm birth - labor that is delayed until the fetus and the placenta

Postterm birth

is also called travail, accouchement, parturition and confinement.

Labor

- a woman in labor

Parturient

Real Cause of Labor:

unknown

The most acceptable theory. Uterine muscles stretches from the increasing size of the fetus and amniotic fluid (fetal membranes) which results in release of prostaglandins.

Uterine Myometrial Irritability / Uterine Stretch Theory

- are a group of lipids made at sites of tissue damage or infection that are involved in dealing with injury and illness. They control processes such as inflammation, blood the formation of blood clots and the induction of labour.

Prostaglandins

The pressure of the fetal head on the cervix in late pregnancy stimulates the posterior pituitary gland to secret Oxytocin which causes uterine contractions. Oxytocin stimulation works together with prostaglandins to initiate contraction.

Oxytocin Theory

Changing in the ratio of estrogen to progesterone occurs, increasing estrogen in relation to progesterone, which is interpreted as progesterone withdrawal. When progesterone (uterine muscle relaxant) decreases in late pregnancy with corresponding increase in estrogen (uterine muscle stimulant) labor starts,

Low progesterone Theory / Progesterone Deprivation Theory

All hormones have stimulating effect on uterine musculature causing motility

Estrogenic Fetal Hormone and Prostaglandin Theories

Measurements - may be obtained by internal and external pelvic examination (using pelvimeter), x-ray pelvimetry (used rarely in pregnancy and only late in third trimester or in labor), and ultrasound

Passage

The Components of Labor A successful labor depends on four integrated concepts often referred to as the four Ps. 1. The ? ( a woman's pelvis) is of adequate size and contour. 2. The ? ( the fetus) is of appropriate size and in an advantageous position and presentation. 3. The ? (uterine factors) are adequate. 4. The ? , or a woman's psychological state which may either encourage or inhibit labor. This can be based on her Past life experiences as well as her present psychological state.

passage, passenger, powers of labor, psyche

size and type of pelvis, ability of the cervix to efface and dilate, and distensibility of vagina and introitus

Passage

- the bony ring through which the fetus passes during labor and delivery; consists of four united bones (two hip or innominate bones, the sacrum, and the coccyx) between trunk and thighs.

Pelvis

Pelvic types: a. ? - classic female pelvis inlet, well rounded (oval); ideal for delivery, most ideal for childbirth (50% of women) b. ? - resembling a male pelvis, narrow and heart-shaped; usually requires cesarean section or difficult forceps delivery (20% of women) c. ? - flat, broad pelvis; usually not adequate for viu delivery (5% of women) d. ? - similar to pelvis of anthropoid ape; long, deep, a narrow; usually adequate for vaginal delivery (25% of women

Gynecoid, Android, Platypelloid, Anthropoid

Types of

Pelvis

- provides protection to the organs found within the pelvic cavity - provides attachment to muscles, fascia and ligaments - supports the uterus during pregnancy - serves as birth canal.

PELVIS:

Pelvis is consists of the following parts:

a. Inlet/ pelvic brim b. Pelvic Canal c. Outlet

a. ? -entrance to true pelvis AP diameters: * Diagonal Conjugate = 12.5 cm *Obstetric Conjugate = 11 cm (Substract 1-1.5cm from diagonal conjugate) *True Conjugate/ Conjugate Vera = 11.5 cm (or 10.5 - 11c (Substract 1-1.5 cm (or 1.2-2cm) from diagonal corjugate) * Transverse diameter = 13.5 cm *Right and left oblique diameter = 1275 cm

Inlet/ pelvic brim

• Shortest anteroposterior diameter between the sacral promontory and the symphysis pubis • Can only be measured radiographically. • Normally 11 cm

Obstetric conjugate

- is the fetus

Passenger

- the body part of the fetus that has the widest diameter, so this is the part least likely to be able to pass through the pelvic ring.

Fetal head

- bones, fontanelles and suture lines -with seven bones (frontal, parietal, temporal and occipital

Fetal skull

- thin spaces in between bones/ line of junction or closure between bones (sagittal- longtitudinal, between two parietal hones frontal- anterior, between two frontal bones; lamdoidal-posterior, between parietal and occipital bone-Suture - thin spaces in between bones/ line of junction or closure between bones (sagittal- longtitudinal, between two parietal hones frontal- anterior, between two frontal bones; lamdoidal-posterior, between parietal and occipital bone

Suture

- points of intersection of cranial bones; membranous spaces between cranial bones during fetal life and infancya.

fontanels

- formed by 2 frontal and 2 parietal bones. * Diamond-shaped * Measures 25 cm x 2.5 cm • Also called bregma * Ossifies (closes) in 12 to 18 months

Anterior Fontanel

- formed by union of parietal and occipital bones; forms junction with sagittal and lambdoidal sutures * Triangular-shaped * Ossifies in 6-8 weeks or months

Posterior Fontanel

- smallest diameter of the skull, which measures about 9.25 cm.

Biparietal diameter (transverse diameter)

- smallest anteroposterior diameter, approximately 95 cm

Suboccipitobregmatic measurement

- measures from the occipital prominence to the bridge of the nose, is approximately 12 cm. Measured from the occipital prominence to the bridge of the nose, is approximately 12 cm.

Occipitofrontal diameter

which is the widest anteroposterior diameter, approximately 13.5 cm is measured from the posterior fontanelle to the chin.

Occipitomental diameters

- is overlapping of skull bones along the suture lines, which cause a change in the shape of the fetal skull to one long and narrow, a shape that facilitates passage through the rigid pelvis.

Molding

- relationship of the fetal parts to the trunk or to one another. 1. Flexion 2 Extension Degree of flexion the fetus assumes or the relation of the fetal parts to each other a. Vertex (full flexion) b. Sinciput ( moderate flexion) (military attitude) c. Brow (partial extension d. Face (poor flexion, complete extension)

Fetal Attitude

- relationship between the long (cephalocaudal) axis of the fetal body to the long (cephalocaudal) axis of the mother's body.

Fetal Lie

1. - head or breech presents 2. - shoulders presents

Longitudinal, Transverse

part of fetus that presents to (enters) maternal pelvic inlet

Fetal Presentation

1. - head presentation (>95% of labors) a Vertex - head well flexed b. Sinciput - head moderately flexed - military attitude c. Brow - head moderately -extended d. Face - head well - extended

Cephalic/vertex

2. a Complete - flexion of hips and knees b. Frank (most common) - flexion of hips and extension of knee c. Footling/ incomplete - extension of hips and knees

Breech Presentation

**In breech presentation, passage of meconuim is not a sign of fetal distress, FHT is best heard at the upper quadrants and with the findings of leopold's maneuvers ? & ? reversed: - hard, round, ballottable mass (head) - soft, globular, non - ballottable mass (buttocks)

LM1, LM3,

- Transverse lie, fetus lies horizontally in the pelvis so that! the longest fetal axis is perpendicular to that of the mother.Shoulder - Transverse lie, fetus lies horizontally in the pelvis so that! the longest fetal axis is perpendicular to that of the mother.

Shoulder

relationship of the denominator of the presenting part to the 4 quadrants of the mothers pelvis; the quadrants of the maternal pelvis in which the presenting occiput (0), mentum (m), or sacrum (s) is located; could be located on the maternal left anterior or posterior, or on her right, anterior or posterior.

Fetal Position

- dependent upon degree of flexion of fetal head on chest; full flexion-occiput (O); full extension-chin (M); moderate extension-brow (B)Vertex presentation - dependent upon degree of flexion of fetal head on chest; full flexion-occiput (O); full extension-chin (M); moderate extension-brow (B)

Vertex presentation

- sacrum (S) - scapula

Breech presentation, Shoulder presentation

Relation of the presenting part to a specific quadrant of a woman's pelvis

* Left anterior * Right anterior * Left posterior * Right posterior

Refers to the settling of the presenting part of the fetus far enough into the pelvis to be the level of the schial spines, a midpoint of the pelvis. Station-level of presenting part of fetus in relation to imaginar line between ischial spines (zero station) in midpelvis of mother

Engagement

- unengagedpresenting part.

Floating or high

- presenting part at the level of the ischial spines.

2. Station 0

- mechanism by which the greatest transverse diameter of the fetal head (biparietal diameter) passes through the pelvic inlet.

Engagement

- first requisite for the birth of the baby - may occur earlier in nulliparous woman: before labor - usually begins with engagement in multiparous woman. - four forces to descent a. amniotic fluid pressure b. direct fundal pressure upon the breech c. abdominal muscle contraction d. fetal body extension and straightening

Descent

- when the chin is brought in contact with the chest. - results to the smallest anteroposterior diameter of the fetal head (suboccipitobregmatic diameter - 9.5 cm) to present

Flexion

- turning of the head so that the occiput moves anteriorly toward the symphisis pubis. - associated with descent -Not accomplished until the head is engaged - after internal rotation, the occiput is just under the symphisis pubis.

Internal rotation

- the head is moved backward as it proceeds under the symphysis pubis and baby is born by extension over the perineum

Extension

- movement of head to align itself with face and shoulders (restitution) and then rotation bringing shoulders into anteroposterior diameter appears as one movement

Restitution and external rotation

- first the anterior shoulder under the symphysis pubis, then the posterior shoulder over the perineum, followed rapidly by the rest of the body; time of birth is recorded at this time

Expulsion

a. Primary Power - uterine contractions 1. Characteristics - involuntary, intermittent, regular activity of uterine musculature 2. Purposes a. Propel presenting part downward/ forward. b. Effacement of the cervix - thinning out, pulling up, shortening of the cervical canal. c. Dilatation of the cervix - opening, widening, enlarging, increasing in diameter of the cervical os from 0 to 10 cm.

Power

- the phase of the increasing intensity of contraction, the first phase; the onset

Increment (crescendo)

the height of the uterine contractions

Acme (apex)

- the phase of decreasing contractions: the end.

Decrement (decrescendo)

- intensity of comraction increase

Increment

- the contraction strongest

Acme

- the time from the beginning of one contraction to the beginning of next contraction

Frequency

- time from the moment the uterus first tenses until it relaxed again.

Duration

- the time from the beginning of one contraction to the beginning of same contraction The time for checking maternal BP, FHT, delivering the fetal had in precipitate labor to prevent lacerations; the time for maternal sleep and relaxation during labor

Interval

- can be determined by placing the hand lightly on the fundus with the fingers spread; may be mild, moderate and strong

Intensity

? - the uterus is contracting but does not become more than minimally tense ? - the uterus feels firm ? - the contraction is so intense the uterus feels as hard as a wooden board at the peak of contraction

mild,moderate, strong

a. Pregnant women's general behavior and influences upon her also influence labor progress (1) Cultural influences and perceptions about labor and delivery. (2) Responses to uterine contractions (3) Childbirth preparation process (classes) (4)Support system (5) Previous experience (6)Ability to communicate feelings to significant others

Psyche

(1) Traction on the peritoneuum (2) Uterine contractions (3) Emotional tension (4)Hypoxia (5)Pressure

Causes of pain in Labor

- descent of the presenting part to the true pelvis.

Lightening

- has lightening earlier; 2 weeks before labor

Primigravida

- lightening happens a day before labor or on the day of the labor

Multigravida

Increased Braxton Hicks constractions 3 to 4 weeks before labor.

(a) False labor contractions (b) They do not dilate the cervix (c) Abdominal (d) Relieved by walking, enema (e) Generally painless but may be quite annoying

Increased maternal energy/ burst of energy bacause of hormones ?

epinephrine

Latin Abbreviations

JULLIANNE DANDAN · 43問 · 2年前

Latin Abbreviations