5 THE PELVIS False Pelvis True Pelvis Represents Supports the weight of the uterusShallow basin above the inlet or brimTrue PelvisRepresentsthe bonylimits of thebirth canal1. Differentiate between the terms true pelvis and false pelvis.
6 True Pelvis vs. False Pelvis Inlet - upper margin of pubic bone toupper margin of sacrumOutlet - Lower pubic bone to tip ofcoccyx. This area is thesmallest portion that the babymust travel through.2. Explain the difference between the two main sections of the true pelvis and how they impact delivery of the fetus.Which of the following is most important in providing a successful delivery? Why?
8 Fetal HeadBecause of its size and rigidity, the Fetal Head has a major impact on delivery.The bones are not firmly united. There are sutures between the bones that allow them to overlap or MOLD to the birth canal.Head also can rotate, flex, and extend3. Compare the bones, suture lines and fontanels of the fetal head. What do the bones of the fetal head do to accommodate the birth canal?
9 Attitude Relationship of fetal body parts to each other Optimum attitude isovoid4. What is attitude? What is the optimum attitude for delivery?The head is flexed forward, with the chin almost resting on the chest. The arms and legs are flexed.
10 Fetal LieRelationship of the long axis of the fetus to the long axis of the mother.Longitudinal Lie Transverse Lie5. Define the term "fetal lie". Explain the difference between transverse lie and longitudinal lie. Which is the most favorable for a vaginal delivery?
11 True or False? The optimum lie of the fetus is the longitudinal lie. A. TrueB. FalseTrue
12 Fetal PresentationThat portion of the fetus that enters the Pelvis first and covers the internal os.Three Types:CephalicVertex, Face, BrowBreechShoulder6. Define the term “fetal presentation” and explain difference between presentations.Cephalic PresentationThe head is entering the pelvis first.
13 Reference Points Cephalic = Occiput, posterior fontanel Breech = SacrumFace = Mentum7. What reference point would the nurse use when assessing cephalic presentation? A breech presentation? A face presentation?9. What reference point would the nurse use when assessing breech presentation?
14 RelationshipofMaternal PelvisandPresenting Part
15 EngagementEngagement-largest diameter of presenting part has passed through the pelvic inletAssessed duringvaginal examBallotable8. What is engagement? How is it determined?Engaged
16 Station- degree that the presenting part has descended into the pelvis Relationship to ischial spinesGoalMove from – to + stations9. What is station? How is station determined and measured? Does the station need to be a + or – for delivery?
17 POSITIONRelationship of the Fetal Presenting Part to the Maternal PelvisSteps:1. Determine the Presenting Part2. Divide the mothers pelvis into 4 imaginary quadrants10. What is fetal position? What are the steps in assessing position?A12RL936P
18 Test Yourself !What is the reference point of a cephalic presentation when the head is fully flexed?A. occiputB. mentumC. frontald. sagittal
19 Test YourselfOverlapping of the fetal skull to facilitate its passage through the bony pelvis is ___________.Relationship of fetal body parts to each other is_____________.Head first presentation is_________________.Relationship of the fetal spine to the maternal spine is ________________.Term that refers to the part of the fetus that enters the pelvic inlet first is _____________.
21 Major Powers InvolvedInvoluntary Uterine Contractions or Primary PowersMuscular contractions which lead to dilation and effacement in the First Stage of LaborVoluntary Uterine Contractions or Secondary PowersAbdominal muscles assist in the Second Stage with pushing. Increase intra-abdominal pressure to aid in expulsive forces12. What are the primary and secondary powers/forces of labor?13. When are the secondary powers used during the labor process?15. When are the secondary powers used during the labor process?
22 FORCES OF LABORContraction -exhibits a wavelike pattern that begins slowly climbing (increment) to a peak (acme), and decreases (decrement)acmeDecrementIncrementDuration14. Explain the parts of a contraction and the relationship including:IntervalFrequencyDuration- from beginning of one contraction to the end of the samecontractionFrequency- from beginning of one contraction to the beginning ofanother contractionInterval - Resting time between contractions for placental perfusion
23 Fill in the Blank Length of a uterine contraction__________. Strength of a uterine contraction is ___________.The time from the beginning of one contraction to the beginning of the next contraction is _______.The time that allows for placental perfusion is __.The peak of a contraction is also known as ____.When the biparietal diameter of the head passes through the pelvic inlet it is said to be ________.
27 Progesterone Withdrawal Corticotropin-Releasing Hormone CAUSES OF LABORProgesterone WithdrawalHigh levels ofProstagladinsCorticotropin-Releasing Hormone20. What are the possible causes of labor onset?
28 Myometrial Activity Effacement- thinning of the cervix (%) Dilation – enlargement and widening of the os (cm)21. Define effacement and dilatation and how measured
29 Critical ThinkingIf the fetal head did not descend through the pelvis and stayed at the same station for a prolonged period of time, what do you think would be the treatment of choice?
30 Try this ! When the cervical os widens or opens it is said to________. The level of the ________ _________ is station zero.The most common type of pelvis for a woman ___________.When the cervix shortens and thins is _______________.For delivery to occur, the fetus must accomodate to this rigid passageway______________.
31 Premonitory Signs of Labor The impending signsthat take place the lastseveral weeks ofpregnancy or even thelast several days22. What are the premonitory signs of labor?
32 Premonitory Signs of Labor LIGHTENINGBraxton-Hicks ContractionsCervical changesSHOWROMBACKACHESUDDEN INCREASE IN ENERGY
33 True vs. False Labor TRUE LABOR FALSE LABOR Contractions are: * Regular*Increase in intensity and duration with walking*Felt in lower back, radiating to lower portion of abdomenBloody showDilation and effacementFetus usually engagedFALSE LABORContractions are irregularOften stop with walkingContractions felt in abdomen above umbilicus (abdominal pains)No change in cervixFetus is ballotable23. What assessment findings differentiate true labor from false labor?
34 Phases and Stages of Labor Stage 1 – From 0 cm. dilated to 10 cm.Stage 2 - From complete dilation andeffacement to delivery of thebabyStage 3 - From delivery of baby to thedelivery of the placentaStage 4 - the first hour after delivery
35 Phases of First Stage of Labor Latent Phase – is from 0 to 3 cm. dilatedActive Phase – is from 4cm. to 7 cm.Transistion Phase – is from 8 cm. to 10 cm.24. What are the three phases of the first stage of labor and characteristics of each? (p )
36 Signs of Second Stage of Labor Complete dilatation of cervixUrge to bear downPerineum begins to bulge, flatten and move anteriorlyIncrease in bloody showRectal pressureLabia begins to part with each contraction
37 Mechanisms of Labor/ Cardinal Movements DescentFlexionInternal RotationExtensionExternal Rotation25. Explain the positional changes /cardinal movements of stage 2 and why they occur in this order?Expulsion
38 Signs of Stage Three of Labor GlobularShape of UterusFundus Rise in AbdomenSudden Gush of BloodProtrusion of Umbilical cord26. What are the signs in the third stage that indicate that the placenta is ready for delivery? (p. 412)