Presentation is loading. Please wait.

Presentation is loading. Please wait.

Physiological Adaptations

Similar presentations

Presentation on theme: "Physiological Adaptations"— Presentation transcript:

1 Physiological Adaptations
Normal Labor and Delivery Physiological Adaptations Chapter 17 Presented by Amie Bedgood

2 LABOR The process by which the products of conception are expelled
from the body

3 UTERINE CONTRACTIONS Contraction - exhibits a wavelike pattern that begins slowly climbing (increment) to a peak (acme), and decreases (decrement) Intensity - strength of uterine contraction acme Define the characteristics of uterine contractions. P. 338 The upper two thirds of the uterus produce contractions that push the fetus downward, while the lower one third is less active and reduces the resistance of movement downward. The characteristics of uterine contractions creates thickening of the upper myometrial muscle and a thinning of the lower uterine segment. Decrement Increment

4 UTERINE CONTRACTIONS acme Decrement Increment Duration Frequency
Interval Frequency Duration- from beginning of one contraction to the end of the same contraction 2. Define the following terms related to uterine contractions: a. frequency b. duration c. intensity d. interval Frequency- from beginning of one contraction to the beginning of another contraction Interval - resting time between contractions allows for placental perfusion

5 Uterine Contraction - review

6 Assessment of Contraction
1. Subjective symptoms by woman 2. Palpation and timing by the nurse 3. Use of Electronic Fetal Monitor (EFM)

7 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 ________. Duration Intensity Frequency Interval Acme engaged

8 CERVICAL ASSESSMENT Dilation – is expressed in centimeters of the size of the cervical opening. Full dilation = 10cm Effacement – is estimated as a percentage of the amount the cervix has thinned. Complete effacement = 100% 3. Define the following terms related to cervical changes during labor: p. 339 a. effacement b. dilation Dilation and effacement result from the downward movement of the fetus and the thinning of the lower uterine segment.

9 Myometrial Activity Effacement- thinning of the cervix (%)
Dilation – enlargement and widening of the os (cm) 4. How are cervical dilation and effacement measured? P. 339

10 Passenger Essential Factors in Labor Powers Passageway Psychological


12 Major Powers Involved Primary Force: Secondary Force:
Involuntary Uterine Contractions or Muscular contractions which lead to dilation and effacement in the First Stage of Labor Secondary Force: Voluntary Uterine Contractions or Abdominal muscles assist in the Second Stage of Labor with pushing. Increase intra-abdominal pressure to aid in expulsive forces 5. What are the primary and voluntary forces of labor? P.341 Discuss open glottis & closed glottis pushing.


14 THE PELVIS Determine if the pelvic cavity is of adequate size to allow for the passage of the full term infant Optimum shaped pelvis is Gynecoid See page 396 for pelvic shapes. Pelvimetry is the term used to measure the pelvis.

15 THE PELVIS False Pelvis True Pelvis Represents
Supports the weight of the uterus Shallow basin above the inlet or brim True Pelvis Represents the bony limits of the birth canal 6. Differentiate between the terms true pelvis and false pelvis. p. 342 & 343

16 True Pelvis vs False Pelvis
Inlet - upper margin of symphysis pubis to the upper margin of sacrum Midpelvis - level of the ischial spines Outlet - Lower pubic bone to tip of coccyx This area is the smallest portion that the baby must travel through. 7. Differentiate between the inlet, the midpelvis, and the outlet of the true pelvis?


18 Fetal Head Because 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 extend 8. 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? p. 344

19 Fetal Lie Relationship of the long axis of the fetus to the long axis of the mother. Longitudinal Lie Transverse Lie 9. Define the term "fetal lie". What is the difference between transverse lie and longitudinal lie. Which is the most favorable for a vaginal delivery? P. 341 & 344

20 True or False? The optimum lie of the fetus is the longitudinal lie.
A. True B. False

21 Attitude Relationship of fetal body parts to each other Optimum
attitude is flexion or ovoid 10. What is fetal attitude? What is the normal fetal attitude? p. 334 Extention of the fetal parts such as head or arms straight would be abnormal attitude.

22 Fetal Presentation The portion of the fetus that enters the pelvis first Three Types: Cephalic Breech Shoulder 11. Define the term "fetal presentation" and explain the difference between the following presentations: p. 344 & 345 cephalic presentation Vertex Military Brow Face breech presentation

23 Reference Points of Presentation Cephalic = Head
Vertex, Military, Brow, Face Breech = Buttock or Foot Frank, Full, Footling Shoulder = Transverse lie p. 345 Vertex – most common presentation with fetal head flexed. Favorable position for labor and delivery as smallest diameter of fetal head is presenting. Military – the fetal head is in a neutral position, head is neither flexed or extended. Brow – the fetal head is partially extended. Face – The head is fully extended and the fetal occiput is near the maternal spine. Frank – Buttock is presenting with the fetal legs extended across the abdomen towards the shoulder. Full – (Complete) Buttock is presenting with hips and legs flexed. Footling – one or both feet present. Shoulder – is considered transverse lie and C/S is necessary

24 Cephalic Presentations

25 Breech Presentations

26 Position 12. What is fetal position? Explain the position indicated by the letters: p. 345 LOA ROA LOP ROP Fetal position describes the location of the fixed reference point on the presenting part in relation to the four quadrants of the maternal pelvis. R= right, L= left, O= occiput, A=anterior, P=posterior. 13. What is the reference point for a vertex presentation? Occiput 14. What is the reference point for a breech presentation? Sacrum

27 Position Relationship of the Fetal Presenting Part to the Maternal Pelvis Steps: 1. Determine the Presenting Part 2. Divide the mothers pelvis into 4 imaginary quadrants A 12 R L 9 3 6 P

28 Test Yourself ! What is the reference point of a cephalic presentation when the head is fully flexed? A. occiput B. mentum C. frontal d. sagittal A Mentum = chin

29 Test Yourself Overlapping 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 _____________. Molding Attitude Cephalic Lie Presentation

30 THE PSYCHOLOGICAL 15. How does anxiety, fear, and fatigue physiologically affect the process of labor? P. 347 & 348

15. How does anxiety, fear, and fatigue physiologically affect the process of labor? P. 347 & 348 Anxiety, fear, tension, or fatigue decreases a woman’s ability to cope with pain in labor. Maternal catecholamines are secreted in response and can inhibit uterine contractility and placenta blood flow. Therefore, a nurse’s supportive attitude can strengthen the woman positive psychological control during labor and enhances the birthing process. PAIN

32 CAUSES OF LABOR Increase in Estrogen Decrease in Progesterone
Page 404. Progesterone relaxes smooth muscles – interferes with the conduction of impulses from one dell to the next. It exerts a quieting effect on the uterus during pregnancy. Towards the end of gestation, biochemical changes cause a decrease in progesterone. A decrease in progesterone allows for an increase affect of estrogen. Estrogen increase enhancing uterine sensitivity to substances such as prostaglandins from the fetal membranes and oxytocin from the maternal posterior pituitary gland. Prostaglandin stimulate uterine contractions. Connective tissue loosens to permit softening, thinning, and eventual opening of the cervix. High levels of Prostaglandins Degeneration of Placenta Over-distention of Uterus

33 Premonitory Signs of Labor
The impending signs that take place the last several weeks of pregnancy or even the last several days Warning signs that the woman may experience indicating that labor is near.

34 Premonitory Signs of Labor
LIGHTENING FALSE LABOR PAIN (Braxton Hicks) SHOW Rupture of Membranes (ROM) BACKACHE DIARRHEA SUDDEN INCREASE IN ENERGY Lightening – “dropping” the fetus settles into the pelvic inlet, the woman can usually breath easier. Can result in leg cramps or pain due to pressure on the nerves that pass through the obturator foramen in the pelvis, increase pelvic & bladder pressure, venous stasis leading to edema in the lower extremities, increased vaginal secretions resulting from congestion of the vaginal mucosa. Braxton Hick’s – irregular, intermittent contractions that have been occurring throughout the pregnancy. May be uncomfortable and exhausting. Bloody Show – blood tinge mocusy discharge resulting from exposed capillaries as the cervix soften and effaces. Rupture of membranes – amniotic membrane ruptures before the onset of labor occurs in approximately 12 % of women and labor usually ensues within 24 hours.

35 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 abdomen Bloody show Dilation and effacement Fetus usually engaged FALSE LABOR Contractions are: * Irregular * No change or decrease with walking * Contractions felt in abdomen above umbilicus: Braxton Hicks No change in cervix Fetus is ballotable

36 Mechanisms of Labor/ Cardinal Movements
Descent Flexion Internal Rotation Extension External Rotation 25. Explain the positional changes /cardinal movements of stage 2 and why they occur in this order? Expulsion

37 Station- degree that the presenting part has descended into the pelvis
in relationship to ischial spines. Goal: Move from – to + stations 9. What is station? How is station determined and measured? Does the station need to be a + or – for delivery?

38 Engagement Descent of the fetal presenting part in relation to the ischial spines of the maternal pelvis = 0 station.

39 Engagement Engagement -largest diameter of presenting part has passed through the pelvic inlet Assessed during vaginal exam Ballotable 8. What is engagement? How is it determined? Engaged

40 Phases and Stages of Labor
Stage 1: cm. Phase 1 - Latent - dilate cm. Phase 2 - Active - dilate cm. Phase 3 - Transition - dilate cm Stage 2: From complete dilation and effacement to delivery of the baby Stage 3: From delivery of baby to the delivery of the placenta Stage 4: the first hour after delivery 21. Define the first stage of labor. P. 349. 22. What are the three phases of the first stage of labor? 23. What are the characteristics of each of each of these three phases in terms of cervical dilation, uterine contractions, and maternal behavior? Labor Curve or Friedman curve is used to determine whether labor is progressing at the expected rate.

41 Signs of Second Stage of Labor
Complete dilatation of cervix Urge to bear down Perineum begins to bulge, flatten and move anteriorly Increase in bloody show Rectal pressure Labia begins to part with each contraction 24. Define the second stage of labor and the maternal behavior associated with this stage. P. 349.

42 Signs of Stage Three of Labor
Globular Shape of Uterus Fundus Rise in Abdomen Sudden Gush of Blood Protrusion of Umbilical cord 25. What is the third stage of labor and what are the signs that indicate placental separation? P. 349. Delivery of the placenta

43 Fourth Stage of Labor Recovery period after delivery and bonding with the newborn. Last from 1- 4 hours. 26. Define the fourth stage of labor and the maternal behavior associated with this stage. P. 349. Recovery 1-4 hours after delivery.

44 Nursing Assessment and Interventions during Labor and Birth.
Nursing Care Nursing Assessment and Interventions during Labor and Birth.

45 Technique for Assessing Fetal Presentation and Position
Abdominal Palpation/Leopold’s Maneuver Standing on the right side, face the woman and palpate with the palms of the hands. Step 1 - Start at upper fundus and palpate for the head or buttocks Step 2 - Go down each side and locate back Step 3 - Gently grasp lower portion of uterus and feel for the head or buttock Step 4 - Turn and face the woman feet, using both hands palpate lower abd. for cephalic prominence or brow.

46 Ausculation Assess for the area of greatest intensity of the FHR.
Usually best heard at the fetal back

47 True or False ? If the fetal heart tones (FHT’s) are heard loudest (PMI) in the patient’s upper right quadrant of her abdomen, the fetus would be assessed for a breech presentation. A. True B. False true

48 Amniotic Membranes Intact Ruptured Color Amount SROM AROM Clear Yellow
Meconium Amount

49 Vaginal Examination Presentation – presenting part (head/buttock)
Position – fetal head (OA, OP etc.) Condition of Membranes – ruptured or intact Dilation - enlargement & widening of os (cm) Effacement – thinning of the cervix (%)

50 Vaginal Examination – cont’d
Station- degree that the presenting part has descended into the pelvis. Relationship to ischial spines (-, 0, +) Engagement -largest diameter of presenting part has passed through the pelvic inlet

51 Try this ! When the cervical os widens or opens it is said to________.
The level of the ________ _________ (bony structure) 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 accommodate to this rigid passageway______________. Dialating Ischial spines Gynacoid Effacement Pelvic outlet

52 Duration of Labor Resistance of the Cervix
Presentation and position of the fetus, The woman’s pelvis Preparation and relaxation of the mother Primigravida - up to 22 hrs; average 12 1/2 hrs Multigravida hrs; average 10 hrs. Read this section Duration of labor is depended upon several factors.

53 The End Return to Module

Download ppt "Physiological Adaptations"

Similar presentations

Ads by Google