Presentation on theme: "Physiological Adaptations"— Presentation transcript:
1 Physiological Adaptations NormalLabor and DeliveryPhysiological AdaptationsChapter 17Presented byAmie Bedgood
2 LABOR The process by which the products of conception are expelled from the body
3 UTERINE CONTRACTIONSContraction - exhibits a wavelike pattern that begins slowly climbing (increment) to a peak (acme), and decreases (decrement)Intensity - strength of uterine contractionacmeDefine the characteristics of uterine contractions. P. 338The 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.DecrementIncrement
4 UTERINE CONTRACTIONS acme Decrement Increment Duration Frequency IntervalFrequencyDuration- from beginning of one contraction to the end of the same contraction2. Define the following terms related to uterine contractions:a. frequencyb. durationc. intensityd. intervalFrequency- from beginning of one contraction to the beginning of another contractionInterval - resting time between contractions allows for placentalperfusion
6 Assessment of Contraction 1. Subjective symptoms by woman2. Palpation and timing by the nurse3. 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 ________.DurationIntensityFrequencyIntervalAcmeengaged
8 CERVICAL ASSESSMENTDilation – is expressed in centimeters of the size of the cervical opening.Full dilation = 10cmEffacement – 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. 339a. effacementb. dilationDilation 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
12 Major Powers Involved Primary Force: Secondary Force: Involuntary Uterine Contractions orMuscular contractions which lead to dilation and effacement in the First Stage of LaborSecondary Force:Voluntary Uterine Contractions orAbdominal muscles assist in the Second Stage of Labor with pushing. Increase intra-abdominal pressure to aid in expulsive forces5. What are the primary and voluntary forces of labor? P.341Discuss open glottis & closed glottis pushing.
14 THE PELVISDetermine if the pelvic cavity is of adequate size to allow for the passage of the full term infantOptimum shaped pelvis is GynecoidSee 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 uterusShallow basin above the inlet or brimTrue PelvisRepresentsthe bonylimits of thebirth canal6. 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 sacrumMidpelvis - level of the ischial spinesOutlet - 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 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 extend8. 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 LieRelationship of the long axis of the fetus to the long axis of the mother.Longitudinal Lie Transverse Lie9. 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. TrueB. False
21 Attitude Relationship of fetal body parts to each other Optimum attitude isflexion orovoid10. What is fetal attitude? What is the normal fetal attitude? p. 334Extention of the fetal parts such as head or arms straight would be abnormal attitude.
22 Fetal PresentationThe portion of the fetus that enters the pelvis firstThree Types:CephalicBreechShoulder11. Define the term "fetal presentation" and explain the difference between the following presentations: p. 344 & 345cephalic presentationVertexMilitaryBrowFacebreech presentation
23 Reference Points of Presentation Cephalic = Head Vertex, Military, Brow, FaceBreech = Buttock or FootFrank, Full, FootlingShoulder = Transverse liep. 345Vertex – 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
26 Position12. What is fetal position? Explain the position indicated by the letters: p. 345LOAROALOPROPFetal 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? Occiput14. What is the reference point for a breech presentation? Sacrum
27 PositionRelationship of the Fetal Presenting Part to the Maternal PelvisSteps:1. Determine the Presenting Part2. Divide the mothers pelvis into 4 imaginary quadrantsA12RL936P
28 Test Yourself !What is the reference point of a cephalic presentation when the head is fully flexed?A. occiputB. mentumC. frontald. sagittalAMentum = chin
29 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 _____________.MoldingAttitudeCephalicLiePresentation
30 THEPSYCHOLOGICAL15. How does anxiety, fear, and fatigue physiologically affect the process of labor? P. 347 & 348
31 BREAK THE CYCLE ! FEAR TENSION PAIN 15. How does anxiety, fear, and fatigue physiologically affect the process of labor? P. 347 & 348Anxiety, 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 levelsofProstaglandinsDegenerationofPlacentaOver-distentionofUterus
33 Premonitory Signs of Labor The impending signsthat take place the lastseveral weeks ofpregnancy or even thelast several daysWarning signs that the woman may experience indicating that labor is near.
34 Premonitory Signs of Labor LIGHTENINGFALSE LABOR PAIN (Braxton Hicks)SHOWRupture of Membranes (ROM)BACKACHEDIARRHEASUDDEN INCREASE IN ENERGYLightening – “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 andduration with walking* Felt in lower back,radiating to lower portionof abdomenBloody showDilation and effacementFetus usually engagedFALSE LABORContractions are:* Irregular* No change or decreasewith walking* Contractions felt inabdomen aboveumbilicus:Braxton HicksNo change in cervixFetus is ballotable
36 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
37 Station- degree that the presenting part has descended into the pelvis in relationship to ischial spines.Goal: Move from– to + stations9. What is station? How is station determined and measured? Does the station need to be a + or – for delivery?
38 EngagementDescent of the fetal presenting part in relation to the ischial spines of the maternal pelvis = 0 station.
39 EngagementEngagement-largest diameter of presenting part has passed through the pelvic inletAssessed duringvaginal examBallotable8. 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 cmStage 2: From complete dilation andeffacement to delivery of the babyStage 3: From delivery of baby to thedelivery of the placentaStage 4: the first hour after delivery21. 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 cervixUrge to bear downPerineum begins to bulge, flatten and move anteriorlyIncrease in bloody showRectal pressureLabia begins to part with each contraction24. Define the second stage of labor and the maternal behavior associated with this stage. P. 349.
42 Signs of Stage Three of Labor GlobularShape of UterusFundus Rise in AbdomenSudden Gush of BloodProtrusion of Umbilical cord25. 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 LaborRecovery 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 CareNursing Assessment and Interventions during Labor and Birth.
45 Technique for Assessing Fetal Presentation and Position Abdominal Palpation/Leopold’s ManeuverStanding 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 buttocksStep 2 - Go down each side and locate backStep 3 - Gently grasp lower portion of uterus and feel for the head or buttockStep 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. TrueB. Falsetrue
49 Vaginal Examination Presentation – presenting part (head/buttock) Position – fetal head (OA, OP etc.)Condition of Membranes – ruptured or intactDilation - 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______________.DialatingIschial spinesGynacoidEffacementPelvic outlet
52 Duration of Labor Resistance of the Cervix Presentation and position of the fetus,The woman’s pelvisPreparation and relaxation of the motherPrimigravida - up to 22 hrs; average 12 1/2 hrsMultigravida hrs; average 10 hrs.Read this section Duration of labor is depended upon several factors.