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Labor
RNC-OB Labor information
| Term | Definition |
|---|---|
| Gateway Control Theory | theory that massage, heat, and cold stimulate nerve fibers that block painful stimulation |
| Therapeutic Touch Theory | effects are result of energy exchange between client and nurse to reduce pain and anxiety |
| BIHOP score | Duration of labor inversely correlated >8=successful vaginal delivery <6=needs cervical ripening prior to induction 0: closed, 0-30%, -3, firm, posterior 1: 1-2, 40-50%, -2, med, midposition 2: 3-4, 60-70%, -1-0, soft, ant 3: 5-6, 80+%, +1, very sof |
| Cardinal movements of Delivery | series of 8 adaptations the fetus makes as it moves through maternal bony pelvis Influenced by size, position, powers of labor, size and shape of maternal pelvis, and mother's position. |
| Engagement | 1st cardinal movement. Dropping or "lightening" |
| Descent | 2nd cardinal movement assessed by station -3 - +3 |
| Flexion | 3rd cardinal movement fetal head nodding forward toward chest |
| Internal Rotation | 4th cardinal movement generally rotates OT to OA |
| Extension | 5th cardinal movement describing the crowning and delivery of the head |
| Restitution | 6th cardinal movement describing the realignment of head and body after delivery of the head |
| External Rotation | 7th cardinal movement shoulders rotate to AP diameter of pelvis |
| Expulsion | 8th cardinal movement describing the birth of the body |
| Prolonged Latent Phase | >20 hours - primips >14 hours - multips caused by unripe cervix and early anethesia |
| Protracted Active Phase | <1.2 cm/hr - primips <1.5 cm/hr - multips caused by CPD, malpresentation, early anesthia, ROM before onset |
| Secondary Arrest of Active Labor | cervical dilatation stops in active phase. No dilatation after 2 hours or when complete for >3 hours (primips) or >1 hour (multips) Caused by anesthesia, malposition, CPD, AROM |
| Precipitous Labor | cervical dilatation >5 cm/hr (primips) or >10 cm/hr (multips) |
| Protracted Descent | rate of descent is <1 cm/hr (primips) or <2 cm/hr (multips) caused by protracted dilatation in active stage, CPD, malpresentation, anesthesia |
| Arrest of Descent | no descent in active phase for >1 hour (primips) or >0.5 hr (multips) caused by advanced gestation, >4000g, CPD, malpresentation, coexisting labor disorder |
| First Stage of Labor | 0-10 cm dilatation 3 phases: Latent, Active, Transition |
| Latent Phase of Labor | 0-3 cm mild contractions distraction most effective in this stage |
| Active Phase of Labor | 4-7 cm moderate contractions |
| Transition Phase of Labor | 8-10 cm strong contractions characterized by panic and fear |
| Second Stage of Labor | 10cm - birth prolonged when >3 hours (primips) or >2 hours (multips) Pelvic phase - period of fetal descent Perineal phase - active pushing |
| Open Glottis Pushing | expel air slowly over 6-8 seconds preferred over holding air methods bc they elad to decreased uterine blood flow, increased fatigue and risk of tears and increased risk of GU problems after delivery |
| Third Stage of Labor | delivery of placenta |
| Fourth Stage of Labor | 1-4 hours after delivery maternal physiologic adjustment |
| Leopold's Maneuvers | 1) palpate lower abdomen (attitude) 2) palpate sides for back and small parts (position) 3) palpate upper abdomen (presentation) 4) palpate facing mom's feet for cephalic prominence (attitude) |
| Fetal Lie | relationship of long axis of baby to mother Longitudinal - cephalic or breech Transverse Oblique |
| Fetal Presentation | part of fetus entering pelvis first Shoulder Breech - complete, frank, footling Cephalic - vertex, brow, face |
| Fetal Attitude | relationship of fetal parts to each other Flexion - chin to chest (easiest delivery) Extension Military - neither flexion or extension |
| Position | relationship of presenting part to specific area, right or left, anterior or posterior, on mom's pelvis |
| Anterior Fontanelle | diamond shape, bigger |
| Posterior Fontanelle | Triangle shape, smaller |
| Theories of Initiation of Labor | CRH (hormone synthesized in increased amounts during pregnancy) stimulates increased estrogen and progesterone which stimulates increased prostaglandins which leads to contractility and softening cervix. |
| Ferguson Reflex | urge to push caused by baby putting pressure on the cervix and Ferguson plexus of nerves |
| Gynecoid Pelvis | Typical female pelvis adequate for labor |
| Android Pelvis | Typical male pelvis narrow dimensions associated with halting labor |
| Anthropoid Pelvis | Apelike pelvis adequate for labor |
| Platypelloid Pelvis | wide-narrow pelvis unfavorable for labor |
| Category I FHTs | baseline 110-160 bpm moderate variability possible early decerations possible accelerations |
| Category II FHTs | not category I or III FHTs |
| Category III FHTs | Absent variability + any of the following recurrent late decelerations recurrent variable decelerations bradycardia sinusoidal pattern |
| IUPC monitoring uterine baseline | 5-15 mmHg, never >30 mmHg |
| IUPC monitoring 30 mmHg | decreased uterine blood flow |
| IUPC monitoring 40 mmHg | complete cessation of blood flow to uterus |
| MVUs <150 mmHg | inadequate labor |
| MVUs 180-250 mmHg | should indicate adequate labor |
| MVUs >300 mmHg | increased uterine activity, tachysystole |
| Baroreceptors | receptors effected by BP changes |
| Chemoreceptors | receptors effected by Oxygenation changes |
Created by:
kanani8806
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