Labor and Delivery In-class activity

Labor and Delivery In-class activity Amniotomy - Breaking the bag of waters Amnioinfusion - Infusing sterile fluid into the uterine cavity to dilute meconium stained fluid or alleviate pressure on the umbilical cord Leopold's Maneuver - Four maneuvers used to determine position of the baby External version - Attempt to turn breech fetus to cephalic position Induction and Augmentation of labor - To initiate or strengthen uterine contractions to hasten delivery Signs of Labor Onset- Premonitory - -Increased Braxton Hick contractions -Lightening -Increased vaginal secretions -Bloody show -Increase in energy level -Weight loss True Labor Signs - -Contractions become progressively closer together -Contractions dilate and efface cervix False Labor (Prodromal Labor) - -Contractions do not result in observable dilation and effacement of the cervix -Misnomer Mechanical Induction - -Sweeping membranes, stretching cervical opening manually or inflating a foley in cervical opening to dilate cervix Natural Induction - Sex, acupuncture, castor and primrose oil Medical Induction - -Prostaglandin gel or suppositories vaginally (Prostin, cervidil, and cytotec) -Prostaglandin is a cervical ripening agent that can start contractions Pitocin - Given intravenously to initiate or augment labor contractions Bishop Score - -Determines likelihood of a successful induction -Cervix is assessed for consistency, dilation, effacement, position, and station of fetal head (location of head related to ischial spine) Reasons for C-Sections - -Fetal distress/ Maternal distress or compromise -Abnormal placental implantation/ abruption -Cervical/ vaginal abnormalities -Fetal malpresentation -Cord prolapse -True CPD -Prior classical (undocumented caesarian incision) -STIs (HIV, Herpes) C-Section - Delivery of infant during an abdominal incision Types of Incisions for C-Section - -Skin incisions: pfannenstiel/Low transverse, vertical incision into uterine body -Uterine incisions: low transverse, low vertical, classical C-Section Procedure - -About 30 mins -Spinal anesthetic may be used or an epidural -Client has to consent and have a foley placed -Her abdomen will be shaved and skin will be prepped with an antimicrobial solution in OR -Incision is made above symphysis pubis through skin, subcutaneous tissue and lower uterine segment -Membranes are ruptured with an instrument, fluid is suctioned out and baby is delivered -Placenta is manually removed and incision is repaired 5 Factors Afecting Labor/ Five Ps - 1. Passenger (fetus and placenta) 2. Passageway (birth canal) 3. Powers (contractions) 4. Position of the mother 5. Psychological response Factor #1- Passenger/Fetus - 1. Size of head determines how easy the baby moves through birth canal and position 2. Presentation: part of the fetus that enters the birth canal first 3. Fetal Lie: relationship of the spine of the mother in comparison to the spine of fetus 4. Fetal attitude: relation of fetal parts to each other 5. Fetal position: relation of presenting part to the four quadrants of the mother's pelvis -Engagement: presenting part has locked into the pelvis -Station: relation of presenting part to the imaginary line drawn between ischial spines Size of the Fetus Head and Labor - -Composed by 2 temporal bones, 2 parietal bones, an occipital bone and a frontal bone -Bones overlap during delivery due to sutures and fontanels, the skull returns to its normal shape within 3 days after birth -Anterior fontanel that is diamond shaped closes at 18 months -Posterior fontanel is triangular and closes at 6-8 weeks