What pharmacological strategies can a labouring client use to manage pain
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IV pain medication, epidural
Factors that influence the labour process
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passenger - movement of fetus and placenta through birth canal
influenced by size, presentation, attitude, position, etc.
passage - birth canal, composed of the mother's rigid body pelvis and the
soft tissues of the cervix, pelvic floor, vagina, and introitus
powers - contractions, involuntary (primary) and voluntary (secondary)
powers combine to expel the fetus and the placenta from the uterus
position - (of mother), affects woman's anatomical and physiological
adaptations to labor
psychology - state of woman, anxious, emotional, amount of sedation
risk factors for jaundice
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J - jaundice within 24 hours of birth
A - a sibling who has had jaundice as a neonate and required treatment, or
an infant who has asphyxia, acidosis, or albumin <3.0 g/dL
U - unrecognized haemolysis (ABO< Rh or other blood incompatibility, red
cell membrane defects)
N - newborn born <37+0 weeks gestation
D - deficiency in glucose-6-phosphate dehydrogenase
I - infection or infant of a diabetic mother
C - cephalohematoma/bruising or central hematocrit > 65%
E - east asian, mediterranean, middle eastern, indigenous
D - due to sub-optimal feeding
Third stage of labour
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, from the birth of the fetus until the placenta is delivered, normally lasts 3-5
minutes but can last up to 1 hour
Placenta normally separates with the third or fourth strong uterine
contraction after the infant has been born, and is then delivered with the
next contraction
Separation is facilitated by decreased catecholamine production and
increased oxytocin production, thus a warm environment, skin-to-skin
contact, and reduced fear and anxiety are encouraged
Criteria for discharge
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Education about sexual activity, contraception, self-care, peri-care, etc.
Medications: pain, laxatives, MMR if rubella +, rhogam if infant is Rh+ and
mom is Rh- (would have received immunoglobulin at 28 weeks)
Follow up: mom 6 weeks, infant 3-7 days, PH nurse will call within 24-48
hours
Support
Maternal effects of elevated BP
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increased GFR (can lead to kidney damage), reduced perfusion of the
placenta (constriction of vessels supplying the spiral arteries)
, Hemabate: carboprost tromethamine
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Last resort after conventional methods. A prostaglandin that is used to treat
severe bleeding postpartum as it enhances uterine contractility and causes
vasoconstriction, given IM. Side effects include DIARRHEA, htn,
tachycardia, and is CONTRAINDICATED IN ASTHMA AND HTN. Monitor
bleeding, tone, and BP (large dose may cause HTN)
Preterm vs. late preterm vs. term vs. postterm
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Preterm: 24+0 to 35+6
Late preterm: 36+0 to 37+6
- increased risk for hypoglycemia, impaired temperature regulation,
jaundice, respiratory distress
Term: 38+0 to 40+6
- assess whether the NB is SGA or LGA, are any maternal risk factors
present?
Post-term: 41+
- After 42 weeks, placenta stops functioning, so labour must be induced
Foremilk vs hindmilk
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Give this one a try later!
IV pain medication, epidural
Factors that influence the labour process
,Give this one a try later!
passenger - movement of fetus and placenta through birth canal
influenced by size, presentation, attitude, position, etc.
passage - birth canal, composed of the mother's rigid body pelvis and the
soft tissues of the cervix, pelvic floor, vagina, and introitus
powers - contractions, involuntary (primary) and voluntary (secondary)
powers combine to expel the fetus and the placenta from the uterus
position - (of mother), affects woman's anatomical and physiological
adaptations to labor
psychology - state of woman, anxious, emotional, amount of sedation
risk factors for jaundice
Give this one a try later!
J - jaundice within 24 hours of birth
A - a sibling who has had jaundice as a neonate and required treatment, or
an infant who has asphyxia, acidosis, or albumin <3.0 g/dL
U - unrecognized haemolysis (ABO< Rh or other blood incompatibility, red
cell membrane defects)
N - newborn born <37+0 weeks gestation
D - deficiency in glucose-6-phosphate dehydrogenase
I - infection or infant of a diabetic mother
C - cephalohematoma/bruising or central hematocrit > 65%
E - east asian, mediterranean, middle eastern, indigenous
D - due to sub-optimal feeding
Third stage of labour
Give this one a try later!
, from the birth of the fetus until the placenta is delivered, normally lasts 3-5
minutes but can last up to 1 hour
Placenta normally separates with the third or fourth strong uterine
contraction after the infant has been born, and is then delivered with the
next contraction
Separation is facilitated by decreased catecholamine production and
increased oxytocin production, thus a warm environment, skin-to-skin
contact, and reduced fear and anxiety are encouraged
Criteria for discharge
Give this one a try later!
Education about sexual activity, contraception, self-care, peri-care, etc.
Medications: pain, laxatives, MMR if rubella +, rhogam if infant is Rh+ and
mom is Rh- (would have received immunoglobulin at 28 weeks)
Follow up: mom 6 weeks, infant 3-7 days, PH nurse will call within 24-48
hours
Support
Maternal effects of elevated BP
Give this one a try later!
increased GFR (can lead to kidney damage), reduced perfusion of the
placenta (constriction of vessels supplying the spiral arteries)
, Hemabate: carboprost tromethamine
Give this one a try later!
Last resort after conventional methods. A prostaglandin that is used to treat
severe bleeding postpartum as it enhances uterine contractility and causes
vasoconstriction, given IM. Side effects include DIARRHEA, htn,
tachycardia, and is CONTRAINDICATED IN ASTHMA AND HTN. Monitor
bleeding, tone, and BP (large dose may cause HTN)
Preterm vs. late preterm vs. term vs. postterm
Give this one a try later!
Preterm: 24+0 to 35+6
Late preterm: 36+0 to 37+6
- increased risk for hypoglycemia, impaired temperature regulation,
jaundice, respiratory distress
Term: 38+0 to 40+6
- assess whether the NB is SGA or LGA, are any maternal risk factors
present?
Post-term: 41+
- After 42 weeks, placenta stops functioning, so labour must be induced
Foremilk vs hindmilk
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