REVIEW
CARDIOVASCULAR SYSTEM – Heart displaced upward to the left and
forward
Enlarges uterus increases pressure to blood
vessels, slows circulation
Prone to developed edema and varicosities
Left/sims lateral position to avoid impeding the
vena cava
Hematologic system –iron supplement physiologic anemia
Respiratory system – hyperventilate, respiratory alkalosis; tingling
sensation, lightheadedness ( paper bag, cupped hands)
GItract – PICA , a medical disorder non-nutritive, inedible
substance
Renalsystem – prone to UTI , relaxation of
renal pelvis and ureter leading to urine
stagnation
Musculoskeltalmuscle –placenta is capable
of producing relaxin
Physiologic
lordosis – pride of pregnancy, increased
outward curvature, there is a back pain
Drugs to be avoided during pregnancy
Chloramphenicol
Chloramphenicol is an antibiotic that’s usually given as an
injection. This drug can cause serious blood disorders and
gray baby syndrome.
Ciprofloxacin (Cipro) and levofloxacin
Ciprofloxacin (Cipro) and levofloxacin are also types of
antibiotics. These drugs could cause problems with the
baby’s muscle and skeletal growth as well as joint pain
and potential nerve damage in the mother.
Ibuprofen (Advil, Motrin)
High doses of this OTC pain reliever can cause many serious problems,
including:
miscarriage
delayed onset of labor
premature closing of the fetal ductus arteriosus, an important artery
jaundice
hemorrhaging for both mother and baby
necrotizing enterocolitis, or damage to the lining of the intestines
oligohydramnios, or low levels of amniotic fluid
fetal kernicterus, a type of brain damage
abnormal vitamin K levels
Common exercises taught in pregnancy
to strengthen perineal muscle
Squatting
Tailor sitting
Pelvic floor contractions Kegel exercises
Abdominal muscle contractions
Abdominal muscle contraction
Pelvic rocking strengthen the abdominal muscle and helps relieve backache
Methods to manage pain in childbrith
Bradley Method – pregnancy and childbirth are joyful, natural processes,
pts partner should play a role during pregnancy, labor and early newborn
period.
Dick Read’s method of fear leads to tension which leads to pain, focus on
abdominal breathing during contractions ( Grantly Dick Read)
Psychosexual method – ( Sheila Kitsinger) conscious relaxation, active
calming of the mind, while in the state of discomfort as well as level of
progressive breathing that encourage the pt to flow with rather than
struggle against contraction.
Hypnobirthing – meditative practices (Dick Read ) meditation during
pregnancy
Lamaze method psycho- prophylactic preventing pain in labor, prophylaxis by
the use of mind Psyche
Theories of labor
Uterine Stretch Theory – any hollow body organ when stretched to
capacity will necessarily contract and empty
Oxytocin Theory – labor, considered a stressful event, stimulates the
hypophysis to produce oxytocin from the posterior pituitary gland.
Oxytocin causes contraction of the smooth muscles of the body. The
fetus presses on the cervix which stimulates the release of oxytocin
from th e posterior pituitary gland
Progesterone Deprivation Theory – progesterone, being the hormone
designed to promote pregnancy, is believed to inhibit uterine motility.
Since its amount is now decreasing, uterine contractions will then occur.
Prostaglandin Theory – initiation of labor results from the
release of arachidonic acid produced by steroid action on lipid
precursors. Arachidonic acid is said to increase prostaglandin
synthesis which, in turn, increases uterine contractions
Theory of Aging Placenta – because of the decrease in blood
supply to the placenta, the uterus contracts.
Labor is defined as;
• The time and processes that occur during parturition
from the beginning of cervical dilatation to the
delivery of the placenta
• Onset of rhythmic contractions
• Relaxation of the uterine smooth muscles
• Effacement of the cervix
• Dilation or dilatation of the cervix
• Expulsion of the fetus and products of conception
from the uterus.
Signs of True Labor
a. Uterine contractions - the surest sign that
labor has begun is the initiation of effective,
productive uterine contractions.
Phases of Uterine Contraction
1. Increment or Crescendo- the time when contraction is
starting and intensity is building up. The first phase is when
during which intensity of contraction increases. This is the
longest phase.
2. Acme or Apex- the peak or highest intensity of contraction.
The height of the uterine contractions.
3. Decrement or Decrescendo- the time when muscles start to
relax. The last phase during which the intensity of contraction
Parameters of Uterine Contraction
Interval- from the end of one contraction to the beginning
of the next contraction.
• Early labor- 10 to 20 minutes between
contractions
• Late labor-
3 to 5 minutes
between
contractions
Duration- from the beginning of one contraction to the end of the
same contraction
• Early labor- 20 second long contraction
• Late labor-
40 to 80
second long
contraction
Frequency - from the beginning of one contraction to the beginning of the
next contraction.
Time for 3-4 contractions to be able to get a good
picture of the
frequency.
To compute for interval;
Frequency minus duration= interval
Quality/ Intensity– refers to the strength of a
contraction at acme.
Early labor- uterus can be dented
(poor quality)
Late labor- uterus is hard
(good quality)
Differences between False and True
Labor Pains
FalseLabor Pains
1. Remain irregular
2. Generally confined to the abdomen
3. No increase in duration, frequency and
intensity
4. Often disappears if the woman
ambulates
5. Absent of cervical changes
True Labor Pains
1.Maybe slightly irregular at first but become
regular and predictable within a
matter of hours.
2. First felt in the lower back and sweep around
to the abdomen in a girdle-like fashion.
3. Increase in frequency, duration and intensity.
4. Continue no matter what the woman’s level of
activity is.
5. Accompanied by cervical effacement and
dilatation (the most important difference)
Signs of true labor
TRUE LABOR FALSE LABOR
Starts at lumbar or back Confined to hypogastric area
Regular interval Irregular interval
Progressive cervical dilation and effacement No cervical dilation and effacement
Intensity is increasing No change in intensity
Ambulation intensifies uterine contraction Ambulation stops the contraction
in true labor
Sedation has no effect Sedation stops false labor
b. Effacement- shortening and thinning of the
cervical canal from 1-2 cm. to one in which no canal
as distinct from the uterus exists. It is expressed in
percentage.
c. Dilatation- enlargement of the external cervical os
up to 10 cm. primarily as a result of uterine
contractions and also because of the pressure of both
the fetal presenting part and the bag of water.
• In primis, effacement occurs before dilatation.
• In multis, dilatation precedes effacement.
Assessing Cervical Dilatation
• 1 finger = 1.25 cm
• 2 fingers = 3 cm
• 3 fingers = 4.5 cm
• 4 fingers = 5.5 cm
• 5 fingers = 7 cm
• 6 fingers = 8.5 cm
• 7 fingers = 9.5 cm
Condition of the cervix
(hard, soft, close, open,
effacement , dilatation ,
position of the cervix)
d. Uterine change
Retraction refers to the permanent shortening of the
muscles fibers that occurs with each uterine contraction.
Retraction causes the uterus to differentiate into two
portions:
1. Upper uterine segment – becomes thick and active in
order to expel the fetus; is the only part which contracts.
2. Lower uterine segment – becomes thin-walled, supple
and passive so that the fetus can be pushed out easily.
Physiological retraction ring is formed at the boundary of the
upper and lower uterine segments. In difficult labor, when the
fetus is larger than the birth canal, the round ligaments of the
uterus become tense during dilatation and expulsion, causing
an abdominal indentation called Bandl’s pathological
retraction ring.
Bandl’s pathological retraction ring is a danger sign of labor
signifying impending rupture of the uterus if obstruction is not
relieved.
Stages of Labor
1. First stage (Cervical Dilatation
Stage) - begins with true labor
contractions and ends with
complete dilatation of the cervix.
Three Phases of the First Stage
1. Latent Phase
• Ends when cervix is dilated 4 cm.
• Contractions more frequent.
• The duration becomes longer.
• Intensity - moderate.
• Mother is usually alert and talkative, can
walk
• Contractions last from 30 to 45 seconds
• The frequency of contractions is from 5 to 20
minutes.
• True labor is considered to be at 4 cm.
• Duration varies
2. Active Phase
• Begins when cervix is dilated 4 cm, ends when
the cervix is dilated 8 cm.
• Contractions occur every 3 to 5 minutes with
duration of 40 to 60 seconds.
• Intensity progresses to strong.
• The client focuses more on breathing techniques
in contractions, less talkative.
• Unable to walk
• This phase is considered the onset of true labor.
3. Transition Phase
• Begins when cervix is dilated 8 cm, ends when
cervix is dilated 10 cm.
• Contractions occur every 2 to 3 minutes
• Duration of 60 to 90 seconds.
• The intensity of contractions is strong.
• Completion of this phase marks the end of the first
stage of labor.
• Urge to push or to have a BM
Characteristics of the Transition Phase
a. The mood of the woman suddenly changes and
the nature of the contractions intensify.
b. If membranes are still intact, this period is
marked by a sudden gush of amniotic fluid as the
fetus is pushed into the birth canal.
• If spontaneous rupture of the BOW does not occur,
amniotomy (snipping of the BOW with a sterile,
pointed instrument to let amniotic fluid drain out) is
done by the doctor to prevent fetus from aspirating
the amniotic fluid into the lungs as he makes
different position changes.
• Amniotomy, however, is not done if station is still
“minus” because this can lead to cord compression.
c. Show becomes prominent
d. There is an uncontrollable urge to push with
contractions (a sign that second stage of labor is
very near) so that profuse perspiration and
distention of neck veins are seen.
e. Nausea and vomiting is a reflex reaction due to
decreased gastric motility and absorption.
f. In primis, baby is delivered within 20
contractions (40 minutes); in multis, after about
10 contractions (20 minutes).
2. Second Stage of Labor- Stage of
Expulsion/Expulsive Stage- begins when cervical
dilatation is complete and ends with birth of the
baby.
Impending Signs
• Bulging of the perineum.
• Dilatation of the anal orifice.
• Nausea, Irritability and uncooperativeness.
• Complaints of severe discomfort.
• Dilatation and effacement is complete - patient
is instructed to push with each contraction to
bring the presenting part down into the pelvis.
Second Stage of Labor
3. Third Stage of Labor- Placental Stage
• The period from birth of the baby through delivery of
the placenta.
• Dangerous time because of the possibility of
hemorrhaging.
Signs of the placental separation
a. Uterus become round and firm again, rising high to the
level of the umbilicus (Calkin’s Sign) the earliest sign of
placental separation.
b. The uterus rises in the abdomen.
c. The umbilical cord descends three inches or more
further out of the vagina.
d. Sudden gush of blood.
4. Fourth Stage of Labor – Immediate postpartum
period
• Also referred to as the Recovery Stage
• Period from the delivery of the placenta until the
uterus remains firm on its own.
• Uterus makes its initial readjustment to the non-
pregnant state.
• The primary goal is to prevent hemorrhage from
the uterine atony and the cervical or vaginal
lacerations.
• Atony is the lack of normal muscle tone.
• Uterine atony is failure of the uterus to contract.
• First 1-2 hours after delivery which is said to be a
dangerous stage for the mother because her vital signs
are still unstable
• Blood loss is usually between 250 ml and 500 ml.
• Uterus should remain contracted to control bleeding,
positioned in the midline of the abdomen, level with the
umbilicus.
• Mother may experience shaking chills.
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