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the relationship of the presenting part to the four quadrants of the mother’s pelvis
-identified with abbreviation: (1 letter, 2 letter, 3 letter)
relationship of presenting part of fetus to an imaginary line drawn between the maternal ischial spines and is the measure of the degree of descent of the presenting part of fetus through birth canal
- should be determined as soon as labor begins so the rate of descent can be measured
term used to indicate that the largest transverse diameter of the presenting part has passed through the maternal pelvic brim and into the true pelvis (corresponds to station 0 )
- occurs the weeks right before labor or during labor for multigravidas
Reverse CNS depression effects of opioids
If given to mother must make her aware that pain with return
Neonatal narcosis: state of CNS depression in newborn. Alterations may be present for up to 72 hours. (usually given to the baby)
If delivery occurs sooner than anticipated may need to be given IM to neonate
useful for second stage of labor, episiotomies and birth. Relieves pain in lower vagina, vulva and perineum by numbing the pudendal nerve
Commonly used for impending episiotomy when time or the fetal head position makes a pudendal block contraindicated (usually just done for repair)
Local anesthetic injected through the third, fourth or fifth lumbar space into the subarachnoid space, at which point the medication mixes with the CSF.
Mostly used for C-sections.
Effects are within 1-2 minutes and lasts 1-3 hours.
Risks: marked hypotension, decreased cardiac output and placental perfusion and respiratory inadequacy
-Begins with regular uterine contractions
-Ends with full cervical effacement and dilation
ladies are home and start to feel pain not real regular (very slow can be 12 hours) (little cervical pain) (can be uncomfortable) (prolong stage can be detrimental – because they get so tense and un-rested, can admit for therapeutic rest (give sedative and analgesic))
-assess FHR every 45 -60 minutes
typically when you admit people, contractions are around 5 min apart lasting 60 seconds, pri – dilatation of about 1 cm per hour, multi – 11/2cm per hour
Transition: when things really get intense, can start to get the urge to push
assess fetal heart rate every 15-30 min
-Then q hour
•Observe for signs of placental separation and assist
-Until peeing then transfer – can not move until mom is able to do this on her own
Baseline FHR less than 110 beats per min (NICHD)
Fetal bradycardia is commonly associated with fetal hypoxemia. However, a number of causes must be considered
Complete heart block (Maternal SLE, CMV infection)
Congential heart block
Umbilical cord compression
Amniotic fluid embolism
As with fetal tachycardia, the bradycardic FHR must be analyzed for the presence of periodic changes and decreased variability. These findings are more consistent with hypoxemia. Some fetuses may display a bradycardic FHR but be completely normal. It should be remembered that the range of 110-160 does not represent all normal fetuses. The likelihood of a FHR in the range of 100-110 representing a normal variant increases as the fetus, and its nervous system, matures.
Baseline FHR greater than 160 beats per min (NICHD)
Drugs (Atropine, Vistaril, Phenothiazines, Beta-sympathomimetics)
Fetal heart failure
Severe fetal anemia, fetal hydrops
Fetal tachycardia is occasionally seen after a deceleration of the FHR, and in this instance is likely indicative of hypoxemia. This may be due to an attempt by the fetus to increase perfusion by increasing cardiac output or it may be due to increased catecholamine activity from the adrenal medulla in response to the stress of hypoxemia, when associated with a deceleration, and the loss of vagal tone.
FHR accelerations and good (moderate) variability are closely associated and sometimes may be visually indistinguishable, though both are reflective of a well-oxygenated fetus.
Causes by head compression – see as baby is decending into the vaginal canal – mirrors contractions of mom (can be deep or suddel) these are normal and okay to have – baby must recover by end of contraction
The presence of accelerations forms the basis of the nonstress test (NST). An NST is said to be reactive when there are at least two accelerations in a 20 minute period, along with moderate variability and no decelerations.
- An abrupt (onset to nadir less than 30 sec), visually apparent decrease in the FHR below the baseline
- The decrease in FHR is 15 beats per min or more, with a duration of 15 sec or more but less than 2 min (NICHD)
-not thought to represent hypoxia, but repetitive severe variable decelerations with diminished or absent FHR variability may indicate hypoxia.
-Related to cord compression – can be suddle or deep, not happening ontop of contraction look like a “V”
Cord that is against babies head as the baby descends
If baby cant recover or deal with them mom goes to C-cection
-In association with a uterine contraction, a visually apparent, gradual (onset to nadir 30 sec or more) decrease in FHR with return to baseline
Onset, nadir, and recovery of the deceleration occur after the beginning, peak, and end of the contraction, respectively (NICHD)
Uterine hyperactivity Maternal hypotension
Maternal hypertensive disorders
Placental abruption Placenta previa
IUGR Maternal DM
Chorioamnionitis Postterm gestation
Maternal anemia, SS anemia, etc.
Rh isoimmunization Maternal cardiac disease
Start at end of the contraction
Associated with uterine placental consistency
Often have a lose of variability
Baby will eventally crash
Measured in finger breaths
Takes about a week before it becomes a pelvic organ again
6 wks. About the pre pregnant size – never return to pre preg size
the discharge that flows from the vagina after childbirth. During the first 2 to 4 days after delivery, the lochia is red or brownish red (called lochia rubra) and is made up of blood, endometrial decidua, fetal lanugo, vernix, and sometimes meconium, and it has a fleshy odor. About the third day the amount of blood diminishes. The placental site exudes serous material, erythrocytes, lymph, cervical mucus, and microorganisms from the superficial layer called lochia serosa. During the next 10 to 14 days bacteria appear in large numbers along with mucinous decidual material and epithelial cells, causing the lochia to appear whitish yellow (lochia alba).
- is the first discharge, red in color because of the large amount of blood it contains. It typically lasts no longer than 3 to 5 days after birth.
up to 6 weeks
- Clear or very light pink but mostly white
- ) is the name for lochia once it has turned whitish or yellowish-white. It typically lasts from the second through the third to sixth weeks after delivery. It contains fewer red blood cells and is mainly made up of leukocytes, epithelial cells, cholesterol, fat, and mucus
-Don’t exercise for 6 weeks after childbirth, don’t left anything heaver than the weight of the baby until the lochia alba
of uterus to contract
-Temp above 100.4 then start patient on something
-Displaced to the left and above the umbilicus – can be a reason for uterine distension – have patient use restroom and reassess
clues to look for
Pink Period is first day or two after delivery – char. By heightened joys and feelings of well-being.
Blue Period peaks around day 5 and subside by day 10.
- Oxygenation of the fetus occurs through transplacental gas exchange → at birth the lungs must be established as the site of gas exchange.
- In utero, fetal blood was shunted away from the lungs but with birth the pulmonary vasculature must be fully perfused for this purpose. Clamping the cord causes a rise in blood pressure which increases circulation and lung perfusion.
- All these things must happen within the first minute of life
1.The neonate’s skin is thin.
2.The newborn’s blood vessels are close to the surface.
3.Little subcutaneous or white fat is present to serve as a barrier for heat loss. (the percentage of subcutaneous fat in newborns is only half in adults)
4.Newborns have three times more surface area to body mass than adults.
EvaporationWhen wet surfaces are exposed to the air evaporation occurs. Heat is lost when the surface dries. At birth the neonate is bathed with amniotic fluid. As the amniotic fluid dries up on the infant’s skin (evaporation), the infant loses heat. The same occurs in bathing an infant
When a neonate comes in direct contact with an object cooler than their skin heat loss by conduction occurs. Heat loss by conduction occurs when an infant is placed on a cooler surface or touching them with a cool object or hands.
1.Keeping the newborn out of drafts.
2.Maintaining warm environmental temperature.
3.Keeping a preterm neonate in an incubator.
The transfer of heat to cooler objects that are not in direct contact with the neonate is called the heat loss by radiation. When infants are placed near cold windows or walls heat is lost by radiation. Even neonates placed in incubators losses heat to the walls of the incubator if it is cold even if the surrounding air temperature is warm.
1.Incubators must have double walls.
2.Cribs and incubators should be placed away from the walls and windows
- is the flow of heat from the body surface to cooler ambient air (rooms kept at 75°)
– loss of heat from the flow of heat from the body’s surface to cooler ambient air – baby laying in crib not will covered. Airflow around baby causes baby to be cold
– the loss of heat from the body surface to a cooler solid surface not in direct contact but in close proximity (windows/drafts)
- loss from the body’s surface to a cooler solid that is close to the infant but not touching the infant – closer to a window in winter
– loss of heat that occurs when a liquid is converted to a vapor. (drying infant)
– loss of heat from a body surface to cooler surfaces in direct contact (pre-warm Ohio’s, covered scales)
Allows the head to accommodate the birth cannel
Will return back to normal within 24 hours
- does not cross the suture line
outcome but are good indicators of transition
to extrauterine life
-2 points for each one at best, best score is 10
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