Passageway

Passenger

Powers

Psyche

Pelvic structure varies between everyone.

When you initially go to doctor they assess you to see if pelvis is favorable for delivery.

False Pelvis-the flared part

True Pelvis-area of pelvis below the linea terminalis. Boney passageway. Opening in which the baby will pass.

Gynecoid

Anthropoid

Android

Platypelloid

Shape of pelvis.

Very common. 50% of women have.

Round in shape allows fetus to move through.

Most favorable for vaginal birth.

Pelvic shape. Elongated in shape.

Usually allows for vaginal birth.

Anterior & posterior diameter is generous, but transverse diameter is narrow.

25% of women have.

Pelvic shape. Heart shaped.

Typical male pelvis. Not favorable for vaginal delivery.

20% of women have.

Pelvic shape. Flat in dimension.

Narrow anterior and posterior diameter with generous transverse diameter.

Usually requires C-section. 

5% of women have.

Provider will make an estimate of the measurements of the pelvis during prenatal care to calculate the likelihood of delivering vaginally.

Measures by using obstetric conjugate and diagonal conjugate.

Measures the smallest diameter of the inlet through which the fetus must pass.

Determined by subtracting 1.5 from the diagonal conjugate.

A measurement of 11 is considered adequate.

Most important measurement!

Midpelvis: Distance between the ischial spines

Angle of the pubic Arch: Should be at least 90 degrees

Soft tissues making up the "passageway" are the cervix and vagina

Cervix: has two processes

-effacement

-dilation

Process where the cervix gets thinner and shorter.

It's expressed as a %.

Process where cervix opening increases in diameter to allow for baby to go through.

It's referred to in centimeters.

Fetal adaptations to delivery: Skull bones have cartilage b/w them which can overlap to decrease the diameter of the skull.

Molding: Skull can elongate due to pressure from vaginal wall. Creates a cone head like appearance.

Fetal Orientation

(Fetal Lie)

Fetal Lie: relationship to long axis of the mother

-Longitudinal-most common. Fetus is parallel and lying up and down.

-Transverse-Fetus is perpendicular. Lying side to side.

-Oblique-Combination b/w the two. Diagonal lying.

Fetal Orientation

(Fetal Presentation)

Fetal Presentation: 1st part of the body entering the pelvic inlet.

-Cephalic-Head 1st. 97% of babies.

-Breech-Feet/butt first.

-Shoulder

Fetal Orientation

(Fetal Attitude)

Position of the head in a cephalic presentation.

Vertex-chin is flexed to chest. Most favorable b/c the smallest diameter of head is showing.

Military-Neither flexed/extended. Larger diameter of head showing.

Brow-Neck is partially extended.

Face-Problem. Come out horribly bruised.

Position of presenting part in relation to quadrants of maternal fetus.

1st designation-which side the presenting part is facing on (either left/right)

2nd desig-reference point on present part

3rd desig-front, back, or side of the maternal pelvis in which the reference point is found.

OA-preferred (oxiput anterior)

Oxiput-military/vertex

Frontum-brow position

Sacrum-breech position

Scapula-shoulders

Describes the position of the widest part of the presenting part in relation to the level of the ischial spine.

Before fetus becomes engaged it's in the negative numbers. When it descends through the pelvis it goes into the positive numbers and becomes engaged at ischial spine.

Involuntary uterine contractions and voluntary abdominal muscle contractions both assist in cervical dilation and expelling fetus.

Contractions can be described by: frequency, duration, strength/intensity

(of contractions)

Interval of time from beginning of one contraction to the beginning of another one.

Counts how often they're occuring.

(of contractions)

How long they last.

Beginning of one contraction to the end of that contraction.

Factors that affect the Mental State of Laboring Women:

If the pregnancy is easy/complicated

Previous birth experiences

Expectations, Preparation

Support system, Culture

Lightening-"baby has dropped." Puts pressure on bladder. Baby has settled into pelvis.

Braxton Hicks Contractions-Irregular, false labor pains. Practice contractions. More intense and frequent towards end of pregnancy.

Loss of Mucous Plug-Can be 1-2 weeks prior to labor.

Nesting-Burst of energy in preparation for baby to come.

Cervical Ripening or softening.

Cervical effacement and

Dilation.

Dilation-the process by which the opening of the cervix increases in diameter. (0-10cm)

Effacement-The process by which the cervix gets shorter. Expressed as a %. When the thickness is so small the effacement is 100%.

Fetal Station-Description of the location of the widest part of the presenting part of the ischial spine.

Labor Ends 1hr after the delivery of the placenta.

1st stage-Begins with onset of true labor and ends when pt is fully dilated. Longest stage. (3 phases)

2nd Stage-Begin when pt is fully dilated and ends with delivery of infant.

3rd Stage-Begins once fetus is expelled and ends when placenta is delivered.

4th Stage-Begins when placenta is delivered and continues for 1-4hrs.

Early/Latent-0-4cm contractions are mild-moderate and becoming more freq and intense.

Active-4-8cm more active contractions. Mod-strong contractions. Fetus is decending and cervix is dilating.

Transition-8-10cm most intense part of labor. Strong contractions. Exhausted, frustrated. Tremble from surge of hormones. Urge to bear down, but can't push down until fully dilated or cervix can become swollen or will tear.

Dorsal Recumbant

Lay on back at a 45 degree angle with knees bent and out.

Gush of blood from vagina

Lengthing of umbilical cord

Inspect placenta to check it's intact to make sure there's no more left inside. Don't want to risk infection or anything else.

Lasts 1-4hours depending on the method and bleeding.

C section is generally a longer recovery.

Observe and take vitals frequently. Check uterus.

Do fundal massage.

Unique-a normal physiologic process, increasing intensity is desirable and positive, predictable (labor pains)

Threshold-amount of pain necessary for the individual to percieve pain.

Tolerance-Ability to withstand pain once it's been percieved.

Everyone responds differently.

Age, level of pain experience in life

How many deliveries have they had

Length of labor

Fear of pain, Level of anxiety

Culture

Non-pharmacologic Interventions-labor support, comfort measures, relaxation techniques, breathing techniques, attention focusing, different movements & positioning, forms of massage, water therapy, hypnosis, water injections, and accupuncture.

Pharmacologic-Analgesia:reduce sensation of pain (opiods/narcotics)

Anesthesia:block sensation of pain (epidural block most common/spinal block for c-section)

Purpose is to detect early signs of fetal distress.

Monitoring contractions-very important  to asses fetal heart rate in response to contractions. Less fetal oxygenation during contractions.

-Palpate uterus

-TOCO-external device on abdomen

-IUPC-Intrauterine pressure catheter measures freq, duration, and intensity. Measures inside uterus. Membranes need to be ruptured to use. Measures in mmHg.

Monitoring fetal heart rate in relation to contraction to assess fetal well being.

Intermittent ausculation-Do in early labor, when not any pitocin is going. Use hand held doppler. Listen for at least a minute through one full contraction.

Continous Electronic Fetal Monitoring-external/internal-spiral electrode gets attached to fetuses head screws into outer layer. Accurate continuous recording of HR. Membranes need to be ruptured. (internal)

Establish a baseline heart rate. Has to be over 10 minute period. (110-160BPM)

Assess variability (flunctuation in HR).

Variability results from the interplay b/w the sympathetic and parasympathetic nervous sytem.

It's the up and down movement. Shows that the nervous system is intact and that they're well oxygenated.

Accelerations-A spontaneous increase of at least 15 beats above baseline for 15 seconds or more.

If acceleration lasts longer than 10 minutes then it is considered a change in baseline.

Accelerations are reassuring sign which indicate that the fetus is doing well.

Early Decelerations-have a U shaped apperance and begin at the start of the contraction and end at the contraction.

Must hit its lowest point at the peak of a contraction. 

Results from head compression during contraction.

Mirror contractions.

Variable Decelerations- Sudden drop. May occur at any time during a monitoring period.

Variables have a jagged appearance. Look like a U, V, or W.

Indication of cord compression of some type.

As long as variables resolve quickly and aren't severe, intervention is minimal. Aimed at relieving compression. Turn the mom. If ruptured membranes might do amnioinfusion to provide baby with more cushion.

Late Decelerations

(Non-reassuring)

Most ominous. Appear smooth and U shaped, but are offset from the contraction.

They begin after the onset of the contraction and don't resolve until after the contraction ends.

They result from a problem with blood flow from the uterus to the placenta.

Intervention aimed at improving utero-placental perfusion.

Give O2 immediately, increased IV fluids, change positions, back off of pitocin to give uterus a rest. If not resolved often have to do C section.

Post date: haven't delivered and placenta stops working

PROM: premature rupture of membranes. Risk for infection.

Fetal indication: intrauterine growth restriction. Baby stops growing for some reason.

Maternal Indication: HTN

Elective:cutting back on doing this.

Cervical Ripening-medication which is a vaginal suppository for 12 hours which releases prostaglandins and softens the cervix.

AROM-artificial rupture of membranes. Amniohook use. Once they rupture deliver within 24hours.

Pitocin-synthetic form of oxytocin which stimulates uterine contractions.

Episiotomy-Surgical cut into the perineum to allow room for delivery of fetus. Usually done only if baby shows signs of distress. Now just let it tear on it's own.

Vacuum delivery-suction applied to fetal head. Can be traumatic to fetus & maternal soft tissue.

Forceps delivery-metal tongs applied to either side of baby's head to assist. Can also be traumatic.

C-Section-Baby is delivered through an incision in the lower abdomen. About 25% of births.

Has risk same as other surgeries.

Most common indications:

Previous c section

labor stops/dystocia

Baby distress, placenta previa

malpresentation (breech, etc)

Cephaloplevic dysproportion (babies head too big)

Herpes outbreak

Diabetes, HTN