1 / 76

Fast Track into OB

Fast Track into OB. Labor and Delivery. Lightening. Five Ps of Labor. Passage Passenger Psyche Powers Pain. Passage: the bony pelvis and soft tissue. False pelvis (upper flaring part) True pelvis (lower part) Inlet Middle Outlet Shaped like a wide curved funnel Soft Tissue

abeni
Télécharger la présentation

Fast Track into OB

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Fast Track into OB Labor and Delivery

  2. Lightening

  3. Five Ps of Labor • Passage • Passenger • Psyche • Powers • Pain

  4. Passage: the bony pelvis and soft tissue • False pelvis (upper flaring part) • True pelvis (lower part) • Inlet • Middle • Outlet • Shaped like a wide curved funnel • Soft Tissue • Impacted by previous births • Impacted by scaring

  5. More on the true and false pelvis • See text page 25 • Divided by false line: linea terminalis • Extends from sacroiliac joint to anterior iliopubic prominence • The upper false pelvis support the enlarging uterus and guides fetus into true pelvis • The TRUE pelvis however dictated the bony limits of the birth canal

  6. Anatomical picture of pelvic inlet

  7. Passage dimensions

  8. Anatomical features of the pelvic outlet Page 25-26 • Transverse diameter between the inner surfaces of the ischial tuberosities (spines) (bi ischial diameter) • Anterior posterior measurement of outlet is between lower border of symphysis pubis and tip of sacrum.

  9. Passenger Page 122 • Fetal skull page 123 • Lie: orientation to Mom’s spine • Attitude: normally flexed • Presentation: part entering pelvis • Position: how a reference point on the fetal presenting part oriented within the mother’s pelvis

  10. The Passenger

  11. Passenger

  12. Molding

  13. Transverse Lie

  14. Fetal Lie

  15. Fetal Lie LongitudinalFetal Presentation: Vertex

  16. Attitude: Flexion/Extension

  17. Fetal Attitude: a well flexed head

  18. Attitude; Brow

  19. Presentation: Breech

  20. Presentation

  21. Fetal Positions

  22. Position: Posterior

  23. Fetal Positions

  24. Using Fetal Heart Tones to Determine Position

  25. Psyche • Woman’s mental state • Emotional; not described as surgical procedure • Mental State greatly impacts mothers ability to cope and tolerate discomfort • Perception of pain • Anxiety

  26. Powers of Labor • Involuntary forces of labor • Contractions • Voluntary forces of labor • Mother’s pushing efforts

  27. Contraction Cycle

  28. Effects of contractions on the cervix • Effacement • Thins the cervix • Before labor approximately 2 cm long • Thinning of cervix is expressed in % • 100% thin slick membrane at edge of fetal head • Dilation • Opening of the cervix • Described in cm of opening • Full dilation at 10 cms

  29. Effacement and Dilation

  30. Effects of Contractions on Cervix

  31. Effacement

  32. Dilation

  33. Mechanisms of Labor • Descent • Flexion • Rotation • Extension • Restitution • External Rotation

  34. Engagement: Stations

  35. Mechanisms of labor with effacement and dilation

  36. Read to learn activity • Signs of impending labor (page 131) • Signs of True Labor (136) • Signs of False Labor (135-136) • Read those sections and then we will do a quiz together. RELAX!

  37. Contractions; Page 120-21 • Frequency • Duration • Interval • Increment/Peak/decrement • Intensity: Mild, moderate, strong

  38. Contraction MonitoringThe basics • Frequency • From the beginning of one contraction to the beginning of the next contraction • Duration • From the beginning of one contraction to the end of that contraction • Interval • The space between two contractions; from the end of one contraction to the beginning of the next one

  39. Rule of contractions • Based on infant getting adequate oxygenation • The frequency must not be less than two minutes • The duration must not be more than 90 seconds • The interval must not be less than 60 seconds

  40. Fetal Heart monitoring • Intermittent • Allows freedom of movement • Does not offer a continuous record • Obtain a baseline rate • Rule: any FHR outside the normal limits or slowing that persists after the contraction ends is promptly reported to the health care provider • See box 6-2 page 133

  41. Continuous Fetal Heart Monitoring • Offers a written record • Allows collection of more data • May however run a strip on admission and then re run a strip at regular intervals during the labor • Referred to in terms of reassuring and non reassuring patterns. • Box 6-3 page 135

  42. Fetal and Contraction MonitoringThe Basics • Top of strip is the fetal heart monitoring • Bottom of strip is the contraction pattern • Each small square is 10 seconds • Between each bold line is 60 seconds

  43. Reassuring fetal heart/contraction pattern • 110-160 bpm • Variability • Accelerations • Early decelerations • Contraction frequency greater than every 2 minutes, duration less than 90 seconds; relaxation interval of at least 60 seconds.

  44. Non reassuring patterns • Fetal tachycardia • Fetal bradycardia • Variable decelerations • Late decelerations • Absences or decreased variability

  45. Decelerations • Early • Due to fetal head compression during contractions and are expected • Late • Due to utero-placental insufficiency and are non reassuring • Variable • Due to cord compression and are non reassuring.

  46. Early decelerations • Reassuring pattern of deceleration during the early contraction due to fetal head compression • Always return to baseline before the end of the contraction • They often mirror a contraction

  47. Picture of an early deceleration

  48. Late deceleration • NON reassuring • Due to lack of oxygen to the baby • Uteroplacental insufficiency • Do NOT return to baseline FHR after the contraction ends

  49. Picture of late deceleration

  50. Variable Deceleration • Due to cord compression • V, W, or U shaped • Do not exhibit a consistent pattern in relation to the contractions

More Related