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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

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Fast Track into OB

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  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

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