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Placental Shearing begins where? Which part detaches last?

begins at caudal part... the upper area detaches last


Definition of Labor

- regular uterine contractions that increase in intensity
- progressive cervical effacement
progressive uterine dilation
("false" labor is when is there is no change in cervical dilation)
- delivery


Term Pregnancy timeline

37-42 weeks


First Stage of labor - Latent Phase:

"early labor"
- bet onset of labor and point at which rate of cervical dilation increases
- slow dilation*
- contractions 5-10 min apart, 30-45 sec*


First Stage of labor - Active Phase:

"active labor"
faster rate of dilation
-begins at ~4cm*
- contractions 2-4 min apart, 60 sec; more intense


First Stage of labor - "Transition"

mix of cervical dilation and descent of fetus


At onset of labor, what hormones are involved?

- PG's
- Progesterone
- Estrogen
- Oxytocin
- Hypothalamic-pituitary-adrenal factors (cortisol, PG's)


At onset of labor, what do Prostaglandins do?

soften cervix and help cause contractions


At onset of labor, what does Progesterone do?

mb progesterone withdrawal


At onset of labor, what does Estrogen do?

up regulates receptors on uterus increasing contractility


At onset of labor, what does Oxytocin do?

stimulates uterine contractions - stronger contractions


fetal secretion of cortisol does what?

increases placental CRH, corticotropin-releasing hormone which then enhances PG production in placenta and primes uterine myometrium


What is the first stage of labor?

interval bet onset of labor and full cervical dilation (10cm)


What is the Second Stage of labor?

ave 1-2 hrs
interval bet full cervical dilation and delivery of infant


What are cardinal movements?

changes in the position of the fetal head during the passage thru the maternal pelvis:
1. head floating
2. engagement, flexion, descent
3. descent, internal rotation
4. complete rotation, beg extension
5. complete extension
6. restitution (external rotation)
7. delivery of ant. shoulder
8. del. of post. shoulder


Definition of Restitution

the spontaneous realignment of the fetal head with the fetal body, after delivery of the head


What are the Mechanics of Labor?

1. Power - strength of uterine contractions
2. Passenger - the fetus (presentation, attitude (flex/ext of head), position)
3. Pelvis


First Stage of Labor - what should you evaluate?

- cervical status, hx of medical conditions and new disorders, fetal status
- Vitals, Fetal heart rate, Freq. and Duration of contractions
- labs - urine for protein, CBC for hgb


Upon cervical exam, what are you looking for?

- ruptured membranes
- dilation
- effacement (%)
- station of fetal head
- status of amniotic membranes, presence of meconium
- fetus presentation and position


How often should you monitor vitals?

every 4 hrs if normal
- if abN, 1-2 hrs


What 3 things should you monitor during labor?

1. vitals
2. uterine contractions
3. cervix
4. fetal heart rate


How often should you monitor the cervix?

cervix exam:
- on admission
- 1-4 hr intervals during 1st stage
- 1 hr intervals during 2nd stage
- when pt feels urge to push
- w any fetal heart rate abN


How often should you monitor fetal heart rate? what is a normal rate?

- every 15-60 min during 1st stage
- every 5 min during 2nd
- listen during and after contractions
NORMAL: 110-160 bpm


How to augment labor?

- hydration
- calories
- position changes
- acu
- homeo
- herbs
- breast pump
- amniotomy


What does an amniotomy do?

artificial rupture of membranes -> release of amniotic fluids
- increases contraction strength
- improve contact of fetal head to cervix
- expose cervix to PGs in amnio fluid


All pregnant pts should be screened for what?

Group B beta hemolytic strep
- tx w intrapartum IV penicillin 4 hrs before delivery


When is an Episiotomy indicated?

- fetal distress at +4 station
- prolonged crowning
- need for instrumentation

(this is when the vagina is cut)


What is the third stage of labor? How long?

interval bet fetal delivery and complete expulsion of placenta
- ave is 5-6 min
- 97% within 30 min
* PPH increases w length


benefits of delayed clamping

- higher hgb
- halved rate of anemia
- imp. in babies whose mothers have low ferritin, will be breastfed wo iron supplementation, low birth weight
- if preterm, decrease anemia, lowers risk of necrotizing enterocolitis, less intraventricular hemorrhage


what are some positions the woman can be in during labor?

standing, sitting, side-lying, squatting, hands and knees, kneeling


What are signs of placental shearing?

- gush of blood
- umbilical cord lengthens
- uterus becomes firmer and globular
- uterus moves upward


Tx for retained placenta?

1. angelica
2. homeopathics - pulsatilla, sabina


How much is normal blood loss during labor?



PPH is blood loss of how much?

500 ml or greater


What is uterine atony?

Uterine atony is a loss of tone in the uterine musculature. Normally, contraction of the uterine muscle compresses the vessels and reduces flow. This increases the likelihood of coagulation and prevents bleeds. Thus, lack of uterine muscle contraction can cause an acute hemorrhage.


What are some causes of PPH?

- uterine atony
- episiotomy
- vaginal/cervical lacerations
- ruptured or inverted uterus
- retained products of conception
- placenta accreta
- maternal coag defects


SSx of PPH

rising fundus
vaginal bleeding
tachycardia before BP drop


How to Tx PPH?

1. pharm - oxytocics
2. uterine massage or bimanual pressure
3. IV
4. belladonna, lachesis, sabina, aletri
5. cinnamon/erigeron
- after mother is stable, collonsonia


how to deliver in emergency situation

baby crowns: counter pressure, pant, flex head
head delivered: cord around neck? lift over baby’s head
Shoulders come out
1st thing to do w baby: warm it up, dry off
If baby is not crying: rub back, KD 1, mouth to mouth
leave cord attached
once you deliver placenta: rub tummy, get clots out


What are some abN placenta variations?

- infarcts
- meconium staining
- pale
- dark red
- edema


A cause of prolonged labor

cephalopelvic disproportion
(occurs when a baby's head or body is too large to fit through the mother's pelvis. It is believed that true CPD is rare, but many cases of “failure to progress” during labor are given a diagnosis of CPD.)