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Unformatted text preview: OB LECTURE NOTES PROCESS OF NORMAL LABOR EVENTS BEFORE ONSET OF LABOR • Unknown what actually starts labor • Lightening: “baby drops down”, baby settles in maternal pelvis • Vaginal discharge or bloody show: pink stained mucus • Energy spurt or nesting time • False labor: no cervical dilation • Spontaneous rupture of membranes or SROM • Cervical changes – effacement & dilatation MAJOR VARIABLES IN THE BIRTH PROCESS: THE 4 P’S • PELVIS--size and shape of the pelvis • PASSENGER- fetus size and position • POWERS-effectiveness of contractions • PSYCHE-preparation, previous experience PELVIS • Must be adequate proportions in order for the fetal head to fit through • Angles are downward, forward, & upward somewhat like the letter “J” PASSENGER • Fetal Head – must be able to stand extreme pressure • Fetal Bony Skull – bones thin, very elastic, allows for molding FETOPELVIC RELATIONSHIP • Attitude • Lie – relationship of the longitudinal axis of the fetus to the mother, should be parallel, not crosswise • Presentation, body part lowest in mother’s pelvis, fig 7-4 • Position, more specific description of the relationship of the fetal presenting part to the maternal pelvis, fig 7-4 • Station – fig 7-5, -5 to +5, ischial spines used, hardest to determine during a vaginal exam POWERS-UTERINE CONTRACTIONS • Involuntary • Intermittent but regular • Exhibit a wavelike pattern in 3 phases: • Increment, building up • Acme, peak • Decrement, decreasing intensity • Affected by maternal position o Supine, more freq, lower intensity o Side lying, less freq, more effective ASSESSMENT OF UTERINE CONTRACTIONS • Frequency: amount of time between the beginning of one contraction to the beginning of the next • Duration: time between the onset of the contraction & it’s end • Intensity: strength of the contraction, rough estimate made by palpation; o Mild – easy to indent, like touching tip of nose o Moderate – harder to indent but still able to; touching the chin o Strong – fundus is very firm & difficult to indent, like touching the forehead PSYCHE • Psychological and Cultural factors that affect labor • Anxiety and fear can decrease ability to cope, previous poor experience can effect present experience negatively •...
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This note was uploaded on 11/10/2010 for the course PRACTICAL KSPN 124 taught by Professor Ljnelson during the Fall '10 term at Kansas City Kansas Community College.

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