10 cm dilation is large enough to allow passage of the average sized term fetus

10 cm dilation is large enough to allow passage of

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10 cm dilation is large enough to allow passage of the average sized term fetus. (about the size of regular bagel) 1 finger = 2 cm, 2 fingers = 3.5cm, 3 fingers = 5.5cm, 4 fingers = 7.5cm Cervix Assess with sterile gloves and sterile lubricant Dilatation: How far has the cervix opened (in cm) Effacement: How thin is the cervix (in cm or %) Dilation of Cervix Uterus pull upward over baby’s head Friedman’s curve Describes progress of two variables over time: dilation of cervix and descent of baby Labor is “dysfunctional” when cervix stops dilating or fetal descent stops or both Possible diagnosis of failure to progress C-Section indicated Maybe due to CPD (cephalon pelvic disproportion) or epidural anesthesia (can slow labor) Status of Membranes
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Status of membranes Nitrazine paper turns blue in the presence of alkaline amniotic fluid (“nitrazine positive”) Vaginal secretions are nitrazine negative (yellow) because of their acidity Pooling amniotic fluid in the vaginal vault s a reliable source Fern test: swab on slide, under microscope looks like fern leaves if its amniotic fluid Membranes Rupture 600 to 800 cc Color Odor Consistency Assess FHR with ROM Cardiovascular System During each uterine contraction blood flow to the placenta gradually decreases. This causes an increase in mom’s BP and slows her pulse VS should be assessed during the interval between contractions. Supine Hypotension may occur of mom lies on her back. Encourage laboring patient to rest in positions other than the supine position to promote blood return to her heart and enhance flow to the placenta and promote fetal oxygenation. Respiratory System Depth and rate of respirations increase (esp if pt is anxious or in pain). Rapid and deep breathing may experience hyperventilation Tingling in hands/feet, numbness, dizziness Help pt to slow breathing and breath into cup hands or paper bag (return blood levels of carbon dioxide to relieve these symptoms) Gastrointestinal System Gastric motility is reduced Not hungry, esp during active labor Usually have c/o thirst and dry mouth Food and large volumes of fluid us withheld to decrease risk of vomiting and aspiration. Ice chips, Popsicles or hard candy on a stick. Urinary System Decreased sensation of a full bladder Unaware that the bladder is full (if had epidural) bladder scan/strait cath Full bladder inhibits fetal descent (takes up space in the pelvis) Fluid retention is normal during pregnancy-reverses urine is excreted in lg quantities Hematopoietic System Hemodilution 1 to 2 liters (Kool-Aid effect) Normal 500cc blood loss Hgb of 11 & HCT of 33% or higher is an adequate margin of safety of blood loss Leukocyte count Clotting factors (fibrinogen) increase – want her to move around Protection hemorrhage risk clots increase
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Fetal Response Fetal responses include the: Placental circulation cardiovascular system Pulmonary system Placental Circulation Exchange of oxygen, nutrients, and waste products between mother and fetus occurs without the mixing of maternal
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