Labor and Delivery Dr Meity Elvina, Mked,SpOG,PGCert 9/12/

Presentasi berjudul: "Labor and Delivery Dr Meity Elvina, Mked,SpOG,PGCert 9/12/"— Transcript presentasi:

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2 Labor and Delivery Dr Meity Elvina, Mked,SpOG,PGCert 9/12/2019 1

3 What is Labor? Demonstrating progressive cervical changes, in the presence of regular, frequent, painful uterine contractions 9/12/2019 2

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5 Phases of Labor During First Stage Latency (0 to 3 cm) Prodromal, early, preliminary 4- 24 hours Active (4 to 7 cm) 3 to 5 hours Transition (8 to 10 cm) ½ to 2 hours 9/12/2019 4

6 Physiologic Forces of Labor Frequency of contractions Effectiveness of pushing 9/12/2019 5

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8 Uterine Contractions Palpation Timing Frequency Duration strength 9/12/2019 7

9 Birth Passage Size of maternal pelvis Type of maternal pelvis Ability of cervix to dilate Ability of vaginal canal to distend 9/12/2019 8

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11 Dilation and Effacement 9/12/2019 10

12 Fetal Head 9/12/2019 11

13 Fetal attitude Fetal lie 9/12/2019 12

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17 Passage Engagement Station Fetal position 9/12/2019 16

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19 Psychosocial considerations Mental and physical preparation for childbirth Sociocultural values Previous experience Support Emotional status 9/12/2019 18

20 Admission to Labor Suite History Contractions When they last ate Vital signs Ultrasound Examination 9/12/2019 19

21 Membranes Rupture 600 to 800 cc Color Odor Consistency Nitrazine Paper 9/12/2019 20

22 Leopold’s Maneuvers 9/12/2019 21

23 External fetal monitoring Two belts Uterine contractions Fetal heart monitoring benefits negatives 9/12/2019 22

24 Internal fetal monitoring 9/12/2019 23

25 Fetal heart variability 9/12/2019 24

26 Early decelerations Head compressions 9/12/2019 25

27 Late decelerations Uteroplacental insufficiency 9/12/2019 26

28 Variable decelerations Cord Compression 9/12/2019 27

29 Maternal Responses to labor Cardio, B/P Respiratory Renal, GI Immune/blood Pain causes 9/12/2019 28

30 Cardinal movements Descent Flexion Internal rotation Extension Restitution External rotation Expulsion 9/12/2019 29

31 Fetus moving through the Pelvis

32 Placental delivery Contraction Globular uterus Cord lengthens Rush of vaginal blood 9/12/2019 31

33 Causes of Pain in Labor Stage One Stretching of the cervix during dilation & effacement Uterine Anoxia Stretching of the uterine ligaments

34 Causes of Pain in Labor Stage Two Stage Two Distention of the vagina and Perineum Compression of the nerve ganglia in cervix & lower uterus Pressure on urethra, bladder, rectum during fetal descent Traction on and stretching of the perineum

35 Factors affecting Mothers Response to Pain in Labor Preparation - Knowledge and confidence gained through childbirth classes Cultural influences on expression of pain Maternal fatigue, anxiety, sleep deprivation Previous experiences with pain Support

36 Methods of Pain Relief Nonpharmacological Childbirth methods Breathing Techniques Relaxation Techniques Touch Focusing attention on one object Effleurage

37 Breathing Methods Basic principles Comfortable position Chest breathing Focal point Verbal and non-verbal cues Cleansing breath Rhythmic chest Shallow chest Pant-blow Exhalation pushing 9/12/2019 36

38 Non-Pharmacological Sensory Stimulation Listening to music; subdued lighting Imagery Applying heat and cold Massage (lower back); Counterpressure TENS Position Changes

39 Pain Management Narcotic Analgesics Timing Effect on labor Common meds used Stadol Nubain 9/12/2019 38

40 Pain Relief in Labor Criteria for administering an analgesic: Needs to be in active phase of labor If give in latent phase – it may slow labor If give in transition phase – can lead to neonatal respiratory depression

41 Regional Anesthesia Epidural Spinal Pudendal Side effects Hypotension Bladder distention 9/12/2019 40

42 Nursing Care related to an epidural Preparation Assess platelet count – must be normal Empty bladder Assess vital signs for baseline IV fluids Following Assess V/S – especially the B/P because the main side effect is hypotension Rotate position between right and left side-lying Assess bladder and catheterize as needed Assess for other side effects and intervene

43 Terimakasih