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09 Process of Birth
09 Process of Birth
09 Process of Birth
ADOLESCENT,ANDFAMILY
IDIANALEBATCH2024
ST.LUKE’SCOLLEGEOFNURSING
TOPIC9:PROCESSOFBIRTH
● beyond 30 minutes - referral na ng client
toahospital
Duncan
● dirtyduncan
● sidengplacentamauunamatanggal
● causesplacentalflip
Schultze
● centersiyamagdedetach
Placentalexpulsion
● pressure of the uterine walls cause it to
slidedownward
● gentle fundal
pressure and
traction on the
cordcompleteitsdelivery
BrantAndrewsmaneuver
● pressure sa lower uterine while you pull
theplacenta
Fourthstage
Hindinaallowedtoambulatepagrupturedbag
● first4hoursafterexpulsionofplacenta
kasiproneto: ● uterus contracts to control bleeding at
placentalsite
- cordprolapse ● monitorBPq15mins
- infection ● palpateuterusandmassage(bimanual)
● normalangfirsthour=checkbpq30mins
STAGESOFLABOR
Firststage
Preeclampsia is caused by the spiral of the
● onsetoflabortocompletecervicaldilation chorionicvilli
● Latentphase-laboronsetto3cmdilation Hypertensive mother - babagsak bp right after
○ mommy uwi
ka
muna
kasi
hindi
ka
detachmentofplacenta
pamanganganak
● Activephase-4-7cmdilation
● Transition-8-10cmdilation
○ strongcontractions
● Fullydilated-10cms
● 1cmperhour-primigravida
● 1.5cmperhour-multigravida
Secondstage
● completedilationtobirthofbaby
● urgetopush
● transfertodeliveryroom
● Primigravida-fullypalangtinatransferna
● Multigravida - tinatransfer pag crowning
na
Thirdstage
● birthtoplacentalexpulsion
● 5-30minutes
PROPERTYOFODLID
42
CAREOFMOTHER,CHILD,
ADOLESCENT,ANDFAMILY
IDIANALEBATCH2024
ST.LUKE’SCOLLEGEOFNURSING
○ supporting the perineum para di
maglacerate
● Avoidprecipitousdelivery
EPISIOTOMY
● surgical incision through the perineum
made to enlarge the vagina and assist in
childbirth
● 1cmabovetherectum
Medianincision
● masmabilismagheal
Mediolateralincision
● for short perineum kasi iniiwasan yung
rectum
Rectovaginalfistula
● hindi properly nasuture yung 4th degree
suture
Episiorrhaphy
● anoto?
FETALASSESSMENT
● Non-stresstest(NST)
○ Reactive-positiveresult,normal
○ Non-reactive
● Contraction Test
Graph (CTG)
/ Contraction
StressTest(CST)
○ +or-results
MECHANISMOFLABOR/CARDINAL
MOVEMENTSOFLABOR
● Engagement
● Descent
● Flexion
● Internalrotation
● Extension
● Restitution(rotation)
● Expulsion
○ 9 ang perfect score sa APGAR pag
firstminute
DELIVERY
● assessthepositionofthebaby ● Conditions requiring External Fetal
● Ritgenzmaneuver Monitor
PROPERTYOFODLID
43
CAREOFMOTHER,CHILD,
ADOLESCENT,ANDFAMILY
IDIANALEBATCH2024
ST.LUKE’SCOLLEGEOFNURSING
○ previous stillbirth at > 38 weeks ● intensity
gestation ● interval
○ preeclampsia ● regularity
○ placentaprevia ● degree of uterine relaxation between
○ abruptioplacentae contractions
○ multiplegestation
○ prolonged or premature rupture of
membranes
○ inductionoflabor
○ PTL
○ decreasedfetalmovement
○ non-reassuringfetalstatus
○ meconiumstaining EarlyDeceleration
○ trial of labor after cesarean birth ● begin with contraction and return to
(VBAC) baselineafterthecontraction
FetalHeartRateMonitoringTerminology ● notreatmentnecessary
● normal
Latedeceleration
Baseline 110-160bpm
● FHT does not return to baseline
Tachycardia >160bpm contraction
● particularly ominous if coupled with
Bradycardia
<110bpm decreasedvariability
● GiveO2at10Lpm
● Reposition(offvenacava)
● Variability - minute fluctuations f rom ● DCoxytocininfusion
baseline triggered by CNS control and ● noimprovement=immediatedelivery
environmentalchanges
● Accelerations - transient rise in FHR in
responsetofetaloruterineactivity
● Decelerations (decels)
- transient decrease
from baseline in response to
environmentalchangesorstress
CausesofFetalTachycardia
● maternalfeveranddehydration
● tocolytic agents like terbutaline,
isoxsoprine
● prematurity
● activity
● infection
● maternalhyperthyroidism-increaseBMR
Possiblecausesofdecreasevariability
● sleepingfetus(nomovement)
● prematurity
Variabledeceleration
● anticholinergics
● V shaped or U shaped decelerations of
● analgesics
variableonset
● hypoxia
● ascertaintype
UterineContractions
● positionalchanges
● duration
PROPERTYOFODLID
44
CAREOFMOTHER,CHILD,
ADOLESCENT,ANDFAMILY
IDIANALEBATCH2024
ST.LUKE’SCOLLEGEOFNURSING
● pelvicexamtoseeifcordhasprolapsed ○ decreasing efficiency of uterine
● oxygenbymaskat10Lpm contractions
○ diminishing ability of mom to
cooperate
○ causing need for operative
intervention
ParenteralAnalgesia
● OpioidAnalgesic
○ reduce the perception of pain
withoutlossofconsciousness
■ meperidine(demerol)
■ fentanyl(sublimaze)
■ butorphanol(stadol)
■ nalbuphine(nubain)
■ Naloxone(Narcan)
PAINMANAGEMENTDURINGCHILDBIRTH ● Sedatives-smalldoseofshortacting
Non-PharmacologicPainManagement ○ barbiturates - thiopental
● Relaxation (pentothal)
○ environmentalcomfort VaginalBirthAnesthesia
○ generalcomfort ● Local infiltration Anesthesia - xylocaine
○ reducinganxietyandfear (Lidocaine2%)
○ specificrelaxationtechniques PudendalBlock
■ lamazeclass
● Cutaneousstimulation
○ selfmassage
○ massagebyothers
○ counterpressure
○ touch
○ thermalstimulation
○ acupressure
● Hydrotherapy
● Mentalstimulation
○ imagery
○ focalpoint
● Breathingtechniques
PharmacologicPainManagement
ChoiceofAnesthesia/Analgesia
● patientcondition
● laborstatus
● risks
● personnel
● localpractice
● physician’spreference
● patient’spreference
GoalsofAnesthesia/Analgesia
● painreliefthatissimpletousewithout
○ endangeringmother/baby
PROPERTYOFODLID
45
CAREOFMOTHER,CHILD,
ADOLESCENT,ANDFAMILY
IDIANALEBATCH2024
ST.LUKE’SCOLLEGEOFNURSING
Subarachnoid Block/Anesthesia (Spinal
Anesthesia)
EpiduralAnesthesia
EpiduralBlock
ComplicationsofSpinalAnesthesia
● Hypotension
● Bradycardia
● TotalSpinalAnesthesia
● Neurological Complications - Cauda
EquinaSyndrome
● PostDuralPunctureHeadache
● Infection
● Backache
GeneralAnesthesia
● complete loss of perception and
consciousness
● fundamentalattributes
○ lossofconsciousness
PROPERTYOFODLID
46
CAREOFMOTHER,CHILD,
ADOLESCENT,ANDFAMILY
IDIANALEBATCH2024
ST.LUKE’SCOLLEGEOFNURSING
■ does not block autonomic ○ used often when there is minimal
reflexestopainfulstimuli molding
○ vegetativestabilization ○ moresuitableforoutletdelivery
○ analgesia
■ loss of pain sensation,
suppression of autonomic
relaxation
○ musclerelaxation
● induction of
all
the
GA
attributes facilitated
by mosaic assembly of partial effects of
many substances such as anesthetics,
analgesics,tranquilizers,myorelaxants
VACUUMASSISTEDDELIVERY
TYPESOFVAGINALBIRTH
NORMALSPONTANEOUSDELIVERY(NSD)
FORCEPSASSISTEDDELIVERY
● SimpsonForceps
○ most commonly used
type in
outlet
delivery
○ elongatedcephaliccurve
○ when there is substantial molding
ofthefetalhead IndicationforOperativeDelivery
Maternal Fetal
● Exhaustion ● failureoffetalhead
● ProlongSecond torotate
StageofLabor ● fetaldistress
● Cardiac/pulmonary ● shouldnotbeused
● Elliotforceps disease forpreterm,face
○ adjustable pin
for
regulating
lateral
presentationor
pressureonthehandles
PROPERTYOFODLID
47
CAREOFMOTHER,CHILD,
ADOLESCENT,ANDFAMILY
IDIANALEBATCH2024
ST.LUKE’SCOLLEGEOFNURSING
VAGINAL BIRTH AFTER CESAREAN SECTION
breech
(VBAC)
Complication
VAGINAL DELIVERY AFTER CESAREAN SECTION
(VDAC)
Maternal Fetal
● Lacerationsalong ● cephalhematoma IndicationforCesareanDelivery
birthcanal ● skullf racture ● completeplacentaprevia
● uterinerupture ● intracranial ● cephalopelvicdisproportion
● hemorrhage hemorrhage ● placentalabruption
● bladderinjury ● paralysis ● activegenitalherpes
● multiplegestation(3ormorefetuses)
● umbilicalcordprolapse
● failuretoprogressinlabor
● provenfetalstress
● previousclassicalincisiononuterus
● tumorsthatobstructbirthcanal
AdvantagesofTransverseLowerUterineIncision
● thinnest part of uterus involves less
blood
loss
● requires only moderate dissection of the
bladderf romthemyometrium
● easiertorepair
● less likely to rupture with subsequent
pregnancies
● decreased risk of adherence of bowel or
omentumtoincisionline
PARTIALBREECHEXTRACTION
COMPLETEBREECHEXTRACTION
UsesofVerticalLowerUTerineIncision
● multiplegestation
● abnormalpresentation
PROPERTYOFODLID
48
CAREOFMOTHER,CHILD,
ADOLESCENT,ANDFAMILY
IDIANALEBATCH2024
ST.LUKE’SCOLLEGEOFNURSING
● placentaprevia
● non-reassuringfetalstatus
● preterm
● macrosomiafetus
PROPERTYOFODLID
49