4 "P’s" of Labor – Flashcards
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What are the 4 "p's" of labor?
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Passenger Power Passageway Psyche
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How the passenger is positioned?
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Lie - Relationship of the longitudinal axis of the baby to the longitudinal axis of the mother Longitudinal Transverse
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Passenger station refers to what?
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Relationship of the presenting part to the ischial spines
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Passenger stations:
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Engagement - Station 0 or below Minus stations - Above the spines Positive stations - Below the spines
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Passenger presentation refers to what?
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Part of the passenger that enters the pelvis first
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Occurrence of presentations
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Vertex presentation - 95% - head first/cephalic Breech presentation - 4% - feet first Brow, face, shoulder - 1% - forehead first
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What are common risks associated with breech presentation?
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Prolapsed cord Cardiopulmonary distress Asphyxia C-section (C/S) Meconium aspirations
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Position is noted by three letters denoting relationship of a landmark on the baby to the mother's pelvis:
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Direction: L or R (left Right) Landmark = Occiput/vertex Sacrum/breech Face faces: A or P (Anterior or Posterior)
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Example of position note:
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Ex. LOA = Left occiput anterior (The occiput of the baby is pointing toward the left front of the mother's pelvis.)
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What are the passenger mechanisms of labor?
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Engagement/ descent Flexion Internal rotation Extension External rotation/restitution
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Reshaping of fetal skull bones in response to pressure against the maternal pelvis is know as:
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Molding
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Power during the fist phases of labor comes from_________ _________ of the upper uterine segment. Second stage of labor adds power from the _______ _________.
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strong contraction, abdominal muscles
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What can be used to stimulate uterine contractions administered vaginally?
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Prostaglandins Prepidil gel Cervidil vaginal insert Cytotec vaginal tablet
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What is administered via IV to stimulate contractions?
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Oxytocin (Pitocin)
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Examples of cervical ripening agents:
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Prostaglandins Evening Primrose Oil Mechanical dilation using balloon cath. "Stripping" the membranes Castor Oil Sexual Intercourse
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Risks of Oxytocin:
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Hyperstimulation Fetal distress Uterine rupture Hypertension
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What are the four types of pelvic cavities? GAAP
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gynecoid android anthropoid platypelloid
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Gynecoid pelvis
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Most common type of pelvic inlet in females. Best for child bearing.
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Android pelvis
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Male-shaped pelvis, "funnel shaped", pelvic inlet heart shaped, fetus typically fails to rotate, prognosis of labor poor, leads to C-section
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Anthropoid pelvis
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Oval, not conductive to vaginal birth has oval shaped inlet with large anterio-posterior diameter and comparatively smaller transverse diameter. It has larger outlet. The problem in this pelvis is the inlet. The diameters of inlet favors the engagement of fetal head in occiput-posterior position that may slow down the progress of labor. If head engages in anterior position then labor progresses normally in most of the cases.
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Platypelloid
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When educating a group of nursing students about the different types of pelvis, the nurse describes one type as being flat, having a wider transverse diameter than anterior-posterior diameter, with ischial spines that are wide apart, and a short sacrum. The students are correct when they identify which of the following
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Gynecoid pelvis =
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Great Gynecoid for birth
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Android pelves =
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Awful Android for birth
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Anthropoid Pelvis =
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Anterior Faceing Anthropoid (face foward)
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Platypelloid =
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Flat PLAT is not great for birthing
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What is the passageway?
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Pelvis & Cervix "PC"
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Types of passageway episiotomies
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- Midline/Median are the most common - Cut right before the delivery of the head to minimize blood loss - Midline = Skin and perineal muscle - May extend into the anal sphincter/rectal mucosa if lacerations occur
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Passageway - Lacerations
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1st degree = tearing of perineal skin 2nd degree = skin & perineal muscle 3rd degree = skin, muscle & anal sphincter 4th degree = skin, muscle, sphincter & rectal mucosa
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Possible Indications for C-section
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- Cephalopelvic disproportion (big head) - Active genital herpes - Nonreassuring fetal heart rate patterns (late decels/declining variability) - Prolapsed umbilical cord - Fetal malpresentations (breech, transverse lie) - Certain prior uterine surgeries (classical cesarean incision, etc.) - Certain maternal diseases where labor not advisable
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Horizontal or Verticle
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Skin Incisions for Cesarean Birth can be
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Nursing care in prep for C-Section
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- Pre-op teaching (if possible) - Touch, eye contact, info. to decrease anxiety - Needs IV line, Foley, shave prep lower abd. - Keep NPO- may give antacid like "Bicitra" - Notifies pediatrician - Prepare baby items - Positioning on OR table - displace uterus - Monitor FHR until procedure-check one more time prior to surgery
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Local Anesthesia in the form of Pudendal Block
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- Infiltration of the pudendal nerves transvaginally - provides effective perineal anesthesia - performed using an Iowa trumpet late in 2nd stage - very low risk/few side effects
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Regional Anesthesia in the form of Epidural
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- provides relief from contraction pain during labor/C/S - usually given once active labor established ( but may be given earlier/later depending on situation) - no penetration of dura, so no risk of headache - give fluid bolus 500-1000 LR
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Risk of epidural
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Hypotension Urinary catheterization Infection Ascending anesthesia
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Regional anesthesia in the form of a Spinal Block:
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- Used for cesarean birth, or BTL - Not used for vaginal delivery - Penetration of dura may cause post spinal HA - Hypotension risk also tx. with fluid bolus
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Complications of a transverse lie:
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Prolapsed cord Variable decelerations Prolonged decelerations
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Cephalopelvic disproportion
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CPD - when head does not fit through the pelvis
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External Breech Verision considerations
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Previous uterine/vaginal surgeries Where is the placenta Cord prolapse What station Size of baby (large) Post term to big Amniotic fluid level NST - needs to be reactive
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What do you do for an external breech version
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- IV - Relax uterin muscles with medications - Set up C-sections - Notify physician - Remain in hospital for a few hours to monitor fetal position
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Multiple passengers increase the risk of?
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Preterm labor and birth Cesarean Delivery Postpartum Hemorrhage
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Position always refers to the _________ of head?
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occiput (back of head)
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Easiest way for baby to come out
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LOA, ROA,
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In positioning the second letter "S" means
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sacrum (butt)
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In positioning the second letter "A" means
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acromion process (sholder)
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Face first presentation=
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extention
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Chin tucked presentation =
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flexation
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In positioning the second letter "o" means
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occiput (head)
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First letter in position notes:
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L-left or R-right
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Last letter in position notes:
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A-anterior or P-posterior
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Augmented labor:
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mother is give drugs
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Induce means:
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to begin labor
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Augment means
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To add to labor
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Ripen means
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soften and efface cervix
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Action means
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Stimulate uterine contractions
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Common propagandists
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Cervidil vaginal insert Cytotech (misoprostil) vaginal tablet (usually used in postpartum)
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soft tissue - cervix, perineal muscle
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Passageway refers to
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cold first - then warm Possitioning movement - to increase circulation Stool softners sitz baths Pericare - squirt bottle pat dry whitch hazel
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How to help healing lacerations?
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Success rate of vaginal birth after cesarean?
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70-80%
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Risks of vaginal birth after cesarean?
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uterine rupture fetal maternal death hysterectomy
