MCN FINALS

The narrowest diameter

(approximately 9.5 cm) is from the inferior aspect of the occiput to the center of the anterior fontanelle (the suboccipitobregmatic diameter).

Friedman (1978)

, a physician who studied the process of labor extensively, used data to divide the first two stages of labor into phases: latent and active labor

second stage

, extending from the time of full dilatation until the infant is born

third or placental stage

, lasting from the time the infant is born until after the delivery of the placenta.

first stage of dilatation

, which begins with the initiation of true labor contractions and ends when the cervix is fully dilated;

Physical Assessment

- Inspection of body areas

Anterior fontanelle

- also called "Bregma",lies in the junction of the coronal and Sagittal sutures and in diamond shape. It measures 3- 4 cm. ( anterior- posterior ), and 2- 3 cm ( transverse ) in diameter. It closes when the infant is 12 to 18 months of age.

vertex

- the space between the two fontanelles is referred to as the. The area over the frontal bone is referred to as the sinciput. The area over the occipital bone is referred to as the occiput

Diagnostic Test

-Karyotyping -Maternal Serum screening -Chorionic Villi sampling -Amniocentesis -Percutaneous Umbilical Blood Sampling -Fetal Imaging -Magnetic resonance imaging (MRI) -Ultrasound -Fetoscopy -Preimplantation Diagnosis

Lightening

-Primigravida 10-14 days before labor begins -Multigravida usually occurs on the day of labor or even after labor has begun

The Role of the Nurse to Achieve the Purpose of Genetic Counseling

-Provide concrete, accurate information about inherited disorders. -Allow those affected with the disorder to make informed choices about future reproduction -Educate people about inherited disorders and how they are inherited. -Offer support to couples/ individual who are affected with the genetic disorder.

Theories of Labor Onset :

-Uterine Muscle Stretching -Pressure on the cervix -Change in the ratio of estrogen -to progesterone -Placental age -Rising fetal cortisol levels -Fetal membrane production of prostaglandin

Signs of True Labor

-Uterine contraction -Show -Rapture of the membrane

First Stage

. Three separate divisions mark the first stage of labor: the latent, the active, and the transition phase.

Cephalic Presentation

A cephalic presentation is the most frequent type of presentation, occurring as often as 95% of the time. With this type of presentation, the fetal head is the body part that will first contact the cervix.

Phases.

A contraction consists of three phases: the increment, when the intensity of the contraction increases; the acme, when the contraction is at its strongest; and the decrement, when the intensity decreases

Platypilloid

A flattened pelvis

A successful labor depends on four integrated concepts:

A woman's pelvis (the passage) is of adequate size and contour. The passenger (the fetus) is of appropriate size and in an advantageous position and presentation. The powers of labor (uterine factors) are adequate. A woman's psychological outlook is preserved, so that afterward labor can be viewed as a positive experience.

Types of Pelvis

A. Gynecoid B. Android C. Platypilloid D. Anthropoid

Placental Separation

Active bleeding on the maternal surface of the placenta begins with separation; this bleeding helps to separate the placenta still farther by pushing it away from its attachment site.

Placental Expulsion

After separation, the placenta is delivered either by the natural bearing-down effort of the mother or by gentle pressure on the contracted uterine fundus by a physician or nursemidwife (Credé's maneuver).

Maternal Serum screening

Alpha-fetoprotein (AFP) is a glycoprotein produced by the fetal liver that reaches a peak in maternal serum between the 13th and 32nd week of pregnancy

Anthropoid

An ape- like pelvis

Genetic Counseling:

An educational process that seeks to assist affected individuals of getting an inherited condition to understand the nature of thegenetic disorder, its transmission and the options there might be for prevention andor testing.

Contour Changes

As labor contractions progress and become regular and strong, the uterus gradually differentiates itself into two distinct functioning areas.

Show

As the cervix softens and ripens, the mucus plug that filled the cervical canal during pregnancy (operculum) is expelled. The exposed cervical capillaries seep blood as a result of pressure exerted by the fetus.

Active Phase

During the active phase of labor, cervical dilatation occurs more rapidly, increasing from 4 to 7 cm. Contractions grow stronger, lasting 40 to 60 seconds, and occur approximately every 3 to 5 minutes. This phase lasts approximately 3 hours in a nullipara and 2 hours in a multipara.

Transition Phase

During the transitionphase, contractions reach their peak of intensity, occurring every 2 to 3 minutes with a duration of 60 to 90 seconds and causing maximum cervical dilatation of 8 to 10 cm.

Assessment:

History Physical Assessment

Braxton Hicks Contractions

In the last week or days before labor begins, a woman usually notices extremely strong contraction

Rupture of the Membranes

Labor may begin with RM , experienced either as a sudden gush or as scanty, slow seeping of clear fluid from the vagina. Early RM can be advantageous as it can cause the fetal head to settle snugly into the pelvis, actually shortening labor.

Fetal Imaging

Magnetic resonance imaging (MRI) and ultrasound are diagnostic tools used to assess a fetus for general size and structural disorders of the internal organs, spine, and limbs. Because

Uterine Contractions

Origins labor contractions begin at a "pacemaker" point located in the uterine myometrium near one of the uterotubal junctions. Each contraction begins at that point and then sweeps down over the uterus as a wave. After a short rest period, another contraction is initiated and the downward sweep begins again.

Percutaneous Umbilical Blood Sampling

PUBS, or cordocentesis, is the removal of blood from the fetal umbilical cord at about 17 weeks using an amniocentesis technique. This allows analysis of blood components as well as more rapid karyotyping than is possible when only skin cells are removed.

Passenger

Refers to the fetus

Passage

Refers to the route the fetus must travel from the uterus through the cervix and vagina to external perineum.

Structure of the Fetal Skull

The cranium, the uppermost portion of the skull, is composed of eight bones. The four superior bones

Psyche

The fourth "P," or a woman's psychological outlook, refers to the psychological state or feelings that a woman brings

Latent Phase

The latent or preparatory phase begins at the onset of regularly perceived uterine contractions and ends when rapid cervical dilatation begins. short, lasting 20 to 40 seconds. Cervical effacement occurs, and the cervix dilates from 0 to 3 cm.

Second Stage

The second stage of labor is the period from full dilatation and cervical effacement to birth of the infant; with uncomplicated birth, this stage takes about 1 hour

Diameters of the Fetal Skull

The shape of a fetal skull causes it to be wider in its anteroposterior diameter than in its transverse diameter.

Uterine Contractions

The surest sign that labor has begun is productive... Because contractions are involuntary and come without warning, their intensity can be frightening in early labor.

Third Stage

The third stage of labor, the placental stage, begins with the birth of the infant and ends with the delivery of the placenta. Two separate phases are involved: placental separation and placental expulsion.

Powers of Labor

This is the force supplied by the fundus of the uterus, implemented by uterine contractions, a natural process that causes cervical dilatation and then expulsion of the fetus from the uterus.

Types of Fetal Presentation

Types of Fetal Presentation This is determined by a combination of fetal lie and the degree of fetal flexion (attitude).

Karyotyping

a sample of peripheral venous blood or a scraping of cells from the buccal membrane is taken.

Labor

an involuntary physiologic process whereby the contents of the gravid uterus are expelled through the birth canal into the external environment.

Slight Loss of Weight

as progesterone level falls, body fluid is more easily excreted from the body. This increase in urine production can lead to a weight loss between 1 and 3 pounds.

Breech presentation

either the buttocks or the feet are the first body parts that will contact the cervix.

Increase in Level of Activity

increase in activity is related to an increase in epinephrine release initiated by a decrease in progesterone produced by the placenta

Chorionic Villi sampling

is a diagnostic technique that involves the retrieval and analysis of chorionic villi from the growing placenta for chromosome or DNA analysis The test is highly accurate and yields no more false-positive results than does amniocentesis

Ripening of the cervix

is an internal sign seen only on pelvic examination. Cervical ripening this way is an internal announcement that labor is very close at hand.

Preimplantation Diagnosis

is possible for in vitro fertilization procedures. It may be possible in the future for a naturally fertilized ovum to be removed from the uterus by lavage before implantation and studied for DNA analysis this same way. The ovum would then be reinserted or not, depending on the findings and the parents' wishes. This would provide genetic information extremely early in a pregnancy.

effacement

is shortening and thinning of the cervical canal. Normally, the canal is approximately 1 to 2 cm long.

Fetoscopy

is the insertion of a fiberoptic fetoscope through a small incision in the mother's abdomen into the uterus and membranes to visually inspect the fetus for gross abnormalities. It can be used to confirm an ultrasound finding, to remove skin cells for DNA analysis, or to perform surgery for a congenital disorder such as a stenosed urethra.

coronal suture

is the line of juncture of the frontal bones and the two parietal bones.

lambdoid suture

is the line of juncture of the occipital bone and the two parietal bones.

Amniocentesis

is the withdrawal of amniotic fluid through the abdominal wall for analysis at the 14th to 16th week of pregnancy. Because amniotic fluid has reached about 200 mL at this point, enough fluid can be withdrawn for karyotyping of skin cells found in the fluid as well as an analysis of AFP or acetylcholinesterase.

Ultrasound

is used concurrently with amniocentesis.

sagittal suture

joins the two parietal bones of the skull.

Posterior fontanelle -

lies at the junction of the lamdoid and sagittal sutures. It measures 2 cm. across the widest part. it closes when an infant is about 2 months of age.

Dilatation

refers to the enlargement or widening of the cervical canal from an opening a few millimeters wide to one large enough (approximately 10 cm) to permit passage of a fetus

Station

refers to the relationship of the presenting part of a fetus to the level of the ischial spines

Engagement

refers to the settling of the presenting part of a fetus far enough into the pelvis to be at the level of the ischial spines, a midpoint of the pelvis.

Types of Fetal Position

right anterior, left anterior, right posterior, and left posterior.

The bones of the skull meet at suture lines.

sagittal suture coronal suture lambdoid suture

"fourth stage"

termed the FS to emphasize the importance of the close maternal observation needed at this time.

Molding

the change in shape of the fetal skull produced by the force of uterine Contractions pressing the vertex against the undilated cervix.

Android

the male pelvis.

Fontanelles

the membranes that are found at the junction of the main suture line.

Gynecoid

the normal female pelvis.

Genetics

the study of individual genes and their impact on relatively rare single gene disorder.