Labor Progress Monitoring and Care

Study Notes

Normal Labor and Delivery

Description and Timing:
- Partographic monitoring is the favored tool for labor progress
- Monitoring every 4 hours in latent phase and early active phase, more frequent in late labor
- Indications for monitoring: sudden fetal distress, cord prolapse
Analgesia and Anesthesia:
- Provided on an individual basis and for specific stages of labor
Emotional Care:
- One-to-one care to provide emotional support throughout labor
- Allow the person she wishes to be with her during labor
Positioning:
- Left lateral position if in bed, can ambulate in the first and early second stage of labor
Bladder Care:
- Encourage urination whenever she feels the urge
- Catheter drainage intermittently if necessary

Mechanisms of Labor

Cardinal movements: changes in position of fetal head during its passage through the birth canal
Rotations are required for the fetus to successfully negotiate the birth canal due to asymmetry of the fetal head and maternal bony pelvis

Delivery of Placenta and Examination

Slowly pull to complete the delivery of the placenta
Receive placenta in cupped hands and perform gentle up-and-down movements to deliver membranes
Examine the placenta, umbilical cord, and fetal membranes
Note the site of insertion of the umbilical cord into the placenta
Inspect the cord for length, correct number of umbilical vessels, true knots, hematomas, and strictures
Examine fetal and maternal surfaces of the placenta for fibrosis, infarction, calcification, and adherent clots

Support of Fourth Stage of Labor

Massage the fundus of the uterus through the woman's abdomen until the uterus is contracted

Preeclampsia and Eclampsia

Preeclampsia: development of hypertension with proteinuria and edema after 20 weeks of gestation
Criteria for diagnosis: systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg, proteinuria, and edema
Severe preeclampsia: blood pressure ≥160 mm Hg systolic or ≥110 mm Hg diastolic, marked proteinuria, oliguria, and seizures
Management: induction of labor and/or cesarean section, close monitoring of blood loss, administration of magnesium sulfate to prevent postpartum eclamptic seizures

HELLP Syndrome

Liver dysfunction manifesting as right-upper-quadrant pain, nausea, and emesis
Treatment: cardiovascular stabilization, correction of coagulation abnormalities, and delivery

Hyperemesis Gravidarum

Definition: severe, intractable form of nausea and vomiting in pregnancy
Risk factors: population incidence varies, ethnic or familial predilection, high or rapidly rising serum levels of pregnancy-related hormones, psychological components, hyperthyroidism, previous molar pregnancy, diabetes, gastrointestinal illnesses, and asthma
Complications: adverse pregnancy outcome, including increased risk of preterm birth and low birth weight babies

Description

This quiz covers the assessment of labor progress, including partographic monitoring, and the provision of emotional care and analgesia to individuals during labor. It also touches on the evaluation of labor progress and the importance of one-to-one care.