MCN Notes PDF: Labor, Pregnancy, and Postpartum Care

Okay, here is the conversion of the images into a structured markdown format: ### BMI Formula - **Imperial System**: $BMI = 703 \times \frac{Weight (in pounds)}{Height^2 (in inches)}$ - **Metric System**: $BMI = \frac{Weight (in kilograms)}{Height^2 (in meters)}$ **Image Description**: An image d...

Okay, here is the conversion of the images into a structured markdown format: ### BMI Formula - **Imperial System**: $BMI = 703 \times \frac{Weight (in pounds)}{Height^2 (in inches)}$ - **Metric System**: $BMI = \frac{Weight (in kilograms)}{Height^2 (in meters)}$ **Image Description**: An image demonstrating how to measure fundal height with a measuring tape, pointing to the top of the uterus and top of the pubic bone. ### Leopold's Maneuver 1. **Fundal Grip** - determines what fetal part occupies the fundus (cephalic, breech, transverse lie). - **1st Leopold Maneuver also known as Fundal Grip** 2. **Umbilical Grip** - to determine which maternal side does the fetal back is located. Fetal backs is the best location to auscultate heart sounds. - **2nd Leopold Maneuver also known as Lateral or Umbilical Grip** 3. **Pawlik's Grip** - to evaluate presenting part into the pelvis and engagement. - **3rd Leopold Maneuver also known as Pawlik's Grip** 4. **Pelvic Grip** - to confirm the presenting part of the fetus and its descent into the pelvis "Is the fetal head engaged or not?" - **4th Leopold Maneuver also known as Pelvic Grip** **Important Points** * Why should you position the patient in a supine position? * To prevent SHS (Supine Hypotensive Syndrome). A drop in blood pressure that occurs when a person, esp. a pregnant woman in the last trimester lies on her back. ### McDonald's Rule * Use Fundal height measurement, measure from the symphysis to the top of the fundus. * Months = measure cm. $X \frac{2}{7}$ * Weeks = measure cm. $X \frac{8}{7}$ ### Naegele's Rule * Used for estimating the expected date of delivery (EDD) based on LMP (last menstrual period) $DATE \space OF \space LAST \space MENSTRUAL \space PERIOD - 3\space CALENDAR \space MONTHS + 7 \space DAYS + 1\space YEAR$ **Remember**: * How many days are in each month? * 30 days hath September, April, June & November. All the rest have 31, except February alone (28 days) **Example** * 1st day of Last Period: September 2, 2015 * Minus 3 calendar months: June 2, 2015 * Plus 7 days: June 9, 2015 * Plus 1 year: June 9, 2016 **Facts about Naegele's rule** * Bases calculation on a woman who has a 28-day cycle (most woman vary) * The typical gestation period is 280 days (40 weeks) * First-time mothers usually have a slightly longer gestation period. ### Stages of Labor **Stage 1 CERVIX DILATES FROM 0-10 CM** * **Latent (early)** * Cervix dilates: 1-3 cm * Intensity: Mild * Contractions: 15-30 mins **Interventions** * Promote comfort. * Warm shower, massage, or epidural * Offer fluids & ice chips * Provide a quiet environment * **Active** * Cervix dilates: 4-7 cm * Intensity: Moderate * Contractions: 3-5 min (30-60 sec in duration) * Encourage participation in care & keep informed * Instruct partner in effleurage (light stroking of the abdomen) * Encourage effective breathing patterns & rest between contractions * **Transition** * Cervix dilates: 8-10 cm * intensity: Strong * Contractions: every 2-3 min (60-90 sec in duration) **Stage 2 THE BABY IS DELIVERED** * Starts when cervix is fully dilated & effaced * Ends after the baby is delivered Remember! The mnemonic! Pushing! **Interventions** * Provide ice chips & ointment for dry lips * Provide praise & encouragement to the mother * Monitor uterine contractions & mothers vital signs * Maintain privacy & encourage rest between contractions * Encourage effective breathing patterns & rest between contractions * Monitor for signs of birth (perineal bulging or visualization of fetal head) **Stage 3 THE PLACENTA IS DELIVERED** * The PLACENTA is expelled (5-30 min after birth) * SIGNS OF A PLACENTA DELIVERY * Lengthening umbilical cord * Gush of blood * Uterus changes from oval to globular shape **Interventions** * Assessing mothers vital signs * Uterine status (fundal rubs every 15 minutes) * Provide warmth to the mother * Promote parental-neonatal attachment * Examine placenta & verify it's intact - Should have two arteries & one vein **Stage 4** recovery * Recovery: first 1-4 hours after delivery the placenta **Interventions** * Assessing the fundus * Continue to monitor vital signs & temperature for infection * Administer IV fluids * Monitor lochia discharge (lochia may be moderate in amount & red). FIRM midline, SOFT boggy, Displaced * Monitor for respiratory depression, vomiting, & aspiration if general anesthesia was used * Great time to watch for complications such as bleeding (postpartum hemorrhage) ### Labor & Birth Processes **5 P's** 5 Factors that affect process of labor & birth PASSENGER, PASSAGEWAY, POSITION, POWERS, PSYCHOLOGY **Passenger - Fetus & Placenta** * Size of the fetal head * Fontanels * Space between the bones of a skull allows for molding * Anterior(larger) * Diamond-shaped * Ossifies in 12-18 months * Posterior * Triangle shape * Closes 8-12 weeks Molding * Change in the shape of the fetal skull to "mold" and fit through the birth canal. * Fetal presentation * Refers to the part of the fetus that enters the pelvic inlet first through the birth canal during labor. * Cephalic * Head first * Presenting part: Occipital (back of head/skull) * Breech * Buttocks, feet, or both first. * Presenting part: Sacrum * Shoulder * Shoulder first * Presenting part: Scapula * Fetal Lie: Relation of a long axis (spine) of the fetus to a long axis (spine) of the mother * Longitudinal or Vertical - The long axis of the fetus is parallel with the long axis of the mother * Longitudinal: cephalic or breech. * Transverse, Horizontal, or Oblique * Long axis of the fetus is at a right angle to a long axis of the mother. * Transverse: vaginal birth CANNOT occur in this position. * Oblique: usually converts to a longitudinal or transverse lie during labor ### Labor and Birth Processes (Continued) * Fetal attitude * General Flexion - Back of fetus is rounded so that the chin is flexed on the chest, thighs are flexed on the abdomen, legs are flexed at the knees. * Biparietal diameter - 9.25 cm at term, largest transverse diameter and important indicator of fetal head size. * Suboccipitobregmatic Diameter - Most critical and smallest of the anteroposterior diameters. **Passageway** * Types of Pelvis * Gynecoid: Classic female type - Most common * Android - Resembling like male pelvis * Anthropoid - Oval-shaped * Wider anteroposterior diameter * Platypelloid - The flat pelvis, Least common * Fetal position * Fetal Station: Where the baby's presenting part is located in the pelvis * **Presenting part?** Head, foot, butt (closest to exit of uterus) * Measured in centimeters (cm) * Find the ischial spine = zero * Above the ischial spine is (-) * Below the ischial spine is (+) * +4/+5 = Birth is about to happen * Engagement: Fetal station zero = baby is "engaged" * Presenting parts have entered down into the pelvis inlet & is at the ischial spine line (0) * Where does this happen? First-time moms at 38 weeks/Already had babies can happen when labor starts **The birth canal** : Rigid bony pelvis, soft tissue of cervix, pelvic floor, vagina & introitus. **Soft tissue** * Lower Uterine segment: Stretchy * Cervix - Effaces (thins) & dilates (opens) After the fetus descends into the vagina, the cervix is drawn upward and over the first portion. * Pelvic Floor Muscles * Helps the fetus rotate anteriorly * Vagina * Introitus * External opening of the vagina ### Labor and Birth Processes * Position of the mother during the birth * **Upright position**: sitting on a birthing stool or cushion * **"All Fours" Position**: On all fours: putting your weight on your hands & feet * **Lithotomy Position**: Supine position with buttocks on table * **Lateral position**: Lying on a side; Frequent changes in position helps with: reliving fatigue, increasing comfort, improving circulation *Contractions: Primary and Secondary* **Primary powers** * Involuntary uterine contractions * Signals the beginning of labor * Dilation - Dilations of the cervix is the enlargement or widening of the cervical opening & canal once labor has begun. * Cervix closed full dilation (10cm) * Effacement: Shortening & thinning of the cervix during the first stage of labor **Secondary powers** * Doesn't affect cervical dilation but helps with explosion of infant once the cervix is fully dilated. Voluntary bearing-down efforts by the woman once the cervix has dilated. **Psychology** *Anxieity can increase pain perception and the need for more medications* * Things to consider:\ social support, past experience, knowledge ## ASSESSMENT OF UTERINE CONTRACTIONS | | | | | :--------------- | :--------------------------------------------------------------- | :--------------------------------------------------------------- | | **Duration** | BEGINNING of the contraction to the END of that same contraction | Lasts 45 - 80 seconds, Should not exceed 90 second | | **Frequency** | Number of contractions from the BEGINNING of one contraction. | 2-5 contractions every 20 mins, Should not be more freq than 2 | | **Intensity** | Strength of a contraction at its PEAK | 25-50 mm hg Mild-nose | | **Resting Tone** | Tension, soft/firm | Average-10 | ## Postpartum Assessment Bubbles * Check for breast sore * uterus atony( Uterine Fatigue * bowels constipation is normal * Bladder- Retention is normal, check and out catheterization, * lochia color * Emotional status, postpartum #### Mastitis * Infection and inflmmation. continue breastfeeding.