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NURSING II
KRISHAN SORIANO, MSN
LABOR and DELIVERY
• LABOR- process by which the product of
conception is expelled
• THEORIES of LABOR
• 1. Uterine Stretch or Myometrial irritability
• 2. Theory of Aging Placenta
• 3. Progesterone Deprivation Theory
• 4. Estrogen Theory
• 5. Oxytocin Theory
• 6. Fetal Hormone Theory
• 7. Prostaglandin Theory- most acceptable
Premonitory Signs of labor
• 1. Lightening- descent of presenting part
• 2. Increase braxton-hicks contraction
• 3. Increase in maternal activity
• 4. Decrease in maternal weight by 2-3 lbs
• 5. Rupture of BOW
• 6. SHOW
• 7. Nesting
Factors that affect labor
• 1. POWER
• A. Primary/ Involuntary- refers to UTERINE
CONTRACTIONS
• Monitor:
• DURATION- start to end
• INTERVAL- end to start
• FREQUENCY- start to start
• INTENSITY
B E
A C D F
• 2. BITEMPORAL = 8 CM
• 3. SHOULDER
TYPES OF MULTIPLE GESTATION
• 1. TWINNING
• A. MONOZYGOTIC/ IDENTICAL/MATERNAL= 1
ovum + 1 sperm
• 1 placenta, 1chorion, 2 cords, 1 sex
• B. DIZYGOTIC/ FRATERNAL/ UNIDENTICAL = 2
ovum + 2 sperms
• 2 placenta, 2 chorion, 2 cords, 1 or 2 sex
3. CONJOINED- ( SIAMESE )
• = twins whose body parts are connected with
one another
Lochia alba-
on the 9th day,
the amount of flow decreases and
becomes colorless or white.
,
.
Perineum-
1. is tender, discolored and
edematous.Should be clean with
intact stitches. Check for laceration
manifested by trickling of blood
with the uterus firm and
contracted.
Types of laceration:
– First degree- involve the vaginal
mucous membrane,and perineal skin
to the fourchette.
– Second degree- involve the vaginal
mucous membrane, perineal skin,
and perineal muscles
– Third degree- involve the entire
perineum, perineal skin and muscles,
and external sphincter of the rectum.
– Fourth degree- involve the vaginal
mucous membrane, perineal skin and
muscles, rectal sphincter and rectal
mucusa.
• Management: Episiorraphy under local
anesthesia ( (Xylocaine )
•
Bladder
1. should be emptied every 2 hours. A full
bladder is evidenced by a fundus in the right
side of the midline, dark red bleeding with
some clots, may delay uterine contraction
2. bladder mucosa shows varying degrees of
edema and hyperemia with decrease muscle
tone thus most women do not have the
sensation of having to void resulting to
urinary stasis and infection (( Cystitis )
Vital signs
• Temperature- may have a slight increase on the
first 24 hours due to dehydration ( fluid and
blood). Any increase after the first day with boggy
uterus and abnormal discharge may mean
Puerperal sepsis
B.
Episiotomy
1. Breastfeed frequently
• 10 to 6 weeks postpartum
• Realistic regarding role transition.
• Shows pattern of life-style that includes
the new baby but still focuses on entire
family as a unit.
Accepts baby as separate person
• 10 to 6 weeks postpartum
• Realistic regarding role transition.
• Shows pattern of life-style that includes the
new baby but still focuses on entire family as
a unit.
• Accepts baby as separate person.
– Mother may feel deep loss over separation of the
baby from part of the body and may grieve over the
loss
• Causes:
• Inappropriate use of analgesic
• Pelvic bone contraction
• Poor fetal position
• Over distention- due to multiparity, multiple
gestation, polyhydramnios or macrosomia
Types
1. Primary ( hypertonic ) uterine dysfunction-
2. Relaxation are inadequate and mild, therefore,
ineffective.
3. Since uterine muscle is in a state of greater than
normal tension, latent phase is prolonged.
Treatment:
Sedation with Diazepam, provision of comfort
measures like bedbath and restful environment
• Secondary ( hypotonic ) uterine dysfunction-
contractions have been good but gradually
became infrequent and poor of quality and
dilatation ceases.
Treatment:
a) Oxytocin administration or
b) amniotomy to augment
4.Uterine rupture
- occurs when the uterus undergoes
more strain than it is capable of
sustaining.
CAUSES
• Scar from a previous classic CS
• Unwise use of Oxytocin
• Faiulty presentation
• Prolonged labor
• Overdistention
Signs and symptoms:
• Sudden,severe pain
• Hemorrhage
• Change in abdominal contour with two
abdominal swelling; the retracted uterus
and the extrauterine fetus
Treatment:
Hysterectomy
UTERINE INVERSION
turning inside out of the uterus
• Causes:
• Insertion of placenta at the fundus, so that as as
fetus is rapidly expelled the fundus is pulled
down
• Strong fundal push when mother fails to bear
down effectively
• Attempts to deliver the placenta before
placental separation occurs.
• Treatment: Hysterectomy
AMNIOTIC FLUID EMBOLISM
occurs when amniotic fluid enters the maternal
circulation causing cardiopulmonary failure
• Prematurity:
Small fetus allows more space around
presenting part.
Predisposing Factors
• Multiple fetal gestation
• FetoPelvic disproportion
• Placenta Previa
• Intrauterine tumors that prevent the
presenting part from engaging
• Twin gestation,
• Hydramnios
• Small fetus
• NOTE:
First discovered when there is variable
decelerated pattern
• Dystocia
Cardinal Sign
• Rupture of Membrane spontaneously
Note:
Do not attempt to push the cord into the
uterus.
Confirmatory Test
• Amniotomy:
Rupture of Membranes
Best Major Surgery
• OTHERS:
Prematurity,
Hypoxia,
Meconium aspiration,
Fetal death if delayed or undiagnosed
Best Position
Heparin IV
• Emotional support
Labor and Delivery
• if uterine contractions occur before 38 weeks
gestation
• If no bleeding and cervical dilatation –
premature contractions can be stopped by
drugs:
• OTHERS ARE:
> 4000 gms neonate,
> excessive oxytocin use
> Polyhydramnios and Placental Disorders.
SIGNS OF HEMORRHAGE
• Boggy uterus (does not respond to massage)
• Signs of shock
• Fluid replacement
• Emergency lap
• Oxygen
• Vital signs
• Perineal pad count
• Psychological support
Massaging the lower abdomen
after delivery is done to maintain
a firm uterus, which will aid in the
clumping down of blood vessels in
the uterus, thereby preventing
any further bleeding
• “BOGGY UTERUS
• Uterine atony means that the uterus is not
firm or it is not contracting. The nurse should
gently massage the uterus which will contract
the uterus and make it firm. Clients who are
predisposed are usually MULTIPLE
GESTATION, POLYHYDRAMNIOS, PROLONGED
LABOR and LGA (LARGE GESTATIONAL AGE
fetus.
THROMBOPLEBITIS
Fever Antibiotics
Rupture of Chills Oxytocin
membranes over 24 Poor appetite Analgesics
hours before delivery General body Maintain hygiene
Retained placental malaise Semi-fowlers
fragments Abdominal pain positions
Foul-smelling lochia Vital signs
Early ambulations
Assess lochia
PREDISPOSING MANIFESTATION MANAGEMENT
FACTORS
Fatigue
Weeping anxiety
Mood instability
Postpartum depression
Normal processes during Onset: 3-5 days lasting more than
postpartum include the
2 weeks
withdrawal of progesterone
and estrogen and lead to the Confusion
psychological response Fatigue
known as "the blues." Agitation
Postpartum depression is a Feeling of hopelessness and
psychiatric problem that shame “let down feeling”
occurs later in postpartum
Alterations in mood “roller
and is characterized by
more severe symptoms of coaster emotions”
inadequacy. Because the Appetite and sleep disturbance
client's behavior is normal,
notifying her physician and
conducting a home
assessment aren't
Because the According to Rubin, dependence
client's behavior and passivity are typical during the
is normal, taking-in period, which may last up
notifying her to 3 days after delivery. A client
experiencing postpartum
physician and
depression demonstrates anxiety,
conducting a
confusion, or other signs and
home assessment symptoms consistently. Maternal
aren't necessary. role attainment occurs over 3 to 10
months. Attachment also is an
ongoing process that occurs
gradually.
Onset: 3-5 days postpartum
Placenta
Decrease of
Estrogen
And
Progesterone
Prolactin will
Stimulate Causes the
Anterior Pit. The acinar Posterior smooth
Gland cells Pit.Gland Muscles in the
To To Is stimulated Lactiferous
Produce manufacture To produce Tubules
Prolactin Milk and store OXYTOCIN To contract
In the Resulting
Lactiferous Milk ejection/
tubules Let down
reflex
Benefits of Breastfeeding
• To infants
Provides a nutritional complete food for the
young infant
Strengthens the infant’s immune system ,
preventing many infections
Safely rehydrates and provides essential
nutrients to a sick child, especially those
suffering from diarrheal diseases
Reduces the infant’s exposure to infection
To mother
Reduces a woman’s risk of excessive blood
loss after birth
Provides a natural method of delaying
pregnancies
Reduces the risk of ovarian and breast
cancers and osteoporosis
General Principles in Breastfeeding
• Oxytocin causes uterus to contract and
uterine cramping maybe experienced
• 2. Retracted Nipples
• Nipple –rolling
• wear breast-shield
• 3. Cracked nipple
• Lubricate nipple with Vit A and D
• Rotate feeding position
• expose nipple to air 10-20 mins after feeding