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Concepts Of Maternal-Child (NUR 4130) OB TEST2 chapter 13-14-21-15-20 THIS One

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John Marsh
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Nova Southeastern University

Concepts Of Maternal-Child Nursing And Families (NUR 4130)

OB TEST2 chapter 13,14,21,15,20 THIS Oneeee

Class notes:
If chord is around babies neck it will need to be reduced.
If chord can’t be reduced will need to be clamped and cut.
If there’s a broken clavicle baby won’t move its arm. Will wrap it and keep it splinted and not
to worry too much.
Week 3
Labor and Birth Process
Chapter 13
Factors Influencing the Onset of Labor
• Uterine stretch
• From fetus and amniotic fluid volume
• Progesterone withdrawal
• To estrogen dominance
• Estrogen increases and progesterone decreases-leads to gap junctions
which are proteins that connect the cell membranes and facilitate
coordination of uterine contractions and myometrial stretching.
• Increased oxytocin sensitivity
• Oxytocin also aids in stimulating prostaglandins synthesis through receptors in
the decidua.
• Increased release of prostaglandins
• Lead to additional contractions, cervical softening, gap junction induction, and
myometrial sensitization, thereby leading to progressive cervical dilation.
Note: uterine contractions two main functions: dilate cervix and push out fetus.
Premonitory Signs of Labor (will see on test) Signs vary.
• Cervical changes (cervical softening, possible cervical dilation)
• With descent of the presenting part into the pelvis occur.
• 1 month to 1 hour before birth.
• Cervical softening, and thinning occur secondary to the effects of prostaglandins
and pressure from Braxton hick’s contractions.
• The ripening and softening of the cervix are essential for effacement and
dilation, which reflect the enhanced collagen breakdown that was previously
inhibited by progesterone.
• At the beginning of pregnancy, the cervix is rigid and firm, and it must soften so
it can stretch and dilate to allow fetus passage
• Softening of the cervix is called ripening
• As term approaches, the cervix weakens and soften
• Lightening
• Occurs when the fetal presenting part begins to descend into the true pelvis
(engagement). The uterus lowers into a more anterior position. With this
descent breathing becomes easier (the fundus no longer presses on the
diaphragm) and there is a decrease in GERD.
• However, with increased downward pressure of the presenting part, the woman
may notice the following
• Leg cramps or pains due to pressure on the nerves that pass through the
pelvis
• Increased pelvic pressure
• Increased venous stasis, leading to edema in lower extremities
• Increased vaginal secretions resulting from congestion of the vaginal
mucous membranes
• Increased urination.
• Increased energy level (nesting)
• Usually occurs 24-48 hours before onset of labor.
• Bloody show
• At the onset of labor or before, the mucus plug that fills the cervical canal during
pregnancy is expelled as a result of cervical softening and increase pressure of
the presenting part.
• Pink tinged blood mucus (rupture of cervical capillaries mixed with mucus)
• Braxton Hicks contractions
• Typically felt as pulling or tightening sensation on top of the uterus.
• Felt in abdomen in groin (true labor felt in lower back).
• Aid in moving cervix form posterior to anterior position- also help with ripening
and softening of the cervix.
• Irregular and can be decreased by walking, voiding, eating, increasing fluid
intake, or changing position.
• May mimic real contractions
• Always miss and don’t dilate cervix.
NOTE: if contractions last longer than 30 seconds and occur more often than 4-6 times an hour,
advise to contact HCP for preterm labor. Esp if under 38 weeks.
• Spontaneous rupture of membranes
• Need to come into hospital
a) Rupture of membranes (not own or not in book)
o Occurs when the amniotic sac surrounding the fetus, amniotic fluid, and placenta
ruptures or is perforated and results in the expulsion of amniotic fluid from the
vagina
– After membranes rupture, the majority of woman give birth within 24 hours
o Woman who are 34 weeks’ gestation or more and who present with ruptured
membranes w/o contractions are often started on an oxytocin infusion to decrease
the incidence of chorioamnionitis
o Woman with preterm gestation of less than 34 weeks are managed conservatively
o When the membranes rupture, the amniotic fluid may be expelled in large amounts
o If engagement has not occurred, there is danger of the umbilical cord washing out
with the fluid (prolapsed cord)
– The open pathway into the uterus increases the risk for infection
 Because of this woman is advised to call physician
o In some instances, the fluid is expelled in small amounts and may be confused with
episodes of urinary incontinence associated with urinary urgency, coughing, or
sneezing
b) Other signs
o Weight loss of 1 to 3 lbs resulting from fluid loss and electrolyte shifts produced by changes
in estrogen and progesterone levels
o Diarrhea, indigestion, or nausea and vomiting just before onset of labor
2) Differences Between True and False Labor
a) Contractions of true labor produce progressive dilation and effacement of the cervix
o They occur regularly and increase in frequency, duration, and intensity
o The discomfort of true labor contractions usually starts in the back and radiates
around the abdomen
o Pain is not relieved by walking (walking may intensify the pain)
b) Contractions of false labor do not produce progressive cervical effacement and dilation
o They are irregular and do not increase in frequency, duration, and intensity
o The contractions may be perceived as a hardening up or “balling up” w/o discomfit,
or discomfit may occur mainly in the lower abdomen and groin
– Discomfit may be relieved by ambulation, changes of position, drinking large
amount of water, or a warm shower/tub bath
c) Many times the only way to differentiate accurately between true and false labor is to
assess effacement and dilation (vaginal examination)

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