Académique Documents
Professionnel Documents
Culture Documents
Theories of Labor
1. Uterine Stretch theory -a hollow organ when stretched to capacity contract and empty. 2. Oxytocin theory- production of oxtytocin from posterior pituitary gland----contraction of the uterus. 3. Progesterone Deprivation theory-progesterone inhibit uterine motility. A decrease in progesterone----uterine contraction.
Theories of Labor
4. Prostaglandin Theory- increase prostaglandin synthesis---uterine contraction. 5. Theory of aging placenta- decrease in blood supply to the placenta----uterine contraction.
Increased lordosis as the fetus enters the pelvis and falls further forward
Increased varicosities
Shooting pains down the legs because of pressure on the sciatic nerve
Goodells Sign
Mild contraction the uterine muscle becomes somewhat tense, but can be indented with gentle pressure. Moderate contraction the uterus becomes moderately firm and a firmer pressure is needed to indent. Strong contraction the uterus becomes so firm that it has the feel of wood like hardness, and at the height of the contraction, the uterus cannot be indented when pressure is applied by the examiners hand.
2. Uterine Changes
As labor contractions progress, the uterus is gradually differentiated into two distinct portions. These are distinguished by a ridge formed in the inner uterine surface, the physiologic retraction ring. a. Upper uterine segment this portion becomes thicker andactive, preparing it to exert the strength necessary to expelthe fetus during the expulsion phase. b. Lower uterine segment this portion becomes thinwalled,supple, and passive so that the fetus can be pushed cut of theuterus easily. c. Contour of the uterus changes from a round ovoid to astructure markedly elongated in a vertical diameter thanhorizontally. This serves to straighten the body of the fetusand place it in better alignment to the cervix and pelvis.
3. Cervical Changes There are 2 changes that occur in the cervix Effacement This is the shortening and thinning of the cervical canal to paper thin edges. To primiparas, effacement is accomplished before dilatation begins while with multiparas, dilatation may proceed before effacement is complete. Dilatation This refers to the enlargement of the cervical canal from an opening a few millimeters wide to one large enough (approx. 10 cm) to permit passage of the fetus.
First, uterine contractions gradually increase the diameter of the cervical canal lumen by pulling the cervix up over the presenting part of the fetus. Second, the fluid-filled membranes press against the cervix.
.4. Show
This is the blood-tinged mucus discharged from the vagina because of pressure of the descending fetal part on the cervical capillaries causing their rupture. Capillary blood mixes mucus when operculum is released.
Once membranes have ruptured, labor is inevitable, meaning to say that uterine contractions will occur within next 24 hours. The initial nursing actions for patients with ruptured membranes are: Notify physician Lie patient to bed to ensure that the fetus is not impinging on the cord. Check the fetal heart rate to determine for fetal distress.
If the patient claims she can feel a loop of the cord coming out of her vagina (umbilical cord prolapsed), lower the head of the bed (Trendelenberg position) in order to release pressure on the cord. Also apply sterile, saline-saturated gauze to prevent drying of the cord, if needed. If labor does not occur spontaneously at the end of 24 hours after membrane rupture, it will be induced ,provided the woman is estimated to be at term.
Show
Not present. May have brownish discharge that may be from vaginal exam if within the last 48 hours.
Cervix
Becomes effaced and dilates Usually uneffaced and closed. progressively. No significant change, even May intensify for a short period or it though fetus continues to may remain the same. move.
Fetal Movement