Professional Documents
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(PREGNANCY)
Preparation for Labor and
Delivery
How Labor is induced?
• Your due date came and went a week and a
half ago. Your telephone rings constantly
and every time you answer it, a friend or
relative exclaims, "You're still home!" These
last few days seem longer than the previous
nine months. Your practitioner told you at
this week's appointment that if you haven't
gone into labor by next week, you will need
to be admitted to the hospital so labor can
be induced. Emotionally, you're relieved to
have an end to the waiting in sight, but you
wonder whether inducing labor is necessary
Because no one really understands how
normal labor starts, we are at a loss to
explain why some labors don't start until
weeks after the due date. This would not be
of concern, except that after nine months of
pregnancy have passed, the placenta often
fails to keep up with the growing oxygen
and nutritional needs of the overdue baby.
In fact, the mortality rate of babies born
after 43 weeks is double that of those born
on time. After 44 weeks, the mortality rate
is triple the normal rate. That is why most
practitioners are extremely reluctant to
allow pregnancies to continue much past 42
Antepartum testing determines which babies
are at highest risk for difficulties before and
during labor. Most practitioners routinely
recommend such testing after 41 weeks. It
includes a non-stress test and a biophysical
profile performed during an ultrasound exam. If
this testing reveals abnormalities, induction of
labor is recommended. Even if the test results
are normal, induction is recommended at 42
weeks.
How is labor induced? There are a variety of
methods, used alone or in combination, which
can induce labor. If the cervix is more than
slightly dilated, the simplest way is to rupture
the membranes artificially. Most women will go
• There are a number of disadvantages to using
this method alone, however. First, not all
women will go into labor. Second, as soon as
the membranes are ruptured, the potential
exists for chorioamnionitis, infection of the
membranes and amniotic fluid. This type of
infection affects the mother as well as the baby.
The risk of infection increases over time. There
is not much chance for infection to occur if the
labor is well along and the delivery will happen
within the next few hours. However, if labor has
not even started, the delivery may not take
place for 24 hours or more, which significantly
raises the possibility of infection.
Chorioamnionitis can be treated with
The second method of inducing labor is the
use of Prostaglandin gel. This technique
became available only a few years ago, but it
has become popular very quickly. Prostaglandin
gel contains one type of the hormone
prostaglandin, which naturally causes the cervix
to soften and thin out in preparation for labor.
Prostaglandin gel may even stimulate mild
contractions and, for some women, this is
enough to start labor.
Prostaglandin gel is applied directly to the
cervix during a cervical exam. Because of its
potential to cause contractions, it is usually
applied in the hospital setting and the baby is
monitored for several hours thereafter. If no
Prostaglandin gel may stimulate labor
alone, but more commonly it is used in
conjunction with Pitocin. Pitocin is the
synthetic version of the naturally
occurring hormone oxytocin, which
causes uterine contractions. The
advantage of giving prostaglandin gel
first is that the cervix tends to become
thinner and even slightly dilated after
the gel is applied, making the Pitocin
more likely to be effective at smaller
doses. Pitocin is administered initially in
minute quantities, and the amount is
The fetus is monitored during
administration of Pitocin to make
sure that the amount given does not
cause the baby stress or contractions
that are too frequent. If labor has not
started within 12 to 24 hours after
application of prostaglandin gel, the
mother is readmitted to hospital to
receive Pitocin through an
intravenous line.
Are there disadvantages to Pitocin? Some
practitioners believe that Pitocin causes
stronger contractions than those that occur
naturally. Most research suggests, however,
that Pitocin-induced contractions are very
similar to those of normal active labor. The
potential does exist to cause contractions
that are more frequent than naturally
occurring contractions and, therefore, these
contractions may be more stressful for the
baby. That's why careful monitoring is
essential during administration of Pitocin. It
is easy to decrease the frequency of
contractions just by lowering the dose of
The disadvantages must be
weighed against the risks, of course.
It would be inappropriate to induce
labor just to have the delivery occur
on a convenient date. The use of
Pitocin for induction is justified only if
the baby is at significant risk for
serious problems, either because an
abnormality has been found on
antepartum testing, or because the
• There are other, less common
reasons for inducing labor. These
include preeclampsia, gestational
diabetes (but not before 38 weeks),
and intrauterine growth
retardation (IUGR) if the fetus is in
less than the 10th percentile for
gestational age. In the case of pre-
eclampsia, induction is performed to
treat the mother. In the case of
Instructions
Step 1:
Week 14
• Now that you are 14 weeks pregnant,
you have officially started your second
trimester. The risk of miscarriage is
significantly decreased at this point. In
addition to your baby's reproductive
organs developing, your baby will also
begin to grow some hair as well as form
eyelids, fingernails and toenails. You
may even be able to feel your baby
Week 18
• By the time your are 18 weeks
pregnant, your baby's finger and toe
pads will have formed, which means the
fingerprints won't be far behind. The
bones in your baby's inner ear will have
developed enough by this point that he
may start responding to loud outside
sounds. Additionally, your baby could
weigh as much as 7 ounces now and
Week 22
• Your baby’s sense are so developed
by the time you are 22 weeks
pregnant that she is likely to starting
experimenting. Don’t be surprised to
if you see her sucking her thumb on
an ultrasound. Your baby’s sweat
glands also begin to develop this
week while her brain begins to
quicken its development.
THIRD TRIMESTER
Week 26
• During this week, development of the
retinas will finish and your baby’s eyes
will begin to open and even blink. If
your baby were born now, he would
have a 50% chance of survival with
proper medical care. This week also
marks the end of your second trimester.
Next week, when you are 27 weeks
pregnant, you will officially be in your
Week 30
• As your baby begins practicing how
to breathe this week, she may end
up with a case of the hiccups if she
swallows too much amniotic fluid.
Your baby is also putting on more
body fat, which will help keep her
warm when she is born. Although
your baby would be premature if she
was born now, she would have a
good chance of surviving.
Week 40
• This is the official end of the
gestational period. Even though your
baby is ready and able to live outside
of you, it is perfectly normal for your
baby to arrive as much as two weeks
after his due date.
Menstrual cycle
•Labia majora: The labia majora enclose and protect the other external
reproductive organs. Literally translated as "large lips," the labia majora are
relatively large and fleshy, and are comparable to the scrotum in males. The labia
majora contain sweat and oil-secreting glands. After puberty, the labia majora are
covered with hair.
•Labia minora: Literally translated as "small lips," the labia minora can be very
small or up to 2 inches wide. They lie just inside the labia majora, and surround
the openings to the vagina (the canal that joins the lower part of the uterus to the
outside of the body) and urethra (the tube that carries urine from the bladder to the
outside of the body).
•Bartholin's glands: These glands are located next to the vaginal opening and
produce a fluid (mucus) secretion.
•Clitoris: The two labia minora meet at the clitoris, a small, sensitive protrusion that
is comparable to the penis in males. The clitoris is covered by a fold of skin, called
the prepuce, which is similar to the foreskin at the end of the penis. Like the penis,
the clitoris is very sensitive to stimulation and can become erect.
The internal reproductive organs include:
• Vagina: The vagina is a canal that joins the cervix (the lower
part of uterus) to the outside of the body. It also is known as the
birth canal.
• Uterus (womb): The uterus is a hollow, pear-shaped organ that
is the home to a developing fetus. The uterus is divided into two
parts: the cervix, which is the lower part that opens into the
vagina, and the main body of the uterus, called the corpus. The
corpus can easily expand to hold a developing baby. A channel
through the cervix allows sperm to enter and menstrual blood to
exit.
• Ovaries: The ovaries are small, oval-shaped glands that are
located on either side of the uterus. The ovaries produce eggs
and hormones.
• Fallopian tubes: These are narrow tubes that are attached to the
upper part of the uterus and serve as tunnels for the ova (egg
cells) to travel from the ovaries to the uterus. Conception, the
Benefits of Pregnancy
Exercise
• Joints
Due to pregnancy hormones, the ligaments that
support your joints become more relaxed. Because of
this added mobility in your joints, your risk of injury
increases. For this reason, you should avoid bouncy,
high-impact or jerky exercises.
• Balance
As your pregnancy progresses, the extra weight in
your belly shifts your center of gravity and stresses
your joints and muscles — particularly those in the
pelvis and lower back. The result is greater instability,
back pain, loss of balance, and increased risk of
falling.
• Heart Rate
because your weight increases during pregnancy, your
heart has to work harder. Exercise increases your
Diagnosis
• the identification of the nature of anything,
either by process of elimination or
other analytical methods. Diagnosis is used
in many different disciplines, with slightly
different implementations on the application
of logic and experience to determine
the cause and effect relationships. Below
are given as examples and tools used by the
respective professions in medicine, science,
engineering, business. Diagnosis also is
used in many other trades and professions
to determine the causes of symptoms,
mitigations for problems, or solutions to
Health
History
• The health history is a current
collection of organized information
unique to an individual. Relevant
aspects of the history include
biographical, demographic, physical,
mental, emotional, sociocultural,
sexual, and spiritual data.
Purpose
• name
• gender
• age
• date of birth
• occupation
• family structure or living arrangements
• source of referral
• Once the basic identifying data is collected,
the history addresses the reason for the
current visit in expanded detail. The reason
for the visit is sometimes referred to as the
chief complaint or the presenting complaint.
Once the reason for the visit is established,
additional data is solicited by asking for
details that provide a more complete picture
of the current clinical situation. For example,
in the case of pain, aspects such as
location, duration,
intensity, precipitating factors, aggravating
factors, relieving factors, and associated
symptoms should be recorded. The full
• The review of systems is a useful
method for gathering medical
information in an orderly fashion.
This review is a series of questions
about the person's current and past
medical experiences. It usually
proceeds from general to specific
information. A thorough record of
relevant dates is important in
determining relevance of past
illnesses or events to the current
The names for categories in the review of
systems may vary, but generally consists of
variations on the following list: