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Notes for unit test on Friday 1/6/11 COMPONENTS OF LABOR - Pilliteri 1.

Passageway – is the adequate size and contour of a woman’s pelvis. a. Two pelvic measurements are important to this: i. The diagonal conjugate (the anteroposterior diameter of the inlet) ii. The transverse diameter of the outlet. 2. Passenger – the fetus should be of appropriate size and in an advantageous position and presentation

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Powers – the uterine factors should be adequate a. Powers are strongly influenced by the woman’s position during labor. Psyche – the outlook of a woman on the events that happened during labor. a. It should be preserved so that a positive experience.

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COMMON CAUSES OF DYSFUNCTIONAL LABOR Inappropirate use of analgesia (excessive or too early administration) Pelvic bone contraction that has narrowed the pelvic diameter so that a fetus cannot pass. o Could occur in a woman with rickets Poor fetal position Ectention rather than flexion of the fetal head Overdistention of the uterus o Woman with multiple pregnancy, hydramnios, or an excessively over sized fetus o Cervical rigidity Presence of full rectum or urinary bladder Woman becoming fatigued from labor Primigravida status

PROBLEMS WITH POWER 1) Inertia – is a time- honored term to denote that sluggishness of contractions, or the force of labor, has occurred. 2) Dysfunctional labor – occurrence of the sluggishness of contracts or the force of labor. a) Two classifications of dysfunctional labor i) Primary occurring at the onset of labor ii) Secondary occurring later in labor 3) Effects of prolonged labor: a) High risk of: (1) Postpartum infection (2) Hemorrhage (3) Infant Mortality. 4) Factors affecting PL: a) Large Fetus (fetus is too big) b) Hypotonic, Hypertonic and Uncoordinated contractions INEFFECTIVE UTERINE FORCE  Physiology of uterine contractions o Uterine contractions are the basic force that moves the fetus through the birth canal.  This happens due to the combination of:  contractile enzyme ATP  Influence of major electrolytes such as Ca, Na, K  Specific contractile proteins (actin and myosin)  Hormones such as, epinephrine, norepinephrine, oxytocin, estrogen, progesterone and prostaglandins. 1) HYPOTONIC CONTRACTIONS  The number of contractions is unusually low or infrequent  Not more than two or three occurring in a 10 minute period  The resting tone of the uterus remains less than 10 mm Hg and the strength of the contractions does not rise above 20 mm Hg  Mostly likely to happen during active phase  May happen after administration of analgesia  Especially with the cervix is not dialated to 3 to 4 cm  Or bladder or bowel is distended  Preventing firm engagement.  Prevents descent  May also happen due to an over stretched uterus, multiple gestation, grand multiparity, large fetus, hydramnios  Are not that painful – though some women may think they are really painful  Prolongs labor  Increases chance of postpartal hemorrhage.  Nursing intervention  In the first hour after birth palpate the uterus and assess lochia every 15 minutes to ensure that postpartal contractions are not hypotonic and therefore inadequate to halt bleeding. HYPERTONIC CONTRACTIONS  Contractions are marked by an increase in resting tone to more than 15 mm Hg.  Intensity of contractions may not be any stronger than those with hypotonic contractions.  Instead they happer more frequently  Latent Phase

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Dangers: o Fetal anoxia early in the latent phase of labor o Any woman whose pain seems to great to the quality of her contractions  Should have both a uterine and a fetal external monitor applied for at least 15 minutes to ensure that resting phase of the contractions is adequate. They tend to be more painful than usual. o So it is “wiped clean” to clean a new pacemaker stimulus. Breathing exercises for childbirth are ineffective with this type of contraction.  Cesarean may be necessary 3) UNCOORDINATED CONTRACTIONS . o Because the myometrium becomes tender due to lack of relaxation and anoxia of uterine cells.  And that fetal pattern does not show late deceleration o If deceleration in the fetal heart rate or an abnormally long first stage of labor or lack of progress with pushing “second stage arrest” occurs.  This may happen because more than one pacemaked is stimulating contractions.    This happens because the muscle fibers of the myometrium do not repolarize or relax after a contraction.