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LABOR PAIN –is caused by contractions of the muscles of the uterus and by pressure on the cervix.

Stages of Labor:
1st Stage:
a.) not in active labor – cervical dilatation at 0-3 cm, weak contractions less than 2 in 10 minutes
b.) in active labor – cervical dilatation 4cm or more
2nd stage:
- Delivery of the baby and give immediate newborn care
- Cervical dilatation of 10cm or bulging perineum and visible head
3rd stage:
- Birth of the baby and delivery of the placenta

Cardiotocography (CTG) – records both the FHR and labor contractions


About 2 hours after delivery – roomed-in of mother with baby
PRP status (platelet-rich plasma) – to determine the accumulation at the fetal–maternal interface of scrapie-infected ewes

Fetal lie: Fetal presentation:


-Longitudinal -cephalic (head first) – vertex (crown), sinciput (forehead), brow, face, chin
-Transverse -breech (buttocks/feet first) – complete, footling, frank breech
-Shoulder - arm, shoulder, and trunk
- compound presentation (when any other part presents along with the fetal head)

Fetal Heartbeat: 120-160bpm


If less than 100bpm or more than 180bpm  turn woman to her left side, then count again

Classification (stages of labor):


 Imminent delivery – bulging, thin perineum, vagina gaping and head visible, full cervical dilatation
 Late Active Labor – multigravida: ≥5cm
- primigravida: ≥4cm
 Early Active Labor – cervical dilatation ≥4cm
 Not yet in Active Labor – cervical dilatation: 0-3cm; weak contractions, less than 2 in 10minutes

OBSTETRICAL PROBLEMS: (ourpsorpprdhp)


1. Obstructed Labor – labor >24H
-transverse lie
-continuous contractions with constant pain in between
-sudden and severe abdominal pain
-horizontal ridge across lower abdomen
2. Uterine and Fetal Infection
-PROM (premature rupture of membranes
-fever >38∘C
-Foul-smelling vaginal discharge
3. Risk of Uterine and Fetal Infection
-rupture of membranes at <8months of pregnancy
4. Pre-eclampsia – diastolic blood pressure >90mmhg
5. Severe Anemia – severe palmar and conjunctival pallor and/or HGB <7g/dl
6. Obstetrical Complication –
-breech or other malpresentation
-multiple pregnancy
-fetal distress
-prolapsed cord
7. Risk of Obstetrical Complication – age less than 14yo
-warts, keloid tissue that may interfere with delivery
-bleeding any time in 3rd trimester
-prior delivery (CS, forceps/vacuum)
8. Preterm Labor
-labor before 8 completed months of pregnancy
9. Possible Fetal Distress – FHR <120 or >160bpm
10. Rupture of membranes – ROM at term and before labor
11. Dehydration – thirsty, sunken eyes, dry mouth, skin pinch goes back slowly
12. HIV-positive – HIV test is positive; counselled on ARV treatment and infant feeding
13. Possible Fetal Death – no fetal movement; no FHB on rpt exam

Give supportive care throughout labor:


1. Communication
2. Eating and Drinking – allowed to eat & drinks throughout labor??
3. Cleanliness
4. Breathing technique
5. Mobility
6. Pain and discomfort Relief
7. Urination
8. Birth companion