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. The ideal conduct of labor and delivery - Birthing is recognized as a normal physiological process that most women experience without complication - Intrapartum complications can arise very quickly and unexpectedly. ADMISSION PROCEDURES. Identification of labor -One of

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1. Ch 13. CONDUCT OF NORMAL LABOR AND DELIVERY ????? ???? R1 ? ? ?

2. The ideal conduct of labor and delivery - Birthing is recognized as a normal physiological process that most women experience without complication - Intrapartum complications can arise very quickly and unexpectedly

3. ADMISSION PROCEDURES Identification of labor -One of the most critical diagnoses in obstetrics is the accurate diagnosis of labor -Hx, PEx, V/S (BP, PR, BT) -Uterine contraction (duration, frequency, intensity) -fetus (presentation, heart rate, size) -fetal membrane, vaginal bleeding & leakage ->The fetal heart rate should be checked, especially at the end of a contraction and immediately, thereafter, to identify pathological slowing of the heart rate

4. ADMISSION PROCEDURES True labor -regular interval -gradually shorten -intensity: increase -discomfort back & abdomen -cervix: dialte -discomfort: not stopped by sedation False labor -irregular interval -remian long -intensity: unchanged -discomfort low abdomen -cervix: not dilate -discomfort: usually relieved by sedation

5. ADMISSION PROCEDURES Federal requirements for inter-hospital transfer of laboring women -all Medicare-participating hospitals with emergency services must provide an appropriate medical screening examination for any pregnant women -LABOR: the precess of childbirth beginning with the latent phase of labor continuing through delivery of the placenta -penalty; $50,000

6. ADMISSION PROCEDURES Electronic admission testing -NST (nonsterss test) :an assessment of fetal heart rate accelerations or lack of the same with fetal movement -CST (contraction stress test) : an assessment of fetal heart rate before, during, and following a uterine contraction if the patient is in labor -fetal heart rate: variability and variable deceleration with fetal acoustic stimulation

7. ADMISSION PROCEDURES Vaginal examination -aseptic conditions 1) amnionic fluid: membrane rupture posterior vaginal fornix (vernix or meconium) , swab 2) cervix: softness, effacement, dilatation, location presentation , presence of membrane 3) presenting part

8. 4)station: the degree of descent high level- fundal pressure 5)pelvic architecture: diagonal conjugate ischial spine, pelvic sidewall sacrum

9. ADMISSION PROCEDURES Cervical effacement - the length of the cervical canal compared to that of an uneffaced cervix -reduced by one half: 50 % effaced completely: 100 % effaced Cervical dilatation -the average diameter of the cervical opening -dilated fully: 10cm

10. ADMISSION PROCEDURES Position of the cervix -the relationship of the cervacal os to the fetal head -posterior, modposition, or anterior (ex. preterm labor: posterior) Station -the presenting part in the birth canal in relationship to the ischial spine -ischial spine: halfway between the pelvic inlet and the pelvic outlet

11. -the lowermost portion of the fetal presenting part is at the level of the ischial spine: ZERO (0) engagement -divided into third ->ACOG (1988) divided into fifth (-5 -4 -3 -2 -1 0 +1 +2 +3 +4 +5) -If the head is unusually molded, of if there is an extensive caput formation, or both, engagement might not have taken place even through the head appears to be at 0 station

12. ADMISSION PROCEDURES Detection of ruptured membranes -Ruptere of membrane 1) if not fixed in the pelvis, prolapse & cmpression of umbilical cord is greatly increased 2) if the pregnancy is at or near term, labor is likely to occur soon 3) if delivery is delayed for 24 hours or more after membranes rupture, serious intrauterine infection

13. -diagnosis of rupture of the membrane : pooling in the posterior fornix or passing from the cervical canal of the amnionic fluid : testing of pH ? normal (4.5~5.5) amnionic fluid (7.0~7.5) Nirazine test false-positive: blood, semen bacterial vaginosis false-negative: minimal fluid #Nitrazine test: insert sterile cotton tip->touching it to a strip-> comparering the color -arborization, ferning pattern or AFP of amnionic fluid

14. ADMISSION PROCEDURES Vital signs and review of the pregnancy record Preparation of vulva and perineum -cleansing and scrubbing -clipping or mini-shaving or hair (But. not routinely) Vaginal examination -sterile gloves -avoid the anal region -the number of vaginal exam: infectious morbidity especially rupture

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