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Medicine - Care of women during childbirth
This is a mind map about the care of women during childbirth, which introduces the factors that affect childbirth, Nursing care for women with normal delivery, care for women during labor, etc. Hope it helps everyone.
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Medicine - Care of women during childbirth
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- Outline
Care for women during childbirth
childbirth
When pregnancy reaches or exceeds 28 weeks, the fetus and appendages are delivered through the maternal birth canal.
Factors affecting childbirth
productivity
uterine contractility
Main productivity
Features: Rhythm, symmetry, polarity, abdominal contraction effect
Abdominal wall muscle and diaphragm contractility
Important auxiliary force in the second stage of labor
Levator ani muscle contraction force
Assist the fetal presenting part to flex and internally rotate in the pelvic cavity
B
bony birth canal
Pelvic inlet plane (transverse oval)
Entrance front and rear diameter 11cm
Entrance cross diameter 13cm
Entrance slope diameter 12.75cm
Mid-pelvic plane (minimum plane of pelvis, longitudinal oval)
The front and rear diameter of the middle pelvis is 11.5cm
Middle pelvis transverse diameter 10cm
Pelvic outlet plane (composed of two triangles that are not in the same plane)
Exit front and rear diameter 11.5
Exit cross diameter 9cm
Sagittal diameter before exit: 6cm
Posterior sagittal diameter of exit 8.5cm
When the sum of the posterior sagittal diameter of the exit and the transverse diameter of the exit is >15cm, the fetal head can be delivered through the posterior triangle.
Pelvic axis and pelvic tilt (60 degrees)
soft birth canal
Lower uterine segment, cervix, vagina and pelvic floor soft tissue
formation of lower uterine segment
The length of the non-pregnant uterine isthmus is about 1cm
Regular uterine contractions after labor further elongate the lower uterine segment to 7-10cm.
cervical changes
Cervical canal disappears and cervix dilates
Changes in vaginal, pelvic tissue, and perineum
The perineal body changes from 5cm thick to 2-4cm thin
fetus
The fetal head is the largest part of the fetal body
fetal skull
Anterior fontanel (large fontanel): in front of the fetal head, diamond-shaped
Posterior fontanel (small fontanel): behind the fetal head, triangular
The fontanel is an important symbol for determining the fetal position.
fetal diameter
Biparietal diameter: approximately 9.3cm at term, used to determine fetal size by ultrasound
Occipital and forehead diameter: About 11.3cm at full term
Suboccipital anterior fontanel diameter: about 9.5cm at term, the fetus passes through the birth canal with this diameter
Occipital chin diameter
Fetal position: Longitudinal position, easy to pass
infant deformity
social factors
Nursing care for women with normal childbirth
Mechanism of occipital presentation of delivery
The birth mechanism refers to the whole process in which the presenting part of the fetus passively undergoes a series of adaptive rotations according to the different shapes of each plane of the pelvis, and passes through the birth canal on its smallest diameter. The most common occipital left anterior position
connect
The biparietal diameter of the fetal head enters the pelvic inlet plane, and the lowest point of the skull is close to or reaches the level of the ischial spine.
decline
Throughout the entire process of childbirth
The degree of fetal head descent is an important marker for judging the progress of labor
Submission
Change the occipitofrontal diameter when the fetal head is connected to the suboccipital bregma diameter
internal rotation
Adapt the sagittal suture of the fetal head to align the anteroposterior diameter of the midpelvis and outlet
The first stage of labor is incomplete due to internal rotation of the fetal head
Stretch
Reduction and external rotation
After the fetal head is delivered, the occipital part of the fetal head is rotated 45 degrees to the left to restore the normal relationship between the fetal head and the fetal shoulders, which is called reset.
The fetal shoulder continues to descend in the pelvis, and the front shoulder rotates 45 degrees toward the midline of the mother's pelvis, so that the diameter of the fetal shoulders adapts to the front and rear diameter of the pelvic outlet. At this time, the fetal head and occiput continues to rotate 45 degrees to the left, which is called external rotation.
Fetal shoulder and fetal delivery
labor
Regular and gradually increasing uterine contractions, lasting 30 seconds or more, with an interval of 5-6 minutes
The contractions cannot be suppressed even with strong sedatives
Nursing care for women in the third stage of labor
nursing assessment
placental ablation
The uterus becomes hard and spherical, and the fundus of the uterus rises above the umbilicus
Small amount of vaginal bleeding
The umbilical cord leaking from the vaginal opening descends and extends on its own
When you use the ulnar side of your palm to gently press the lower uterine segment above the maternal pubic symphysis, the uterine body will rise and the exposed umbilical cord will no longer retract.
method of delivery of fetus
Fetal face delivery (common)
maternal face delivery
Neonatal assessment
general condition
Apgar score: determines whether there is neonatal asphyxia and the severity of asphyxia
Nursing measures
Newborn care
Clear respiratory tract (first step)
Dry and keep warm
Immediately after delivery, place it on the mother's abdomen and dry the whole body with a preheated towel.
Treating the umbilical cord
Umbilical cord cutting can be delayed if the mother and child are healthy. The umbilical cord can be ligated 30-60 seconds after the birth of the newborn or after the umbilical cord blood vessels have stopped pulsing.
Disinfect the umbilical cord section with 5% povidone-iodine solution or 75% ethanol solution
maternal care
Assist in delivering the placenta
Check the placenta and fetal membranes
Check the soft birth canal
If there is a laceration, suture it immediately
Postpartum 2h care
General care, observing vital signs
Prevent postpartum hemorrhage
Observe uterine contractions, vaginal bleeding, perineal and vaginal hematoma, and bladder fullness every 30 minutes. Catheterize if necessary to prevent urinary retention.
When the amount of bleeding exceeds 300ml, it should be treated as postpartum hemorrhage
Nursing care for women in the second stage of labor
During the delivery period of the fetus, the uterine contractions reach their strongest, the interval is the shortest, and breath-holding force begins to appear.
nursing assessment
fetal head exposed
As labor progresses, the fetal head emerges from the vaginal opening during contractions, and retracts into the vagina during intervals between contractions.
fetal head crown
The fetal head no longer retracts during intervals
Nursing measures
fetal monitoring
Listen to the fetal heart rate every 5-10 minutes between contractions
Guidance on delivery positions
Semi-recumbent position with knees bent is common
Instructing mothers to hold their breath and exert force
Correct use of abdominal pressure is the key to shortening the second stage of labor
Preparing for delivery
When the fetal head of a primiparous woman is exposed by 3-4cm, the cervix of a multiparous woman is nearly fully dilated, and the perineum is bulging and tense, be prepared for delivery.
Assess the need for episiotomy
Only when the perineum is too tight or the fetus is too large, perineal tearing is expected to be inevitable during delivery, or the mother and fetus have pathological conditions that urgently need to end delivery.
Care for women in the first stage of labor
nursing assessment
Measure blood pressure every 4-6 hours during labor
Fetal heart rate
Auscultate every hour during the latent period and every 30 minutes during the active period.
Observe and record the duration, interval time and intensity of uterine contractions
Descended fetal head
Important signs that determine whether vaginal delivery is possible
The degree of fetal head descent is marked by the relationship between the lowest point of the skull and the plane of the ischial spine.
Rupture of fetal membranes
Immediately lie in bed, listen to the fetal heartbeat, observe the characteristics and amount of amniotic fluid, and record the time of membrane rupture
If the membranes have ruptured for more than 12 hours and have not given birth, antibiotics should be used as directed by the doctor.
It usually occurs when the cervix is nearly fully dilated.
Nursing measures
general care
diet
No dietary restrictions during the first stage of labor, choose high-calorie, easy-to-digest, light foods
Activity
The uterine contractions are not strong and the membranes have not ruptured. Pregnant women are encouraged to leave the bed and move around.
The fetal membranes have ruptured, so stay in bed
defecation and urination
Encourage pregnant women to urinate every 2-4 hours
specialist care
Promote uterine contractions
If uterine atony occurs, follow the doctor's advice and use intravenous infusion of low-dose oxytocin to promote uterine contractions.
Total labor stage and stages
First stage of labor (cervical dilation)
Second stage of labor (fetal delivery period)
The third stage of labor (placenta delivery period)