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Labour and Delivery - Coggle Diagram

- - - - Preterm <37 weeks
      - Term: 37-40 weeks
      - post term: >42 weeks
  - - - Small increase in dilation
    - - Acceleration and maximum slope and deceleration of dilation
    - - Fetal descent and delivery
    - - Delivery of placenta
  - - - Thicker, contractions are stronger, and shrinks during labour
    - - Thinner, weaker contractions, and stretches to allow for descent and causes cervical dilatation adn descent
  - - - Contractions: Irregular, Interval between contractions, Intensity does not change, Lower abdomen, No cervical Change, and sedation decreases contractions
    - - Regular Contractions, Decreasing intervals, Worsening intensity, Back and Abdoment, Dilating cervix and no change in sedation effects
  - - - Avoid dystocia
        
        Continuous support f labouring patient -> Uprgiht posture in first stage -> Low epidural dose, no time limit for 2nd stage if good progress is maintained and there is no fetal compromise
    - - Reduce Painful Stimuli: Abulation, position changes
      - Activate peripheral sensory receptors
        
        Massage, acupuncture/presure, Heat/COld, SHower/JAcuzzi
      - Enhance descending inhibitory pathways
        
        Attention focusing, distraction
      - Opioids, Nitrous Oxide, Regional (epidual,Spinal, pudendal), Local
  - - - Vitals, Uterine contractions, intrauterine pressure catheter
    - - Intermittent auscultation, continuous external monitoring (EFm), Internal electrode
  - - - Dilation of <0.5 cm over 4 Hours
    - - No descent of presenting part after 1 hr of active pushing
    - - Power
        
        Contractions (hypotonic, incoordinate, infrequent), Maternal expulsive efforts (ineffective or contraindicated
      - Passenger
        
        Fetal position, attitude, size, abnormalities, adequate power can correct malposition
      - Passage
        
        Bony Pelvis, Soft tissue (tumors, full bladder, full rectum, vaginal septum, high BMI), Make sure bladder is empty
      - Psyche
        
        Pain, Anxiety
    - - Type of dystocia
        
        L:ack of cevical dilation of descent despite adequate power
      - Management
        
        Oxytocin Augmentation
        
        Implemented prior to any surgical intervention
        
        Need to verify strength with intrauterine pressure cathetere
        
        Amniotomy
        
        Adequate maternal hydration, therapeutic rest, IUPC, C-Section
  - - - Position changes, regular and effective contractions, empty bladder, manage comfort, good coaching, fetal and maternal monitoring
- - - - Active management to reduce post partum hemorrhage, oxytocin following anterior shoulder delivery, gentile traction on cord with suprapubic anchoring
      - Timing: Within 5-15 minutes
      - Retaining placenta
        
        Risk for PPH, need for intervention
  - - - Tone - Uterine Atony
        
        Abrnmalities of uterine contraction (overdistension of uterus, uterine muscle exhaustion, intra-amniotic infection, functional/anatomic distortion of uterus, uterine-relaxing medications, bladder distension
      - Tissue - Retained placenta and clots
        
        Retained products of conception, abnormal placentation, retained cotyledon or succenturiate lobe, retained blood clots
      - Trauma - vulvar, vaginal, cervical, uterine injury
        
        Lacerations of vulva, vagina or cervix, extensions, lacerations, uterine rupture, uerine inverssion
      - Thrombin - coagulopathy
        
        Congenital
        
        Hemophilia A, Von Willebrand disease
        
        Acquired
        
        ITP, TTP, Thrombocytoppenia with preeclamsia, DIC