Cervical Dilation

1. Define Cervical Dilation: begins with the onset of regular contractions and ends with complete dilation, the opening of cervix
2. Define Effacement: thinning of the cervix from 0% to 100%
3. Describe Stage One of Labor
   a. Latent Phase: Mild contractions frequency 5-30 min, lasts 15-30 seconds (0-3cm) low back pain.
   b. Active Phase: Moderate Contraction frequency 4-7 cm dilation, frequency. 3-5 min apart, lasts 30-60 seconds.
   c. Transition: Intensity strong, pain becomes more intense 8-10cm, contractions Q2-3 min, lasts 60-90 seconds.
4. Describe Stage Two: greater than 10cm dilation Expulsion stage. In Full effacement and then crowing, the mother must actively push the baby out.
5. Describe Stage Three: delivery of the placenta (5-10min) placental stage begins with the birth of the baby and ends with the placenta expels
6. How is the frequency of contractions measured? From the beginning. Of one contraction to the beginning of the next.
   Latent: every 5-30 mins. Active: every 3-5min. Transition: every 2-3 mins.
7. How is the duration of contractions measured? From the beginning and end of one contraction.
   Latent: 15-30 secs. Active:30-60. Secs. Transition: 60-90 secs.
8. Describe each of the following fetal heart rate patterns:
   a. Accelerations: are normal and usually associated with fetal movement, vaginal Examinations, and contractions.
   b. Early Decelerations: due to uterine contraction- head compression.
   c. Late Decelerations: placental insufficiency.
   d. Variable Decelerations: umbilical cord compression, repositioning mother, oxygen mask, stop oxytocin.
9. List three (3) non-pharmacologic methods of pain management for the laboring mother:
   1.Effleurage: stroking of mother’s abdomen using fingertips during contractions.
   2.Sacral counter pressure: using the heel of the hand to push against the mothers’ sacral part to reduce back labor pain.
   3.Breathing exercises, music, hydrotherapy, heat, or cold therapy.
10. Provide the following information for each:
11. Preeclampsia
    A. Definition: new-onset hypertension after 20 weeks of gestation
    Diagnostic criteria: proteinuria present, BP > 140/90 X 2 four hours apart.
    Signs and symptoms: fluid retention, swelling of the hands and face, headache because of high BP, and visual changes.
    Treatment: cured by delivery, treat symptoms by bed rest, monitor blood pressure and protein. Medication: Hydralazine, Labetalol, nifedipine, mag sulfate.
    Nursing Management: side-lying position, bed rest, labor induction, anti-Hypertensives for seizure prevention, monitoring fetal measurements.
12. Gestational Diabetes
    Definition: occurs in pregnancy in the second and third trimesters to moms with no previous diabetes diagnosis. It happens when the pancreas is unable to respond to insulin demand.

Diagnostic criteria: pregnant women should be screened for gestational diabetes in weeks 24-28 via the 1- hour glucose challenge test; if abnormal results, then a 3- hour Oral glucose test is used to confirm diabetes mellitus.
Signs and symptoms: Excessive thirst, hunger, weight. Loss, frequent urination, blurred vision, glycosuria and ketonuria, large fetus for gestational age, hypertension, and preeclampsia.
Treatment: diet, moderate physical activity, insulin,
Nursing Management: monitor weight, assess signs of preeclampsia, and high blood pressure, assess for S/S of infection, monitor fetal status for signs of distress.

3. Preterm Labor
   Definition: after 20 weeks but before < 37 weeks of gestation.
   Diagnostic criteria: water breaking with vaginal discharge, spotting bleeding.
   Signs and symptoms: frequent uterine contractions, low back pain, pressure on the lower abdominal area, pelvic pressure, and change in vaginal discharge.
   Treatment: tocolytics to prevent contractions, monitor side effects, give fluids,
   Nursing Management: restrict activity, bed rest, monitor fetus and mom.