Question

Laurie is a 32-year-old primigravida at 40 weeks of gestation who is admitted to the Labor and Delivery unit in early labor. She has no known risk factors. Her fetal heart rate is 120 bpm with moderate variability, and she is contracting 3 to 4 minutes minuted apart for 60 seconds.

1. As a woman progresses through the stages, various body system adaptatations will occur.

What are the risks to the maternal fetal unit as a result?

2. what are the cardiovascular physiologic changes that occur during labor?

Laurie's labor progresses, her membrane spontaneously ruptures with clear luquid. She is preloaded with intravenous fluids (IV). Her bladder is distended 1 hour after the epidural is placed and the nurse obtains an order from the Physician for a Foley Catherization.

3. The nurse dipsticks Laurie's urine for protein and it is +1. Should the nurse be concerned about this finding?

4. what are the respiratory physiologic changes that occur during labour?

5. what position is beneficial for the laboring woman due to these cardiovascular changes? explain your answer.

Answer 1

answer 2-

Labour is associated with further increases in cardiac output (15% in the first stage and 50% in the second stage). Uterine contractions lead to an auto-transfusion of 300–500 ml of blood back into the circulation and the sympathetic response to pain and anxiety further elevate the heart rate and blood pressure.During labor, maternal cardiac output increases by 40% compared to the nonpregnant patient and are followed by an increase to 75% following delivery. This significant increase in cardiac output is a consequence of greater venous return and sympathetic tone. During active labor, uterine contractions “auto-transfuse” about 500 mL of blood back into maternal circulation. Following delivery, cardiac output increases are primarily a result of relief of inferior vena cava (IVC) compression.The degree of IVC compression depends on gestational progression and maternal positioning. When a term patient assumes the supine position, the IVC is almost entirely collapsed, significantly reducing venous return and thus cardiac output.

answer 3-

The nurse dipsticks Laurie's urine for protein and it is +1. Should the nurse be concerned about this finding?

yes she should be little concerned as there is some chance to develop preeclampsia. but the patient has no other physical finding regarding that like preeclampsia usually begins after 20 weeks of pregnancy in women whose blood pressure had been normal.patient also develop swelling in the legs and water retention.so these are not present.so there not so much serious in that urine finding.

answer 4-

During labor, minute ventilation increases even more by as much as 140% to 200% depending on the stage of labor leading to an even more pronounced decrease in PaCO2. Metabolic oxygen consumption rises during labor as a result of uterine contractions, sympathetic activity and maternal Valsalva maneuvers to deliver the fetus. As demand for oxygen outpaces oxygen delivery during active labor, anaerobic metabolism results and there is lactic acid production

During labour, arterial PCO2 further decreases with each contraction, while at full dilatation it decreases even between contractions.Prostaglandins stimulate uterine smooth muscle during labour and are present during all three trimesters of pregnancy. Prostaglandin F2α increases airway resistance by bronchial smooth muscle constriction, whereas a bronchodilator effect can be a consequence of prostaglandins E1 and E2

answer 5-

The best position for the laboring woman with cardiac compromise is the left lateral recumbent position. In this position, pulse pressure increases only six percent, compared to an increase of 26 percent in the pulse pressure when the supine position is used.