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 bag of waters is intact, and she is 3 cm dilated, 90% effaced, and –1 station. The fetal heart rate is 120 with moderate variability, and she is contracting 3 to 4 minutes apart for 60 seconds.

As a woman progresses through the stages of labor, various body system adaptations will occur.

1. What are these physiologic changes, and what are the risks to the maternal-fetal unit as a result?

2. How will the nurse modify her care of Laurie in response to these physiologic changes during labor?

3. What are the cardiovascular physiologic changes that occur during labor?

4. What position is beneficial for the laboring woman owing to these cardiovascular changes?

5. What are the respiratory physiologic changes that occur during labor?

Laurie asks the nurse if she can eat the turkey sandwich that her husband bought for her in the cafeteria.

6. Should Laurie eat a sandwich while in labor?

7. What are the gastrointestinal physiologic changes that occur during labor?

Laurie’s labor progresses. Her bag of waters ruptures spontaneously for clear fluid. She is 5 cm dilated on examination. Laurie wants an epidural for pain management. She is preloaded with IV fluid. Her bladder is distended 1 hour after the epidural is placed, and the nurse obtains an order from the physician for an in and out catheterization. The nurse dipsticks Laurie’s urine for protein, and it is 1+.

8. Should the nurse be concerned about this finding?

Laurie is now 10 cm dilated and +2 station, and she feels the urge to push.

9. What instructions should the nurse give Laurie about pushing?

Answer 1

Physiological changes during labour

It consist of 3 stage

First stage : Pain to full dilation of cervix

Second stage : Complete dilatation of cervix till the delivery

Third stage : Placental separation and expulsion.

Labor characterized by increasing utterine contraction, retraction, dilatation and effacement of cervix contractions initially last 19- 15seconds gradually increases up to 40-45 seconds.

Here Laurie has first stage, her dilatation 3cm and effacement is 90%. Here the woman is in acceleration phase with cervical dilatation 3cm and effacement is 90% taking up of cervix.  

Pulse rate is increased. Bag of membrane is intact.

Cardiovascular changes : Uterine contraction increase the venous return causing increase cardiac output and cause reflex bradycardia. Blood pressure increased  

Standing positionand len forward is help the contraction less painful and it increase the speed if labor.

Respiratory changes : increased respiratory rate.

120fetal heart rate is baseline.