Normal Intrapartum
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Transcript of Normal Intrapartum
LABOR
THEORIES ON THE ONSET OF LABOR
Progesterone - Estrogen Ratios
Oxytocin Stimulation
Prostaglandins
Fetal Cortisol level increase
Uterine Distention- cervical pressure
Four P’s
P PASSAGE
P PASSENGER
P POWER
P PSYCHE
PASSAGE (The Pelvis)
False Pelvis True Pelvis
Pelvic inletMid pelvisPelvic outlet
Dilatation and Effacement Stations
Pelvis Types
Gynecoid - most common for NSVD
Android - increased use of forceps/vacuum
Anthropoid - common OP position
Platypelloid - common for C/S
PASSENGER (The Fetus)
Fetal Head Fetal Attitude Fetal Lie Fetal Presentation Fetal Position
Passenger Fetal attitude: relationship of fetal parts to maternal uterus and pelvis Flexion (ideal) Extension: labor will be more
difficult Lie: relationship of fetal spine to
maternal spine Longitudinal (cephalic or
breech) Transverse (c-sec)
Passenger con’t…
Fetal presentation: part of fetus closest to cervix Crown of the head: occiput Chin: mentum Shoulder: scapula Breech: sacrum
Passenger cont’d… Fetal position: relationship of presenting part to the
four quadrants of maternal pelvis; right/left, anterior/posterior quadrants First letter: mother’s right or left (R, L) Second letter: fetal presenting part (O, S, M, Sc) Third letter: mother’s anterior, posterior, or transverse
(A,P,T)
****ideal position: ROA or LOA
POWER(The Forces of Labor)
Primary Forces-Uterine Contractions Frequency Duration Intensity
Secondary Forces Abdominal muscles Perineal muscles Pelvic floor muscles
PSYCHE(The Patient’s Psychological State)
PSYCHE
Motivation for the pregnancy Childbirth Education Sense of Mastery, Self esteem Positive Relationship with Mate Maintaining Control Support System during Labor Not Being Alone during Labor Trust in Medical Personnel
SIGNS /SYMPTOMS OF LABOR
Backache
Nausea/Vomiting
Indigestion
Diarrhea
Cervical changes
Bloody Show
Rupture of membranes
Sudden burst of energy
Stages of Labor First Stage - from onset of true labor to
complete dilatation of the cervix
Latent/Early Phase (0-3 cm) Active Phase (4-7 cm) Transition (8-10 cm)
Stages of Labor Second Stage- from complete dilatation to
birth of the infant
Third Stage- from birth to delivery of the placenta
Fourth Stage - From delivery of the placenta up to four hours after birth
CARDINAL FETAL MOVEMENTS
ENGAGEMENT
DESCENT
FLEXION
INTERNAL ROTATION
EXTENSION
RESTITUTION
EXTERNAL ROTATION
EXPULSION
Labor Analgesics Demerol, Stadol, Nubain
Maternal Side Effects:Respiratory DepressionNausea/VomitingDrowsiness, Dizziness
Fetal Side Effects:Respiratory DepressionLethargy
Poor fetal heart tones Maternal respiratory depression Known allergy
Nursing Implications Monitor fetal and maternal response Administer narcan/ naloxone prn - Route,
dose
Contraindications
Anesthesia for Labor
Regional Anesthesia Epidural Spinal Pudenal Local
General Anesthesia Advantages
Faster access Disadvantages
No support person Discomfort to mother
Anesthesia for Labor
Nursing Responsibilities For Epidurals
Bolus Baseline vital signs and lab work available Ensure client has an empty bladder Position the patient Ongoing monitoring of mother and baby
For General As above Cricoid pressure
Pitocin/Oxytocin
Uses To induce / augment labor To stimulate contractions after birth
Contraindications
Prone to uterine rupture Cephalopelvic disproportion Malpresentation Presence of fetal distress Preterm infant
Side Effects
Abruptio placenta Water intoxication Fetal hypoxia History of rapid labor and/or birth Uterine rupture
Fetal Monitoring External Monitoring
Tocodynameter Ultrasound
Internal Monitoring IUPC FSE
Fetal Monitoring Baseline
Tachycardia >160 bpm Bradycardia <120 bpm
Acceleration – 15 bpm x 15 secs Decelerations
Early - Head compression Late - Placental insufficiency Variables- Cord compression