Intrapartum Quizlet

Active Phase

Admission to Labor and Delivery Delive ry

Aortocaval Compression

Attitude: Extension

Attitude: Flexion

-Stage 1 -4 to 7 cm dilation -Cervical changes: dilates more rapidly -Discomfort increases -Woman's focus increasingly inward -Contractions 2-5 mins apart, last 40-60 sec, moderate intensity -Once a ctive, minimum minimum progress expected is: 1.2 cm/hr c m/hr for nullipara, 1.5cm/hr for multipara

-1st: Focused assessment of mother (vital signs) and fetus (FHR) to determ determine ine their condition and whether w hether birth birth is i s imminent -2nd: Broader Broader ass essment -Obtain essential info from mother, e.g.: History: Age, G, P, EDC, LMP, # wks, ROM, bleeding, present OB hx, past OB hx, etc. -Fetal assessment: Leopold maneuvers, Assessment of FHR and pattern -Labor status: Assessment of uterine contractions, Vaginal examination, examina tion, CBC, CBC, Bld type, RH, midstream midstream urine for protein, protein, glucose -Physical examination

-aka Supine hypotension syndrome, vena cava syndrome -The supine position position allows a llows the heavy uterus to compress her inferior vena cava, reducing the amount of blood returned to the heart and can reduce placental perfusion -Frequent cause cau se of low maternal blood press p ressure ure -If mother is in bed, lay her on side. LEFT side is optimal but right side can be used

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Body Changes During Labor

Bradley Method of Childbirth

-Cardiovascular: BP during contractions, Supine hypotension (Aorto-caval syndrome) syndrome) -Respiratory: Increased rate and depth: Increased chance cha nce of Hyperventilatio Hyperventilation n -GI: Thirst, dry mouth; NPO, ice chips, popsicles -Urinary: Encourage emptying for comfort and better fetal descent, postpartum diuresis -Blood: Increase of blood volume , WBC and clotting factors (check for signs of DVT)

-Similar to Lamaze -Originally called husband-coached childbirth, the first to include father as an integral part of labor. -Slow abd. breathing, relaxation techniques -Seeks to avoid medical interventions

Brow Presentation -Least common of a ll presentation -When the forehead of the fetus becomes the presenting part. -The fetal head is slightly extended instead of flexed, with the result that the fetal head enters the birth canal with the widest diameter of the head (occipitomental) foremost. -C-section birth is preferred. *If vaginal birth is attempted the woman will probably have an episiotomy and may require an extension at birth. *Fetal mortality is increased b/c of injuries received during birth including cerbral and neck compression and damage to the trachea and larynx

Causes of Labor Labor

-Cervical ripening: complex cascade of events (change in E/P ratio, ↑ collagenase activity, ↑PGE2 -Myometrial -Myometrial activation (sensitive to oxytocin release)







Comfort Measures during Labor

a. Lighting b. Keep temperature comfortable comf ortable c. Attend to personal hygiene d. Provide mouth care e. Assess for bladder distention f. Assist woman to position of comfort g. Ice Chips

Contractions

-Comes from the upper 2/3 of the uterus -Frequency -Duration -Intensity (mild, moderate, severe)

Dilatation

The extent to which the cervix has opened in preparation as a result of uterine contractions -Full dilatation is 10cm.

Doulas

Non-medical, non-midwives who provide continous physical, emotional & educational support to the mother before, during & after birth...not required to be certified in the U.S.







Episiotomy a surgical incision made through the perineum to enlarge the vaginal origice to prevent tearing of the tissues as the infant moves out of the birth canal

Face Presentation -The face of the fetus is the presenting part. -The fetal head is hyperextended even more than in the brow presentation. -Occurs frequently in multiparous women or women with a pendulous abdomen. * The risks of CPD and prolonged labor are increased which increases the risk for infection * The fetus may develop edema, the neck and internal structures may swell as a result of trauma received during descent. Petechiae Petechiae swelling and facia l bruising a re seen int the superfici superficial al layers of the facial skin *Results in C-Section delivery

False Labor

-Irregular contractions -Interval same -Intensity -Intensity same or less -Felt in abdomen -Sedation relieves pain -No show -No cervical change with contractions

Fetal Head The fetal head is designed to work with the pelvis, pelvis, in that the cra nial plates can override each other when necessary as when there is a tight squeeze. Also the shortest diameter of the fetal head is when the baby's baby's head is f ully flexed—the flexed—the suboccipitobregmatic diameter 9.5cm vs. 11 or 13.5 cm







Footling Breech One or both feet come first, with , Baby's bottom is at a higher position and either one or both feet come out first during delivery. This breech condition is common in premature deliveries. This position is extremely rare in full-term pregnancies.

Forceps assisted birth A birth in which which a set of instruments, known as f orceps, ar e applied applied to the presenting part of the fetus to provide traction or to enable the fetal head to be rotated to an occiput-anterior position. Forceps-assisted birth is also known as instrumental delivery, operative delivery, or operative vaginal delivery.

Four P's

Fourth Stage of Labor

1. Passenger (fetus) 2. Passage (pelvis, vagina) 3. Powers (physiology of labor) 4. Psyche (psychosocial considerations)

-Till mom stabilizes (usually about 1-4 hours after birth ) -Vital signs q 15 mins first hour, a ssessi ssessing ng fundus fu ndus and a nd amount of lochia -Important for fundus to remain firm! (Pt can hemorrhage in minutes) minutes) -Physiologic changes may cause chill -Encourage pa rent-infant rent-infant contact -Initiate breastfeeding breastfeeding -Ice pack to perineum







Friedman Curve

-Duration of labor usually between 7-13 hours -A graphic representation of the hours of labor plotted against cervical dilation in centimeters.

Full Breech The reversal reversal of the usual cephalic cep halic p osition: osition: everything everything flexed inward but butt presenting first.

Grantly Dick-Read Method of Childbirth

Intrapartum Complications

-Believed fear of childbirth produced tension which made the pain pain worse which created a fear-tension-pain cycle -Introduced relaxation methods to mothers

-Meconium -Inadequate uterine relaxation between contractions -Inadequate uterine contractions -CPD: cephalo- pelvic disproportion disproportion -Prolapsed cord -Shoulder dystocia









Latent Phase

-Stage 1 -0 to 3 cm dilation -Cervical changes: primarily effacement -Contractions gradually increase, mild intensity, 5-30 minutes apart and last for 30-40 30-40 seconds s econds

Left Occiput Anterior The most common and least troublesome birth position

Leopold Maneuvers -Can determine fatal position, presentation, and attitude by performing leopold's maneuvers. have the patient empty her bladder, assist her to a supine position, position, and expose her abdomen 1. Identify what occupies the fundus 2. Identify where the baby's back is, the other side being the hands and feet 3. Attempt to grasp presenting part gently between thumb and fingers to see if the presenting part moves upward. If engaged, it will not move up 4. Face mothers feet, slide hands downward on either side of uterus. One side will be "obstructed" with cephalic prominence, if this is a flexed head, it will be on opposite side as the fetal back; extended head will be on same side as the back

The process or time during late pregnancy







Lochia

Discharge of blood, mucous and tissue from the uterous following delivery delivery lasting 4-6 weeks after delivery

Longitudinal Lie When the long l ong axis of the fetus f etus is parallel to the long axis of the mother the fetus fetu s

Maternal Positions in Labor -Preferred position in labor is UPRIGHT because it takes advantage of the force of gravity, improves the contraction, helps with maternal maternal cardiac o utput and utero-placental utero-placental flow, and increases flow to the maternal maternal kidneys -"All Fours": good for shoulder dystocia dystocia -Lithotomy -Sitting: excellent to facilitate the progress, a bdominal muscles work together in greater synchrony with uterus contractions -Squatting/Kneeling: moves the uterus forward and aligns the fetus with the pelvic inlet which increases the pelvic outlet -Lateral: g oot to slow down the speed of precipitous birth and helps rotate the fetus fetus in a posterior position

-Cardiovascular: *Cardiac output increases *Increase pulse rate *Blood *Blood p ressure ressure changes: increases during contractions, hypotension my occur f rom vena caval syndrome *White blood cell count increases







Multiparous

Woman who w ho has given birth two or more times

Nulliparous

Woman who has never given birth

Nurses Role in Labor

1. Comfort Measures 2. Teaching 3. Providing Encouragement 4. Caring Presence (giving of self) 5. Offering Pain Medication 6. Care for the Birth Partner

-Maternal response: labor-oriented, more inwardly focused and alert, more demanding -Duration: averages 1.2cm/ hour nullip and 1.5 cm/hr multip, range is from 810 hours nullip nullip and 6-7 hours multip (6-10 hrs)







Nursing Care during Latent Phase of Labor

-Maternal response: Happy, excited, sociable, mild a nxiety, cooperative -Duration: nullip-7-8 hrs and 4-5 hrs multip -Coping techniques: *Relaxation techniques techniques *Breathing *Effleurage *Ambulation *Position change *Diversion -Education -Review -Review of birth plan -Encourage voiding q2 hours -Basic hygiene hygiene -Assess maternal BP, HR, RR; uterine activity, FHR q 30 - 60 min -Assess maternal temperature temperature q4 hours until ruptured membranes then then q 1-2 hours

Nursing Care during Second Stage of Labor

-20 mins to 3 hours -Maternal -Ma ternal response: response: *Before baby is born: born: Intense concentration with pushing, dozing in between between ctx, ctx , often oblivious oblivious to surroundings *After the birth: excited a nd relieved, relieved, very tired, may c ry -Nurse responsible for: *Helping the mother bear down, positioning positioning *Preparing delivery delivery equipment, p ersonnel ersonnel *Cleansing of the perineum *Initial care a nd a ssess ssessment ment of the newbor n ewborn n

Nursing Care during Third Stage of Labor

-Separation and birth of the placenta -Uterus continues to contract after the birth of the baby, causing the placenta to separate from the uterine wall -Lasts from 5 to 30 mins -Uterus must remain contracted to compress blood vessels (prevent hemorrhage) -Nurse -Nu rse responsibl responsiblee to administ a dminister er pitocin and a nd continuing c ontinuing care of infant

-Maternal response: irri table, intense concentration, concentration, may lose control, control, n/v -Duration: 30 mins to 3.5 hrs -Comfort measures, coping techniques







Pain in Labor Caused by:

Passenger

-hypoxia of compressed muscle cells -compression of nerves in cervix -stretching of c ervix ervix -stretching of perineum -bladder distension -intensified -intensified w/tension/anxiety/fear w/tension/anxiety/fear -oxytocin [Pitocin]-gives stronger contractions

-Size and number -Lie of baby -Presentation of baby (Fetal structure that enters the pelvis first) (caput swelling and molding of the head) -Fetal -Fetal attitude (flexion [ easier] or extension)

Pelvis -False vs. True Pelvis -We are more concerned with the true pelvis during childbirth

-Lightening -Braxton -Braxton Hicks contractions









Prolapsed Cord

When Whe n the umbilical cord of the baby is expelled first during delivery and is squeezed between the baby's head and the vaginal wall. This presents an emergency e mergency situation since the baby's circulation is compromised.

Relaxin

A hormone produced by the placenta that causes softening in the collagen connective tissue of the symphysis pubis pubis and sacroiliac joint

-Essential to assess FHR after rupture of membranes -Assess -Assess characteristics ch aracteristics of a mniotic fluid a. Color

Rupture of Membranes







Shoulder Dystocia

Stages of Labor

Station

This occurs after the fetal f etal head is delivered and the broad anterior shoulder becomes wedged behind the mother's m other's pubis, fetus f etus cannot expand lungs because is trapped. This difficult delivery could result in maternal lacerations & a fractured clavicle in the infant.

-First stage (beginning of labor to 10 cm) *Latent *Active *Transition -Second Stage (from 10 cm to birth of baby) -Third Stage (from birth of baby to birth of placenta) -Fourth Stage (till mother stabilizes, 1-4 hrs)







The Support Person

1. Assess Assess support person for signs of anxiety and/or an d/or fatigue 2. Respect couple's values with regard to involvement of father 3. Include support person in the plan of care 4. Maternity care is FAMILY-CENTERED, FAMILY-C ENTERED, every every member member of their family fa mily is your your pa tient too

Third Stage of Labor

-Shortest stage -Placenta separates and is expelled -May take up to 30 mins -Signs of placental separation: *Gush of blood *Lengthening of cord *Change in shape of uterus from flat to round, globular -Clamp and cut cord -Skin to skin

Transition Phase

-Stage 1 -8 to 10 cm dilation -Strongest contractions







Vacuum Assisted Assis ted Birth Monitor FHR throug hout. Assist Assist with p ushing. Assess Assess for complications. Look for lacerations. New Born- look for scalp lacerations/hem la cerations/hematoma atoma

Vertex Presentation -Fetal head fully flexed -The most favorable cephalic variation because the smallest possible diameter of the head enters the pelvis. -This occurs occurs in about 96% of births.

Intrapartum Quizlet

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