[15] MIDTERM | INTRAPARTUM PART 3A (STAGES OF LABOR) Flashcards
- regular progression of uterine contractions
- effacement and progressive dilatation of the cervix
- progress in descent of the presenting part
NORMAL LABOR
1ST STAGE OF LABOR
- stage of ____
- begins with the onset of regular ____ and ends with complete ____
- Factors affecting the length of labor: ____, maternal & fetal position, ____, and level of ____
- stage of dilatation
- begins with the onset of regular uterine contractions and ends with complete dilation of the cervix
- Factors affecting the length of labor: analgesia, maternal & fetal position, woman’s body size, and level of physical fitness
1ST STAGE OF LABOR
LATENT PHASE
* Contractions are mild to moderate intensity and short, lasting ____ seconds.
- may start as mild contractions lasting ____ seconds with a frequency of ____ minutes and progress to moderate lasting ____ seconds with a frequency of ____ minutes
- w/ effacement & cervix dilates ____ cm
- Duration: Nullipara: ____ hrs. ; Multipara: ____ hours
- ____ contractions an hour is considered a meaningful signal that spontaneous birth is beginning or imminent.
- Prolonged latent phase: exceeding ____ hours in nullipara & ____ hours in multipara
LATENT PHASE
* Contractions are mild to moderate intensity and short, lasting 20 to 40 seconds.
- may start as mild contractions lasting 20 to 30 seconds with a frequency of 10 to 30 minutes and progress to moderate lasting 30 to 40 seconds with a frequency of 5 to 7 minutes
- w/ effacement & cervix dilates 0-3 cm
- Duration: Nullipara: 6 hours ; Multipara: 4.5 hours
- Twelve contractions an hour is considered a meaningful signal that spontaneous birth is beginning or imminent.
- Prolonged latent phase: exceeding 20 hours in nullipara & 14 hours in multipara
ACTIVE PHASE
* Cervical dilatation occurs more rapidly, increasing from ____ cm ( ____ cm/hr in nulliparas and ____ cm/hr in multiparas)
- Fetal descent is ____
- Contractions become more frequent (every ____ minutes) and longer in duration lasting ____ seconds, and are ____ intensity
ACTIVE PHASE
* Cervical dilatation occurs more rapidly, increasing from 4 to 7 cm (1.2 cm/hr in nulliparas and 1.5 cm/hr in multiparas)
- Fetal descent is progressive
- Contractions become more frequent (every 3-5 minutes) and longer in duration lasting 40 to 60 seconds, and are moderate to strong intensity
ACTIVE PHASE: WHO, 2018
* The duration of active first stage (from ____ cm until full cervical dilatation) usually does not extend beyond ____ hours in first labors, and usually does not extend beyond ____ hours in subsequent labors.
- A minimum cervical dilatation rate of ____ cm/hour throughout active first stage is unrealistically fast for some women and is therefore not recommended for identification of normal labor progression.
- A slower than ____ cm/hour cervical dilatation rate alone should not be a routine indication for obstetric intervention.
ACTIVE PHASE: WHO, 2018
* The duration of active first stage (from 5 cm until full cervical dilatation) usually does not extend beyond 12 hours in first labors, and usually does not extend beyond 10 hours in subsequent labors.
- A minimum cervical dilatation rate of 1 cm/hour throughout active first stage is unrealistically fast for some women and is therefore not recommended for identification of normal labor progression.
- A slower than 1-cm/hour cervical dilatation rate alone should not be a routine indication for obstetric intervention.
ACTIVE PHASE
* Duration: nulliparas ____ hrs and ____ hrs in multiparas
- Show and perhaps spontaneous ____ may occur
- By the end of the active phase, contractions have a frequency of ____ min, duration of ____ seconds, and ____ intensity
ACTIVE PHASE
* Duration: nulliparas 3 hrs and 2 hrs in multiparas
- Show and perhaps spontaneous rupture of the membranes may occur
- By the end of the active phase, contractions have a frequency of 2 -3 min, duration of 60 seconds, and strong intensity
TRANSITION PHASE
* contractions reach their peak of intensity which is ____, occurring every ____ min with duration of ____ seconds and causing maximum dilatation of ____ cm.
- By the end of this phase, both ____ and complete ____ have occurred
TRANSITION PHASE
* contractions reach their peak of intensity which is strong, occurring every 2-3 min with duration of 60-70 seconds and causing maximum dilatation of 8-10 cm.
- By the end of this phase, both full dilatation (10 cm) and complete cervical effacement (obliteration of the cervix) have occurred
TRANSITION PHASE
* Does not usually last longer than 3 hours for nulliparas or longer than 1 hour for multiparas; increased by approx. 1 hour if epidural anesthesia is used
TRANSITION PHASE - Characteristics
* Increasing bloody show
* Hyperventilation
* Generalized discomfort, including low backache, shaking and crampin in legs, and increased sensitivity to touch
* Increased need for partner’s and/or nurse’s presence and support
* Restlessness
* Increased apprehension and irritability
* An inner focusing on her contractions
* A sense of bewilderment, frustration, and anger at the contractions
* Requests for medications
* Hiccupping, belching, nausea, or vomiting
* Beads of perspiration on the upper lip of brow
* Increasing rectal pressure and feeling the urge to bear down
MATERNAL ASSESSMENT
INITIAL INTERVIEW AND PHYSICAL EXAMINATION
Obtain information about the following:
* Woman’s name and age
* LMP and expected date of birth
* Frequency, duration, and intensity of contractions
* Amount and character of show
* Whether rupture of membranes has occurred
* Vital signs (assessed between contractions)
* Time the woman last ate
* Any known drug allergies
* Past pregnancy and previous pregnancy history
* Her birth plan or what individualized measures she has planned
MATERNAL ASSESSMENT
HISTORY
* Physical and psychological events
* Review of past pregnancies
* General health
* Family medical information
* Note that all date are necessary to plan nursing care
MATERNAL ASSESSMENT
CURRENT PREGNANCY HISTORY
* OB score
* A description of this pregnancy
* Plans for labor
* Future child care
MATERNAL ASSESSMENT
PAST PREGNANCY HISTORY
Document the following:
* Number
* Dates
* Types of birth
* Any complications and outcomes
* Sex and birth weights of children
* Current health status of the children
MATERNAL ASSESSMENT
MATERNAL ASSESSMENT
PAST HEALTH HISTORY
* Previous surgeries
* Heart disease or diabetes
* Anemia
* TB
* Kidney disease or hypertension
* STI such as Herpes
* Woman’s lifestyle
MATERNAL ASSESSMENT
FAMILY MEDICAL HISTORY
Ask if any family member is/has:
* Cognitively challeneged
* Heart disease
* Blood dyscrasia
* DM
* Kidney disease
* Cancer
* Allergies
* Seizures
* Congenital disorder
MATERNAL ASSESSMENT
PHYSICAL EXAMINATION
* Thorough PE, including a pelvic examination, to confirm the presentation and position of the fetus and the stage of cervical dilatation
* Include inspection, palpation, and auscultation
MATERNAL ASSESSMENT
VITAL SIGNS - Temperature
* Obtained q4h
* >37.2 C (99 F) → infection
* on NPO, ↑ temp → dehydration
* After rupture of the membranes, temperature should be taken q2h
MATERNAL ASSESSMENT
VITAL SIGNS - Pulse and Respiration
* Q4h
* PR: 70-80bpm
* PR >100 bpm → tachycardia (dehydration/ hemorrhage)
* RR:18-20 cpm
* Contractions = ↑RR
