Chapter 8: Intrapartum Care

Question 1

Maternal Changes before onset of labor

Answer 1

Contractions increase in strength and intensity

Discomfort over uterine fundus with radiation to low back and abdomen

Lightening = Pt reports change in abdomen shape and feels baby as lighter as fetal head descends into the pelvis.

Bladder hit = need to pee.

Breathe easier since Diaphragm no longer irritated

Bloody Show – Cervix begins thinning (effacement), mucus from endocervical glands, small amount of bleeding from small vessels in area. Internal OS slowly drawn into lower uterine segment

Question 2

Braxton Hicks contractions?

Answer 2

b. Spontaneous contractions (Braxton-Hicks) = False labor = not associated with dilation of the cervix. Not felt by the patient at first, and occur throughout pregnancy, becoming stronger and more frequent later, and patient perceives them.
i. Makes history difficult to interpret. Labor or not labor?
ii. Typically less intense, shorter duration. Discomfort in lower abdomen and groin. Resolve often with hydration, analgesia, ambulation.

Question 3

When should a provider be contacted for possible labor?

Answer 3

i. Contractions every 5 minutes for one hour
ii. Sudden gush of fluid or constant leakage (ROM = Rupture of membranes)
iii. Significant vaginal bleeding
iv. Significant decrease in fetal movement

Question 4

What are leopold maneuvers? Describe them.

Answer 4

Leopold Maneuvers: Four palpations of the uterus and fetus through the abdominal wall to determine fetal lie, presentation, and position

a. What’s in the fundus (head or breech, breech less defined)
b. Small Parts: Arms? Legs? Spine?
c. Descent of the presenting part (breech or head)
d. Cephalic prominence (flexion of head)

Question 5

What is lie?

Answer 5

a. Lie: Fetal axis in comparison to mom’s. 99% = longitudinal

Question 6

What is presentation?

Answer 6

b. Presentation: Part of fetus lowest in birth canal

Question 7

What is position?

Answer 7

c. Position: Relation of fetal presenting part to R or L of mom pelvis

Question 8

When do we not do a vaginal exam to detect degree of effacement and cervical dilation?

Answer 8

a. Contraindicated in women with premature ROM or vaginal bleeding

Question 9

What is effacement?

Answer 9

b. Effacement: Shortening of cervical canal from length of 2cm to a mere circular orifice with almost paper-thin edges. Expressed as percent of thinning

Question 10

What is dilation?

Answer 10

c. Dilation: After 100% effacement, when there is complete opening present.

Question 11

What is fetal station and why do we care?

Answer 11

Identify the level of the fetal presenting part in the birth canal in relation to ischial spines (halfway between pelvic inlet and outlet, where 0 = at spines). SIGNIFICANT at 0 as this means the widest part of the head has passed into the inlet. +5 = at introitus

Question 12

Describe the first stage of labor

Answer 12

a. First Stage: Onset of labor to full cervical dilation (10cm)
i. Latent phase: Cervical effacement and early dilation
ii. Active phase: More rapid cervical dilation (usually 4cm and on)

Question 13

Discuss the second stage of labor

Answer 13

b. Second Stage: Complete cervical dilation through delivery of infant

Question 14

Discuss the third stage of labor

Answer 14

c. Third Stage: End of baby delivery to delivery of placenta

Question 15

Discuss the 4th stage of labor

Answer 15

d. Fourth Stage: 2 hours post-partum s/p delivery of placenta as patient undergoes significant physiologic adjustment

Question 16

What are the cardinal movements?

Answer 16

7

Engagement
Flexion 
Descent
Internal Rotation
Extension
External Rotation/Restitution
Expulsion

Question 17

Describe the first cardinal movement, engagement.

Answer 17

i. Engagement – 0+ (Biparietal part of head below pelvic inlet)
1. Days to weeks prior to labor if first. Onset of labor if you’ve got experience.
2. Means the pelvis can physically have the baby

Question 18

Describe the second cardinal movement, flexion

Answer 18

ii. Flexion

1. Allows smaller diameters of fetal head to present to maternal pelvis

Question 19

Describe the third cardinal movement, descent

Answer 19

iii. Descent

1. Greatest rate of descent occurs at end of first stage and into the second stage

Question 20

Describe the fourth cardinal movement, internal rotation

Answer 20

iv. Internal Rotation

1. Facilitates presentation of optimal diameters of the head to bony pelvis, typically from transverse to ant or post

Question 21

Describe the fifth cardinal movement, extension

Answer 21

v. Extension

1. Occurs as fetus reaches introitus. To accommodate upward curve of the birth canal, the flexed head now extends

Question 22

Describe the 6th cardinal movement, external rotation

Answer 22

vi. External Rotation/ Restitution

1. After delivery of the head, head rotates to sit anterior to shoulders

Question 23

Describe the 7th cardinal movement, expulsion

Answer 23

vii. Expulsion

1. Rapid delivery of the body

Question 24

Why do we use the supine left lateral position during normal labor?

Answer 24

1. Supine left lateral keeps uterus off of the IVC to improve cardiac output