Intrapartal Care

Question 1

Difference between primary and secondary force

Answer 1

Primary force is uterine muscular contractions which cause the changes in the 1st stage of labor complete effacement and dilatation of the cervix.

2. Secondary force is the use of abdominal muscles to push during the 2nd stage of labor.

Question 2

Phases of contractions:

And how to describe them

Answer 2

Contractions have 3 phases

1. Increment,
2. Acme (peak)
3. decrement (letting up)

Description of contractions –

• frequency (time between beginning of one to the beginning of the next),
• duration (measured from the beginning of the contraction to the end of said contraction),
• intensity

Question 3

SIGNS of LABOR

Answer 3

• Lightening – fetus settles into pelvic inlet – mother can breathe more easily
• Braxton Hicks Contractions – irregular, intermittent contractions, may be uncomfortable and exhausting
• Cervical Changes – softening of the cervix is called ripening
• Bloody show – with softening and effacement of the cervix the mucous plug is expelled.
• Rupture of Membranes (ROM)– approx 12% of ♀ the amniotic membranes rupture before onset of labor – p ROM 80% of women will experience spontaneous labor within 24 hrs.
• Sudden burst of energy – some ♀ report approx. 24-48 hrs before labor.
• Other signs – Wt loss 2.2 – 6.6 kg, increased backache, diarrhea, indigestion or N/V

Question 4

STAGES OF LABOR

Answer 4

• FIRST STAGE- begins with contractions; ends with fully dilated cervix – 10cm
• SECOND STAGE- full dilatation to birth of infant. Crowning to pushing the fetus out of the birth canal. Assessment BP, P, R q 5-15 min, continual uterine contractions palpated, FHR q 15 for low-risk and q 5 for high risk women.
• THIRD STAGE- begins with expulsion of the infant and placenta
• Fourth Stage – according to some clinicians – 1-4 hours after expulsion of placenta – uterus effectively contracts to control bleeding.

Question 5

Phases of first stage of labor. (begins with contractions; ends with fully dilated cervix – 10cm.)

Answer 5

o Latent phase (preparatory) onset to rapid cervical dilatation 1-4 cm, contractions every 10-30 minutes, 15-20 second duration. progressing to every 5-7 min. 30-40 sec. Assessment BP, R every hour, Temperature every 4 hrs.; Contractions every 30 min. FHR every hour low-risk, every 30 min high.

o Active phase- cervical dilatation 4 – 7cm. Stronger contractions lasting 40-60 seconds q 2-3 minutes. Assessment – BP, P, R q hr contractions q 30 min. FHT q 30 min low risk, q 15 min high risk ♀

o Transition phase- maximum dilatation of 8-10 cm. Contractions reach their intensity peak, full dilatation, complete cervical effacement. Phase ends with an irresistible urge to push. BP, P, R q 30min, FHR q 30 min low, q15 min high

Question 6

Abruptio Placentae:

Placenta Previa:

Answer 6

o Abruptio Placentae – premature separation of the normally implanted placenta from the uterine wall – sudden onset, toxemia may be present, pain is severe and steady, uterine tenderness, tone is firm to very hard.

o Placenta Previa – improperly implanted in lower uterine segment – onset is quiet, color of blood is bright red, toxemia is absent, pain only in labor, no uterine tenderness, tone is soft and relaxed.

Question 7

AMNIOTOMY

Answer 7

artificial rupturing of membranes with woman in dorsal recumbent position membranes –
most common operative procedure in OB.
At least 2cm of cervical dilatation must be present –
method of induction of labor.

Question 8

INDUCTION of labor

Answer 8

-artificially starting labor at term.
Hygroscopic suppositories of seaweed and prostaglandin gel can be used to ripen cervix.
Oxytocin induces contractions.

Contraindications-client refusal, placenta previa, transverse fetal lie, prolapsed cord, active genital herpes.

Oxytocin infusion – IV admin .
Misoprostol 25ug tablet inserted in the posterior vaginal fornix.

Question 9

What to watch for when administering magnesium

Answer 9

Respiratory rate

Question 10

What is the nitrasine test?

Answer 10

Vaginal fluid test- checks if fluid is amniotic.

If the test strip turns blue then that means the pH is greater than 6 and most likely membranes have ruptured.

Question 11

Action to take with bleeding umbilical cord.

Answer 11

Place another clamp.

Never re-clamp. Always add another clamp.

Question 12

Mom c/o dizziness while supine. What is next action?

Answer 12

Position to left side.

Supine hypertensive syndrome

Question 13

When is Lochia Rubra vs. Lochia Serosa?

Answer 13

Lochia Rubra for the first 3 days,
Lochia Serosa for 3-7 days,
Lochia alba after that.

Question 14

When is the fetus most susceptible to the effects of rubeola?

Answer 14

2-9 weeks

Question 15

3 phases of uterine contractions?

Answer 15

Increment
Acme
Decrement

Question 16

How to measure duration and frequency of contractions

Answer 16

Frequency: measure beginning of one to the beginning of next.

Duration: from moment uterine muscles begins to contract to full relaxation.

Question 17

What 3 things are assessed in vaginal assessment of woman in labor?

Answer 17

Dilation
Effacement
Station

Question 18

What is effacement and how is it measured

Answer 18

Also called thinning of cervix.
Shortening of cervical canal.
Measured from 0-100

Question 19

N-face position

Answer 19

Face to face with baby.

Shows bonding.

Question 20

Acrocyanosis

Answer 20

Baby with pink body but blue extremities

Question 21

When do you stop pitocin?

Answer 21

If contraction lasts longer than 90 seconds

Question 22

Choice between checking glucose and feeding infant:

Answer 22

Always choose to feed the infant

Question 23

Nursing action for late decelerations

Answer 23

Position to left side

8-12 L oxygen