Intrapartal Period Flashcards by Bailey Pontius

Intrapartal period begins with first sign if true labor when what happens?

Contractions cause cervix to change

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What is the intrapartal period?

The time from the onset of true labor to the birth of the infant and delivery of the placenta

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Are contractions regular or irregular during true labor?

Regular. They are regular contractions that increase in frequency, duration, and intensity

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Series of processes by which the products of conception are expelled from the maternal uterus

Labor

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Delivery is also known as….

Confinement,childbirth, parturition

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What is the preferred pelvic shape for vaginal birth

Gynecoid pelvis

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Characteristics of gynecoid pelvis

True female pelvis, 50% of women have it! inlet is round and outlet is roomy, most favorable for vaginal birth

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Characteristics of anthropoid pelvis

Most common in men occurs in 25% of women, pelvic inlet is oval and the sacrum is long, producing a deep pelvis. Not as good as gynecoid but better than android and platypelloid

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Characteristics of android pelvis

Considered male shaped pelvis. Funnel shape. Occurs in 20% of women. Pelvic inlet is heart shaped and the posterior segments are reduced in all pelvic planes. Prognosis for labor is poor leading to C/S

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Characteristics of platypelloid pelvis

Flat pelvis, least common, 5% incidence, pelvic cavity is shallow but widens at the pelvic outlet making it difficult for fetus to descend through mid-pelvis. Poor labor prognosis

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What is false pelvis composed of

Upper flared parts of the two iliac bones with their cavities and the wings of the base of the sacrum.

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What divides false pelvis from true pelvis

Linea terminalis—-Imaginary line drawn from the sacral prominence at the back of the superior aspect of the symphysis pubis at the front of the pelvis.

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What is above linea terminalis what is below it?

False pelvis is above, true pelvis is below

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What are the parts of a true pelvis

Inlet, outlet, cavity

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Why are joints and connective tissue more relaxed, elastic?

Under influence of relaxin (released from placenta) and estrogen (from placenta)

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Diagonal conjugate is a ________ measurement

Manual

It’s an estimate

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What is Subpubic angle to middle of sacral promontory? What is normal?

Diagonal conjugate

12.5 cm

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What is obstetric measurement

(Estimate)Distance estimated from the diagonal conjugate subtract 1.5 cm to get the true measurement

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Are we expecting the transverse diameter to be wider or narrower than the front to back measurement

We are expecting the transverse diameter to be wider than the front to back ( AP diameter)

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Where does the coccyx move at?

Sacrococcygeal joint

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What is the pelvic floor/diaphragm largely formed by

Levator ani muscles and coccygeal muscles

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Changed shape of the fetal skull at birth as a result of overlapping of the cranial bones

Molding

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What should you tell parents if they are concerned about the distortion of their newborns head?

Reassure the oblong shape is only temporary is usually all that is needed to reduce their anxiety

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What does fetal lie refer to

Relationship of the cephalocaudal axis of the fetus and the cephalocaudal axis of the pregnant woman

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What is the fetal lie most of the time

Longitudinal (99.5%) head or butt coming first

Relationship of fetal parts to one another

Fetal attitude

What is most common fetal attitude when labor begins?

With all joints flexed- the fetal back is rounded, the chin is on the chest, the thighs are flexed on the abdomen, and the legs are flexed at the knees

What are the three fetal presentations

Cephalic, breech, shoulder

What is fetal presentation determined by

Fetal lie and body part of fetus that enters the maternal pelvis first

The relationship of a given point on the presenting part of the fetus to a designated point on the maternal pelvis

Fetal position

What are the cephalic landmarks

Vertex Occiput Face= mentum (M), brow or military

Mentum also means

Chin

The chin (mentum) designates a ______ presentation

Face

Most common fetal position

Occiput anterior

What are positions other than Occiput called

Malpositions

What does a posterior position cause

More pain for mom, trauma for fetus, may prolong labor

Blunted prominences, mark the narrowest diameter through which the fetus must pass

Ischial spines

Presenting part BELOW the spine =assign _______ numbers

Positive numbers

Presenting parts ABOVE spines = assign _______ numbers

Negative numbers

What does +4 mean

Crowning

Ischial spines are ___ station

"0" Station

The largest part of the presenting part reaches or passes through the pelvic inlet

Engagement

Where are fetal heart tones heard best

On back

Largest area to pass through the inlet in a breech presentation

Intertrochanteric diameter

Flexed, in a cephalic presentation, largest part of fetal skull to pass through pelvis

Biparietal diameter

The fetal head is freely movable above the inlet

Floating

Just before engagement occurs, the head begins to descend into inlet

Dipping

Rebound of fetus in response to push against woman's cervix

Ballottment

What questions does Leopolds Maneuvers answer

- what fetal part (head or buttocks) is located in the fundus? - on which maternal side is fetal back located? - what is the presenting part? - is the fetal head flexed and engaged in the pelvis?

Primary contractions are known as ________ contractions

Involuntary

Secondary are _________ contractions

Voluntary

3 parts of contraction

Increment= increase Acme=strongest Decrement= decreasing

Period of increase in intensity. Longer than other two combined.

Increment

Period of greatest intensity of a contraction

Acme

Decreasing/ letting go period of the contraction

Decrement

Timed from beginning of one contraction to the beginning of the next

Frequency

Timed from beginning of one contraction until it ends

Duration

Strength of a contraction

Intensity

How can you tell intensity

Palpate uterine wall with fingers Can be easily indented= mild Cannot be indented= strong Moderate in between

You must have a _______ period between contractions

Resting

What should you do with early decelerations

Just watch, turn on left side

What happens with early deceleration

Happens with head compression then heart rate does back up after

Are late decelerations okay?

No! Means there is uteroplacental insufficiency. The fetus is not responding after contraction has stopped squeezing

What is going on with variable decelerations?

Umbilical cord compression

when do you do assessments on the laboring mother in a low risk situation

Every 30 minutes during 1st stage | Every 15 minutes during 2nd and 3rd stages

What are two things you can do to help a laboring mother

Encourage slow breathing | Offer support to decrease anxiety

When should you check vitals on the mother during the laboring process

In between contractions

After ROM what is the most precise way to monitor the fetus

Fetal Scalp Electrode It is a direct ECG of the fetal heart rate

What can be inserted into the uterus to give a true measurement of the strength of a contraction

Intrauterine pressure catheter

What should a nurse and doctor try to eliminate if the woman is bleeding

Vaginal exams

How do you preform vaginal exams differently if a woman has ROM and if she has not

If she has you must use sterile gloves | If she has not you can just use clean gloves

What could pushing before woman is 10 cm dilated cause

Prolonged labor and more chance of a tear

What are the different emotions the women will experience during the latent phase? Active phase? Transition phase?

Latent- talking, laughing, walking Active- more quiet/sleepy Transition- very irritable

What is significant about the second stage

Baby is born

Why would you obtain a fetal scalp blood sample during labor

If baby is having decreased HR you need to see if it is affecting the fetus

Fetal fibronectin

Glycoprotein produced by trophoblast and other fetal tissues

What is fetal fibronectin a strong predictor of

Preterm labor if found in cervicovaginal secretions between 24-34 weeks

Why do you need to obtain a lecithin/sphingomyelin sample

Make sure baby does not have RDS due to lack of surfactant

What is phosphatidylglycerol

A phospholipid found in surfactant Often obtained with the lecithin/sphingomyelin ratio

When is best to ambulate with laboring mother

First stage

Abruptio placenta

Placenta tears from uterine wall abruptly

Uterine atony

Failure for uterus to contract properly

If you are inducing a women into labor with oxytocin and within an hour her contractions are lasting 60-90 seconds and coming every 3 minutes what is the first action you would do

Stop oxytocin immediately

What are four things you can do to help mother with comfort during labor

Change bed linens Empty bladder Keep feet warm Coach with breathing