Intrapartal Period Flashcards
Intrapartal period begins with first sign if true labor when what happens?
Contractions cause cervix to change
What is the intrapartal period?
The time from the onset of true labor to the birth of the infant and delivery of the placenta
Are contractions regular or irregular during true labor?
Regular. They are regular contractions that increase in frequency, duration, and intensity
Series of processes by which the products of conception are expelled from the maternal uterus
Labor
Delivery is also known as….
Confinement,childbirth, parturition
What is the preferred pelvic shape for vaginal birth
Gynecoid pelvis
Characteristics of gynecoid pelvis
True female pelvis, 50% of women have it! inlet is round and outlet is roomy, most favorable for vaginal birth
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
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
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
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.
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.
What is above linea terminalis what is below it?
False pelvis is above, true pelvis is below
What are the parts of a true pelvis
Inlet, outlet, cavity
Why are joints and connective tissue more relaxed, elastic?
Under influence of relaxin (released from placenta) and estrogen (from placenta)
Diagonal conjugate is a ________ measurement
Manual
It’s an estimate
What is Subpubic angle to middle of sacral promontory? What is normal?
Diagonal conjugate
12.5 cm
What is obstetric measurement
(Estimate)Distance estimated from the diagonal conjugate subtract 1.5 cm to get the true measurement
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)
Where does the coccyx move at?
Sacrococcygeal joint
What is the pelvic floor/diaphragm largely formed by
Levator ani muscles and coccygeal muscles
Changed shape of the fetal skull at birth as a result of overlapping of the cranial bones
Molding
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
What does fetal lie refer to
Relationship of the cephalocaudal axis of the fetus and the cephalocaudal axis of the pregnant woman
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
