Intrapartum Period Flashcards
by Prof Glinoga
1
Q
The period that extends from the beginning of contractions that cause cervical dilation to the first 1 to 4/6 hours delivery of the newborn and placenta
A
Intrapartum
2
Q
Refers to the medical and nursing care given to the pregnant woman during labor and delivery
A
Intrapartal Care
3
Q
What are the Five (5) Theories of the Onset of Labor
A
- Uterine Stretch Theory
- Prostaglandin Theory
- Progesterone Deprivation
- Theory of Aging Placenta
- Oxytocin Stimulation Theory
4
Q
This theory is due to the stimulation of “arachidonic acid” substance, this hormone causes contractions
A
Prostaglandin Theory
5
Q
This theory is all about the pressure on the nerve endings and increased irritability of the uterine musculature brought about by the developed fetus cause contractions. The uterus is a hollow organ that once it is stretched to its maximum potential, it will always contract and expel content.
A
Uterine Stretch Theory
6
Q
Steps in labor according tom Prostaglandin Theory
A
pain –> contraction –> cervix dilation –> expulsion of the product of conception
7
Q
This theory refers to the sudden drop in this hormone near delivery stimulates labor
8-9 months (this hormone goes down)
decreased hormone –> there will be contractions –> possible labor
A
Progesterone Deprivation
7
Q
As the placenta begins to degenerate by 36 weeks. The body perceives it as a foreign body
A
Theory of Aging Placenta
8
Q
The production of the posterior pituitary gland of this substance will cause uterine contractions
Natural: Anterior Pituitary Gland (nipple)
Artificial: Through IV or IM, production of the posterior pituitary gland of this substance will cause uterine contractions
A
Oxytocin Stimulation Theory
9
Q
What are the 6 P’s of Labor?
A
- Passenger
- Passageway
- Power
- Placenta
- Psyche
- Prayer
10
Q
This suggests that any hollow organ, such as the uterus, once stretched to its maximum, will contract and expel its contents. This theory posits that the developed fetus causes uterine contractions due to pressure on nerve endings and increased irritability of uterine muscles
A
Uterine Stretch Theory
11
Q
This theory suggests that the sudden drop in progesterone near delivery stimulates labor. The decrease in progesterone leads to uterine contractions and the onset of labor.
A
Progesterone Deprivation Theory
12
Q
This theory proposes that prostaglandins, produced due to the stimulation of arachidonic acid, cause uterine contractions. This leads to cervical dilation and the expulsion of the fetus
A
Prostaglandin Theory
13
Q
Refers to the fetus and its ability to pass through the birth canal
A
Passenger
14
Q
Uterine contractions and maternal pushing efforts
A
Power
15
Q
The bony pelvis and soft tissues through which the fetus passes
A
Passageways
16
Q
Placental expulsion
A
Placenta
17
Q
The mother’s mental status and stress level
A
Psyche
18
Q
Respect for the spiritual needs of the mother
A
Prayer
19
Q
What are the four (4) stages of labor?
A
- First Stage (Dilating Stage)
- Second Stage (Expulsion Stage)
- Third Stage (Placental Stage)
- Fourth Stage (Immediate Recovery Period)
19
Q
What are the important measurements of the fetal head during labor?
A
> Biparietal diameter: 9.25 cm (largest transverse diameter)
Bitemporal diameter: 8.0 cm
Bimastoid diameter: 7.0 cm (smallest transverse diameter, quicker delivery)
20
Q
Stages of Labor:
From the onset of true contractions to full cervical dilation.
A
First Stage (Dilating Stage)
20
Q
Stages of Labor:
From full cervical dilation to delivery of the fetus.
A
Second Stage (Expulsion Stage)
21
Q
Stages of Labor:
From delivery of the fetus to the delivery of the placenta.
A
Third Stage (Placental Stage)
22
Stages of Labor:
From delivery of the placenta to 1-4 hours postpartum
Fourth Stage (Immediate Recovery Period)
23
What are the three (3) phases of the First Stage of Labor?
Latent, Active, and Transitional Phase
Mnemonics
L: Labor
A: Actively
T: Transitioning
24
Phases of the First Stage of Labor:
Cervical dilation from 0 to 3 cm; contractions every 5-10 minutes.
Latent Phase
25
Phases of the First Stage of Labor:
Cervical dilation from 4 to 7 cm; contractions every 3-5 minutes.
Active Phase
25
Phases of the First Stage of Labor:
Cervical dilation from 8 to 10 cm; contractions every 2-3 minutes
Transitional Phase
26
What are the causes of labor pain?
Causes of Labor Pain includes:
> Uterine contractions
> Hypoxia in the myometrium
> Cervical stretching and dilation
> Stretching of supporting tissues
> Compression of nerve ganglia
> Emotional tension due to fear
27
What are the phases of labor contractions?
Increment (Crescendo)
Acme (Peak)
Decrement (Decrescendo)
28
Phases of Labor Contractions:
The gradual buildup of contraction strength, starting from the fundus.
Increment (Crescendo)
29
Phases of Labor Contractions:
The height of contraction intensity, felt mostly in the abdomen.
Acme (Peak)
30
Phases of Labor Contractions:
The decrease in contraction strength as it ends
Decrement (Decrescendo)
31
What are some key interventions for pain management during labor?
Key interventions include:
> Breathing techniques
> Massages
> Warm baths
> Aromatherapy
> Prayer and mental focus exercises
> Yoga and biofeedback techniques
32
It involves covering the mother’s anus with a sterile towel and exerting upward and forward pressure on the fetal chin during delivery, while applying gentle pressure to the emerging fetal head to control its delivery
Ritgen's Maneuver
33
What are the normal fetal heart rate (FHR) parameters?
The normal fetal heart rate for a full-term fetus is between 120 and 160 beats per minute (bpm). Variations beyond this range may indicate distress
34
What does tachycardia in the fetus signify, and what are possible causes?
Tachycardia is when the fetal heart rate exceeds 160 bpm for over 10 minutes. Causes include early fetal hypoxia, maternal fever, or certain drugs (e.g., atropine). It's considered serious if associated with late or severe variable decelerations
35
What are the characteristics of late decelerations, and what interventions are necessary?
Late decelerations are a fall in FHR after a contraction begins, often due to uteroplacental insufficiency. This is a sign of fetal distress, and interventions include positioning the mother on her left side, elevating her legs, increasing IV fluids, and administering oxygen
36
What is an epidural, and when is it typically administered during labor?
An epidural is a type of regional anesthesia where a catheter is placed in the space between L3-L4 vertebrae. It is typically administered during the first stage of labor after the cervix is 5-6 cm dilated and may be used throughout labor
37
What are the side effects of spinal anesthesia, and how does it differ from an epidural?
Spinal anesthesia is administered directly into the subarachnoid space and is usually given just before delivery. Side effects include hypotension and possible postpartum headaches, as it affects both the vagina and lower extremities. Unlike an epidural, the dura is penetrated, which can lead to cerebrospinal fluid leakage
38
Describe the process of fetal descent during labor.
Fetal descent refers to the downward movement of the fetus into the birth canal, primarily due to uterine contractions, pressure from the amniotic fluid, and contractions of abdominal muscles. This process is most notable during the second stage of labor
39
What is internal rotation, and why is it important during labor?
Internal rotation occurs as the fetal head turns to align with the mother's pelvic inlet, moving from a transverse position to an anteroposterior one. This rotation is crucial for the fetus to pass through the birth canal efficiently
40
What are the key assessments performed during the fourth stage of labor?
Key assessments during the fourth stage of labor include checking the uterine fundus every 15 minutes in the first hour, monitoring vaginal discharge (lochia), blood pressure, and ensuring bladder function. It's important to monitor for uterine atony and hemorrhage
41
How is uterine atony treated immediately postpartum?
Uterine atony, a condition where the uterus fails to contract properly, is treated by fundal massage, applying an ice pack to the uterus, and using medications like oxytocin to promote contraction. Nipple stimulation can also encourage uterine contraction
42
What is a failure to progress during labor, and what might cause it?
Failure to progress is when cervical dilation slows or stops despite regular contractions. Causes may include fetal malposition, cephalopelvic disproportion, or inadequate contractions. Management may involve labor augmentation with oxytocin or amniotomy
43
What are the signs of meconium-stained amniotic fluid, and why is it concerning?
Meconium-stained amniotic fluid indicates that the fetus has passed stool in utero, often due to fetal distress. This can lead to meconium aspiration syndrome, where the fetus inhales the contaminated fluid, potentially leading to respiratory complications
44
What are the different types of pelvis?
1. Gynecoid
2. Anthropoid
3. Android
4. Platypelloid
45
Type of Pelvis:
The most common female pelvis, rounded and ideal for vaginal delivery.
Gynecoid
46
Type of Pelvis:
Narrow and oval-shaped, still adequate for vaginal delivery.
Anthropoid
46
Type of Pelvis:
Wedge-shaped and more common in males, less favorable for labor.
Android
47
Type of Pelvis
Flat, wide pelvis, offering a 50/50 chance for vaginal delivery
Platypelloid
48
What is the role of pelvic measurements in labor, and what is the significance of the diagonal conjugate?
Pelvic measurements help determine if a woman can give birth vaginally. The diagonal conjugate is measured between the sacral promontory and the symphysis pubis and is usually around 11.5-12.5 cm. It is a key measure to predict if the pelvis is large enough for vaginal delivery
49
What are the different types of cephalic presentations?
1. Vertex
2. Sinciput (Military)
3. Brow
4. Face
50
Type of Cephalic Presentation:
The head is fully flexed, and the occiput is the presenting part (most common and favorable)
Vertex
51
Type of Cephalic Presentation:
The head is in a neutral position, with the sinciput presenting.
Sinciput (Military)
52
Type of Cephalic Presentation:
The head is partially extended with the brow as the presenting part.
Brow
53
Type of Cephalic Presentation:
The head is fully extended, and the face is the presenting part
Face
54
What is meant by fetal station?
Fetal station refers to the relationship of the fetal presenting part to the mother's ischial spines
55
It means that the presenting part is at the level of the ischial spines, indicating the fetus is engaged in the pelvis
Station 0
56
What are the common danger signs of labor for the fetus?
Common danger signs for the fetus during labor include:
> Abnormal fetal heart rate (too high or too low)
> Meconium staining in the amniotic fluid
> Fetal hyperactivity or lack of activity
> Fetal acidosis
57
What are common maternal danger signs during labor?
Maternal danger signs during labor include:
> Rising or falling blood pressure
> Abnormal pulse rate
> Inadequate uterine contractions
> Increased maternal apprehension
> Pathologic retraction ring (Bandl’s ring)
58
What are the key breathing techniques used during labor?
The key breathing techniques used during labor include:
1. Cleansing breath: A deep breath taken at the beginning and end of each contraction.
2. Slow chest breathing: Used during early, milder contractions at a rate of 8-10 breaths per minute.
3. Rapid chest breathing: Faster breathing at 16-20 breaths per minute for more intense contractions.
4. Shallow chest breathing: Performed at the peak of intense contractions
59
Why are breathing techniques important during labor?
Breathing techniques help the mother focus, promote relaxation, provide adequate oxygenation, and help manage the pain and anxiety of labor by distracting from the intense sensation of contractions
60
What are the two types of Episiotomy?
1. Midline Episiotomy
2. Mediolateral Episiotomy
61
It is a surgical incision made in the perineum to prevent tearing during delivery.
Episiotomy
62
Type of Episiotomy:
A vertical incision in the middle of the perineum.
Midline Episiotomy
63
Type of Episiotomy:
An incision made at an angle away from the rectum, which offers less risk of extending into the rectum
Mediolateral Episiotomy
64
It is a quick assessment of a newborn’s health immediately after birth, measured at 1 and 5 minutes.
APGAR Score
65
APGAR Score
Appearance (skin color)
Pulse (heart rate)
Grimace (reflex irritability)
Activity (muscle tone)
Respiration (breathing effort)
Each category is scored from 0 to 2, with a total possible score of 10
66
What are the characteristics of the Latent Phase of the first stage of labor?
During the Latent Phase:
> Cervical dilation is between 0-3 cm.
> Contractions occur every 5-10 minutes and last for about 20-40 seconds.
> Contractions are mild, and the woman is usually excited and able to communicate well
67
What are the characteristics of the Active Phase of the first stage of labor?
In the Active Phase:
> Cervical dilation progresses from 4-7 cm.
> Contractions become more frequent, every 3-5 minutes, lasting 30-60 seconds.
> The intensity increases, and the woman may experience difficulty following directions due to discomfort
68
What happens during the Transitional Phase of the first stage of labor?
During the Transitional Phase:
> Cervical dilation reaches 8-10 cm.
> Contractions are very strong and occur every 2-3 minutes, lasting 45-90 seconds.
> The mother may experience severe pain, nausea, and the urge to push, with hyperesthesia (increased sensitivity to touch)
69
What are some non-pharmacological interventions to relieve labor pain?
Non-pharmacological interventions for labor pain include:
> Breathing techniques (slow and rapid chest breathing)
> Massage and back rubs
> Bathing or warm compresses
> Focusing and imagery
> Yoga and relaxation exercises
> Aromatherapy and essential oils
> Herbal preparations
70
What is the significance of emotional support during labor, and how does it help?
Emotional support during labor helps reduce the mother's anxiety, promotes relaxation, and enhances coping skills. Support from family members or healthcare professionals can provide reassurance and reduce the perception of pain, improving the overall labor experience
71
What are the impending signs of labor?
1. Lightening
2. Increased Braxton Hicks contractions
3. Cervical Ripening
4. Sudden Burst of energy
5. Weight loss
72
Impending Signs of Labor:
When the fetus descends into the pelvis, relieving pressure on the diaphragm.
Lightening
73
Impending Signs of Labor:
These irregular contractions increase in frequency and intensity.
Increased Braxton-Hicks contractions
74
Impending Signs of Labor:
The cervix softens and thins.
Cervical ripening
75
Impending Signs of Labor:
Known as the "nesting instinct," the mother may feel a surge in energy.
Sudden burst of energy
76
Impending Signs of Labor:
The mother may lose 1-2 pounds before labor begins
Weight loss
77
Contractions become regular, increase in intensity, and lead to cervical dilation. Pain usually starts in the lower back and radiates to the abdomen.
True labor
78
Contractions remain irregular and do not increase in intensity or lead to cervical changes. Pain is often confined to the abdomen and may disappear with movement or rest
False Labor
79
What are the signs of placental separation?
Signs of placental separation include:
> The uterus changes shape from a soft disc to a firm, globular shape (Chalkin's sign).
> A sudden gush of blood occurs as the placenta detaches.
> The umbilical cord lengthens as the placenta moves down.
> The uterus rises slightly in the abdomen
80
What are the two mechanisms of placental expulsion?
1. Schultz Mechanism
2. Duncan Mechanism
81
Mechanism of Placental Expulsion:
The placenta separates from the center first and folds onto itself, presenting the shiny fetal side (80% of cases).
Schultz Mechanism
82
Mechanism of Placental Expulsion:
The placenta separates from the edges first, presenting the maternal side, which is rough and red
Duncan Mechanism
83
What is the primary goal during the fourth stage of labor?
The primary goal during the fourth stage of labor is to monitor the mother's recovery and prevent postpartum hemorrhage. This involves assessing the uterine tone (fundus), ensuring it is firm, and checking for excessive vaginal bleeding
84
What nursing interventions are important to prevent uterine atony postpartum?
To prevent uterine atony:
> Perform regular fundal massage to encourage uterine contraction.
> Apply an ice pack to the uterus to promote contraction.
> Encourage the mother to breastfeed, as nipple stimulation helps trigger uterine contraction.
> Administer medications like oxytocin to support uterine tone
85
What are key nursing responsibilities during the second stage of labor (expulsion stage)?
Key nursing responsibilities during the second stage include:
> Monitoring maternal vital signs and fetal heart rate every 5 minutes.
> Coaching the mother to push during contractions.
> Observing for signs of impending birth, such as perineal bulging and the appearance of the fetal head.
> Assisting with perineal cleansing and preparing for delivery
86
What are some comfort measures provided to the mother during delivery?
Comfort measures include:
> Offering ice chips to keep the mother hydrated.
> Applying a cool cloth to her forehead.
> Supporting her body and extremities during pushing efforts.
> Encouraging changes in position to relieve pressure and promote comfort
87
It is a series of four abdominal palpations performed by the healthcare provider to determine fetal position, presentation, and engagement in the mother's pelvis. It helps assess the contour of the uterus, fetal lie, and location of the fetal back for monitoring
Leopold's Maneuver
88
What is the most favorable fetal position for vaginal delivery, and why?
The Left Occiput Anterior (LOA) position is the most favorable for vaginal delivery. In this position, the fetal head is flexed, and the occiput (back of the head) is oriented towards the mother's left side. This allows for optimal alignment with the birth canal and easier passage during labor
89
What are the types of breech presentation?
1. Complete Breech
2. Frank Breech
3. Footling Breech
4. Kneeling Breech
90
Type of Breech Presentation:
Both thighs and legs are flexed (legs tucked in).
Complete Breech
91
Type of Breech Presentation:
The thighs are flexed, and the legs are extended towards the head (most common)
Frank Breech
92
Type of Breech Presentation:
One or both feet are presenting, with the legs extended.
Footling Breech
93
Type of Breech Presentation:
The knees present first
Kneeling Breech
94
Why is breech presentation a concern during labor?
Breech presentation is a concern because the fetal head, which is the largest part of the body, is delivered last. This increases the risk of cord prolapse, head entrapment, and trauma to the fetus, making vaginal delivery more challenging and potentially dangerous
95
What are the key characteristics of effective uterine contractions during labor?
Effective uterine contractions are:
> Involuntary: Occur without conscious control, initiated by the uterus.
> Regular and rhythmic: Follow a consistent pattern, with increasing frequency and intensity.
> Longer and stronger: As labor progresses, contractions become more frequent, lasting longer and with greater intensity to facilitate cervical dilation and fetal descent
96
What are the phases of a single uterine contraction?
1. Increment (Crescendo)
2. Acme (Peak)
3. Decrement (Decrescendo)
97
Phase of Single Uterine Contraction:
The gradual build-up of contraction strength.
Increment (Crescendo)
98
Phase of Single Uterine Contraction:
The point of maximum intensity of the contraction.
Acme (Peak)
99
Phase of Single Uterine Contraction:
The gradual easing of contraction strength as it diminishes
Decrement (Decrescendo)
100
It is the premature separation of the placenta from the uterine wall before the delivery of the fetus. It is a medical emergency because it can result in severe maternal bleeding, fetal hypoxia, or death if the oxygen and nutrient supply is cut off
Placental abruption
101
It occurs when the placenta partially or completely covers the cervix. This condition can lead to painless vaginal bleeding and complicates vaginal delivery, often requiring a cesarean section to prevent severe hemorrhage
Placenta previa
102
What are the reasons for labor induction?
Labor induction may be necessary for several reasons, including:
> Post-term pregnancy (beyond 42 weeks)
> Premature rupture of membranes (PROM) without labor
> Fetal growth restriction
> Maternal medical conditions like diabetes or hypertension
> Suspected fetal compromise
103
What methods are used to induce labor?
Common methods of labor induction include:
> Amniotomy: Artificial rupture of membranes to stimulate labor.
> Oxytocin (Pitocin): IV administration to stimulate uterine contractions.
> Prostaglandin E2 gel: Vaginal suppositories to ripen the cervix and induce labor
104
What are common indications for a cesarean section (C-section)?
Common indications for a cesarean section include:
> Fetal distress (e.g., abnormal fetal heart rate)
> Breech or transverse fetal presentation
> Cephalopelvic disproportion (baby's head too large for mother's pelvis)
> Placenta previa
> Umbilical cord prolapse
> Previous C-section with complications or desire to avoid vaginal birth after cesarean (VBAC)
105
What are the potential complications associated with cesarean delivery?
Potential complications of cesarean delivery include:
> Infection
> Hemorrhage
> Blood clots
> Injury to surrounding organs (bladder, intestines)
> Surgical injury to the fetus
106
What are the primary causes of postpartum hemorrhage?
The primary causes of postpartum hemorrhage include:
> Uterine atony: The uterus fails to contract effectively after delivery.
> Retained placental fragments: Pieces of the placenta remain in the uterus, preventing full contraction.
> Cervical or vaginal lacerations: Tears in the birth canal that cause significant bleeding.
> Uterine inversion: The uterus turns inside out after delivery
107
How is postpartum hemorrhage managed?
Management includes:
> Fundal massage to stimulate uterine contraction.
> Administration of uterotonic drugs like oxytocin or methylergonovine.
> Removing retained placental fragments.
> Surgical interventions, if necessary, to repair tears or stop bleeding
108
What are the primary goals of immediate newborn care after delivery?
The primary goals of immediate newborn care include:
> Establishing and maintaining a patent airway: Clearing the airway to ensure effective breathing.
> Maintaining body temperature: Providing warmth through skin-to-skin contact or radiant warmers.
> Preventing infection: Ensuring cleanliness and sterility during handling.
> Promoting parental-newborn attachment: Encouraging early bonding, often through skin-to-skin contact and early breastfeeding
