intrapartum pt 1: stages of labor

Question 1

how many stages of labor are there?

Answer 1

four

Question 2

in stage 1 of labor what are it’s phases?

Answer 2

latent & active

Question 3

stage 1: what is the latent phase?

Answer 3

cervical dilation of 0-6 cm
- onset of regular contraction
- slow effacement & dilation
- ROM or not
- pain level varies
- sedation can slow time frame
- wide range of emotions

Question 4

stage 1 latent phase: what is the time frame of nulliparas?

Answer 4

20 hour average

Question 5

stage 1 latent phase: what is the time frame of multiparas?

Answer 5

14 hours

Question 6

stage 1: what is the active phase?

Answer 6

cervical dilation of 6-10 cm
- more rapid effacement & dilation
- progressive fetal descent
- increase discomfort with contraction –> mom has the urge to push
- n/v
- increase bloody show
- emotional changes

Question 7

what are the different types of arresting of labor?

Answer 7

• adequate contraction pattern: no cervical change in 4 hours
• inadequate contraction pattern: no cervical change in 6 hours

Question 8

what can you as a nurse do to continue the labor if there is an arrest? what does it mean if nothing works?

Answer 8

rupture their membrane
- if nothing works – might mean there is an underlying cause

Question 9

what is happening in stage 2 of labor?

Answer 9

this is the complete cervical dilation to birth
- perineum flattens and stretches
- crowning of head in introitus/vagina
- usually around 4 hours
- cardinal movements

Question 10

what is the introitus?

Answer 10

an entrance, one that goes into a canal or hollow organ such as the vagina

Question 11

what are the steps of cardinal moments (in order)?

Answer 11

1. before engagement
2. engagement, flexion, descent
3. descent, rotation – OA position
4. complete rotation, beginning extension
5. compete extension
6. restitution (external rotation)
7. anterior shoulder delivery
8. posterior shoulder delivery

Question 12

what is happening during stage 3 of labor?

Answer 12

birth to delivery of placenta

Question 13

stage 3: what is happening with placental separation?

Answer 13

this is when the uterus contracts and decreases the uterine capacity & placental surface area

Question 14

stage 3: what are the signs of placental separation?

Answer 14

• globular shaped uterus
• increased fundal height in abdomen (make sure to massage fundus to help with contractions)
• sudden gush or trickle of blood
• lengthening of umbilical cord out of vagina

Question 15

stage 3: what do they usually give before or after placenta delivery?

Answer 15

Pitocin IV or IM

Question 16

what is happening in stage 4 of labor?

Answer 16

delivery of placenta to 8 hours post labor, hemodynamic readjustment
- uterus should be contracted & midline
- drop in BP
- increase pulse pressure
- moderate tachycardia

Question 17

stage 4: why do we have hemodynamic readjustment?

Answer 17

• blood loss (avg of 250-500 cc of vaginal delivery)
• reduced weight of uterus
• redistribution of blood into venous beds

Question 18

stage 4: what are the types of cervical or vaginal lacerations?

Answer 18

• 1st degree: superficially disrupts mucosa
• 2nd degree: divides perineal body (episiotomies)
• 3rd degree: tear involves anal sphincter
• 4th degree: tear involves rectal mucosa