W - Intrapartum

Question 1

Components of labour? 4Ps

Answer 1

1. Power
   - Force generated during a uterine
   contraction
   > powers = > successful outcome
2. Passage
   Maternal bony pelvis + soft tissues (cervix,
   pelvic floor musculature) that fetus passes through
3. Passenger
   Fetal size ~2.8-3.5 kg
   - fetus, membrane, placenta, fetal components of head, lie, attitude, presentation, position

Lie - longitudinal, transverse or oblique
Presentation (the leading fetal part in the pelvic) –
vertex or breech
Attitude (the degree of flexion of the fetal head)
Position (relationship Relation of the presenting part
to a specific quadrant of a woman’s pelvis Eg, Rt
occipital anterior

4. Psyche
   - mother’s psychological response to labour & birth

Question 2

Stages of Labour!!!

Answer 2

1st stage
- onset of labor –> full cervical dilation (10cm)
– pain relief and comfort

2nd stage
- full cervical dilation –> delivery of baby
- 2 phases: passive & active
- encourage pushing!!! = pull back knees, take a
deep breath, chin to the chest, bear
down for 10 sec x 3 during each
contraction.

3rd stage
- delivery of baby –> expulsion of the placenta
- -> active management to control bleeding and
expel the placenta & membranes

signs:
- gush of blood
- lengthening of umbilical cord
- uterine fundus becomes firmer & more globular

4th stage
- Immediately after baby‘s birth
(Postpartum & Newborn Care)

Question 3

Signs of established labour!!!! after start of labour (5)

Answer 3

• Painful & rhythmic/ regular uterine contractions
• Presence of show (blood & mucous discharge) or/ ruptured membranes)
• leaking liquor: amniotic fluid from vagina
• Confirmed with vaginal examination (Cervical dilation of > 2 to 3cm)

Question 4

Pain management during labour? (3)

Answer 4

1. nitrous oxide gas
   - easily self administered using handheld face mask
   - cheap & safe for mother & fetus
2. pethidine injection
   - opioid IM injection
   - fetal respiratory depression, bcs can cross placenta
   - vomit, nausea, sedation
   - disfavoured bcs of side effects
3. epidural analgesia
   - most effective, done by anesthetist
   - expensive
   - frequent side effects: hypotension, itching, vomit, nausea, spinal headache, fever
   - infreq: fits, breathing difficulties, nerve damage, death

Question 5

Whats the nursing assessment of women in labour?

Answer 5

• frequency, duration, intensity of uterine contractions
• effective contractions -> progressive dilation of cervix + push fetus through birth canal