Week 4 Intrapartal Period Flashcards
This stage lasts from beginning of dilation to when the cervix is fully dilated
1st stage of labor
Lasts from full dilation to birth of infant
2nd Stage
Lasts from the infants birth to the expulsion of the placenta - typically 30 min max
3rd stage of labor
1st 2 hours after birth
4th stage of labor
Name the phases of the 1st stage of labor
Phase I- Latent or early phase -0-3/4 cm
Phase 2- Active phase-4-7 cm
Phase 3- Transitional Phase- 7to 10 cm
Second stage is ________ cm to _________
10 cm to delivery
delivery of baby to delivery of placenta is the ____ stage
3rd stage of labor
4th stage of labor is
Recovery period
What are the 5p’s of labor?
Powers
Passageway
Passenger
Position of the woman
Psychological Responses
Forces that affect the progress of labor and help to bring about childbirth
Name factors affecting Labor
Primary Powers UCS
- Effacement
- Dilation
- Ferguson reflex- application of pressure to the Ferguson plexus or cervical and vaginal structures
Secondary Powers: Abdominal MS
Valsalva
How strong and affective are contractions?
Lot of factors involved
Frequency and duration
Beginning on one contraction to end of the same contraction
Duration
Beginning of one contraction to the beginning of another
Frequency
Resting time between contractions allows for placental perfusion
Interval
How are contractions measured?
External TOCO
Measured peak to peak
Start from top left of uterus and makes it way down and around
What are the uterine muscle layers?
Outer
Middle
Inner
Power=
Contractions + Maternal Pushing
Uterine contractions are initiated by
Pacemakers - uterotubal junction
Contractions meet at the fundus
Contraction waves progress downward
Shortening of muscle fibers
Retractions
Intra uterine pressure
Additional forces- maternal pushing and intraabdominal pressure= pushing out of fetus
Contractions of the uterus after the cervix has been stimulated
During labor this causes urge to push
Urge to push is caused by baby pressing onto this plexus of nerves
Ferguson Reflex
During process of labor the myometrium contracts by positive feedback effect
Ferguson reflex
Strong contraction of myometrium are influenced by what hormone?
Oxytocin
Secreted by posterior pituitary gland and hormone prostaglandins from the placenta
These contractions expel the fetus from the uterus into the vagina and also constrict blood supply from the
Placenta
After delivery, myometrium contracts to expel the placenta and reduce blood loss where Criss cross fibers compress the blood vessels
During childbirth baby’s head pushes against sensors near opening of uterus …
Oxytocin is released- stimulates uterine contractions
More contractions- more oxytocin
Only stops when pushing stops
Estrogen from ovaries induces
oxytocin receptors on uterus
Oxytocin from fetus and pituitary stimulates
Uterus to contract
Stimulates placenta to make prostaglandins
Stimulate more contractions of uterus
Contractions of uterus wall force baby head to cervix
Stretching of cervix
Receptors stretch sensitive nerve cells in cervix send nerve impulses
- Control center brain interprets input and releases oxytocin
Hit effector muscles in wall of uterus contract more forcefully
Baby body stretches cervix more
Ferguson Reflex
Positive feedback
Stretching of cervix= more oxytocin
Effects of the cervix in the primigravida
Beginning of labor- no cervical effacement or dilation. Fetal head is cushioned by amniotic fluid.
Then as cervix effaces, more amniotic fluid collects below the fetal head.
Cervix begins to be about one half effaced and slightly dilated. Increasing amount of amniotic fluid creates hydrostatic pressure.
Complete effacement and dilation.
How to gauge cervical dilatation?
Nurse places the index and middle fingers against the cervix and determines the size of the opening.
Can NOT insert before labor begins. During labor begins cervix begins to dilate. Goes from 1-10cm.
Name the primary and secondary powers affecting labor
Primary
- Effacement
- Dilation
- Ferguson reflex
Secondary
- Abdominal MS
- Valsalva
Valsalva Maneuver
Same maneuver as you would have a bowel movement
Closed glottitis - air pressure increases in lungs increases and exerts force against anterior surface of vertebral column-
Erector muscle contraction- Fluid pressure in abdomen increases and exerts force against anterior surface of the vertebral column
The passageway or birth canal is composed of?
Bony Pelvis
Soft tissues of cervix
Pelvic floor
Vagina
Introitus - External opening to the vagina
Type of continuous and slightly movable joint
Amphiarthrosis
Connected by broad flattened disks of fibrocartilage, of a more or less complex structure, which adhere to the ends of each bone, as in articulations between the bodies of the vertebrae or the inferior articulation of the two hip bones- aka the pubic symphysis.
Symphysis
Passenger of labor includes
Size of the fetal head
Fetal Presentation
Fetal lie
Fetal attitude
Fetal Position
What is the major factor in determining the course of the birth?
Fetal Head
When there is a mismatch we call that Cephalopelvic Disproportion
Name the landmarks significant in birth
Sinciput
Vertex
Occiput
Mastoid fontanelle
Mentum
Sphenoid fontanelle
Posterior fontanelle
Typical anteroposterior diameters of the fetal skull
Vertex of the fetus presents and the fetal head is flexed with the chin of the chest
Smallest anteroposterior enters birth canal- subocciptobregmatic
Transverse diameters of fetal skull
Biparietal
Bitemporal
_________ creates the smallest anteroposterior diameter enters the birth canal
Flexion
- subocciptobregmatic
How many cm is vertex presentation?
9.5 cm
How many cm is sinciput presentation?
12 cm
What is cm for brow presentation?
13.5 cm
What is fetal attitude?
Relationship of fetal body parts to self
Flexion is normal
Normal fetal attitude is
Head flexed forward
Chin resting on the chest
Arms and legs flexed
Fetal skull is made up number of bones divided by sutures
True
Moulding
These bones only fuse after birth
Allows bones to?
Overlap during delivery to decrease the diameter this is called moulding.
Moulding allows the pelvis to accommodate the fetal head
Referred to the fetal presenting part. Part of the fetus that enters the pelvis first.
Fetal Presentation
Cephalic
Breech
Shoulder
Presentation of any part of the fetus head during labor
Cephalic
Vertex
Relationship of fetal parts to one another all joints in flexion
Fetal Attitude
Relationship of cephalocaudal axis( spinal column) of fetus to the cephalocaudal axis of mother- transverse, parallel
Fetal Lie
Most common fetal presentation
Happens 97% of the time
Cephalic
Vertex- area between the anterior and posterior fontanelles - most common
Head is in neutral position and top of head is presenting part
Military
Head partially extended and brow is presenting part
Brow
- Tough on baby’s neck, could have neck or shoulder injuries during delivery
Head is hyperextended and face is presenting part
Face Presentation
Complete flexion of the head allows the subocciptobregmatic diameter to present to the pelvis
Vertex Presentation
Presentation refers fetal enter pelvis part of 9.5 cm
Median vertex presentation with no flexion or extension
Military
Occipitofrontal diameter presents to the pelvis
Fetal head is in the halfway extension
Brow presentation
Occipitomental diameter which is largest diameter of the fetal head presents to the pelvis
Fetal head is complete extension, and the submentobregmatic diamter presents to the pelvis
Cephalic
Full extension of the head at 13.5 cm occipitomental diameter
Dorsoanterior is or dorsoposterior
Shoulder presentation
Name 3 types of breech positions
Frank breech
Full Breech
Single footing breech
Refers to the position of the long axis of fetus in relation to the long axis of mother
Fetal lie
3 lies
- Oblique lie
- Transverse lie
- Longitudinal lie
Refers to the position of an arbitrarily chosen portion of the fetal presenting part to the right or left side of the maternal birth canal
Fetal Position
Determining points in vertex, face, and breech presentations are fetal occiput, chin, and sacrum
Fetal position part in either what positions?
Anterior
Transversely
Posteriorly
Six varieties of each 3 positions
Name Fetal vertex presentations
ROP LOP
ROT LOT
ROA LOA
Categories of fetal presentation
ROA ROT ROP
LOA LOT LOP
RMA RMP
LMA LSA LSP
Anterior Asynclitism
Anterior parietal
Normal synclitism
Pelvic inlet plane
Occipital frontal plane
Posterior Asynclitism
Posterior parietal
Fetal head is directed toward the pelvis but can still easily move away from the inlet
Floating
Fetal head dips into the inlet but can be moved away by exerting pressure on the fetus.
Dipping
Biparietal diameter of the fetal head is in the inlet of the pelvis.
Engaged
Presenting part is the occiput at level of ischial spine- zero
______________ affects the woman’s anatomic and physiologic adaptations to labor
Position
Frequent changes in position
- Relieve fatigue
- Increase comfort
- Improve circulation
Laboring woman should be encouraged to find positions most comfortable to her
Role of emotions in labor
Tension and fatigue
Experience, preparation, and culture
Psyche
Process of moving fetus, placenta, and membranes out of the uterus and through the birth canal
Labor
________________ ____________ take place in woman’s reproductive system days and weeks before labor begins
Various changes
Labor can be discussed in terms of mechanisms involved in process and stages woman moves through
Seven cardinal movements of mechanism of labor that occur in vertex presentation
Engagement
Descent
Flexion
Internal rotation
Extension
External rotation - Restitution
Expulsion- Birth
Woman progresses through stages of labor, various body system adaptations cause her to exhibit both objective and subjective symptoms
Maternal Adaptation
Physiologic Adaptation to Labor
Maternal adaptation
- CV changes
- Resp. changes
- Renal changes
- integumentary changes
- Musculoskeletal changes
- Neurologic changes
- GI changes
- Endocrine changes
Signs of preceding labor
Lightening
Blood show
Energy spurt
Braxton hicks contractions
Loose stools
Onset of true labor can not be ascribed to single cause
Many factors involved including changes in maternal uterus, cervix, and pituitary gland
Onset of Labor
