Wk 8 Intrapartum Assessment L&D Flashcards
Premonitory signs of labor
Braxton Hicks: practice contractions, comes from fundus
Lightening: dropping of fetus, 2-3 wk before labor
Increase in clear vaginal secretions: pressure from fetus
Bloody show: ripening, dilating, pink/brown in color
An energy spurt: nesting
Small weight loss: 1-3 lbs due to changes of estrogen and progesterone levels
Signs of false labor
Inconsistent in frequency, duration and intensity
Change in activity such as walking does not alter contractions or activity may decrease them
Felt in the abdomen and groin
May be more annoying than truly painful
No significant change in effacement or dilation of the cervix after an observation of 1-2 hours
Signs of true labor
Consistent pattern of increasing frequency, duration and intensity
Walking tends to increase frequency and strength of contractions
Begins in lower back and gradually sweeps around to the lower abdominal girdle
Back pain may persist in some women, early labor often feels like menstrual cramps
Effacement/dilation of cervix occurs, progressive effacement/dilation of cervix are most important characteristics
What are the five “P’s”
Powers Passage Passenger Position Psyche
Five “P’s”
Powers
Powers
Contractions:
involuntary- can not stop or start
frequency- beginning of one contraction to the beginning from the next, measured in minutes and fractions of a minute
duration- beginning of the contraction to the end of the contraction, measured in seconds
intensity- palpation: mild (tip of nose), moderate (chin), strong (forehead)
interval- rest period, uterine relaxation
Five “P’s”
Passage
Maternal pelvis
1 inlet
2 midpelvis (pelvic cavity)
3 outlet (pelvic opening)
Cervix
Soft tissue- vaginal canal and parineium
Five “P’s”
Passage: Pelvis Stations
Ballottable: fetus head seems to float up and down during cervical exam. No engaged into the pelvis
Negative: head is high up in the pelvis
Zero: fetus head is at the level of the Ishial spine/pelvic bone
Positive (up to +5): fetus is descending down the vaginal canal, when fetal head is “crowning” it is at +5 station
Five “P’s”
Passage: Cervix
Softening: before effacement and dilation
Effacement: thinning and shortening of cervix
Dilation: opening of the cervix
Shape of anterior and posterior fontanels
Anterior: diamond shape
Posterior: triangle shape
Five “P’s”
Passenger: Attitude and Presentation
Attitude:
Flexion
Extension
Presentation (fetal part entering the pelvis, presenting part):
Vertex- complete flexion, occiput is the leading part
Military- moderate flexion
Brow- poor flexion (extension), (emergent c-sec)
Face- full extension (emergent c-sec)
Five “P’s”
Passenger: Presentation Breech types (3)
Frank breech: most common, baby’s legs are folded flat up against his head and his bottom is closest to the birth canal
Full breech: both of the baby’s knees are bent and his feet and bottom are closest to the birth canal
Footling breech: single or double foot presentation
Five "P's" Labor: position What does Occiput Mentum Sacrum
Occiput- vertex presentation
Mentum- face presentation
Sacrum- breech presentation
What is Leopold’s maneuver?
Used to determine fetal presentation and position
Five “P’s”
Psyche
Maternal catecholamines are secreted in response to anxiety or fear and can inhibit uterine contractility and placental blood flow.
Marked anxiety, fear, or fatigue decreases a woman’s ability to cope with pain in labor
Relaxation strengthens the natural process of labor
Advocate for the laboring patient to decrease her anxiety and fear
Assessment for the first stage (1 out of 4)
ENDS with complete dilation and effacement.
Latent phase- early labor
Active phase- more rapids dilation of the cervix
Transition phase- intense contractions, fetal descent, and final cervical dilation 7/8cm to complete
Assessment of Latent/early labor
First stage
Dilation 0cm - 3-5cm
Contractions: Initially mild, progress to moderate, every 5 min with reg pattern, duration increases to 30-40 sec
Nulliparous: 7.5-8.5 hours
Multiparous: 4-5.5 hours
Assessment of Active labor
First stage
Dilation 4-10cm Bloody show Contractions: increase duration, frequency, intensity, q2-3 min lasting 40-60 sec, moderate to strong intesity Nulliparous: 8-10 hours Mulitparous: 6-7 hours
Assessment of Transition phase
First stage
Dilation/cervix 7-10cm Contractions: very intense, q2-3 min Station: fetal presentation, urge to push Nulliparous: 3.5 hours Multiparous: 0-30 minutes
Assessment of Second stage
BEGINS with complete cervical dilation and full effacement
Fetus descends low into pelvis
Needing to push, Ferguson reflex (fetal ejection reflex)
ENDS with delivery of infant
Assessment of Third stage
BEGINS with birth of baby
Decrease size of uterus, placental site causing placenta to separate from uterine wall
Contractions: uterus is firmly contracted
Nulliparous and Multiparous: 5-10 min and up to 30 min
ENDS with expulsion of placenta
Assessment of the Fourth stage
STARTS with delivery of the placenta First 1-4 hours after birth Fundus should be firmly contracted Assess lochia color and amount (Lochia rubra, red, some clots) "Golden hour"
Significant problems
Pre-eclampsia: High blood pressure
Eclampsia: same S/S but with seizures
Shoulder systocia: complication during delivery when an infant’s shoulders become lodged in the mother’s pelvic
Non-reassuring fetal heart tones
Normal fetal heart rate?
110-160 bpm
pre-term 26-28 weeks upper end of normal 160
Assessing fetal HR
Accelerations
Temporary increase, peaks at least 15 bpm above the baseline and last for a least 15 seconds
Often with fetal movement
Nonperiodic= no relation to contractions
Periodic= in relation with contractions
