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
