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Intrapartum

Intrapartum. Labor and Delivery. 5 factors to consider in planning your nursing care. Passenger: the fetus Passageway: pelvis, uterus, vagina Powers: contractions, pushing Position: of mom Psych response: culture, experiences, preparedness, etc. The Passenger. Head Diameter

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Intrapartum

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  1. Intrapartum Labor and Delivery

  2. 5 factors to consider in planning your nursing care • Passenger: the fetus • Passageway: pelvis, uterus, vagina • Powers: contractions, pushing • Position: of mom • Psych response: culture, experiences, preparedness, etc.

  3. The Passenger • Head Diameter • suboccipitobregmatic 9.5 • occipitofrontal 11.5 • occipitomental 12.5 • biparietal 9.5 • bitemporal 8 • Shoulders

  4. Lie • Fetal lie- the relationship of the long axis of the baby to the long axis of the mother • horizontal • longitudinal

  5. Presentation • Fetal presentation • part of the fetus closest to the pelvic inlet

  6. Fetal Attitude • The relationship of the fetal parts to each other “Universal Flexion”

  7. Station and Engagement • Station--the relationship of the biparietal diameter of the infant to the ischial spines of the mother • Engagement=station 0

  8. Floating/ballotable

  9. Position • The relationship of fetal landmarks (denominators) to the maternal pelvis occiput=head flexed mentum=head extended (face presentation) brow=head partially extended sacrum=breech acromium process=shoulder

  10. VERTEX ROA LOA ROT LOT ROP LOP OA OP BREECH RSA LSA RST LST LSP RSP SA SP Categories of position/presentation

  11. The most common fetal position

  12. Asynclitism

  13. Breech presentationsfrank complete footling

  14. Determination of Position, Presentation, Lie, Attitude, Station, and Engagement • Ultrasound examination • Leopold’s Maneuvers • Vaginal Exam • Location of fetal heart sounds

  15. Placenta • Previa • Abruptio • Normal Placental Separation • Placenta Accreta

  16. The passage

  17. pelvis • Measurements • Parts • Types • gynecoid • anthropoid • platypeloid • anthropoid

  18. Soft Tissue • Uterus • Cervix • Vagina

  19. The powers Uterine contractions “pushing”

  20. POWERS • PRIMARY • contractions • frequency • regularity • duration • intensity • SECONDARY • maternal bearing-down

  21. Uterine Contractions Contraction wave starts in pacemakers at the cornual ends of fallopian tubes and descends down to lower uterine segment

  22. The Maternal Position

  23. Gravity and Cardiac Output

  24. Psychological Response

  25. Psychological Response • Maternal Past experiences • preparedness • support • financial stability, impact of another child • other children to care for • cultural meaning of children, fertility

  26. The Process of Labor

  27. Initiation of Labor“Lightening” Cervical “ Ripening”/Effacement

  28. Premonitory Signs of Labor • Lightening • cervical ripening • 1-3lb wt loss • increase in vaginal secretions • mucous plug expelled • backache • braxton hicks contractions • “nesting”

  29. Regular contractions Interval shortens Increasing intensity Back to abdomen Walking increases pain No effect from mild sed. Bloody show Dilatation of the cervix Irregular contractions Interval same Intensity same or less Felt in abdomen Walking decreases pain Sedation relieves pain No show 0-ft dilatation True Labor False Labor

  30. Causes of the Onset of Labor • Changes in uterus, cervix, pituitary • Fetal hormonal secretions • Increasing uterine • distension • intrauterine pressure • Aging placenta MECHANISM NOT COMPLETELY UNDERSTOOD

  31. Mechanism of Labor • Engagement • Descent • Flexion • Internal Rotation • Extension • Restitution • Expulsion

  32. Engagement • Biparietal diameter of the baby reaches the ischeal spines of the mother

  33. Descent • Pressure • uterine contractions • maternal bearing-down Measured by station r/t ischial spines

  34. Flexion • The smallest diameter into pelvis • Pressure of uterus on breech causes chin to flex on chest

  35. Internal Rotation • Baby turns from OT to OA (usually) other positions possible e.g. OP

  36. Extension • Head extends upward In a normal vertex delivery the head is born by the process of extension

  37. External Rotation Also called restitution or shoulder rotation The head returns (restitutes) to the position it was in when it entered the pelvis. The shoulders are then able to be delivered.

  38. Expulsion The baby is delivered

  39. THE STAGES OF LABOR

  40. FIRST STAGE From onset of labor to full dilitation and effacement • latent stage (0-3 cm) • active stage (4-7 cm) • transitional phase (8-10 cm) • “complete” at 10 cms

  41. First Stage of Labor • Cervical Dilitation 1-10 cm

  42. Signs of transition • Increased bloody show • rectal pressure • tremors in thighs, legs • Feels she is losing control

  43. Second Stage, from full diliation and effacement to delivery

  44. Third stage--delivery of Placenta

  45. Placental Separation Placental separation occurs because the uterus contracts but the placenta cannot, so it buckles and separates Pressure of the uterine walls cause it to slide downward Gentle fundal pressure and traction on the cord complete its delivery

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