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INTRAPARTAL CARE

INTRAPARTAL CARE. PHYSIOLOGY. Progesterone Estrogen PG Oxytocin Myometrium effacement dilation. STAGES OF LABOR. Stage I – Beginning of Labor until complete cervical dilation. Stage II – Birth of fetus Stage III – Delivery of Placenta

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INTRAPARTAL CARE

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  1. INTRAPARTAL CARE

  2. PHYSIOLOGY Progesterone Estrogen PG Oxytocin Myometrium effacement dilation

  3. STAGES OF LABOR • Stage I – Beginning of Labor until complete cervical dilation. • Stage II – Birth of fetus • Stage III – Delivery of Placenta • Stage IV – First 4 hours of Recovery

  4. CRITICAL FACTORS • Passage • Passenger • Passage/passenger • Primary forces • Psychosocial

  5. PASSAGE(PELVIS) • INLET • MID • OUTLET • TYPES

  6. Figure 15–1 Comparison of Caldwell-Moloy pelvic types.

  7. PASSENGER • Unfused bones (molding) • Sutures • Fontanelles

  8. Figure 15–3 Lateral view of the fetal skull identifying the landmarks that have significance during birth.

  9. Figure 15–4a Typical anteroposterior diameters of the fetal skull. When the vertex of the fetus presents and the fetal head is flexed with the chin on the chest, the smallest anteroposterior diameter (suboccipitobregmatic) enters the birth canal.

  10. Figure 15–4b Transverse diameters of the fetal skull.

  11. FETAL RELATIONSHIPS • Attitude • Lie • Presentation

  12. Figure 15–6a Cephalic presentation. Vertex presentation. Complete flexion of the head allows the suboccipitobregmatic diameter to present to the pelvis.

  13. Figure 15–6b Military (median vertex) presentation with no flexion or extension. The occipitofrontal diameter presents to the pelvis.

  14. MORE RELATIONSHIPS • Engagement • Station • Position

  15. Figure 15–7a Process of engagement in cephalic presentation. Floating. The fetal head is directed down toward the pelvis but can still easily move away from the inlet.

  16. Figure 15–7b Dipping. The fetal head dips into the inlet but can be moved away by exerting pressure on the fetus.

  17. Figure 15–7c Engaged. The biparietal diameter (BPD) of the fetal head is in the inlet of the pelvis. In most instances the presenting part (occiput) is at the level of the ischial spines (zero station).

  18. Figure 15–8 Measuring the station of the fetal head while it is descending. In this view the station is 22/23.

  19. Figure 15–9 Categories of presentation. Source: Courtesy Ross Laboratories, Columbus, OH.

  20. A B C D Figure 16–3a Palpating the presenting part (portion of the fetus that enters the pelvis first). Left occiput anterior (LOA). The occiput (area over the occipital bone on the posterior part of the fetal head) is in the left anterior quadrant of the woman’s pelvis. When the fetus is LOA, the posterior fontanelle (located just above the occipital bone and triangular in shape) is in the upper left quadrant of the maternal pelvis.

  21. Figure 16–6b Location of FHR in relation to the more commonly seen fetal positions (cont.).

  22. Figure 16–6a Location of FHR in relation to the more commonly seen fetal positions.

  23. PRIMARY FORCES • UC • (pushing) • 3 phases • 3 descriptive terms

  24. Figure 15–10 Characteristics of uterine contractions.

  25. Figure 16–2 To gauge cervical dilatation, the nurse place the index and middle fingers against the cervix and determines the size of the opening. Before labor begins, the cervix is long (approximately 2.5 cm), the sides feel thick, and the cervical canal is closed, so an examining finger cannot be inserted. During labor, the cervix begins to dilate, and the size of the opening progresses from 1 cm to 10 cm in diameter.

  26. Figure 15–11a Effacement of the cervix in the primigravida. Beginning of labor. There is no cervical effacement or dilatation. The fetal head is cushioned by amniotic fluid.

  27. Figure 15–11b Beginning cervical effacement. As the cervix begins to efface, more amniotic fluid collects below the fetal head.

  28. Figure 15–11d Complete effacement and dilatation.

  29. FIRST STAGE • Latent • Active • Transition

  30. SECOND STAGE • Crowning • Cardinal movements

  31. Figure 15–13 Mechanisms of labor. A, B, Descent. C, Internal rotation. D, Extension. E, External rotation.

  32. THIRD STAGE • Placenta

  33. MATERNAL RESPONSE TO LABOR Increased blood volume with each contraction Blood pressure increases Respirations-hyperventilation likely

  34. Bladder distention Gastric emptying prolonged Glucose WBC

  35. 4th STAGE (RECOVERY) • In 1-4 hours, it is all reversed!!!

  36. ADMISSION & ASSESSMENTOF THE LABORING FAMILY • Bio-psycho-social-spiritual-cultural

  37. THE REAL THING? • True • False

  38. IMPENDING LABOR? • Lightening • Bx. Hicks contractions • Cx changes • Bloody show • ROM

  39. ADMISSION ASSESSMENT • ROM • UC • Vaginal Discharge • FHT

  40. LABOR PROGRESS • CTX ASSESSMENT • FHT • IUPC • Externally • Fetoscope • Doppler

  41. MORE ASSESSMENT • Vital Signs • IV/blood draw • Permits • Identification

  42. FAMILY INTEGRATION • Expectations of the birthing family

  43. CULTURE INTEGRATION • Knowledge of other cultures imperative…

  44. FIRST STAGE INCIDENTALS • 1st stage care Latent Active Transition

  45. BIRTHING • 2nd stage care • Positions • Perineum

  46. 3RD AND 4TH STAGE • VS • Fundus • Perineum • Lochia • Bladder • Bonding

  47. INITIAL NEWBORN CARE • Apgar • Cord • Warmth • Prophylaxis

  48. Intrapartal Pain Relief

  49. Analgesia vs. Anesthesia • Analgesia: use of a medication to decrease or alter the normal sensation of pain • Anesthesia: use of a medication to provide partial or complete loss of sensation with or without loss of consciousness (AWHONN, Perinatal nursing, 2001)

  50. Non-pharmacologic Pain Relief • Cutaneous techniques: massage, touch, back rub, counterpressure, heat or cold, movement and positioning, hydrotherapy • Auditory or visual: focal point, breathing, distraction, music • Cognitive: prenatal education, relaxation, support

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