INTRAPARTAL NURSING

1. INTRAPARTAL NURSING Developed by D. Ann Currie,R.N., M.S.N.

3. INTRAPARTUM PERIOD • PHYSIOLOGY OF LABOR • CAUSES OF LABOR • PREMONITORY SIGNS OF LABOR • CRITICAL FACTORS IN LABOR • TRUE VS FALSE LABOR • STAGES OF LABOR • NURSING MANAGEMENT OF THE INTRAPARTAL CLIENT

4. INTRAPARTUM PERIOD • MATERNAL RESPONSE TO LABOR • FETAL RESPONSE TO LABOR • PAIN MANAGEMENT DURING THE INTRAPARTAL PERIOD • INTRAPARTAL FETAL ASSESSMENT • HIGH RISK INTRAPARTAL CARE

5. CAUSES OF LABOR • LABOR USUALLY STARTS 38-40 WEEKS OF GESTATION • VARIOUS FACTORS MAY CAUSE LABOR TO START • ESTROGEN.DECREASING PROGESTERONE,PROSTAGLAN-DINS, STRETCHING UTERUS, CORTICOTROPIN-RELEASING HORMONE

6. PREMONITORY SIGNS OF LABOR • LIGHTENING • BRAXTON HICKS CONTRACTIONS • CERVICAL CHANGES • BLOODY SHOW • RUPTURE OF MEMBRANES • BURST OF ENERGY • WEIGHT LOSS-2.2-6.6 LBS.(1-3 KGS)

7. PREMONITORY SIGNS OF LABOR • URINARY FREQUENCY • INCREASED BACKACHES OR SACROILIAC PRESSURE • DIARRHEA • N/V • LOSS OF MUCOUS PLUG

8. TRUE CERVICAL EFFACEMENT AND DILATION UC-REGULAR, STRONGER, LONGER LOCATION- BACK TO FRONT FALSE NO CERVICAL CHANGES UC- IRREGULAR AND NO CHANGE IN FREQ., INTENSITY, DURATION TRUE VS FALSE LABOR

9. TRUE WALKING WILL NOT LESSEN UC MAY INTENSIFY FALSE POSITION CHANGE OR WALKING WILL LESSEN UC. TRUE VS FALSE LABOR

10. CRITICAL FACTORS IN LABOR • KNOWN AS THE FIVE “P’s” OF LABOR • PASSAGEWAY • PASSENGER • POWERS • POSITION • PSYCHE

11. PASSAGEWAY • REFERS TO THE MATERNAL STRUCTURES-BONES OF THE PELVIS, SACRUM AND COCCYX AND THE SOFT STRUCTURES CERVIX AND VAGINA. • SIZE OF MATERNAL PELVIS-DIAMETERS OF THE PELVIC INLET,MIDPELVIS, AND OUTLET

12. Manual Measurement of Pelvis

13. Manual measurement of the Interspinous

14. Passageway

15. PASSAGEWAY • ANTEROPOSTERIOR DIAMETERS OF THE PELVIC INLET-DIAGONAL CONJUGATE( 11.5CM), OBSTETIC CONJUGATE(10CM OR MORE), CONJUGATA VERA(TRUE CONJUGATE)(10cm), TRANSVERSE(13.5CM) AND OBLIQUE (12.75CM)

16. PASSAGEWAY • MIDPELVIS- ANTEROPOSTERIOR DIAMETER(11.5-12 CM),POSTERIOR SAGITAL DIAMETER(4.5-5CM), TRANSVERSE DIAMETER (INTERSPINOUS) (10CM)

17. PASSAGEWAY • PELVIC OUTLET-ANTEROPOSTERIOR DIAMETER (9.5-11.5 CM),TRANSVERSE DIAMETER ( 8-10CM), POSTERIOR SAGITTAL DIAMETER (LEAST 7.5 CM)

18. PASSAGEWAY • TYPE OF MATERNAL PELVIS • GYNECOID • ANDROID • ANTHROPOID • PLATYPELLOID

20. PASSAGEWAY • THE TYPE OF PELVIS AND ITS DIAMETERS CAN INFLUENCE THE DESCENT OF THE FETUS, THE PROGRESSION OF LABOR AND TYPE OF DELIVERY.

21. PASSAGEWAY • SOFT TISSUES- THE CERVIX, VAGINA, AND THE OPENING OF THE VAGINA (INTROITUS) • CERVIX MUST EFFACE AND DILATE • VAGINA AND THE INTROITUS MAY DISTEND • FAT PADS CAN CAUSE PROBLEMS.

22. Bishop Score – Cervical Riping

23. PASSENGER • PASSENGER REFERS TO THE FETUS. IT’S : • SIZE • ATTITUDE • LIE • PRESENTATION • POSITION • ENGAGEMENT • STATION

24. PASSENGER • SIZE-LARGE BABIES MAY NOT BE ABLE TO BE DELIVERIED VAGINAL. • FETAL HEAD-DIAMETERS OF THE FETUS HEAD • BIPARIETAL-9.5CM • BITEMPORAL-8CM • OCCIPITOFRONTAL -11.75CM • OCCIPITOMENTAL-13.5CM

25. PASSENGER • SUBMENTOBREGMATIC-9.5 CM • SUBOCCIPITOBREGMATIC-9.5CM

26. PASSENGER • ATTITUDE-IS THE RELATIONSHIP OF THE FETAL PARTS TO ONE ANOTHER. • FLEXION • EXTENSION

28. PASSENGER • FETAL LIE-IS THE RELATIONSHIP OF THE LONGITUDINAL AXIS OF THE FETUS TO THE LONGITUDINAL AXIS OF THE MOTHER • LONGITUDINAL LIE- VERTEX OR BREECH • TRANVERSE LIE- LATERALLY ACROSS UTERUS. • OBLIQUE LIE -DIAGONALLY

30. PASSENGER • PRESENTATION-REFERS TO THE FETAL PART ENTERING THE PELVIS FIRST • CEPHALIC • FACE • BROW • BREECH • SHOULDER

31. PASSENGER • PRESENTATION • COMPOUND- MORE THAN ONE FETAL PART- IE-HEAD AND HAND.

34. PIPER FORCEPS

35. PASSENGER • POSITION-IS THE RELATIONSHIP OF THE FETAL PRESENTING PART TO THE MATERNAL PELVIS • CAN BE A TWO-LETTER OR THREE- LETTER NOTATION AND IS USED TO DESCRIBE THE FETAL POSITION

36. POSITION • TWO-LETTER NOTATION • 1ST- PRESENTING PART IE O=OCCIPUT,M=MENTUM, S=SACRUM • 2ND-INDICATES THE RELATIONSHIP OF THE LANDMARK(FETAL) TO THE FRONT,BACK OR SIDE OF THE PELVIS.- A=ANTERIOR,P=POSTERIOR, • IE-OA OR OP.

37. POSITION • THREE-LETTER NOTATION • 1ST LETTER- WHICH SIDE OF THE MATERNAL PELVIS IS THE FETAL PART TOWARDS. • R=RIGHT • L=LEFT

38. POSITION • 2ND LETTER INDICATES THE LANDMARK OF THE PRESENTING PART • O=OCCIPUT • M=MENTUM • S=SACRUM • A OR AD OR Sc=SHOULDER

39. POSITION • 3RD LETTER INDICATES THE RELATIOSHIP OF THE LANDMARK OF THE PRESENTING PART TO THE FRONT.BACK, OR SIDE OF THE MATERNAL PELVIS • A=ANTERIOR, P=POSTERIOR, T= TRANSVERSE (SIDE) • ROA,ROT,ROP,LOP,LOT,LOA • RSA,RST,RSP,LSP,LST,LSA

41. PASSENGER • ENGAGEMENT-OCCURS WHEN THE LARGEST DIAMETER OF THE PRESENTING PART REACHES THE PELVIC INLET AND CAN BE DETECTED BY VAGINAL EXAM • FLOATING • BALLOTABLE • ENGAGED

43. PASSENGER • STATION-IS THE RELATIONSHIP OF THE PRESENTING PART TO THE ISCHIAL SPINES OF THE MATERNAL PELVIS • MEASURED IN CM • ABOVE ISCHIAL SPINES(-1 TO-5) • AT THE ISCHIAL SPINES( O STATION) • BELOW THE ISCHIAL SPINES(+1 TO +4)

45. POWER • INCLUDES PRIMARY AND SECONDARY FORCES OF LABOR • PRIMARY FORCES- CONSIST OF THE INVOLUNTARY CONTRACTIONS OF THE UTERINE MUSCLES • CONTRACTIONS-INCREMENT, ACME, DECREMENT PHASES AND RESTING PHASES

46. POWER • PRIMARY FORCES • CONTRACTIONS-FREQUENCY,DURATION,INTEN-SITY • UC CAUSE EFFACEMENT AND DILATION OF THE CERVIX • PRIMIGRAVIDAS WILL EFFACE FIRST THEN DILATE • MULTIGRAVIDAS CAN DO BOTH TOGETHER

48. EFFACEMENT • THE THINNING AND SHORTENING OF THE CERVIX. • MEASURED IN PERCENTAGES • O% TO 100%

49. DILATION • OPENING OF THE CERVIX • MEASURED IN CM • 0CM TO 10CM • 10CM =COMPLETE DILATION.

50. POWER • SECONDARY POWERS-CONSIST OF THE VOLUNTARY USE OF THE ABDOMINAL MUSCLES DURING THE SECOND STAGE OF LABOR TO FACLITATE THE DESCENT AND DELIVERY OF THE FETUS. • PUSHING