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INTRAPARTUM ---------------------------------------------------------------------------------------------------------------------------------- COMPONENTS OF THE BIRTH PROCESS/The 5 “P’s” : 5 major factors that interact during normal childbirth: passage, passenger, powers, position, & psyche. ---------------------------------------------------------------------------------------------------------------------------------- a) Passage : the passage of birth of the fetus consists of the maternal pelvis & the soft tissues. The pelvis is divided by the linea terminalis (or pelvic brim) into 2 parts: b) false pelvis: above c) True pelvis: below. Most important of the 2 in childbirth. Has 3 subdivisions: i) inlet: or upper pelvic opening ii) midpelvis: or pelvic cavity. This is the narrowest part of the pelvis. Midpelvic diameters are measured at the level of the ischial spines. The anteroposterior diameter (between the spines) is normally around 12 cm. iii) outlet: lower pelvic opening Shape of pelvis: a. gynecoid : the normal shape of the birth canal. The configuration is nearly circular b. android : normal shape of male pelvis. About 30% of women share this configuration. Causes problems for childbearing. Heart shaped inlet. c. Anthropoid : structural abnormality. Long, oval, narrow inlet & narrow sacrum. In-creases potential for fetal posterior positions during childbirth. (resembles male’s). d. Platypelloid : resembles a flattened gynecoid pelvis with shortened Ability of cervix to dilate and efface a) Dilation : the cervix is pulled upward & fetus is pushed downward. - Widening of cervical opening and cervical canal. - Diameter of cervix increases from < 1cm (normal) to 10 cm (full dilation). b) Effacement : st stage of labor. Contractions push fetus down as the cervix is pulled up. As a result, the cervix becomes shorter & thinner as it is drawn over fetus & amniotic sac. It merges w/thinning lower uterus rather than remaining a distinct cylindrical structure. - cervix is usually 2 – 3 cm long & 1 cm thick - measured as 0 – 100% effaced. 100% effaced feels like a thin piece of paper around the fetus’ head. - Primagravidas will efface then dilate. - Multiparas will do them at same time ---------------------------------------------------------------------------------------------------------------------------------- 2) Passenger: Must consider several factors: a) Fetal Head: 0. Cranial bones: not fused to allow them to mold . 2 frontal, 2 parietal, and 1 occipital. 1. Sutures -- membranous spaces between cranial bones. Composed of strong but flexible fibrous tissue. Allow bones to move a little during delivery. 2. Fontanelles:
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