Labor and Delivery Intrapartum o The intrapartal period begin with the onset of regular contractions and extends until the expulsion of the placenta Labor Triggers o Maternal Factors Stretching of uterine muscles Estrogen/progesterone changes Oxytocin release Release of prostaglandins o Fetal Factors Fetal cortisol changes Placenta ages Prostaglandins increase causing contractions Initiation of Labor o Cervical changes Cervix ripens o Lightening Movement of fetus toward cervix o Nesting Sudden bursts of activity o Bloody show Mucous plug passed o Braxton-Hicks contractions Can indicate labor o Gastrointestinal changes Nausea Vomiting Diarrhea* o Spontaneous rupture of membranes o True vs. false labor Baseline Check Assess cervical dilation and effacement Fetal heart monitor and contraction rate With activity, there will be cervical changes (30 minutes--1 hour of walking) Increase in cervical dilation The “Five Ps” of Labor o Passageway Birth canal Includes the bony pelvis and the soft tissues of the cervix, pelvic floor, and vagina Gynecoid pelvis is considered the true female pelvis Cervix must efface to allow the presenting fetal part to descend into vagina Types of Pelvis Gynecoid Android Anthropoid Platypelloid
Measuring the diagonal conjugate Determines whether or not mother will be able to push effectively o Passenger Fetus and placenta Fetus, the placenta, amniotic membranes, and amniotic fluid are the passengers Parts of the passenger Fetal head Fetal head is composed of bones separated by sutures and connective tissue The space between sutures is the fontanel “soft spot” Anterior fontanel Diamond shaped Larger Posterior fontanel Triangle shaped Smaller Sutures allow the fetal head to shift during birth to fit in the pelvis Molding Fetal attitude Refers to the posturing (flexion or extension) of the joints and the relationship of fetal parts to one another Fetal lie Describes how the fetus is to the mother’s spine Longitudinal lie Most common Fetus is parallel to mother’s spine (up and down) Transverse lie Fetus is perpendicular to mother’s spine Fetal presentation Determined by which part is presenting Cephalic presentation Vertex presentation Brow presentation Face presentation Breech presentation Complete breech Single footing breech Frank breech Fetal position Six positions Left occiput anterior Left occiput posterior Left occiput transverse Occiput anterior Right occiput anterior Right occiput transverse
Right occiput posterior Occiput posterior Fetal station Fetal engagement Cardinal movements of labor Engagement Descent Flexion Internal rotation Extension External rotation (Restitution)
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- Spring '17