ob exam 3.docx - Labor and Delivery Intrapartum o The...

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)
